BackgroundPostural instability contributes to falls and reduced mobility in people with Parkinson's disease (PD). The Nijmegen Falls Prevention Program (NFPP) has improved balance and reduced falls in other populations, but has not been evaluated in PD.ObjectiveTo assess the feasibility of the NFPP in people with PD and explore its effects on static and dynamic postural control.MethodsFifteen participants with PD completed 10 NFPP sessions delivered twice weekly over 5 weeks. Feasibility was assessed through adherence and a Likert-scale questionnaire. Static balance, anticipatory and compensatory postural adjustments (APAs and CPAs), and center of pressure (COP) displacement were evaluated before and after the intervention. Nine matched healthy participants provided normative reference data.ResultsNFPP was feasible, with 100% adherence and no adverse events. Strongly agree responses were 67% for satisfaction and 73% for load appropriateness. Sway Area decreased during the EOFO (p = .02, r = 0.59) and ECFO (p< .01, d = 0.84) conditions. CPA activity decreased in the tibialis anterior (UU; p = .01, r = 0.58), rectus femoris (UU; p = .03, d = 0.61), and biceps femoris (PU; p = .03, d = 0.60). Backward COP displacement decreased in the PS (p = .01, d = 0.74), US (p = .01, d = 0.73), and UU (p = .01, d = 0.70) conditions.ConclusionsNFPP was feasible for people with PD and produced preliminary changes in static and dynamic biomechanical measures consistent with improved postural control. These findings support larger controlled studies of NFPP in people with PDTrial registration: ClinicalTrials.gov (NCT05771818).
BackgroundHemiplegic gait following stroke has been classified into several gait pattern subgroups; however, characteristics of the classified subgroups and definitions of abnormal gait patterns remain uncertain, despite the emerging importance of individualized gait training tailored to the personalized gait patterns following stroke. Therefore, we aimed to comprehensively explore the existing characteristics of the classified gait pattern subgroups following stroke.MethodsWe conducted this scoping review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews and Joanna Briggs Institute Evidence Synthesis guidelines. We comprehensively searched for studies classifying and investigating abnormal gait patterns following stroke using gait analysis instruments (e.g., motion analysis systems, force plates, and electromyography), published from January 1, 1995, to December 31, 2025, in three databases (PubMed, Scopus, and Web of Science). Two reviewers independently screened the articles to include studies investigating abnormal gait pattern classifications following stroke.ResultsFifty-five studies were identified, of which twenty-six studies focused on gait pattern classifications to identify characteristics of classified subgroups, and twenty-nine studies investigated individual abnormal gait patterns. While classified gait pattern subgroups have been reported with a wide variety based on various gait parameters, the knee-related abnormal gait patterns during the stance and swing phases have frequently been reported from early to recent studies. However, few abnormal gait patterns except for the knee joint were defined using clear objective numerical thresholds following stroke.ConclusionGait classifications regarding the knee-related abnormal gait patterns following stroke may warrant particular attention in clinical settings.
BackgroundCurrent neurorehabilitation often relies on static, diagnosis-driven protocols or generic exercise administration, contributing to suboptimal long-term outcomes. There is a clinical need for a cohesive, mechanism-based framework to guide therapeutic reasoning, dosing, and longitudinal adaptation.MethodsA scoping review of neurorehabilitation literature was conducted according to PRISMA-ScR guidelines to map evidence on dosing, intensity, and longitudinal management. From 9,373 records, 42 studies were synthesized. The literature did not converge on standardized dosing parameters but supported a broad distinction between higher-intensity approaches for non-progressive conditions and more conservative, energy-conserving strategies for progressive conditions. Integrating these findings with author consensus, we developed a collaborative viewpoint proposing a hypothesis-generating clinical framework.Proposed FrameworkWe conceptualize three dynamic clinical pillars: (1) Optimization of Motor Performance, targeting behavioral restitution of activities of daily living through experience-dependent neuroplasticity; (2) Maximization of Motor Performance, promoting active neuroprotection in early degenerative diseases and structural compensation in stable lesions through high physiological effort; and (3) Preservation of Remaining Functions, prioritizing energy conservation and reduction of secondary sequelae in rapidly progressive conditions. The evidence supports the broad progressive versus non-progressive dosing distinction, while the three-pillar structure, FITT-PRO profiles, and transition triggers remain hypotheses requiring validation.Clinical ApplicationA preliminary decision-support structure is proposed around FITT-PRO parameters and longitudinal reassessment. Transition triggers, such as biological plateaus or exacerbations, are not yet operationally defined and require prospective biomarker-based validation.ConclusionThis framework differentiates conditions by functional responsiveness rather than diagnosis, supporting interdisciplinary prognostic reasoning while requiring prospective validation before clinical implementation.
