Spinal cord injury (SCI) leads to impairments in motor, sensory, and autonomic pathways, often resulting in significant disability and reduced quality of life. Recovery of ambulation is a priority for people with SCI and vital for regaining independence and social participation. The increasing incidence of incomplete SCI, especially from non-traumatic causes like degenerative cervical myelopathy, has amplified the clinical relevance of gait recovery. Although gait analysis is widely applied in neurological conditions, its use in people with SCI remains limited, and there is no consensus on standardized protocols or essential methods. This systematic review aimed to identify and summarize the instrumentation and measures used in gait analysis of people with SCI. The review protocol was registered with PROSPERO (CRD42024520587). Electronic databases including PubMed, Embase, Web of Science, Scopus, and Cochrane Library were searched up to May 1, 2025. Inclusion criteria focused on studies involving adult people with SCI capable of walking with or without aids, using computer-based gait analysis tools. Selected studies were analyzed for methodological quality, level of evidence (LoE), types of gait measures assessed, and instrumentation used. We included 48 studies. Over half of studies were fair quality (54

BACKGROUND AND OBJECTIVES:Patients with spinal cord injury (SCI) frequently experience dysphonia, leading to communication difficulties, social participation restrictions, and reduced quality of life. In the absence of consensus guidelines, we conducted a systematic review to synthesize evidence on diagnostic tools and rehabilitation protocols for dysphonia after SCI, with the aim of informing clinical practice and future research. METHODS:Six biomedical, rehabilitation, and speech pathology databases were searched, along with reference lists of relevant studies. Inclusion criteria were as follows: adults with acquired SCI of any etiology, studies reporting dysphonia assessments or rehabilitation protocols, and designs ranging from randomized controlled trials (RCTs) to case reports (English only). Two reviewers independently screened studies, extracted data, and assessed risk of bias (RoB) and level of evidence (LoE) using design-specific tools and Oxford Centre for Evidence-Based Medicine criteria. Dysphonia assessments-including instrumental, acoustic, perceptual, and self-reported measures-were summarized as frequencies and percentages; rehabilitation protocols were described narratively. The review was registered in the International Prospective Register of Systematic Reviews (CRD42024561809). RESULTS:From 626 unique records, 18 studies were included (total n = 303; mean age 39 years; 79.3% male), comprising 4 RCTs (LoE 2) and 14 observational or case studies (LoE 3-4). Most studies focused on cervical SCI with varied etiologies and American Spinal Injury Association Impairment Scale grades (A-D). RoB was generally low to moderate. Dysphonia assessments included instrumental evaluations (83%, mainly spirometry or plethysmography of lung volumes, pressures, and flows), acoustic analyses (83%, most commonly maximum phonation time and sound pressure level), perceptual measures (78%, using heterogeneous tools), and patient questionnaires (67%, mainly the Voice Handicap Index extended and short forms [VHI/VHI-10]). Reported rehabilitation protocols included the use of speech valves for ventilated patients, glossopharyngeal breathing, abdominal binding, and neurologic music therapy. DISCUSSION:Current research on dysphonia after SCI remains limited and methodologically heterogeneous. Evidence supports combining spirometry, indirect laryngoscopy, acoustic and perceptual analyses, and VHI-10 for comprehensive assessment. Among rehabilitation approaches, abdominal binding and neurologic music therapy show the most consistent benefits. High-quality, large-scale studies with longer follow-up are needed to standardize diagnostic and rehabilitation protocols and improve voice outcomes in this underexplored field.

