NeuroRehabilitation最新文献

BackgroundRobotic therapy (RT) and augmented reality (AR) have each demonstrated benefits for stroke rehabilitation. Despite the potential priming effect of robotics, no study has investigated whether robotic priming of AR provides additive effects compared to AR or conventional therapy.ObjectiveThis study examined the effects of AR with and without robotic priming compared with dose-matched control.MethodsIn this exploratory trial (N = 33), participants were allocated to robotic-primed AR (RT + AR), AR, or conventional therapy (CT). Outcomes were the Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Berg Balance Scale (BBS), Chedoke Arm and Hand Activity Inventory (CAHAI), and Stroke Impact Scale (SIS). Patient-reported pain and fatigue were recorded.ResultsAll groups improved in motor recovery and balance immediately after therapy. RT + AR exceeded AR (p = 0.037, η²=0.19) and CT (p = 0.039, η²=0.19) on FMA-UE at post-test and remained superior to CT at follow-up (p = 0.03, η²=0.20). For the BBS, both RT + AR (p = 0.016, η²=0.18) and AR (p = 0.004, η²=0.24) outperformed CT at post-test, and AR retained superiority at follow-up (p = 0.02, η²=0.21). RT + AR surpassed CT on CAHAI (p = 0.046, η²=0.18) and SIS (p = 0.04, η²=0.19) at post-test, with a trend favoring RT + AR on SIS at follow-up (p = 0.06, η²=0.18). No severe adverse responses were observed.ConclusionRobotic priming of AR improved more than AR and CT in motor impairments. AR was beneficial for improving balance. Results of this study should be interpreted with caution and may not be generalized to stroke survivors with different characteristics. There was a lack of multiplicity adjustments in this small exploratory trial. Further research is needed to validate the findings based on larger multicenter trials.

PurposeThis study aimed to investigate the effects of rhythmic auditory stimulation (RAS) gait training combined with real-time vibrotactile feedback (VF) on muscle activation and gait performance in patients with stroke and to compare its effectiveness with that of RAS gait training alone.MethodsTwenty-two patients with stroke who met the inclusion criteria were randomly assigned to either the RAS combined with real-time VF (RVT) or RAS only (RT) groups. Both groups received gait training for 30 min per session, five times per week for 4 weeks. Muscle activation was assessed using surface electromyography, and gait parameters were evaluated using the GAITRite^® analysis system before and after the intervention.ResultsWithin-group comparisons revealed significant post-intervention improvements in the activation of the vastus medialis and tibialis anterior (TA) muscles of the affected side during the stance phase and the TA during the swing phase in both groups (p < .05). Additionally, the RVT group demonstrated significant improvements in gait velocity, cadence, stance time, single-support phase, stride length, and step time differential on the affected side (p < .05). However, no statistically significant differences were observed between the two groups across all outcome variables.ConclusionAlthough no statistically significant differences were found between the two groups, this study suggests that combining RAS gait training with real-time VF may have the potential to improve muscle activation and gait ability in individuals with stroke.Clinical Trial RegistrationThe study was registered in Clinical Research information Service (Registration number: KCT0010212; date: 19 February 2025), https://cris.nih.go.kr/cris/index/index.do.

BackgroundLower limb spasticity (LLS), as part of the upper motor neuron syndrome, can adversely affect function, gait, and quality of life (QOL). A multidisciplinary team (MDT) approach is recommended however, the effects of a coordinated MDT clinic on LLS and ambulation in a mixed neurological population has not been investigated.ObjectivesThis study evaluated: i) clinical and service outcomes of a pragmatic outpatient MDT spasticity service; and ii) patient service satisfaction.MethodsIn this prospective pre-post observational study, 37 participants from a mixed neurological population with LLS received an individualised treatment protocol. Gait speed (10-metre walk test), dynamic balance (Timed-Up and Go), Quality of Life (AQoL-8D), and spasticity-related lower limb function (Leg Activity Measure) were assessed at admission and discharge. Patient satisfaction surveys were completed. Wait times for orthotics were monitored.ResultsSignificant differences were observed in gait speed (median (IQR) 0.30 (0.16-0.39) seconds, p ≤ .001), dynamic balance (median (IQR) 3.87 (2.02-8.59) seconds, p ≤ .001), and lower limb function (median (IQR) 9.00 (-4.00-26.00), p = 0.006) following intervention. QOL improved (median (IQR) -0.70 (-8.5-2.10), however this change did not reach statistical significance (p = 0.206). Over 85% of participants reported service satisfaction. Orthotic wait times reduced, with 64.7% assessed and 52.9% fitted within two weeks of referral.ConclusionAn individualised LLS treatment protocol delivered by a collaborative MDT can improve gait speed, dynamic balance, and lower limb function in a mixed neurological population, while also reducing orthotic wait times. Further research is recommended to explore potential QOL interventions for individuals with LLS.