BackgroundPost-stroke dysphagia (PSD) is associated with swallowing muscle atrophy and impaired tongue performance.ObjectivesThis study aimed to compare oral muscle mass, muscle elasticity, and tongue performance in stroke patients with different swallowing function levels.MethodsIn this cross-sectional pilot study, 41 stroke patients from Kaohsiung Chang Gung Memorial Hospital, Taiwan, were stratified into three groups based on the Functional Oral Intake Scale (FOIS): severe dysphagia (levels 1-3), mild-to-moderate dysphagia (levels 4-6), and no dysphagia (level 7). Tongue and bilateral masseter muscle thickness and elasticity, expressed as shear wave velocity (SWV), were assessed using ultrasonography and sonoelastography. Tongue strength and endurance were evaluated using Iowa Oral Performance Instrument (IOPI). Group differences were analyzed using the Kruskal-Wallis test followed by Mann-Whitney U post hoc comparisons. Associations between FOIS scores and IOPI or sonographic measurements were evaluated using Spearman's rank correlation.ResultsTwenty-seven men and fourteen women were included. Unaffected-side masseter muscle thickness differed significantly among groups (p < 0.05), increasing with better swallowing function. Tongue SWV was highest in the severe dysphagia group (median 1.98 [IQR 0.83] m/s), with significant differences among groups (p < 0.05). Higher FOIS levels were associated with greater tongue strength and endurance, although endurance did not differ between the mild-to-moderate dysphagia and non-dysphagic groups.ConclusionsOral muscle mass measurements alone may not adequately reflect PSD severity. Integrating sonoelastography and IOPI assessments identifies increased tongue stiffness and reduced tongue performance in severe PSD, supporting severity-specific rehabilitation strategies.
ObjectiveTo compare the effects of virtual reality versus whole-body vibration on quadriceps muscle strength and balance in children with Duchenne muscular dystrophy.MethodsIn this assessor-blinded, parallel-group randomized controlled trial (1:1 allocation), 50 ambulatory boys with DMD (aged 6-10 years; AFCSD levels I-II) were recruited from Cairo University's outpatient clinic. Both groups received a structured physical therapy program (warm-up, stretching, isometric contractions) three times weekly for 12 weeks. VR Group (n = 25) additionally performed 10 min of semi-immersive VR (Nintendo Wii Fit Balance Board). WBV Group (n = 25) additionally performed 10 min of side alternating WBV (30 Hz, 2 mm amplitude). The primary outcome was isometric quadriceps strength (Lafayette manual muscle tester). Secondary outcomes were overall stability index (OSI), anterior-posterior stability index (APSI), and medial-lateral stability index (MLSI) measured by the Biodex Balance System. Assessments were conducted at baseline, 6 weeks, and 12 weeks by assessors blinded to group allocation. A mixed MANOVA with Bonferroni correction was used.ResultsA significant treatment time interaction was observed (F = 22.31, p < 0.001, ηp2=0.85). At 12 weeks, the VR group showed significantly greater improvements than the WBV group in right quadriceps strength (p < 0.001, ηp2=0.742), left quadriceps strength (p < 0.001, ηp2=0.757), OSI (p < 0.001, ηp2=0.346), APSI (p < 0.001, ηp2=0.737), and MLSI (p < 0.001, ηp2=0.335). No adverse events were reported.ConclusionIn ambulatory children with DMD, a 12-week VR-based intervention produced greater improvements in isometric quadriceps strength and dynamic postural stability compared to WBV. These findings support VR as a motivating adjunct to physical therapy, though functional outcomes and longer follow-up are needed.