BackgroundPatients after severe acquired brain injury (sABI) have an increased susceptibility to systemic infections, which can severely compromise their rehabilitation process. In this study, we aimed to evaluate the impact of hospital-acquired pneumonia (HAP) on functional outcome and mortality in a large cohort of adult patients underwent inpatient rehabilitation from post-acute to 6 months after sABI.MethodsThis observational retrospective cohort study included patients consecutively admitted after an acute sABI to Neurorehabilitation Unit for 6-month program between December 1, 2019, and December 31, 2022. Demographic data, etiology of sABI (traumatic vs. non-traumatic), length of stay, comorbidities, neurological impairment, presence of invasive devices (tracheostomy and nasogastric tube, percutaneous endoscopic gastrostomy), occurrence of HAP, and death during hospitalization were recorded. Functional assessments were evaluated at admission and discharge with the Functional Independence Measure (FIM), the Levels of Cognitive Functioning (LCF), and the Glasgow Outcome Scale-extended (GOS-E).ResultsOf the 169 patients enrolled, 78 (46.2%) developed HAP during hospitalization. Of the 169 patients enrolled, 78 (46.2%) developed HAP during hospitalization. The multivariable logistic regression analysis identified as significant risk factors for the onset of HAP during hospitalization male sex (OR 0.313, p = 0.003), severity of brain injury (OR 0.825, p = 0.011), and the presence of nasogastric tube or percutaneous endoscopic gastrostomy due to the severity of dysphagia (OR 14.336, p = 0.024). The occurrence of HAP was the main predictor of poorer recovery at discharge in terms of FIM (p = 0.003) and LCF (p = 0.009), independent of other confounding variables at admission (e.g., age, severity, and etiology of brain injury). Furthermore, the occurrence of HAP was independently associated with a threefold (OR 3.088; p = 0.020) increase in mortality during inpatient rehabilitation.ConclusionSeverity of brain injury, male sex and presence of nasogastric tube or percutaneous endoscopic gastrostomy due to the severity of dysphagia may represent an early indicator of the risk of HAP in patients with sABI. Implementing preventive strategies and application of the care bundle to reduce the incidence of HAP, including improved oral hygiene, early mobilization, and appropriate management of dysphagia, may not only improve functional outcomes but also reduce mortality in patients undergoing rehabilitation after sABI.

Background and ObjectivesPatients with spinal cord injury (SCI) frequently experience dysphonia, leading to communication difficulties, social participation restrictions, and reduced quality of life. In the absence of consensus guidelines, we conducted a systematic review to synthesize evidence on diagnostic tools and rehabilitation protocols for dysphonia after SCI, with the aim of informing clinical practice and future research.MethodsSix biomedical, rehabilitation, and speech pathology databases were searched, along with reference lists of relevant studies. Inclusion criteria were as follows: adults with acquired SCI of any etiology, studies reporting dysphonia assessments or rehabilitation protocols, and designs ranging from randomized controlled trials (RCTs) to case reports (English only). Two reviewers independently screened studies, extracted data, and assessed risk of bias (RoB) and level of evidence (LoE) using design-specific tools and Oxford Centre for Evidence-Based Medicine criteria. Dysphonia assessments-including instrumental, acoustic, perceptual, and self-reported measures-were summarized as frequencies and percentages; rehabilitation protocols were described narratively. The review was registered in the International Prospective Register of Systematic Reviews (CRD42024561809).ResultsFrom 626 unique records, 18 studies were included (total n = 303; mean age 39 years; 79.3% male), comprising 4 RCTs (LoE 2) and 14 observational or case studies (LoE 3-4). Most studies focused on cervical SCI with varied etiologies and American Spinal Injury Association Impairment Scale grades (A-D). RoB was generally low to moderate. Dysphonia assessments included instrumental evaluations (83%, mainly spirometry or plethysmography of lung volumes, pressures, and flows), acoustic analyses (83%, most commonly maximum phonation time and sound pressure level), perceptual measures (78%, using heterogeneous tools), and patient questionnaires (67%, mainly the Voice Handicap Index extended and short forms [VHI/VHI-10]). Reported rehabilitation protocols included the use of speech valves for ventilated patients, glossopharyngeal breathing, abdominal binding, and neurologic music therapy.DiscussionCurrent research on dysphonia after SCI remains limited and methodologically heterogeneous. Evidence supports combining spirometry, indirect laryngoscopy, acoustic and perceptual analyses, and VHI-10 for comprehensive assessment. Among rehabilitation approaches, abdominal binding and neurologic music therapy show the most consistent benefits. High-quality, large-scale studies with longer follow-up are needed to standardize diagnostic and rehabilitation protocols and improve voice outcomes in this underexplored field.