BackgroundEmotional consequences are a major area of interest in the field of acquired brain injury (ABI), yet less studied than the other consequences of ABI, despite particularly deleterious consequences on quality of life.Objectives and methodsThis study assessed the relevance of the French version of Difficulties in Emotion Regulation Scale-16 and developed a model of emotional dysregulation in ABI through four studies.ResultsStudy 1 confirmed the unidimensional structure and internal consistency (Cronbach's α = 0.95) of DERS-16 in non-clinical controls. Study 2 established a cutoff of 33.5 for pathological emotional dysregulation and found significantly higher DERS-16 scores in ABI participants compared to non-clinical controls but lower than in borderline personality disorder (BPD) participants (p < 0.001). Study 3 demonstrated consistency between clinical assessments and DERS-16 results, characterizing emotional dysregulation in ABI. Study 4 showed DERS-16 sensitivity to changes (mean DERS-16 difference of 1.21 [0.42; 2.00] per month, p = 0.003).ConclusionsDERS-16 is a valuable scale for screening and monitoring emotional dysregulation in ABI, highlighting the importance of addressing emotional difficulties in rehabilitation programs. The proposed model highlights organic, cognitive, psychological, environmental, vulnerability factors and general population factors contributing to emotional dysregulation in ABI.

ObjectiveIndividuals with stroke frequently experience limitations in activities of daily living, and compensation-based approaches have the potential to enhance functional adaptation. This study aimed to develop and evaluate the feasibility and preliminary effects of a novel intervention, Compensation-Based Problem-Solving Therapy (CBPST), on participation and activities of daily living in individuals with stroke.MethodsCBPST was developed by trained occupational therapists, emphasizing in Occupational Adaptation Model and compensatory strategies. The CBPST was delivered individually in five sessions weekly (during four week and approximately 40 min)and including identifying the problem, developing strategies, selecting strategy and implementing and evaluating the selected strategy. Participants were randomly assigned to intervention or control group. This study involved 50 individuals with stroke assigned to either an intervention (n = 24 and mean age 54.58 ± 7.86) or control group (n = 26 and mean age 54.56 ± 7.09). Outcomes were assessed at baseline and immediately post-intervention using the Functional Independence Measure (FIM), Lawton-Brody Instrumental Activities of Daily Living (Lawton-Brody IADL), Frenchay Activity Indeks (FAI) and the Canadian Occupational Performance Measure (COPM). Statistical analyses included Wilcoxon signed-rank, Mann-Whitney U tests and effect sizes.ResultsBoth groups showed significant improvements (p < 0.05) in participation and activities of daily living. Effect size estimates in the intervention group indicated moderate to large clinical effects across outcome measures (COPM performance and satisfaction: 0.62; FIM: 0.62; Lawton-Brody IADL: 0.53; FAI: 0.55), supporting the preliminary efficacy of CBPST.ConclusionCBPST appears to be a feasible and promising approach to enhance adaptive participation after stroke by integrating problem-solving and compensatory strategies. Larger studies are warranted to confirm its clinical effectiveness.

Background/AimsThe aim of the present study was to examine the potential association between a specific gaze behavior, "overstay fixations," observed during the Trail Making Test, and cognitive functional independence after stroke.MethodsThis study was a cross-sectional, observational study. Hospitalized patients with mild stroke (n = 12) and healthy young adults (n = 19) performed the electronic version of Trail Making Test. The number of overstay fixations and the total completion time were measured. In the patients with mild stroke, the total time in conventional Japanese version of Trail Making Test and the cognitive scores in Functional Independence Measure were measured.FindingsThe mild stroke group showed significantly more overstay fixations as task difficulty increased (p = 0.005). A significant correlation existed between the overstay fixations during the electronic version of Trail Making Test part A and the cognitive Functional Independence Measure scores for Comprehension (r = -0.643) and Memory (r = -0.610). Multiple regression revealed that the total time and overstay fixations in the electronic version of the Trail Making Test were more strongly associated with the Comprehension score (R² = 0.850) compared with the total time in the paper-based Trail Making Test (R² = 0.397). Similarly, the Memory score showed stronger associations with the total time and overstay fixations in the electronic version of the Trail Making Test (R² = 0.684) than with the total time in the paper-based version (R² = 0.391).ConclusionsThe overstay fixation was associated with specific domains of cognitive functional independence in patients with mild stroke.