Background: Stroke-related balance and mobility deficits often persist despite conventional rehabilitation. Virtual reality (VR)-based training may improve functional recovery. This study examined whether short-term VR training enhances clinical mobility outcomes and whether accompanying electroencephalography (EEG) changes reflect global cortical adaptations. Methods: In a prospective single-group repeated-measures study, 28 subacute stroke survivors completed 12 VR sessions over 4 weeks. Outcomes included the Berg Balance Scale (BBS), Timed Up and Go (TUG) test, affected and unaffected limb scores on the Lower-Extremity Motor Coordination Test (LEMOCOT), and resting EEG recorded with the Emotiv EPOC + headset. Assessments were performed at baseline, week 2, and week 4. Global EEG band power was averaged across Fz, Cz, C3, and C4 electrodes. Repeated-measures analyses with adjusted pairwise comparisons and standardized effect sizes evaluated longitudinal changes. Partial correlations controlling for baseline EEG and clinical scores assessed associations between EEG and functional improvement. Results: Clinical outcomes improved significantly over 4 weeks. Mean BBS scores increased from 38.3 to 49.7, TUG time decreased from 68.4 to 47.7 seconds, and affected-side LEMOCOT scores increased from 5.0 to 8.7, with large overall effects. Global EEG power increased progressively in beta, alpha, and theta bands. Balance gains correlated with alpha increases (r = 0.38 overall; r = 0.63 during weeks 2-4), while mobility improvements and early affected-limb coordination were associated with beta modulation. Conclusions: Four weeks of VR training produced meaningful functional gains alongside widespread increases in cortical oscillatory activity, supporting a mechanistic relationship between VR-induced neuroplasticity and recovery in subacute stroke survivors undergoing rehabilitation.
BackgroundDespite fair-to-good motor ability of their affected upper extremity, individuals post-stroke often exhibit limited daily hand-use, possibly due to factors beyond the motor impairment.ObjectiveTo identify the factors that best explain the variance in daily hand-use, beyond the motor impairment.MethodsA cross-sectional study included individuals post-stroke with fair-to-good upper extremity motor ability (Fugl-Meyer Assessment>30/66). Hand-use was assessed using the Rating of Everyday Arm-Use in the Community and Home (REACH), which is a self-report questionnaire. We assessed the following factors (tools); proprioception (Thumb Localization Test), executive functions (Color Trails Test; upper extremity dual-task capacity), self-efficacy (Confidence in Arm and Hand Movement scale), and depressive symptoms (Geriatric Depression Scale). Ordinal logistic regression evaluated the contribution of these factors to daily hand-use.ResultsFifty-nine individuals post-stroke (41.7% women, aged 25-88). Despite high motor ability [median (IQR), FMA: 57 (51-63)], daily hand-use was limited, most participants scoring REACH levels 2-3 out of 5. Dual-task capacity and upper-extremity self-efficacy were significant predictors, explaining 45.9% of the variance in hand-use. Each unit increase in dual-task capacity and self-efficacy raised REACH levels by 5.8% and 4.2%, respectively. Proprioceptive deficits and depressive symptoms were not significant predictors.ConclusionsLimited hand-use was explained by reduced dual-task capacity and lower self-efficacy among individuals with fair-good upper-extremity motor ability post-stroke. These factors may represent promising targets for future rehabilitation interventions and should be considered during clinical assessment.