Background: Spinal cord injury (SCI) impairs sensorimotor function below the lesion and reshapes supralesional circuits, potentially influencing motor control above the injury. Although upper extremity strength and sensation are clinically normal in paraplegia, it is not known whether supralesional reorganization may produce subclinical alterations in the fine motor skills of the upper extremities. The aim of the study was to compare manual dexterity evaluated through the Purdue Pegboard Test between patients with SCI (PwSCI) and healthy subjects (HS). Methods: We recruited 18 PwSCI with complete paraplegia and 18 age- and sex-matched HS. Participants completed the four subtests of the Purdue Pegboard Test: dominant hand (1), non-dominant hand (2), bimanual (3), and assembly (4). For the first three subtests, a mixed 3 × 2 ANOVA (3 subtests × 2 groups) was performed, whereas for the fourth subtest, an independent samples t-test was performed. Spearman’s rho quantified correlations among subtests and with clinical findings. Results: PwSCI showed full upper extremity muscle strength and sensation. The mean scores of the four subtests were significantly lower in PwSCI than in HS. Unilateral and bimanual subtests correlated with each other in both groups; however, the bimanual subtest was not as well predicted by dominant hand alone, as PwSCI depended more on non-dominant ability. In PwSCI, the assembly subtest strongly depended on dominant, non-dominant, and bimanual scores, whereas this dependency was weaker in HS. The subtests were influenced by ageing in PwSCI. Conclusions: Despite upper extremity muscle strength and sensation being clinically normal, PwSCI showed impaired manual dexterity. This may reflect diminished ascending somatosensory input to supraspinal centres and plastic changes in supralesional motor pathways. These preliminary results open new rehabilitation perspectives for PwSCI.

BACKGROUND:Falls are a serious concern in Parkinson's disease (PD), often leading to hospitalisation, dependence and reduced quality of life. Effective fall management requires identification of those at risk. This cross-sectional, discriminative study aimed to evaluate which selection of outcomes best discriminate retrospective fallers from non-fallers, to inform a future prospective clinical prediction tool. METHODS:People with PD were recruited (ICICLE-GAIT; 54- and 72-month follow up assessments). Fallers and non-fallers were stratified based on prospective fall reports. A total of 299 outcomes across 4 domains were collected: clinical (n = 9), lab-based mobility (gait n = 60, turning n = 99), real-world mobility (n = 131). Receiver operating characteristic analysis evaluated classification models distinguishing fallers from non-fallers. Area under the curve (AUC) determined which models were optimal. Models were re-applied at 72-months. RESULTS:Of the 48 participants, 32 (67%) were classified as fallers and 16 (33%) as non-fallers. Significant group differences (faller vs. non-faller) were found in all domains at 54-months; clinical (n = 2/9), lab-based gait (n = 8/60), lab-based turning (n = 19/99) and real-world mobility (n = 5/131). At 54-months, turning was the strongest single-domain model (apparent AUC = 0.86, sensitivity = 0.74, specificity = 0.93; optimism-corrected AUC = 0.61), followed by real-world mobility (AUC = 0.82, sensitivity = 0.68, specificity = 1.00; optimism-corrected AUC = 0.72). All multi-domain combinations including turning showed acceptable discrimination, with AUC values > 0.70. At 72-months, turning alone retained apparent perfect discrimination (AUC = 1.00), whereas clinical (AUC = 0.52), gait (AUC = 0.51) and real-world (AUC = 0.69) models declined substantially. CONCLUSION:Turning showed strong discriminative power in classifying PD fallers remaining robust over time and outperforming other assessments. Real-world mobility also had strong discriminative value, highlighting the importance of ecologically valid continuous monitoring. As this study was discriminative and exploratory in nature, these findings should be interpreted as hypothesis-generating pending external validation. Future models should explore whether real-world turning provides superior discriminative value to lab-based turning.

