(1) Background: The continuous growth of rehabilitation literature makes evidence synthesis increasingly challenging. Lexical network analysis may provide quantitative information on the organization of scientific knowledge. This study aimed to characterize the shoulder rehabilitation literature through an International Classification of Functioning, Disability and Health (ICF)-oriented lexical network approach. (2) Methods: PubMed was searched for papers on shoulder rehabilitation published from 2016 to 2025. ICF-related lexical terms associated with the shoulder were selected from the official ICF framework, and their frequency inside the titles and abstracts of the found papers was calculated. A binary text-term matrix was generated and converted into a bipartite network. Graph-theoretical analysis, including feature reduction, was performed to identify representative topological descriptors and relationships. (3) Results: The analysis identified 6424 paper-word connections. SHOULDER, PAIN, and FUNCTION represented the principal lexical hubs of the network. Feature reduction enabled the characterization of the network by eigencentrality and neighborhood connectivity. Participation- and environment-related terms showed comparatively limited representation. PARTICIPATION showed the highest neighborhood connectivity. (4) Conclusions: The proposed ICF-oriented lexical network approach provides a quantitative framework for exploring the lexical organization of rehabilitation literature, providing complementary information to conventional literature reviews and supporting future evidence synthesis and research planning.

BACKGROUND:Greater trochanteric pain syndrome (GTPS) is associated with structural tendon alterations and functional impairment. Extracorporeal shockwave therapy (ESWT) is a common treatment, but objective monitoring of tendon remodeling and motor recovery remains limited. OBJECTIVE:This study aimed to integrate shear-wave elastography (SWE) expressed in m/s and wearable inertial measurement unit (IMU) as biosensing tools for the quantitative assessment of tendon elasticity, morphology, and hip motion after ESWT in GTPS. METHODS:In a prospective cohort of adults with chronic GTPS, shear wave elastography (SWE) quantified gluteus medius tendon (GMT) elasticity and thickness, while hip abduction range of motion (ROM) was measured using a triaxial inertial measurement unit. Clinical scores on the Visual Analogue Scale (VAS), Harris Hip Score (HHS), Low Extremity Functional Scale (LEFS), and Roles and Maudsley score (RM) were collected at baseline (T0) and at 6 months (T1). RESULTS:Thirty-five patients completed follow-up. Pain and function improved significantly (VAS, HHS, LEFS, RM; all p < 0.05). SWE values of the affected GMT increased, while tendon thickness decreased yet remained greater than on the contralateral side. Hip abduction ROM increased significantly from T0 to T1 (p < 0.05). Correlation analysis showed a negative association between abduction and pain at T1 (r = -0.424; p = 0.011) and, at baseline, between abduction and VAS (r = -0.428; p = 0.010) and RM (r = -0.346; p = 0.042), and a positive association with LEFS (r = 0.366; p = 0.031). SWE correlated negatively with VAS at T1 (r = -0.600; p < 0.05) and positively with HHS at T1 (r = 0.400; p < 0.05). CONCLUSIONS:Integrating elastography with inertial sensor-based motion analysis provides complementary, quantitative insights into tendon remodeling and functional recovery after ESWT in GTPS. These findings support combined imaging and wearable motion measures to monitor treatment response over time.

The integration of electromyography (EMG) and muscle ultrasound (US) is progressively redefining diagnostic and prognostic workflows in rehabilitation medicine. While EMG remains the reference standard for functional assessment of peripheral nerve and muscle disorders, ultrasound provides complementary structural and dynamic information, enabling real-time visualization of nerve morphology, muscle architecture, and secondary changes such as atrophy or fibrosis. A combined electrodiagnostic–imaging approach enhances diagnostic accuracy, shortens time to etiological definition, and supports targeted rehabilitation planning. EMG allows functional localization and grading of axonal loss or demyelination, whereas ultrasound can detect focal nerve swelling, structural discontinuity, entrapment sites, and early muscle changes before irreversible degeneration occurs. The integration of EMG and muscle US supports a pathophysiology-driven model of rehabilitation, facilitating individualized prognosis, monitoring of reinnervation, and adjustment of therapeutic strategies. The limited body of literature on specific nerve branches, particularly the deep fibular nerve, should stimulate further research aimed at standardizing combined protocols and defining diagnostic thresholds. A multimodal approach appears essential for precise, rapid diagnosis and for optimizing outcomes in patients with peripheral nerve injuries undergoing rehabilitation.