Background: Objective, accessible tools are needed to screen fall risk in vestibular patients. Smartphone-based accelerometry (ACC) offers a practical, scalable solution.ObjectivesThis study evaluated the preliminary discriminative validity of smartphone ACC application during the Modified Clinical Test of Sensory Interaction on Balance (mCTSIB) to differentiate vestibular patients with and without a fall history.MethodsIn this cross-sectional study, 42 vestibular patients were classified as fallers (n = 16) or non-fallers (n = 26) based on a 12-month retrospective self-reported history. Postural sway was quantified via resultant root mean square (RMS) acceleration using a custom Android application during four mCTSIB conditions. Area under the curve (AUC) was calculated using receiver operating characteristic analysis, with DeLong's test comparing AUCs. Spearman's rank correlation assessed associations with Mini-BESTest.ResultsAUCs ranged from 0.681 to 0.798, indicating acceptable-to-good preliminary discriminatory capacity, though wide confidence intervals were present and condition AUCs did not differ statistically. The eyes closed-firm condition demonstrated high specificity (96.1%) and a strong positive likelihood ratio (LR+=14.63), suggesting utility as a highly specific "rule-in" screening task, while eyes open-foam yielded the highest AUC (0.798). Significant negative correlations occurred between application RMS metrics and total Mini-BESTest scores across all conditions (ρ = -0.410 to -0.525, p < .05), with eyes closed-foam specifically associating with reactive postural control and dynamic gait subscores.ConclusionsThe application demonstrates preliminary discriminative validity for screening fall risk within vestibular cohorts. Due to modest sensitivity, wide confidence intervals, and the study's cross-sectional nature, this tiered pathway remains strictly exploratory; prospective longitudinal validation is warranted.
BackgroundDespite its impact, sexual health remains a neglected component of rehabilitation for younger stroke patients.AimTo evaluate sexual dysfunction prevelance in stroke patients and examine its association with health-related quality of life and psychological distress.MethodsThis case-control study included 30 stroke patients and 30 matched controls. Data were collected using the Arizona Sexual Experience Scale (ASEX), Stroke-Specific Quality of Life Scale (SSQOL), and Hospital Anxiety and Depression Scale (HADS).ResultsPatients had significantly higher total ASEX scores (19.3 ± 6.6 vs. 13.0 ± 3.1, p < 0.001), and a higher prevalence of dysfunction than controls (p = 0.004), reporting a significant decline in sexual satisfaction (7.5 to 4.1, p < 0.001). Sexual function was significantly associated with the SSQOL Energy, Thinking, and Language domains (p < 0.05), and HADS-Depression (r = 0.450, p = 0.013), but not with functional state.Strengths and LimitationsStrengths include a matched control group. Limitations include a small sample and cross-sectional design, potential selection bias from a high refusal rate, and restricted psychological variance due to clinical exclusions.ConclusionSexual dysfunction represents a multifaceted challenge for young-to-middle-aged stroke patients, appearing more closely linked to perceived quality of life domains (cognitive, energy, emotional well-being) than to motor deficits. Sexual health may be affected even in patients with low physical disability.Clinical ImplicationsRehabilitation should address holistic needs. Healthcare professionals could benefit from incorporating sexual health screenings into routine care, considering the management of fatigue and depressive symptoms to support long-term well-being.
Objective This cross-sectional study assesses the level of HRQoL, self-efficacy, and disease acceptance among patients at different stages of Parkinson's Disease (PD). Methods 83 PD patients were stratified by Hoehn-Yahr stages I-V into 5 groups. HRQoL (SF-12), self-efficacy (CD-SES), and acceptance of the disease (AIS) were assessed. Kruskal-Wallis test was used to compare the mean scores for the outcomes of SF-12, SES, and AIS between patients at each of the five stages of PD; chi-square tests analyzed demographics. Statistical significance was defined as p < .05 (95% confidence level). Results Self-efficacy scores significantly declined from 35.95 ± 15.37 in Stage I, to 17.55 ± 9.47 in Stage V (p < 0.05). Acceptance of illness also declined, from a mean score of 28.73 ± 8.62 in Stage I to 18.91 ± 5.77 in Stage V (p < 0.05). Several individual HRQoL domains demonstrated stage-related deterioration in physical functioning, pain interference, emotional well-being, and social participation. However, no statistically significant difference was observed in the overall SF-12 summary score across stages (p > 0.05). Conclusions The findings underscore the progressive impact of PD on self-efficacy and illness acceptance, while several HRQoL domains demonstrated stage-related deterioration despite relatively stable global SF-12 summary scores. The results highlighted a need for stage-specific interventions, focusing on strengthening self-efficacy, promoting acceptance of illness, and addressing physical, emotional, and social challenges to enhance HRQoL, particularly in the advanced stages of the disease.
