Shoulder pain is a frequent complication after stroke, often associated with reduced arm function, decreased independence, and poorer quality of life. This study aimed to investigate the relationship between post-stroke shoulder pain, motor performance, functional outcomes, and spasticity to provide clinically relevant evidence for rehabilitation. We conducted an observational study including individuals who had experienced a stroke and were undergoing neurorehabilitation. Pain severity and its interference with daily activities were measured through structured clinical evaluation. Motor outcomes were assessed with standardized functional and strength tests, and spasticity was measured using a validated clinical scale. Sociodemographic and clinical variables, including time since stroke and stroke type, were also collected. The mean pain severity score was 4.82 (standard deviation 1.72). Pain severity correlated strongly with pain interference, although neither was significantly associated with motor or functional performance. Motor and functional variables were interrelated: motor recovery scores correlated positively with functional independence and grip strength, and negatively with spasticity. Time since stroke influenced outcomes, with poorer motor and functional results in participants more than two years post-event. Stroke type influenced pain, with greater interference reported in patients with ischemic stroke. No significant differences were observed between sexes. These findings highlight the multifactorial nature of shoulder pain after stroke and emphasize the importance of early and individualized rehabilitation strategies. Addressing pain, spasticity, and functional limitations together may improve long-term outcomes and quality of life for individuals living with the consequences of stroke.

We aimed to explore views of people with stroke regarding aerobic exercise participation during rehabilitation. Qualitative descriptive study informed by a pragmatic worldview. People with stroke attended online or in-person one-on-one semi-structured interviews focused on their general attitudes about aerobic exercise, and their capability, motivation and opportunities to exercise that have or have not been provided during rehabilitation after stroke. Codebook thematic analysis was performed by two independent coders. Thirteen people, 2 to 10 months post-stroke participated in the interviews. Six themes were identified: 1) having an exercise program routine and trusting the physiotherapist during rehabilitation facilitated doing exercise; 2) emotions can make exercise during rehabilitation more or less difficult; 3) limited physical ability post stroke leads to poor exercise self-efficacy and sense of control; 4) knowledge of what exercise is and its benefits affects perseverance in exercising during rehabilitation; 5) personal identity affects perseverance in doing exercises during rehabilitation; and 6) environmental factors facilitate exercise performance (consisting of 2 sub-themes of supportive social environment promotes exercise participation, and more resources (e.g., time, space, staff, other programs) facilitate exercising during and after rehabilitation). People with stroke are more likely to participate in exercises if they are incorporated into their treatment plan. This novel finding could help ensure stroke rehabilitation clinicians prescribe structured exercises within stroke rehabilitation programs.

Clinical Research Information Service Identifier: KCT0008968.

Pain is a prevalent and complex symptom in neurorehabilitation, with differentiation between neuropathic pain (NP) and musculoskeletal pain (MSK) often proving challenging. This study evaluates the effectiveness of the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) and Douleur Neuropathique en 4 Questions (DN4) tools in distinguishing NP from MSK pain, aiming to guide appropriate analgesic selection in a rehabilitation setting. Seventy inpatients undergoing active rehabilitation (32 males, 38 females) aged 18-91 years (mean: 67 years) were assessed using LANSS and DN4 scores over a 2-week period. Prescribed analgesia was recorded and correlated with pain classification based on these scores. The results showed that stroke patients exhibited a higher prevalence of NP, reflected in elevated LANSS and DN4 scores. Spinal cord injury (SCI) patients had the highest total scores, often necessitating dual therapy with pregabalin and amitriptyline. Conversely, patients with fractures had the lowest scores, suggesting predominantly MSK pain, with minimal neuropathic features. Pregabalin was prescribed to 29% of stroke patients but only 6% of fracture patients. In conclusion, LANSS and DN4 effectively identified NP, with DN4 proving easier to interpret. Findings underscore the need for targeted analgesic strategies in neurorehabilitation particularly that of NP in stroke and SCI patients. This is still under-researched in literature, compared to conditions like diabetic neuropathy, and future studies are needed to explore tailored pain management protocols in rehabilitation patients.