BACKGROUND:Oropharyngeal dysphagia is a common and disabling consequence of stroke. Transcranial direct current stimulation (tDCS) has shown potential in promoting swallowing recovery, although evidence remains limited. OBJECTIVE:To determine whether bilateral anodal tDCS combined with intensive speech-language therapy (SLT) improves swallowing outcomes compared with sham stimulation in patients with post-stroke dysphagia. Exploratory analyses examined the influence of treatment phase, sex, lesion site, and baseline severity. METHODS:This multicenter, randomized, double-blind, sham-controlled trial enrolled patients with supratentorial or infratentorial ischemic stroke and oropharyngeal dysphagia. Participants received either bilateral anodal tDCS or sham stimulation (1.5 mA, 20 min/day, 5 days/week for 2 weeks) combined with intensive SLT over 6 weeks. Swallowing outcomes were assessed at baseline, 2 weeks, and 6 weeks using the Dysphagia Outcome and Severity Scale (DOSS, primary outcome), Penetration-Aspiration Scale (PAS), Mann Assessment of Swallowing Ability (MASA), and Swallowing Quality of Life questionnaire (SWAL-QoL). RESULTS:Forty-six patients (24 active, 22 sham) completed the protocol. Both groups showed significant improvement across all outcomes (p < 0.001), with no significant difference between active and sham stimulation. The DOSS was the most sensitive measure, showing sustained improvement over time. Exploratory analyses indicated greater MASA gains with active tDCS in infratentorial strokes (p = 0.04). Correlation analyses showed that greater baseline dysphagia severity was associated with larger functional gains. CONCLUSIONS:Intensive SLT was associated with meaningful recovery in post-stroke dysphagia, regardless of stimulation condition. Exploratory findings suggest that bilateral tDCS may confer additional benefit in selected lesion subgroups.

BackgroundMeasuring 18F-FDG PET-detected brain glucose uptake provides reliable information on metabolic tissue abnormalities, cells dysfunction, and neurovascular changes after traumatic brain injury (TBI).ObjectivesWe aimed to study the relationship between post-traumatic brain glucose metabolism and functional outcomes in the so far unexplored field of longitudinally 18F-FDG PET-monitored patients undergoing rehabilitation after moderate-to-severe TBI.MethodsFourteen patients consecutively admitted to our unit in the post-acute phase after TBI underwent 18F-FDG-PET scans performed before and 6 months after inpatient rehabilitation program. The Glasgow Coma Scale (GCS) for neurological status, and the Functional Independence Measure (FIM) plus the Glasgow Outcome Scale-Extended (GOSE) scales for the rehabilitation outcome, were applied on admission and discharge. Voxel-wise analyses were performed, with the Statistical Parametric Mapping (SPM12) software, to investigate pre- vs. post-rehabilitation changes of brain metabolism, and their relationships with clinical indices.ResultsIn the whole sample, 18F-FDG uptake significantly increased in the following five regions that were hypometabolic before rehabilitation: inferior frontal gyrus bilaterally, alongside right precentral gyrus, inferior parietal lobule, and cerebellum. However, only for the right precentral gyrus the median voxel peak-value at baseline resulted a significant predictor of both cognitive (FIM cognitive subscale, p = 0.012), and functional (GOS-E, p = 0.02; post- vs. pre-treatment GOS-E difference, p = 0.009) improvements. ROC curve analysis showed that a peak voxel-value of 1.7998 was the optimal cut-off for favorable rehabilitation outcome. Unfavorable functional outcomes were predicted by increased 18F-FDG uptake in the inferior frontal gyrus (GOS-E, p = 0.032) and precentral gyrus (FIM cognitive subscale, p = 0.017; GOS-E, p = 0.015).ConclusionThis proof-of-principle study enlightens the metabolic changes occurring in moderate-to-severe TBI course. Notably, such changes preferentially involve definite frontal brain areas regardless of TBI localization and entity. These findings pave the way for further studies with translational purposes.