BackgroundProgressive respiratory muscle weakness in neuromuscular diseases (NMD) impairs cough effectiveness and increases respiratory morbidity. We compared peak cough flow (PCF) and vital capacity (VC) across airway clearance/cough augmentation techniques in adolescents and young adults using home noninvasive ventilation (NIV).MethodsIn this cross-sectional physiological study, adolescents and young adults with NMD receiving home NIV were evaluated at home. PCF and VC were measured at baseline and immediately after manual assisted cough (MAC), NIV at usual settings, NIV at inspiratory positive airway pressure of 30 cmH2O, air stacking (AS), glossopharyngeal breathing (GPB), and mechanical insufflation-exsufflation (MI-E). Techniques were tested alone and in combination with MAC; the sequence was randomized within participants.ResultsTwenty-four participants (70.8% male; age 17.5 ± 2.4 years) were included. Baseline PCF was 211.2 ± 89.4 L/min. Compared with baseline, PCF increased with MAC, AS, NIV at usual settings, NIV at 30 cmH2O, and MI-E (all p < 0.05), whereas GPB showed no significant change. When combined with MAC, all techniques further increased PCF (e.g., AS + MAC, 306.7 ± 98.4; NIV-30 + MAC, 297.1 ± 94.0 L/min; all p < 0.001), with no between-technique differences. VC increased after AS, MI-E, and NIV (all p < 0.005), but not after GPB.ConclusionsIn adolescents and young adults with NMD using home NIV, AS, NIV, and MI-E improved cough effectiveness and lung volume, and adding MAC produced additional PCF gains.
Background The International Classification of Functioning, Disability and Health (ICF) is widely used as a framework for post-stroke rehabilitation, but its clinical application requires further synthesis. Objective This narrative review examined the current applications of ICF in post-stroke rehabilitation, benchmarked against the United Kingdom Stroke Guideline (UK Guideline). Methods The review followed the Scale for the Assessment of Narrative Review Articles. ICF-based assessments and interventions described by the original study authors from selected studies were extracted. Results A total of 546 assessments were mapped to the ICF across 166 studies, overlapping with more than 80% of the UK Guideline topics. These assessments appeared to be primarily Body Function-based (40.7%) and Activity-based (27.1%). For ICF-based interventions, 247 interventions were identified across 66 studies and covered fewer than half of the UK Guideline topics. Mapping based on intervention content covered 36% of the combined Activity and Participation component. Both assessment and intervention mapping allocated less attention to the Participation component and Contextual Factors (CF), indicating limited specificity to community reintegration after stroke. Conclusions To promote the holistic ICF framework in post-stroke rehabilitation, more work is needed to address the assessment-intervention mismatch in current practice, particularly for Participation and CF. Resources, such as clinician training and service-level support, should also be mobilized to support the routine clinical application of the ICF.