Chronic pain is increasingly recognized as a multidimensional condition sustained by interacting cognitive, behavioral, emotional, attentional, and metacognitive processes. Within this framework, physical exercise has gained relevance as a non-pharmacological intervention that may influence psychological mechanisms involved in pain persistence and disability. This narrative review provides an updated synthesis of recent evidence on the effects and mechanisms of physical exercise on cognitive, behavioral, emotional, and metacognitive dimensions of chronic pain. A structured literature search was conducted across PubMed/MEDLINE, Scopus and Web of Science, focusing on peer-reviewed studies published between January 2016 and December 2025. Evidence was synthesized narratively across mechanistic domains, integrating findings from rehabilitation science and clinical psychology. The literature suggests that exercise may act as an active experiential intervention capable of targeting several psychosocial factors in chronic pain. Across studies, exercise was associated with reductions in catastrophizing and maladaptive pain beliefs, improvements in pain self-efficacy, and attenuation of kinesiophobia. Exercise may also modulate attentional bias and hypervigilance, and psychologically informed exercise approaches appear particularly relevant for metacognitive processes, including reduced rumination, increased decentering, and improved non-reactive awareness of bodily sensations. In parallel, exercise shows beneficial effects on emotional aspects of chronic pain, likely mediated by both neurobiological and psychosocial mechanisms pathways. Overall, physical exercise should be conceptualized as a comprehensive intervention capable of acting on cognitive, behavioral, emotional, and metacognitive processes that sustain chronic pain. Future research should clarify modality-specific mechanisms, identify moderators of response and incorporate process-based outcomes to support personalized exercise prescriptions.

Brain-Computer Interfaces (BCIs) are increasingly used in neurorehabilitation, but the rapid expansion of scientific literature complicates the identification of clinically relevant studies. This study investigated whether expert-defined relevance within BCI rehabilitation literature emerges as a structural property of semantic networks through the integration of graph theory and Principal Component Analysis (PCA). A Lexical Network Analysis Based on Graph Theory (LENGTH) was applied to randomized controlled trials indexed in PubMed over the last decade using the query "brain computer interface" AND rehabilitation. Titles and abstracts were analyzed to construct a semantic network linking articles and lexical terms. Multiple graph-theoretical metrics were calculated and residualized against weighted degree to minimize document-size bias. PCA was subsequently applied to the residualized metrics. Forty-eight studies were included. The network showed a compact and highly interconnected structure, centered on motor and functional recovery concepts. PCA identified two principal components explaining of total variance. Relevant articles tended to occupy regions characterized by higher semantic integration and lower hierarchical influence. Although no clear categorical separation emerged, a consistent positional tendency was observed. These findings suggest that relevance may be represented as a topological property within a multidimensional semantic landscape, supporting the use of semantic-network approaches for literature screening and evidence synthesis.

The efficacy of botulinum neurotoxin (BoNT) is strongly dependent on its accurate delivery to hyperactive muscles and, ideally, to motor endplate regions. Although guidance techniques such as electromyography (EMG) and ultrasound (US) improve injection precision, each technique provides only partial information—either functional or anatomical. Integrating these techniques could enhance targeting accuracy, optimize dose distribution, and reduce off-target effects. A structured PubMed search was performed using terms related to BoNT, spasticity/dystonia, EMG, and US. Filters included clinical trials, randomized controlled trials, meta-analyses and reviews published within the last decade. Fifty-nine studies met the inclusion criteria. The publications were predominantly in neuroscience and rehabilitation journals. Only 17 studies reported combined EMG–US guidance. These focused mainly on stroke and cervical dystonia. While EMG-US integration is a promising strategy, we emphasize the added value of EMG guidance for US approaches, which is particularly important when treating complex neurological conditions involving complex, overlapping muscle activation patterns, or when targeting structures that are inaccessible to conventional imaging techniques. The EMG-US integrated approach is a promising strategy for optimizing BoNT therapy by combining structural visualization with real-time functional assessment. Despite its promising advantages in terms of accuracy and dose optimization, its clinical adoption is limited by a lack of high-quality evidence.

