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

Depressive symptoms show an increased prevalence in individuals affected by spinal cord injury (SCI), yet their in-depth characterization and association with clinical outcomes remain underexplored. We investigated depressive symptoms, operationalized through the items in the Beck Depression Inventory (BDI), in a longitudinal, observational study of 165 individuals with SCI, and explored their trajectories and association with neurological and functional recovery. 134 and 43 individuals with major depressive disorder (MDD) diagnosis from two reference cohorts were investigated to evaluate similarities and differences of the clinical manifestation of depression. At baseline (one month after injury), 25% of individuals with SCI showed a clinically relevant degree of overall depressive symptoms, and 21% at follow-up (six or twelve months after injury). Predominant depressive symptoms involved physical-somatic phenomena such as sleep disturbances, fatigue, changes in eating habits, and reduced libido. In contrast, individuals with MDD diagnosis exhibited a broader range of symptoms, particularly those related to self-rejection and self-blame. A development of a clinically relevant degree of overall depressive symptoms from the baseline to the follow-up stage in individuals with SCI was primarily reflected in increases in BDI scores for items related to self-hatred, anhedonia, emotional overload, or cognitive stress. A random forest (RF) model using psychiatric, SCI-specific, and demographic baseline features to predict the presence of a clinically relevant degree of overall depressive symptoms at follow-up demonstrated only mediocre predictive performance. In contrast, similar RF models exhibited good performances in predicting neurological and functional recovery following SCI, relying primarily on SCI-specific (rather than psychiatric) baseline features. Depressive symptoms in individuals with SCI appeared to be largely unrelated to neurological and functional recovery and were primarily related to physical-somatic phenomena. This distinguishes them from the broader range of symptoms observed in individuals with MDD diagnosis, which more commonly encompass self-blame, self-hatred, and other cognitive-emotional dimensions. To help reduce the risk of undetected development of a clinically relevant degree of overall depressive symptoms during SCI treatment, it may be useful to focus particularly on cognitive-emotional symptoms, alongside physical-somatic symptoms, which may be affected by the direct consequences of the injury itself.

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.

Whiplash-associated disorders (WAD) include a range of physical and psychological symptoms, profoundly impacting individuals' quality of life. The effectiveness of psychological interventions in WAD management is still uncertain. Thus, the aim of this study is to investigate the effectiveness of psychological interventions on clinical outcomes (e.g., pain, disability, psychological distress) among individuals with WAD. Are psychological interventions effective in improving clinical outcomes (e.g., pain, disability, psychological distress) among individuals with WAD? Three databases were comprehensively searched for randomized controlled trials (RCTs) that investigated the effects of psychological interventions on pain, disability, depression, stress, anxiety, or fear of movement in patients with WAD compared with control groups receiving usual care or no intervention. Meta-analyses were performed by calculating the weight mean difference (WMD), 95

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/Objectives Multiple sclerosis (MS) causes various impairments, affecting physical, psychological, and cognitive functions. While stress is common in patients with MS (PwMS), its impact on balance and gait speed has not yet been explored. This study aimed to examine the impact of stress on balance and gait speed in PwMS while also assessing its prevalence in this population. Methods A total of 125 individuals diagnosed with MS based on the 2017 McDonald criteria participated. Outcome measures included a socio-demographic questionnaire, the Patient Determined Disease Step (PDDS) to assess disability level, the Perceived Stress Scale (PSS) to measure stress levels, the Modified Fatigue Impact Scale (MFIS) for fatigue assessment, the Montreal Cognitive Assessment (MoCA) and Symbol Digit Modalities Test (SDMT) for cognitive function, the Berg Balance Scale (BBS) for balance, and the 10-Meter Walking Test (10-MWT) for gait speed evaluation. Results A significant negative correlation was found between stress and balance (r = -0.373, p = 0.0001), and a significant positive correlation was observed between stress and time taken to complete the 10-MWT (r = 0.216, p = 0.01). However, after controlling for confounders (age, BMI, PDDS, disease duration, and disease onset), these correlations were no longer significant. Conclusion The findings suggest a high prevalence of stress in PwMS, with potential effects on balance and gait speed. Stress management interventions may play a crucial role in enhancing mobility and stability in PwMS. Further research is warranted to investigate additional factors influencing this relationship.

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.