BackgroundExercise is the only established disease-modifying intervention in Parkinson's disease (PD), and continued exploration of innovative and engaging exercise modalities may further enhance outcomes for individuals living with PD. Table tennis (TT) is a cognitively engaging, task-specific activity integrating visuospatial processing, anticipatory motor planning, and dynamic postural control.ObjectiveTo examine the feasibility, including attendance, retention, and safety, and effects of a 12 week TT-based program, NeuroPongTM, on motor and non-motor symptoms in individuals with PD.MethodsIn this single-arm pilot study, 30 participants were enrolled and 26 completed 12 weeks of twice-weekly, 2-h TT sessions. The primary outcome was the Movement Disorders Society-Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS III). Secondary outcomes included the Berg Balance Scale (BBS), Timed Up and Go (TUG), Six-Minute Walk Test (6MWT), Montreal Cognitive Assessment (MoCA) and several patient-reported outcomes. Pre-post comparisons were conducted using paired T-tests.ResultsImprovements were observed in the MDS-UPDRS Part III (mean change -5.73, 95% CI -9.02 to -2.44, p = 0.0014), BBS (mean change +3.08, 95% CI 1.987 to 4.17, p < 0.0001), TUG (mean change -1.04, 95% CI -1.69 to -0.38, p = 0.0032), and 6MWT (mean change 66.77, 95% CI 49.82 to 83.71, p < 0.0001). Self-reported depression decreased (Hospital Anxiety and Depression Scale, HADS-D mean change -1.12, 95% CI -1.97 to -0.26, p = 0.0129). Attendance averaged approximately 90%, and no adverse events were reported. No significant changes were observed in other outcomes.ConclusionsA 12-week TT-based program, NeuroPong™, was feasible and associated with improvement in motor function, balance, walking endurance and self-reported depression in PD. The multidimensional motor and cognitive demands of table tennis may contribute to these observed benefits. Larger randomized controlled trials are warranted.
BackgroundHand and wrist spasticity is a common post-stroke complication that compromises quality of life and functional independence. Because conventional stretching is time-intensive, devices that enable consistent, minimally supervised stretching may improve long-term management. This study evaluated the efficacy of Hand Stretcher®, a novel dynamic stretching device, for reducing spasticity and improving hand function in patients with chronic stroke.MethodsThirty chronic stroke patients (>12 months post-stroke) with mild upper limb motor weakness (Manual Muscle Testing (MMT) grade3-4) and mild-to-moderate spasticity (Modified Ashworth Scale (MAS) < 3) were enrolled. Participants were randomized to an intervention group (n = 15), which used the dynamic passive stretching device 4 times daily for 15-20 min per session, 7 days a week, over 2 months, and a control group (n = 15). Both groups also received conventional rehabilitation. Outcomes included MAS, MMT, Manual Functional Test, and Brunnstrom stage, assessed at baseline (T0), 1 month (T1), and end of the 2-month intervention period (T2).ResultsOnly the intervention group showed significant reductions in wrist and finger flexor spasticity with no serious adverse events. Manual Functional Test and Brunnstrom stage also improved at T2. No significant changes in wrist or finger extensor strength (MMT) were observed in either group.ConclusionTwo months of intensive use of the Hand Stretcher® significantly reduced wrist and finger flexor spasticity without concurrent gains in extensor strength in patients with chronic stroke. These preliminary findings support the device's potential as a safe, practical adjunct to conventional rehabilitation in post-stroke recovery.Clinical Trial Registration NumberThe study was registered with the Clinical Research Information Service (CRIS) (KCT 0010204).
ObjectiveTo perform the cross-cultural adaptation of the Patient-Reported Impact of Spasticity Measure (PRISM) into Mexican Spanish and to examine the internal consistency and preliminary convergent validity of the PRISM-MX in adults with post-stroke spasticity.MethodsThis cross-sectional pilot study included 30 adults with ischemic or hemorrhagic stroke and clinically confirmed spasticity attending an outpatient rehabilitation clinic in Merida, Mexico. Cross-cultural adaptation followed standard procedures, including forward translation, synthesis, back-translation, expert committee review, and cognitive debriefing. Preliminary psychometric evaluation included descriptive item-level analysis, internal consistency of the original 41-item PRISM-MX version, and exploratory correlations with disability, motor performance, and quality-of-life measures.ResultsThe Mexican Spanish version was considered understandable, culturally relevant, and acceptable by participants during cognitive debriefing. The original 41-item PRISM-MX version was retained, and no item deletion was performed based on the present pilot sample. No missing PRISM-MX item responses were observed. Internal consistency was high for the total score (Cronbach's alpha = .956). Higher PRISM-MX scores were significantly associated with greater disability and poorer quality of life, with correlation coefficients ranging from ρ = -.46 to ρ = .61, supporting preliminary convergent validity.ConclusionsPRISM-MX was successfully cross-culturally adapted and showed preliminary evidence of acceptability, high internal consistency, and clinically plausible associations with disability and quality-of-life indicators. Definitive psychometric validation, including structural validity, test-retest reliability, responsiveness, measurement error, and measurement invariance, remains pending.