Parkinson's disease (PD) is a neurodegenerative disorder characterized by neuroinflammation and motor dysfunction. Current treatments primarily provide symptomatic relief. Microcurrent (MC) stimulation has recently emerged as a promising noninvasive technique for Alzheimer's disease; however, its therapeutic potential in PD remains underexplored. This study investigated the effects of MC therapy in a 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced mouse model of PD. Female C57BL/6 mice were divided into 3 groups: control, MPTP treated, and MPTP plus MC treated. A step-form waveform (5 V, 7 Hz base frequency with 44 kHz superposition) was applied for 4 weeks. Motor function was evaluated using rotarod and open field tests, and neuropathological changes were assessed by analyzing tyrosine hydroxylase, poly (ADP-ribose) polymerase (PARP), Toll-like receptor (TLR) proteins, caspase-3, and immunohistochemistry. MC therapy significantly improved motor activity in MPTP-treated mice, with increased latency to fall compared to the MPTP-only group. In the substantia nigra, the MC-treated mice had reduced tyrosine hydroxylase neuronal degradation and α-synuclein accumulation. Western blot analysis further revealed that the MC-treated mice had attenuated neuroinflammation by downregulating the TLR4 pathway and reducing PARP and cleaved caspase-3 expression. These findings suggest that MCs preserve dopaminergic neurons by suppressing neuroinflammation in a mouse model of PD, highlighting their potential as a therapeutic modality for PD.

Apraxia of speech (AOS) is a motor speech disorder that occurs despite the absence of paralysis, weakness, or incoordination of the speech muscles and is characterized by difficulty in planning, programming, and sequencing speech movements. Currently, the Korean language lacks sufficient measures for evaluating AOS, whereas the Apraxia of Speech Rating Scale (ASRS) has been widely used internationally to assess the presence and severity of AOS. This study aimed to translate the Apraxia of Speech Rating Scale into Korean (K-ASRS) and verify its reliability and validity. The translation process comprised four stages: forward and backward translation, expert committee review, and author approval. Thirty native Korean speakers aged 18 years or older with post-stroke aphasia participated. Three speech-language pathologists conducted two assessments over 1 month, and intra- and inter-rater reliability were evaluated using internal consistency and intraclass correlation coefficients. Among the 30 participants, six were diagnosed with AOS. The K-ASRS effectively distinguished the presence of AOS, showing strong internal validity and excellent inter-rater reliability overall, although items five, six, and eight demonstrated only fair agreement. The K-ASRS demonstrated good-to-excellent validity and reliability in patients with post-stroke aphasia and showed high clinical utility because of its short administration time and applicability to both in-person and video assessments.

Reversible splenial lesion syndrome (RESLES) is a transient neuroimaging finding associated with various etiologies. Although RESLES has been reported in diverse conditions, including medications, metabolic disorders, and infections, its occurrence in autoimmune encephalitis, such as anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, is rarely described. This report details a rare case demonstrating this association. A 24-year-old woman presented with a 4-month history of progressive behavioral changes, which culminated in paranoid delusions and catatonic symptoms. The initial diagnosis was delusional disorder, but her condition rapidly worsened with fever. A brain magnetic resonance imaging (MRI) revealed a reversible lesion in the splenium of the corpus callosum (SCC). Laboratory tests confirmed the presence of anti-NMDAR antibodies in her cerebrospinal fluid, and an abdominal computed tomography scan revealed bilateral ovarian teratomas. She was treated with high-dose corticosteroids and intravenous immunoglobulin, followed by surgical removal of the teratomas. Rituximab was later administered for long-term immunomodulation. The patient's clinical state, including her psychiatric and neurocognitive symptoms, gradually improved significantly. A follow-up MRI 2 months after discharge confirmed complete resolution of the SCC lesion. This case highlights that RESLES can be the initial neuroimaging manifestation of anti-NMDAR encephalitis. It underscores the critical importance of considering autoimmune causes of acute-onset psychiatric symptoms and atypical neuroimaging findings. Early and appropriate diagnosis and treatment of the underlying autoimmune etiology are essential for favorable neurological and psychiatric outcomes.