BackgroundSevere acquired brain injury (sABI) is a major cause of mortality and long-term disability. Although its prevalence is increasing among older adults (≥65 years), evidence on independent determinant of rehabilitation outcomes in this population remains limited. This study aimed to identify early factors associated with poor functional outcomes and mortality in younger and older patients undergoing intensive inpatient rehabilitation following severe acquired brain injury (sABI).MethodsIn this single-center, retrospective cohort study, 215 patients (91 aged ≥65; 124 aged <65) admitted to a tertiary neurorehabilitation unit were enrolled. Demographic characteristics, sABI etiology, comorbidities, dysphagia, and multidrug-resistant organism (MDRO) colonization at admission, as well as the occurrence of sepsis, hospital-acquired pneumonia (HAP), and in-hospital mortality, were evaluated. Multivariable linear regression models were used to identify factors independently associated with poorer outcomes in terms of Glasgow Coma Scale (GCS), Functional Independence Measure (FIM), and Glasgow Outcome Scale–Extended (GOS-E) scores recorded at discharge from the unit.ResultsAmong older patients, dysphagia (FIM p < 0.0001; GOS-E p = 0.022) and diabetes mellitus (FIM p = 0.006) were associated with poorer functional outcomes after sABI. In addition, MDRO colonization at admission (p = 0.016) and sepsis (p = 0.019) were associated with worse neurological status at discharge. In younger patients, dysphagia (FIM p < 0.0001; GOS-E p = 0.002) and MDRO colonization (FIM p = 0.007) were associated with poorer functional outcomes, whereas MDRO colonization at admission (p = 0.014) and HAP (p = 0.016) were associated with worse neurological status at discharge. Despite comparable functional outcomes at discharge, older patients had significantly longer LOS (p = 0.049) and higher in-hospital mortality (34 vs. 12, p < 0.0001). HAP was the factor most strongly associated with mortality in the overall cohort.ConclusionsDysphagia and pre-existing comorbidities, particularly diabetes mellitus, were associated with poorer rehabilitation outcomes in older patients with sABI. The association of MDRO colonization, HAP, and sepsis with poor outcomes across both age groups underscores the importance of early identification of high-risk patients and targeted preventive strategies to reduce modifiable complications, length of stay, and mortality during intensive rehabilitation after sABI.

Background and Objectives Spinal cord injury (SCI) incidence is rising among the elderly, yet the relationship between age and recovery remains controversial. The aim of this study was to evaluate the relationship between age and neurologic and functional outcomes and to identify an age cutoff associated with a decline in recovery. Methods We conducted a prospective cohort study using data from patients with traumatic and ischemic SCI enrolled in the European Multicenter Study about Spinal Cord Injury between 2001 and 2022. Linear regression models assessed the relationship between age and changes from baseline to 1 year after SCI in the total motor score (TMS) of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and in the Spinal Cord Independence Measure (SCIM) total score. Additional analyses examined the relationship between age and the evolution of ISNCSCI light-touch and pinprick scores, as well as ambulation parameters (6-minute walking test, 10-meter walking test, and Walking Index for Spinal Cord Injury). Models were adjusted for baseline scores, sex, year of injury, American Spinal Injury Association Impairment Scale (AIS) grade, and level of injury. The age cutoff was determined using a change-point model. Results A total of 2,171 patients (median age 47 years, 77.9% male, 51.9% injured at the cervical level, and 50.0% with a motor complete injury [AIS-A and AIS-B]) were included in the analysis. Increased age was not associated with changes in TMS (p = 0.896) but was significantly associated with reduced SCIM improvement (p < 0.001), with an estimated decline of 4.3 SCIM points per decade of age. Sensory outcomes were not significantly affected by age (Delta light-touch: p = 0.273; Delta pinprick: p = 0.520) while ambulation recovery declined with increasing age (all outcomes p < 0.01). A noticeable reduction in functional recovery was observed in patients older than 70 years. Discussion Older age does not seem to affect neurologic recovery but is linked to poorer functional and ambulation outcomes. These findings, including the identified age cutoff, should inform future clinical trial design and guide tailored care strategies for older adults with SCI.