BACKGROUND Parkinson disease (PD) is a common neurodegenerative disease. Intensive rehabilitation programs improve motor and non-motor symptoms in people with PD. Quite recently, deep-brain stimulation (DBS) has become an established therapeutic tool for treating patients with a disease who have troublesome motor fluctuations and dyskinesias refractory to best medical therapy. CASE REPORT A 56-year-old man affected by PD with motor complications was admitted to undergo deep-brain stimulation. After the operation, he was transferred to the Intensive Rehabilitation Department and received multidrug therapy. First, we tried to optimize the pharmacological therapy. To achieve this goal, we performed a physiatric evaluation with the device turned off. We set up an Individual Rehabilitation Project with active kinesitherapy for maintaining the strength and muscular resistance of the shoulder and pelvic girdle, upper limbs, and lower limbs, exercises to improve trunk stability and balance reactions, exercises to improve motor coordination and static and dynamic balance, gait training with gait pattern, training for climbing and descending stairs, and functional re-education. For the headache, we requested a magnetic resonance imaging (MRI) of the brain, that showed the correct positioning of the electrodes bilaterally, with the identification of a moderate amount of air (pneumocephalus). At the same time, adjustment/switching on of the stimulator was carried out, which was well tolerated, adjusting the stimulation parameters of the sensors both on the right and left during hospitalization and gradually modifying the pharmacological therapy. CONCLUSIONS The combination of internal-geriatric expertise together with the collaboration between neurologist and physiatrist are fundamental for management of these patients. Intensive rehabilitation is ideal for these subjects before discharge and subsequent post-procedural follow-up.

Consensus was sought from 17 nominated global expert leaders to provide guidance on the combined use of neuromuscular ultrasound (NMUS) and electrodiagnostic tests (EDX) in the investigation of peripheral neuropathy (PN) in clinical practice. Consensus was based on an initial systematic review of the literature by the experts themselves, followed by three anonymised surveys, using the Delphi method. No consensus was defined as < 60 % rating frequency. The panel agreed that NMUS should be used if EDX cannot differentiate an axonal from a demyelinating process or an acquired from a hereditary process, and in the investigation of vasculitic neuropathy; NMUS of the brachial plexus should be used in Guillain-Barre' syndrome if EDX is negative; when NMUS is used, at least two nerves of the upper limbs should be scanned; NMUS should be used for screening or repeat testing for carpal tunnel syndrome in children with mucopolysaccharidoses. Areas of disagreement exposed gaps in current knowledge and informed the direction of future research, which should aim to identify situations in which NMUS can stand alone as a diagnostic test, particularly for screening or repeat testing and especially in vulnerable individuals and paediatric populations.

ObjectiveWe wanted to identify prevalent symptoms and patterns of long-COVID syndrome, assess the impact on health-related quality of life, and explore factors linked to lower quality of life, including vaccination status and symptom count, in a real-life cohort.DesignThis is an observational retrospective study.ResultsWe assessed 133 patients and 85 completed the evaluations. The most common symptoms reported were motor deficit (95.29%) and fatigue (94.12%), while respiratory symptoms, cognitive deficits, and weakness (76.47%) were less frequent. Many patients experienced multiple symptoms, with the majority reporting 5-8 symptoms simultaneously, most associated with fatigue. However, the number of symptoms did not correlate with health-related quality of life as measured by the 12-Item Short Form Survey questionnaire. Finally, vaccination status did not significantly affect 12-Item Short Form Survey scores or the number of reported symptoms.ConclusionsOur analysis highlighted the presence of diverse multisystemic symptoms in long-COVID patients. Many individuals experienced multiple associated symptoms, negatively affecting their overall quality of life. Neither vaccination status nor the number of symptoms appeared to influence reported quality of life. This emphasizes the need for a comprehensive, early, and multidisciplinary approach to address the syndrome's diverse symptoms.