This clinical practice guideline (CPG) is the second part of the fourth edition of the Korean Stroke Rehabilitation Guidelines, following the first part published in 2023. While, the first part addressed rehabilitation for motor function, while this second part focuses on both motor and sensory rehabilitation. Beginning with the fourth edition, significant methodological advancements have been introduced, transitioning from a consensus-based approach to an evidence-based framework using the Grading of Recommendations Assessment, Development, and Evaluation methodology. The target population encompasses adult stroke patients, both male and female, with ischemic and hemorrhagic stroke types included, while pediatric stroke cases are excluded from consideration. This guideline is primarily intended for physiatrists and specialized therapists who provide rehabilitation services to patients with stroke-related motor impairments and activities of daily living limitations across primary, secondary, and tertiary healthcare facilities. The development team consisted of eighteen stroke rehabilitation specialists and one expert in CPG development methodology. Key questions were formulated based on target population preferences and international stroke rehabilitation guidelines, with subsequent refinement by specialists responsible for each respective topic. Draft recommendations underwent a formal consensus process using the RAND-UCLA Appropriateness Method, followed by further refinement through public hearings and external expert evaluation.

This review presents a clinical framework for motor rehabilitation in patients with Parkinson’s disease and atypical parkinsonian syndromes. Its purpose is to provide practical, individualized rehabilitation strategies that consider both disease stage and the clinical characteristics of each syndrome. Motor symptoms such as bradykinesia, rigidity, postural instability, and gait disturbance are major contributors to disability and reduced independence in these populations. Although pharmacological treatment remains fundamental, rehabilitation is crucial for maintaining mobility and preventing falls. This review discusses stage-based approaches, including early education in self-management and compensatory movement strategies, as well as advanced interventions for patients with severe motor dysfunction. Syndrome-specific features are also addressed. For example, patients with progressive supranuclear palsy often exhibit early axial rigidity and postural extension, while those with multiple system atrophy may experience cerebellar ataxia or autonomic dysfunction. In corticobasal degeneration, motor planning deficits and sensory loss may resemble symptoms seen in cortical stroke. Additionally, the review emphasizes the importance of recognizing and managing dystonia, which can further impair motor function and safety. While the primary focus is on motor symptoms, the influence of non-motor features such as cognitive impairment and autonomic instability is also acknowledged in rehabilitation planning. Overall, this review aims to support clinical decision-making through a structured, patient-centered approach to motor rehabilitation in parkinsonism.

Repetitive transcranial magnetic stimulation (rTMS), a non-invasive neuromodulation technique, has emerged as a potential adjunct to conventional rehabilitation though findings remain inconsistent. This study investigated the efficacy of rTMS combined with conventional rehabilitation in improving motor function and spasticity after stroke through a systematic review and meta-analysis. MEDLINE, Embase, and the Cochrane Library were comprehensively searched through February 2022. Sixty-eight randomized controlled trials were included based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias and certainty of evidence were assessed using the Cochrane tool and Grading of Recommendations Assessment, Development and Evaluation methodology. rTMS significantly improved upper limb motor outcomes including Fugl-Meyer assessment scores (mean difference [MD], 3.04; 95% confidence interval [CI], 1.16 to 4.92; p = 0.002), hand function (standardized MD, 0.28; 95% CI, 0.04 to 0.52; p = 0.02), and grip strength (MD, 3.61; 95% CI, 1.20 to 6.03; p = 0.003), with low-certainty evidence. It also significantly reduced upper limb spasticity (MD, −0.48; 95% CI, −0.64 to −0.33; p < 0.00001), with low-certainty evidence. No significant effects were observed for lower limb motor outcomes, and evidence for lower limb spasticity was insufficient. These findings suggest that rTMS may be considered as an adjunct to to enhance upper limb motor function and reduce spasticity in stroke rehabilitation. However, its use for lower limb recovery should be individualized based on neurological status. Further studies are needed to establish optimal protocols and long-term effects.