BackgroundUpper-limb hemiparesis is a frequent, disabling post-stroke complication. While initial severity is a dominant predictor of long-term recovery, performing complex motor assessments is often challenging during the unstable, very acute phase.ObjectivesTo evaluate the association between very acute hand-finger paresis severity and subsequent subacute outcomes across multiple domains: motor impairment, motor capacity, and activities of daily living (ADL).MethodsThis retrospective cohort study included post-stroke individuals (N = 473) receiving continuous rehabilitation from acute to subacute phases between 2019 and 2021. Initial hand-finger motor paresis severity was assessed using the Stroke Impairment Assessment Set Finger-Function (SIAS-FF). Outcomes at hospital discharge were evaluated using SIAS-FF, SIAS Knee-Mouth (SIAS-KM) test for proximal function, the Simple Test for Evaluating Hand Function (STEF) for motor capacity, and Functional Independence Measure (FIM) selfcare items for ADL. Multivariable regression models (ordinal logistic regression and generalized linear models) adjusting for age and length of hospital stay were implemented to test associations between the acute hand-finger paresis severity and subacute outcomes.ResultsAnalyses included 356 participants (mean age, 66.7 years). Acute finger paresis severity (assessed at 1.7 days post-stroke) was associated with subacute outcomes (at 86.9 days) in multivariable regression models (p < 0.01). Participants with better SIAS-FF scores in the acute phase achieved better discharge outcomes across all measures, including SIAS-FF, SIAS-KM, STEF, and FIM selfcare scores, even after controlling for age and length of hospital stay.ConclusionsSeverity of hand-finger paresis in the very acute phase is significantly associated with global upper-limb recovery. The SIAS-FF is a simple clinical tool that provides useful information for estimating post-stroke functional outcomes.
ObjectiveBefore 2019, the Republic of Korea lacked a coordinated rehabilitation healthcare delivery system, which resulted in limited access to intensive rehabilitation during the subacute stage. To overcome this limitation, a specialized rehabilitation hospital system was implemented in 2020, whereby hospitals meeting predefined criteria were designated to provide intensive subacute rehabilitation. However, evidence regarding the effectiveness of the specialized rehabilitation hospital system is sparse. Therefore, this study evaluated changes in healthcare utilization for inpatient rehabilitation among patients with traumatic brain injury (TBI) before and after the implementation of the specialized rehabilitation hospital system.MethodsThis study used data from the National Health Insurance Service–Nationwide Health Insurance Database of the Republic of Korea. Patients were categorized into two groups: the case group, consisting of those admitted to a specialized rehabilitation hospital within 90 days of TBI onset, and the control group, consisting of those not admitted to a specialized rehabilitation hospital within 90 days of TBI onset. Propensity score weighting using the average treatment effect on the treated (ATT) was applied to improve comparability between the groups, followed by a difference-in-differences (DID) analysis of length of stay (LOS). Logistic regression was performed to identify factors associated with admission to a specialized rehabilitation hospital. Healthcare utilization pathways involving specialized rehabilitation hospitals and long-term care hospitals (LTCHs) within 90 days of TBI onset were evaluated.ResultsThe ATT-weighted DID analysis showed a significant 10.0% increase in LOS following implementation of the specialized rehabilitation hospital system (95% confidence interval [CI], 0.3–20.6; p = 0.043). The odds of admission to a specialized rehabilitation hospital were significantly higher in the post-implementation period than in the pre-implementation period (OR, 1.36; 95% CI, 1.18–1.55; p < 0.001). The proportion of patients who utilized a specialized rehabilitation hospital first increased from 4.0% to 7.2%, with significantly higher relative odds in the post-implementation period (OR, 2.00; 95% CI, 1.61–2.49; p < 0.001).ConclusionsImplementation of the specialized rehabilitation hospital system was associated with increased healthcare utilization and changes in post-acute healthcare utilization pathways among patients with TBI. These findings provide evidence regarding changes in healthcare utilization following implementation of the system.