OBJECTIVE:To study the current practice of epilepsy surgery in Italy and the relative impact of coronavirus disease 2019 (COVID-19) pandemic on it. METHODS:We launched a survey through the Italian National Virtual Epilepsy Institute, to identify centers with epilepsy surgery programs and collect data on the current preoperative and surgical practices. We reported changes in surgical volumes and complications and seizure outcomes between 2018 and 2022, that is, before and after the COVID-19 pandemic in Italy. RESULTS:A total of 21 of the 26 surveyed centers (80.7%) responded. Eleven centers (52.4%) reported having an established epilepsy surgery program, with most performing complex procedures, such as multilobar, disconnective, and hemispheric interventions. However, only a few carry out minimally invasive surgeries. Presurgical evaluation protocols vary across centers, but in keeping with international standards. Globally, 618 surgeries were performed in children and 621 in adults (total 1239) between 2018 and 2022. The most frequent type of surgery was unilobar extratemporal lobectomy for children (38.7%, p < 0.0001) and unilobar temporal lobectomy for adults (63.3%, p < 0.0001). Hemispheric surgeries were more frequent in children than in adults (11.5% vs 2.1%, p = 0.001), whereas interventions in unrevealing magnetic resonance (MRI) cases were more frequent in adults than in children (p = 0.030). At the onset of COVID-19outbreak in Italy (March 2020), we observed a significant decrease in the total number of operations compared to 2019, especially for hemispheric interventions (p = 0.027). Surgical volumes resumed in 2021, particularly for temporal lobe epilepsies and in adult cohorts. Surgical complications increased significantly in 2020 (Incidence Rate Ratio [IRR] = 13.13), whereas seizure outcome did not change significantly between 2018 and 2022. SIGNIFICANCE:Advanced pre- and postsurgical evaluation protocols are currently implemented across Italy, with a great variability between centers. Starting in 2021, epilepsy surgery volumes have regained their pre-pandemic levels, albeit with a slight loss of complexity, whereas seizure outcome has remained stable.

Objectives: We assessed the difference between quiet stance and gait in the spatial distribution and intensity of foot plantar pressures and whether it is possible to estimate the distribution during gait from data obtained during stance. Methods: A total of 60 healthy subjects with a mean age of 31.0 ± 9.4 years performed two trials for quiet stance and four trials for gait on a baropodometric walkway with their eyes open. Foot plantar pressures were recorded from 10 areas of the foot sole. Results: During quiet stance, the highest plantar pressure occurred at metatarsal heads (M2 to M4) and the medial (MH) and lateral halves of the heel (LH). During gait, the profile of plantar pressure values was like that during stance, but significantly higher. The differences concentrated at the big toe (T1), M2 to M4, MH, and LH, whilst toes (T2,3,4,5) and midfoot (MF) showed the smallest difference. A significant positive correlation was found between the corresponding areas of foot pressure during gait and stance. Conclusions: During quiet stance and gait, the overall profile of plantar pressure distribution was similar. During quiet stance, the subjects loaded more on the heels, in keeping with the known position of the center of pressure just in front of the ankles. During gait, higher pressures on the metatarsal areas are related to the forward propulsion of the center of mass. The correlation between the corresponding areas of foot pressure during gait and stance suggests that the pressure distribution during gait can partly be estimated from that during stance. This finding might be useful in most clinical settings when a single sensorized platform rather than a complete walkway is available.