Ultrasound-guided percutaneous interventions are well-established as effective treatments for shoulder calcific tendinopathy. In this work, we modified the conventional double-needle approach by incorporating a closed-circuit irrigation system and assessed the procedure’s clinical and radiological outcomes. We enrolled prospectively 24 patients (10 males; median age 54 years, IQR: 50–62) with painful calcific tendonitis of the shoulder between October 2023 and March 2024. All patients had a calcification > 5 mm treated with ultrasound-guided closed-circuit irrigation. Radiography, ultrasound evaluation, and OSS and SPADI clinical questionnaires were administered before the treatment and 3 months after. After the procedure, there was a significant reduction in the size of the calcifications (12 mm, IQR: 10–20 mm vs. 5.5 mm, IQR: 2–10 mm; p < 0.001). After the procedure, none of the patients experienced infections, while two developed bursitis. Three months after the procedure there were significant improvement in the OSS (16.5, IQR: 10–23 vs. 32, IQR: 36–45.5; p < 0.0001) and reduction in SPADI scores: pain (88, IQR: 74–95 before vs. 13, IQR: 4–24; p < 0.0001), disability (72, IQR: 60–90 before vs. 8, IQR: 4–20; p < 0.0001), and total score (78, IQR: 66–91 before vs. 11, IQR: 4–20; p < 0.0001). The closed-circuit double-needle irrigation for calcific tendinopathy of the shoulder is an effective treatment that improves both shoulder pain and function with a very low risk of short-term complications.

Ultrasound nerve cross-sectional area (CSA) of patients affected with axonal neuropathy usually shows normal value. Cerebellar ataxia, neuropathy and vestibular areflexia syndrome (CANVAS) seems to represent an exception, showing smaller CSA, but previous reports did not test for biallelic RFC1 gene repeat expansions. We compared nerve CSA from CANVAS patients (tested positive for biallelic RFC1 gene repeat expansions) with the CSA from a group of patients with chronic idiopathic axonal polyneuropathy (CIAP) who tested negative for RFC1 gene repeat expansions, hereditary axonal neuropathy (Charcot-Marie-Tooth type 2, CMT2), and Friedreich ataxia (FRDA). We enrolled 15 CANVAS patients (eight men, mean age 66.3 ± 11.5 years, mean disease duration 9.3 ± 4.1 years), affected with sensory axonal neuronopathy. Controls consisted of 13 CIAP (mean age 68.5 ± 12.8 years, seven men), seven CMT2 (mean age 47.9 ± 18.1 years, four men), 12 FRDA (mean age 33.7 ± 8.8, five men). Nerve ultrasound was performed at median, ulnar, sciatic, sural, and tibial nerves and brachial plexus, bilaterally. The nerve CSA from CANVAS patients was significantly smaller than the one from the other cohorts at several sites with significant and high accuracy at Receiver-operating characteristic (ROC) curve analyses. RFC1 AAGGG pentanucleotide expansion, disease duration, and disability did not correlate with CSA at any site, after Bonferroni correction. Decreased sonographic nerve sizes, in arms and legs, in patients with sensory neuropathy and normal motor conduction studies could point to CANVAS-spectrum disease and help guide appropriate genetic testing.

Megaprostheses are well-known, reliable, and effective reconstruction prostheses used in oncologic surgery for limb salvage in patients affected by primary or metastatic bone tumors. Rehabilitation plays a major role after MUTARS replacement, with the aim of improving function after surgery and maintaining the highest possible quality of life. Only a few studies have been published about the use of megaprostheses for the upper limb. The aim of this narrative review is to describe the results of functional and rehabilitative outcomes of patients affected by bone primary or metastatic bone cancer of the upper limb and surgically treated with MUTARS prostheses. A comprehensive search was conducted on PubMed and Scopus using the following MESH terms: “Mutars”, “Megaprosthesis”, “bone”, “tumors”, “metastasis”, “upper limb”, “rehabilitation”, “outcome”, “quality of life”, and 10 studies were included. The most frequent oncological pathology was found to be metastases of the proximal humerus treated with modular endoprosthesis or modular reverse implants. Outcome measures used were ROM, MSTS, ASES, DASH, Constant-Murley score, Enneking score, VAS, MEP, TESS, and WOSI. Reconstruction of the proximal humerus with the MUTARS system seemed to be a valid treatment option after bone tumor resection. Rehabilitation after MUTARS surgery is very relevant, but currently, functional and rehabilitative outcomes are inadequately represented in the literature. Hence, further studies are needed to define standardized rehabilitation protocols after oncological orthopedic surgery that can be applied routinely in clinical practice.

We read with high interest the study by Chan and colleagues about the muscle characteristics in scoliosis and their relationships with the curve features. The authors conducted a systematic review and found that the paraspinal muscles on the concavity presented different important alterations [1]. The results of this work are very important, especially for supporting the studies about rehabilitation in scoliosis. The application of quantitative measures, like the ones mentioned in the review, deserves a lot of attention because they allow precise calculations able to sustain valid reasonings.