ObjectiveTo investigate the effects of a two-week robot-assisted gait training (RAGT) program on walking performance and brain activation in children with spastic hemiplegic cerebral palsy (CP).DesignSingle-group, pre-post pilot study.MethodsEight children with CP were enrolled; six completed the protocol and provided usable gait and functional MRI (fMRI) data. Participants received 10 RAGT sessions over two weeks. Walking performance (6-min walk test [6MWT], 10-meter walk test [10MWT], GAITRite gait speed and cadence) was assessed at baseline, immediately after the intervention, and at one-month follow-up. Pre- and post-intervention fMRI during a lower-limb motor task quantified activated voxels in motor and cerebellar regions.Results6MWT distance, 10MWT speed, and GAITRite gait speed and cadence improved significantly (all p ≤ 0.009) at post-intervention and follow-up versus baseline. In children with isolated subcortical lesions (n = 4), activated voxels during the lower-limb task increased in the lesioned motor cortex (from 363 to 1,075; p = 0.02), with similar increases in ipsilesional cerebellar hemispheres (p = 0.02), whereas no significant changes were seen in children with additional hydrocephalus (n = 2). Change in cadence correlated positively with change in lesioned motor cortex activation (Spearman's ρ = 0.83, p = 0.03).ConclusionsIn this small cohort, a two-week RAGT program was associated with short-term improvements in walking performance and increased fMRI activation in motor-related regions, particularly in children with subcortical lesions. These preliminary, lesion-type-specific findings suggest neuroplastic responses to RAGT that warrant confirmation in larger controlled studies.

BackgroundDepression is frequently encountered in patients suffering from post-concussive syndrome (PCS) after mild traumatic brain injury (mTBI). Clinical strategies for predicting and managing such depression remain underdeveloped.ObjectiveTo determine whether pre- and post-injury alcohol, tobacco, marijuana, and antidepressant medication use are associated with risk of depression in PCS.MethodsWe conducted a retrospective chart review of 297 patients diagnosed with PCS at a Honolulu neurology clinic between January 2020 and January 2023, analyzing substance and antidepressant use patterns before and after PCS diagnosis and their relationship to post-injury depression risk using PHQ-2 scores.ResultsOf screened patients, 31% were identified as at risk for depression after concussion. Pre-injury tobacco use and marijuana use (both before and after concussion) were significantly associated with greater depression risk. Notably, prior antidepressant use emerged as a strong predictor of depression following concussion, particularly for those who discontinued antidepressants after injury. Patients co-using marijuana and antidepressants had the highest risk.ConclusionsTobacco, marijuana, and exposure to antidepressants prior to concussion, especially discontinuation of these agents, are key risk factors for depression in PCS. These findings emphasize the importance of proactively screening patients with post-concussion syndrome for psychiatric symptoms. Regular assessment of substance use and close monitoring of antidepressant adherence should be integrated into neurorehabilitation care. A coordinated, multidisciplinary approach involving neurology, physiatry, psychiatry, and addiction specialists is essential to identify and address these risk factors early, improving patient outcomes through timely intervention. Future studies should clarify mechanisms and optimal intervention timing.

BackgroundSpasticity is a stretch reflex disorder, clinically characterized by increase in muscle tone and is often seen in upper motor neuron lesions, which can limit function in daily activities. While botulinum toxin injections are widely used treatment option, nerve blocks may offer complementary or alternative benefits.ObjectiveTo evaluate the indications, techniques, and clinical outcomes of nerve blocks for spasticity management.MethodsA literature search of major databases from July 2000- July 2025, identified studies on diagnostic nerve blocks, therapeutic neurolysis, and cryoneurolysis. Fourteen studies met inclusion criteria. Extracted data included patient characteristics, targeted nerves, agents and volumes, imaging guidance, tone reduction, functional outcomes, predictive value for BoNT, and adverse events. Due to heterogeneity in outcomes and methodologies, results were narratively synthesized.ResultsDiagnostic nerve blocks consistently aided treatment planning; one case-control study showed higher goal attainment (≈70% vs 40%) when diagnostic blocks guided BoNT injections. Phenol or alcohol neurolysis and cryoneurolysis produced meaningful spasticity reduction, typically improving Modified Ashworth Scale scores by 1-2 grades with effects lasting 3-6 months, often longer than BoNT. Across modalities, adverse events were uncommon and generally mild, most often transient pain or dysaesthesia. Publication trends showed increased use of ultrasound guidance and greater interest in diagnostic blocks and cryoneurolysis after 2018.ConclusionNerve Blocks are effective yet underused techniques that can provide rapid and sometimes durable spasticity reduction and support individualized long term rehabilitationplanning. Further standardized, long-term studies are needed to optimize their integration into multimodal spasticity care.