Parkinson's disease (PD) and multiple sclerosis (MS) are two chronic neurological diseases (CNDs) that have a high demand for early and continuous rehabilitation. However, accessing professional care remains a challenge, making it a key priority to identify sustainable solutions for ensuring early rehabilitation availability. Objective: The FIT4TeleNEURO pragmatic trial proposes to investigate, in real-life care settings, the superiority in terms of the effectiveness of early rehabilitation intervention with harmonized, mix-model telerehabilitation (TR) protocols (TR single approach, task-oriented-TRsA; TR combined approach, task-oriented and impairment-oriented-TRcA) compared to conventional management (control treatment, CeT) in people with PD and MS. Design, and Methods: This multicenter, randomized, three-treatment arm pragmatic trial will involve 300 patients with CNDs (PD, N = 150; MS, N = 150). Each participant will be randomized (1:1:1) to the experimental groups (20 sessions of TRsA or TRcA according to a mix-model-3 asynchronous + 1 synchronous session/week) or the control group (20 sessions of CeT). Primary and secondary outcome measures will be obtained at the baseline (T0), post-intervention (T1, 5 weeks after baseline), and follow-up (T2, 3 months after the end of the treatment). A multidimensional evaluation (cognitive, motor, and quality of life domains) will be conducted at each time point of assessment (T0; T1; T2). The primary outcome measures will be the assessment of change (T0 vs. T1 vs. T2) in static and dynamic balance, measured using the Mini-Balance Evaluation Systems Test. Usability and acceptability assessment will be also investigated. Expected Results: Implementing TR protocols will enable a more targeted and efficient response to the growing demand for rehabilitation in the early stages of CNDs. Both the TRsA and TRcA approaches are expected to be more effective than CeT, with the combined approach likely providing greater benefits in secondary outcome measures. Finally, the acceptability of the asynchronous modality could open the door to scalable solutions, such as digital therapeutics.

BACKGROUND AND OBJECTIVES:Spinal cord injury (SCI) incidence is rising among the elderly, yet the relationship between age and recovery remains controversial. The aim of this study was to evaluate the relationship between age and neurologic and functional outcomes and to identify an age cutoff associated with a decline in recovery. METHODS:We conducted a prospective cohort study using data from patients with traumatic and ischemic SCI enrolled in the European Multicenter Study about Spinal Cord Injury between 2001 and 2022. Linear regression models assessed the relationship between age and changes from baseline to 1 year after SCI in the total motor score (TMS) of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and in the Spinal Cord Independence Measure (SCIM) total score. Additional analyses examined the relationship between age and the evolution of ISNCSCI light-touch and pinprick scores, as well as ambulation parameters (6-minute walking test, 10-meter walking test, and Walking Index for Spinal Cord Injury). Models were adjusted for baseline scores, sex, year of injury, American Spinal Injury Association Impairment Scale (AIS) grade, and level of injury. The age cutoff was determined using a change-point model. RESULTS:A total of 2,171 patients (median age 47 years, 77.9% male, 51.9% injured at the cervical level, and 50.0% with a motor complete injury [AIS-A and AIS-B]) were included in the analysis. Increased age was not associated with changes in TMS (p = 0.896) but was significantly associated with reduced SCIM improvement (p < 0.001), with an estimated decline of 4.3 SCIM points per decade of age. Sensory outcomes were not significantly affected by age (Δlight-touch: p = 0.273; Δpinprick: p = 0.520) while ambulation recovery declined with increasing age (all outcomes p < 0.01). A noticeable reduction in functional recovery was observed in patients older than 70 years. DISCUSSION:Older age does not seem to affect neurologic recovery but is linked to poorer functional and ambulation outcomes. These findings, including the identified age cutoff, should inform future clinical trial design and guide tailored care strategies for older adults with SCI. TRIAL REGISTRATION INFORMATION:ClinicalTrials.gov Identifier NCT01571531.

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.

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.

Neonatal brachial plexus palsy (NBPP) is a flaccid paralysis of the upper limbs that occurs in about 0.4 percent of live births. This condition can produce permanent disabilities; to date, there is no consensus on protocols to be applied for the rehabilitation of children with this condition. The aim of this article is to provide a concise overview of conservative treatment beyond traditional physical therapy for the management of the child with NBPP and to offer a number of useful options for creating the most comprehensive and functional rehabilitation treatment possible. We conducted a narrative review after analyzing articles from the past 50 years on PubMed, Cochrane Library, Scopus, and Web of Science with the following search string [(“neonatal brachial plexus palsy” OR “obstetric brachial plexus palsy” OR “birth brachial plexus palsy”) AND (“rehabilitation” OR “physiotherapy” OR “conservative treatment”)]. We identified a potential of 1275 articles, but only 11 were exclusively about conservative approaches. The most represented rehabilitation approaches in the literature were botulinum toxin, constraint-induced movement therapy (CIMT), virtual reality, neuromuscular electrical stimulation, and kinesiotaping. In conclusion, the various rehabilitation approaches for NBPP are promising, but none can be considered the best option when used alone. In light of the current evidence, a multimodal approach is needed.