OBJECTIVE:To assess the reliability of the Rehabilitation Complexity Scale-Extended (RCS-E) as a measure of rehabilitation complexity. Secondary outcomes include identifying which baseline data, including the RCS-E, are most predictive of rehabilitation stay effectiveness and exploring its role as a predictor of reimbursement for hospital admissions. DESIGN:A retrospective observational study. Demographic and clinical variables were collected, including length of stay, modified Rankin Scale, modified Barthel Index (mBI), RCS-E, and reimbursement of stay. SETTING:Study on inpatients admitted to sixteen neuromotor rehabilitation units. PARTICIPANTS:Of 5870 hospitalizations, 4091 cases (mean age, 71.8 ± 13y; 42.2% men) met the inclusion criteria. The pre-post analysis was performed on 3792 patients (mean age, 71.8 ± 12.8y; 41.6% men). INTERVENTIONS:Rehabilitation program for neurologic or orthopedic condition (median [1st-3rd quartile], duration: 27 days [20-41]). MAIN OUTCOMES AND MEASURES:RCS-E scores on admission were categorized as follows: <8 (low complexity), 8-10 (medium complexity), and >10 (high complexity). For each patient, we calculated the mBI-derived parameters: mBI gain, rehabilitation efficiency, and rehabilitation effectiveness. RESULTS:A significant moderate Spearman correlation was found between RCS-E score and mBI (rho=-0.53, P<.0001), length of stay (rho=0.41, P<.0001), and premorbid mRS (rho=0.23, P<.0001). Rehabilitation efficiency and effectiveness were significantly lower in the high complexity group. Both RCS-E and mBI at admission significantly correlated with total reimbursement (both P<.0001, rho=0.48, and rho=-0.43, respectively). Regression models indicated a predictive effect of RCS-E at admission on mBI at discharge. CONCLUSIONS:This study demonstrates the reliability and utility of RCS-E in assessing neurologic and orthopedic rehabilitation complexity, predicting outcomes, and informing funding models.

Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome. In the literature, several conservative treatments have been proposed but, to our notice, a practical and ready-to-use guide as regards different rehabilitation techniques is lacking. In this sense, by combining scientific evidence and expert opinion, the present manuscript aims to display the conservative and rehabilitation approach to this challenging pathology. From a total of 145 items identified, the authors analyzed 79 articles—excluding studies that had recruited patients without clinical and/or instrumental diagnosis of CTS or those who had undergone surgery. Four categories of nonsurgical approaches have been defined; injections, rehabilitation techniques, orthoses, and physical therapies. Carpal tunnel injection with 5% dextrose, night wrist orthosis, and extracorporeal shockwave therapy seemed to be the most effective nonsurgical treatment in CTS. Considering the poor description of specific upper limb rehabilitation techniques in the literature, an in-depth focus has also been provided based more on the authors’ experience in hand rehabilitation. Future clinical studies are awaited to establish standardized conservative protocols whereby the injection dose/technique, physical therapy, and the specific rehabilitation technique are reported. Further, a better understanding of the dynamic relationship between the median nerve and the nearby soft tissues inside the tunnel (eg, perineural loose connective tissue) would be noteworthy to optimize the treatment outcome and the hand function in the long term.

The effect of simultaneously performing two tasks (dual-task effects, DTEs) has been extensively studied, mainly focusing on the combination of cognitive and motor tasks. Given their potentially detrimental impact on real-life activities, the impact of DTEs has been investigated in both healthy individuals and patients. In this Registered Report, we aimed to replicate previous DTEs when a task requiring executive-inhibitory skills is involved while also expanding the evidence on basic facets of decision-making. We recruited 50 healthy young participants who performed a stop-signal task and two gambling tasks (loss-aversion and risk-aversion) while sitting and while walking at three treadmill speeds (normal, slow and fast). We report a significant difference in performance during single-task and dual-task, although with high individual variability. The data show no effect of the walking speed on all the cognitive tasks. Analyses on postural alignments, assessed in the cadence, gait cycle length and stance phase, confirm previous results on cognitive prioritization strategies of healthy individuals. Based on our results, we highlight the need to further investigate prioritization strategies when tasks involving higher cognitive functions are performed along a motor task in healthy individuals and patients with the aim of offering targeted training and rehabilitation protocols. The stage 1 protocol for this Registered Report was accepted in principle on 28/06/22. The protocol, as accepted by the journal, can be found at: https://doi.org/10.17605/OSF.IO/5MWH7 .