BackgroundLimb-salvage surgery (LSS) for lower-extremity dedifferentiated liposarcoma (DDLPS) often leads to persistent functional deficits, impaired balance, and gait asymmetry due to extensive muscle resection. Evidence regarding long-term exercise-based rehabilitation (ExR) in this population remains scarce.MethodsA 68-year-old woman, 19 months post-LSS, completed an 18-month supervised ExR program integrating resistance, endurance, gait, and balance training. Assessments were performed at baseline (T0), 9 months (T1), and 18 months (T2). Clinical assessments included the 6-Minute Walk Test (6MWT), Mini-Balance Evaluation Systems Test (Mini-BESTest), Falls Efficacy Scale–International (FES-I), and Toronto Extremity Salvage Score (TESS). Instrumental evaluations comprised kinematic gait analysis during normal walking (NW) and fast walking (FW) using an inertial sensor, and physical activity monitoring via a tri-axial accelerometer.ResultsPost-intervention, positive trends were observed across all outcomes. NW gait speed increased by 0.40 m/s and 6MWT distance by 97 m, exceeding minimal clinically important differences. Step-length symmetry ratio (operated/non-operated limb) normalized in NW (1.16 at T0 vs. 0.98 at T2) and FW (1.13 vs. 1.00), while gait symmetry index increased from 85.0% to 94.7% in NW and 88.0% to 97.2% in FW. Mini-BESTest score (16 vs. 25), FES-I score (40 vs. 21), and TESS (62.7% vs. 100%) showed marked improvements. Daily steps increased from 3,534 to 6,757, while sitting time decreased from 459 to 318 min/day.ConclusionThe single-patient design and absence of a control condition prevent directly attributing the observed improvements to the rehabilitation program. However, these promising preliminary observations suggest that prolonged, individualized ExR may help target long-term deficits after LSS, warranting further investigation in larger prospective controlled cohorts.
Despite technological advancements, a clinically appropriate gait assessment tool has yet to be developed. A clinical gait assessment tool needs to be affordable, portable, easy to use and able to provide accurate, reliable gait metrics. As an initial step to address this need, this study sought to validate the accuracy and reliability of step/stride level and participant-mean level gait metrics from Gaitly, a novel mobile smartphone video-based gait analysis application, against the GAITRite pressure-sensitive walkway system in healthy adults. With the exception of swing time, the temporal measures yielded absolute error ≤5% and ICC ≥ 0.88 for both the step/stride and the participant mean level comparisons. For participant mean level comparisons for spatial measurements the absolute error < 2% and ICC ≥ 0.9. Thus, the Gaitly application offers a innovative, cost-effective gait analysis system that could be used in rural and urban settings.
IntroductionPediatric stroke is a leading cause of neurological disability, often resulting in hemiparetic cerebral palsy (HCP). Non-invasive brain stimulation (NIBS), including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), may enhance motor recovery due to the developing brain's neuroplasticity.ObjectivesTo map the available evidence on the feasibility, safety, and clinical and neurophysiological outcomes of rTMS and tDCS in children and adolescents with hemiparesis secondary to pediatric stroke.MethodsA scoping review of 11 publications representing 8 independent controlled trials published between 2005 and 2025: 4 rTMS trials (6 reports) and 4 tDCS trials (5 reports) involving perinatal or pediatric stroke. Additional reports from the same cohorts were retained when assessing different outcomes or follow-up points but were not counted as independent cohorts. Clinical, neurophysiological, and safety outcomes were synthesized descriptively.ResultsNIBS was feasible and generally well tolerated under the studied protocols, with no serious treatment-related adverse events. Some small rTMS trials reported benefits in selected upper-limb outcomes compared with sham, but effect magnitude and durability remain uncertain. Smaller tDCS trials yielded mixed findings, including improved subjective occupational performance without additional gains in objectively assessed hand function. The largest multicenter trial, involving 89 randomized children with perinatal stroke and unilateral cerebral palsy, found no additional benefit over sham in hand function or achievement of child-identified functional goals. One small rTMS trial included 10 participants with childhood-onset arterial ischemic stroke; no controlled tDCS trial specifically targeting childhood-onset stroke was identified.DiscussionNIBS appears feasible and generally well tolerated in children with stroke-related hemiparesis. Upper-limb motor recovery benefits have been reported, particularly alongside intensive rehabilitation, although the largest pediatric tDCS trial showed no additional motor benefit. Corticospinal and metabolic predictors remain exploratory. The small evidence base, methodological heterogeneity, and interindividual variability preclude definitive conclusions about clinical effectiveness. Evidence predominantly concerns perinatal stroke and unilateral cerebral palsy, limiting generalizability to childhood-onset stroke. Future research should standardize protocols and investigate whether individualized approaches incorporating neuroimaging and neurophysiological biomarkers improve rehabilitation outcomes.