Parkinson's Disease (PD) is a neurodegenerative disorder characterized by both motor and non-motor symptoms (NMS). Among NMS, constipation and pain are both highly prevalent and debilitating affecting up to 80% of PD patients and impairing their quality of life. Here, we investigated the relationship between constipation and pain in PD patients. This is a retrospective study assessing the relationship between pain and constipation in a PD patient population from a clinical database of patients attending the outpatient clinic of the movement disorders division, Neurology Unit of Policlinico Tor Vergata, in Rome. Subjects were assessed with the Unified Parkinson's Disease Rating Scale (UPDRS) part III, Hoehn and Yahr (H&Y) stage, King's Parkinson's Disease Pain Scale (KPPS), Brief Pain Inventory (BPI), Non-Motor Symptoms Scale (NMSS) and Beck Depression Inventory (BDI). Patients were further divided in two groups (Group 1, 32 patients with constipation and Group 2, 35 PD patients without constipation) ANOVA and ANCOVA analysis were used to compare the two groups. PD patients with constipation had significantly higher pain severity and pain interference, as measured by the BPI scale and higher total KPPS score, fluctuation-related pain, nocturnal pain, and radicular pain when compared to PD patients without constipation. This study highlights for the first time a possible interplay between constipation and pain in PD that deserves further investigations.

Spinal cord injury (SCI) produces damage to the somatic and autonomic pathways that regulate lower urinary tract, sexual, and bowel function, and increases the risk of autonomic dysreflexia. The recovery of these functions has a high impact on health, functioning, and quality of life and is set as the utmost priority by patients. The application of reliable models to predict lower urinary tract, sexual, and bowel function, and autonomic dysreflexia is important for guiding counseling, rehabilitation, and social reintegration. Moreover, a reliable prediction is essential for designing future clinical trials to optimize patients' allocation to different treatment groups. To date, reliable and simple algorithms are available to predict lower urinary tract and bowel outcomes after traumatic and ischemic SCI. Previous studies identified a few risk factors to develop autonomic dysreflexia, albeit a model for prediction still lacks. On the other hand, there is an urgent need for a model to predict the evolution of sexual function. The aim of this review is to examine the available knowledge and models for the prediction of lower urinary tract, sexual, and bowel function, and autonomic dysreflexia after SCI, and critically discuss the research priorities in these fields.

Objective: To investigate the psychometric properties of the validated Italian version of the Facial Disability Index (FDI), a patient-reported outcome measure widely used to assess individuals with peripheral facial palsy. Design: Methodological research on cross-sectional data from a convenience sample. Setting: Outpatient university rehabilitation clinic. Participants: A total of 168 (N=168) outpatients (66% female; mean age, 44 +/- 15 years) with peripheral facial palsy of diverse etiology (48% post-surgical, 31% Bell palsy, 8% posttraumatic, 3% congenital, 11% other medical conditions) and severity at the first visit. Interventions: Not applicable. Main Outcome Measures: The 2 FDI subscales, physical function (FDI-PHY) and social/well-being function (FDI-SWB), were separately analyzed using classical test theory methods and Rasch analysis. Results: Cronbach alpha was 0.79 in FDI-PHY and 0.74 in FDI-SWB, while item-rest correlation ranged from 0.36-0.67 in FDI-PHY and from 0.43-0.68 in FDI-SWB. In the FDI-PHY, we deleted 2 underused response categories, rescoring the remaining ones. In the FDI-SWB, some response categories did not function as expected by the Rasch model: their collapse into a 4-level format solved this problem. In each subscale, all items fitted the Rasch model except item 4 (eye tearing/becoming dry) in FDI-PHY that showed an unexpectedly high response variability. The person separation reliability of both subscales indicated that they are useful only for group-level judgments. In both subscales, principal component analysis of the residuals showed unidimensionality and absence of locally dependent items. No significant differential item functioning concerning sex, age, or time from paralysis emerged. Conclusions: Our study demonstrated overall positive psychometric characteristics of FDI except for the functioning of the response categories. We propose a refined version with 4 response categories only and related conversion graphs that may improve the interpretability, feasibility, and metric performance of this tool. (c) 2021 by the American Congress of Rehabilitation Medicine.