INTRODUCTION:Latest epidemiological metrics put a global prevalence of 20.6 million people suffering from spinal cord injury (SCI), leading to a burden of functional disability, deterioration in quality of life and reduced life expectancy. A thorough statement of diagnostic methods and treatment protocols for swallowing disorders after SCI stands as a major priority to streamline patient care and cost-sharing. Here we have provided a systematic overview of the evidence on diagnostic and rehabilitation protocols of dysphagia in the SCI population. EVIDENCE ACQUISITION:The literature was searched in six electronic databases up to April 30th, 2024. Screening the 521 retrieved articles for inclusion criteria resulted in the selection of 43 studies that reported assessment tools and rehabilitation protocols for dysphagia in patients with SCI. Two researchers extracted the data in parallel, and inter-rater reliability (IRR) was used to estimate inter-coder agreement and then κ statistic to measure accuracy and precision. Based on PRISMA concepts and quality assessment steps, a k coefficient of at least 0.9 was obtained in all data extraction steps. All reports were assessed for risk of bias using the NIH Quality Assessment Toolkit. The study protocol was registered on PROSPERO (CRD42023449137). EVIDENCE SYNTHESIS:Dysphagia assessment methods were collected and grouped into four different macro categories (clinical assessment, rating scale, self-reported questionnaire, and instrumental assessment). It was found that the Bedside Swallow Evaluation (BSE) for the clinical assessment category (50%), the Bazaz score (32.5%) for the rating scale category, the Eating Assessment Tool-10 (EAT-10) (44.4%) for the self-reported questionnaire category, and the Videofluoroscopic Study of Swallowing (VFSS) (48.9%) for the instrumental assessment category were the most representative tools. The rehabilitation protocols described included either an early oral feeding exclusion or a consistency-modified oral intake, postural adaptations, oxygen therapy with a high-flow nasal cannula combined with indirect/direct therapy, specific exercises, and neuromuscular electrical stimulation. CONCLUSIONS:Methods of diagnosis and rehabilitation protocols for dysphagia in SCI patients appear inconsistent. Further rigorous studies are needed to achieve better clinical handling in SCI settings while lowering the load of patient morbidity and related healthcare costs.

Standing compared to sitting enhances cognitive performance in healthy subjects. The effect of stance on cognitive performance has been addressed here in patients with Parkinson’s disease (PwPD). We hypothesized that a simple cognitive task would be less enhanced in PwPD by standing with respect to sitting, because of a larger cognitive effort for maintenance of standing posture than in healthy subjects. We recruited 40 subjects (20 PwPD and 20 age-matched healthy subjects, HE). Each participant performed an arithmetic task (backward counting aloud by 7) in two postural states, sitting and standing, with eyes open (EO) and with eyes closed (EC). All trials lasted 60 s and were randomized across subjects and conditions. The number of correct subtractions per trial was an index of counting efficiency and the ratio of correct subtractions to total subtractions was an index of accuracy. All conditions collapsed, the efficiency of the cognitive task was significantly lower in PwPD than HE, whilst accuracy was affected to a lower extent. Efficiency significantly improved from sitting to standing in HE under both visual conditions whilst only with EO in PwPD. Accuracy was not affected by posture or vision in either group. We suggest that standing, compared to sitting, increases arousal, thus improving the cognitive performance in HE. Conversely, in PwPD this improvement was present only with vision, possibly due to their greater balance impairment with EC consuming an excess of attentional resources. These findings have implications for balance control and the risk of falling in PwPD in the absence of visual cues.