BackgroundStroke, multiple sclerosis (MS), and Parkinson's disease (PD) cause balance and walking impairments, which increase the risk of falls and reduce quality of life. Technological advances have enabled novel reactive balance approaches.ObjectiveTo synthesize the current approaches of technology-based perturbation interventions during walking and their effects on physical function in stroke, MS, and PD.MethodsA literature search was conducted in PubMed, PEDro, and ScienceDirect for studies published from January 2014 to December 2025, supplemented by citation tracking and grey literature. Eligible studies included interventional studies utilizing technology-based perturbation during walking in stroke, MS, or PD.ResultsTen studies were included. Participants were diagnosed with stroke (n = 83, 42%), MS (n = 77, 39%), or PD (n = 38, 19%). Most interventions used treadmill-based perturbations to induce slips, trips, or lateral balance instability. Interventions comprised a median of nine sessions over three weeks (25 min per session). Outcomes were grouped into four categories: clinical assessments, patient-reported outcomes, technology-based assessments, and assessments during walking training. Between-group differences compared to similar treatments without perturbation were inconsistent, but within-group improvements in walking speed, balance, and functional mobility were commonly reported. Adverse events were rare, and safety protocols were followed. Considerable heterogeneity in intervention protocols and outcome measures limited synthesis.ConclusionTechnology-based perturbation training during walking may offer an alternative for improving physical function in stroke, MS, and PD. Evidence of superiority over non-perturbation interventions remains inconclusive due to heterogeneity and small samples. Within-group improvements suggest benefits, warranting standardized protocols and larger high-quality trials.
PurposeIndividuals with stroke have difficulty rotating their trunk and adjusting their supporting foot when negotiating spatial constraints. This study aimed to classify movement patterns used when passing through narrow openings and to identify factors associated with stroke-specific patterns.MethodsTwenty-three individuals with stroke (age: 60.7 ± 10.1 years, time after stroke: 15.2 ± 21.1 months, subacute and chronic, independently ambulatory), 23 age-matched community-dwelling adults (61.0 ± 9.7 years), and 12 young adults (25.4 ± 2.5 years) were recruited. Participants walked through openings of various widths. Movement patterns were independently classified by three trained physical therapists, and inter-rater agreement was assessed. Generalized linear mixed models with participants as a random effect were used to examine associations between pattern selection and clinical/environmental factors.ResultsFive passing patterns were identified: (A) pivot, (B-1) early pivot, (B-2) early pivot with reverse trunk rotation, (C) multiple steps, and (D) no-rotation. Inter-rater agreement was substantial (Cohen's κ = .76). Stroke-specific patterns were patterns B-2 and C. The mixed-model analysis showed that B-2 and C were more likely with narrower openings (odds ratio [OR]: .52, 95% confidence interval [CI]: .39-.70; and OR: .18, 95% CI: .11-.32, respectively; both p < .001). TUG performance was not significantly associated with pattern C (OR: 1.22, 95% CI: .99-1.49, p = .056).ConclusionOpening width was associated with stroke-specific pattern selection. Multi-step strategies may reflect increased stability demands, whereas pivot-like strategies may be associated with better mobility. These findings may help clinicians assess movement behaviors in constrained environments.
BackgroundSpastic cerebral palsy (CP) commonly impairs cervico-mandibular mobility and motor coordination due to increased muscle tone and altered postural control, potentially affecting head stability and orofacial function.ObjectiveTo compare the immediate effects of exercise- and manual therapy-based interventions on temporomandibular and cervical mobility in children with spastic CP, contrasting active versus passive rehabilitation strategies.MethodsThis single-blind, randomized crossover trial included 52 children with spastic CP (mean age 10.8 ± 2.4 years; GMFCS levels I-IV). Each received one exercise and one manual therapy session in randomized order with a one-week interval. Owing to missed second-week appointments, 44 children completed the exercise session and 48 completed the manual therapy session, resulting in partial crossover completion. Mandibular range of motion (maximal opening, lateral deviation, protrusion), cervical range of motion (flexion, extension, rotation), and craniovertebral angle were assessed immediately before and after each intervention.ResultsBoth interventions produced significant immediate improvements in mandibular and cervical mobility (p < 0.001). Exercise resulted in greater gains in selected active mandibular movements, whereas manual therapy elicited larger improvements in cervical mobility. Craniovertebral angle increased following both interventions, with no significant between-intervention difference, indicating comparable effects on head posture. Effect sizes were moderate to large, and no carryover effects were detected.ConclusionExercise and manual therapy induce modality-specific immediate neuromechanical responses in the cervico-mandibular system in children with spastic CP. These findings reflect short-term rather than long-term effects and suggest both approaches may be considered in individualized pediatric neurorehabilitation planning.
BackgroundHand edema is a common post-stroke complication that negatively affects function and quality of life. However, interventions for hand edema remain limited.ObjectiveIn this study, we investigated whether contralateral resistance handgrip exercises performed with the non-paretic hand could immediately and sustainably reduce hand edema in patients with stroke.MethodsThis study used a B-A-B single-case design to explore the effects of the intervention in inpatients more than 3 months post-stroke. During the two 8-day intervention phases, the participants performed rhythmic handgrip exercises at 30% of the maximum voluntary contraction for 5 min daily as part of their occupational therapy sessions. A baseline phase without intervention was interposed. The hand volume was measured by using water displacement before and after exercise sessions to assess immediate and sustained effects.ResultsFour inpatients with paretic hand edema (93-110 days poststroke) participated in this study. Contralateral handgrip exercise resulted in immediate reduction in paretic hand edema in three of the four patients; however, only one patient showed a sustained effect. The intervention was simple and feasible, with responses varying across individuals.ConclusionsThis small single-case study suggests that contralateral handgrip exercise may contribute to reducing hand edema in some patients; however, its sustained benefits remain uncertain. This low-cost approach may serve as a candidate adjunct intervention in rehabilitation, particularly when paretic limb movements are limited. However, given the exploratory nature of this small single-case study, further investigation with larger samples and more rigorous designs is warranted.
ObjectiveTo map rehabilitation interventions and rehabilitation-relevant management reported for lateral medullary stroke (Wallenberg syndrome) and distinguish direct intervention evidence from management and assessment reports.Data sourcesPubMed/MEDLINE, Ichushi-Web, and Web of Science Core Collection were searched from inception to 12 March 2026. Cumulative Index to Nursing and Allied Health Literature was searched on 24 April 2026. Citation tracking was performed.Review methodsReports were eligible if they described rehabilitation, rehabilitation-relevant management, assessment, prognosis, or monitoring relevant to recovery or safety. Two reviewers screened records; charting and classification were verified by a second reviewer using operational definitions. Reports were grouped by clinical phase, target domain, safety management, outcome measures, and primary reporting function.ResultsThe searches identified 741 records; 486 unique records were screened and 78 reports were included. Publication years ranged from 1997 to 2026; 60 reports were case reports or case series. Primary reporting functions were categorized as explicit intervention/program (n = 29), management/procedural pathway (n = 21), assessment/prognostic/monitoring (n = 18), and minimal-detail supportive/diagnostic (n = 10). Dysphagia was addressed in 63 reports, but only 22 were explicit intervention/program reports. No included report explicitly described sensory safety education.ConclusionThe accessible literature is useful but mixed. Interpretation is limited by unretrieved full-text candidates, omitted databases/grey literature, no critical appraisal, and no independent agreement statistic for post hoc reporting-function classification. Future reports should separate therapeutic training from management pathways and describe dosage, safety management, reassessment timing, discharge function, sensory safety education, and daily-life precautions.
