BackgroundSpirituality is an essentially universal human experience and is incorporated into concepts of health and well-being in many cultures. The spiritual domain of quality of life, spared in the disability paradox, may be harnessed for recovery through internal adaptation and coping skills. This can help the individual attain his/her full potential while optimizing health-related quality of life. This narrative review explored the role of spirituality in neurorehabilitation.MethodsWe conducted a narrative review of relevant articles published between 2000 and 2024 using the following search terms: "spirituality", "spiritual care", "neurorehabilitation", "stroke rehabilitation", "brain injury rehabilitation", "spinal cord injury", "Parkinson's disease", "recovery", "neuroplasticity", "music therapy". Similar articles were harmonized to avoid redundancy.ResultsWe retrieved 9,200 articles. After the removal of non-relevant duplicates, 50 articles were reviewed. We observed that many cultures have recognized the experience of spirituality and its impact on health for centuries. Recent advances in neuroradiology have enabled us to map such experiences to specific brain pathways. Their activation is associated with increased neuronal activities that potentially lead to the strengthening of existing synapses, the formation of new synapses, and spatial re-orientation of neuronal networks, suggesting that spiritual activation may favorably contribute to neuroplasticity. There is emerging evidence that supports the benefits of spiritually-based interventions such as meditation, prayer, singing, dancing, yoga, and others for improvement in patients.ConclusionWhile observational data are strong, more randomized controlled trials (RCTs) are needed to establish the role of spiritual interventions and inclusion in neurorehabilitation guidelines towards achieving holistic restoration.

IntroductionStroke is a neurological alteration which significantly impacts patient's functional abilities and quality of life. Physiotherapy interventions, including therapeutic exercise, robotic therapy, electrotherapy and hydrotherapy, have demonstrated positive effects in addressing the sequelae that persist in the chronic phase.MethodsThis systematic review was registered in PROSPERO (CRD420251102428). Searches were conducted in Cochrane, PubMed, PEDro, Scopus, and Google Scholar. Randomized controlled trials of physiotherapy interventions in chronic stroke were included if they reported outcomes for functionality and quality of life. Methodological quality was assessed using the PEDro scale. 35 articles met the inclusion criteria, of which 18 focused on therapeutic exercise, 8 on robotic therapy, 8 on electrotherapy, and 1 on hydrotherapy, comprising a total of 2,412 patients.ResultsTherapeutic exercise is the most extensively studied intervention in chronic stroke, consistently demonstrating the most favorable outcomes in functionality. Robotic therapy was the second modality showing improvements in functionality, particularly in gait, balance and hand function. Electrotherapy, along with robotic therapy showed the greatest impact on quality of life outcomes. Evidence for hydrotherapy remains limited, with a single trial reporting improvements in balance. Overall, these results suggest that no single physiotherapy modality is superior across all domains, emphasizing the need for a multimodal and individualized approach in chronic stroke rehabilitation.ConclusionPhysiotherapy interventions in chronic stroke show clear benefits, with therapeutic exercise showing the greatest impact on functional recovery and electrotherapy and robotic therapy on quality of life.

PurposeTo assess the effectiveness of robot-assisted training (RAT) plus acupuncture therapy (AT) on lower limb functional recovery in stroke patients.MethodsThe study protocol was registered with INPLASY (INPLASY2024120107). We searched CNKI, Wanfang, VIP, CBM, PubMed, Embase, Web of Science, and Cochrane Library for RCTs comparing RAT plus AT versus conventional rehabilitation, RAT alone, or AT alone. The risk of bias was assessed using the Cochrane risk-of-bias tool 2.0.ResultsTwenty-one studies (n = 1821) were included. Meta-analyses showed RAT plus AT yielded superior improvements in FMA-LE (MD = 4.02, 95% CI [3.12, 4.93], I2 = 89%), FAC (MD = 0.66, 95% CI [0.43, 0.89], I2 = 86%), MBI (MD = 9.88, 95% CI [6.43, 13.33], I2 = 83%), and BBS (MD = 6.79, 95% CI [5.43, 8.16], I2 = 90%). Significant improvements were also observed in gait parameters: step length (MD = 7.42, 95% CI [6.48, 8.36], I2 = 12%), step speed (MD = 0.16, 95% CI [0.12, 0.21], I2 = 90%), and step width (MD = -2.22, 95% CI [3.96, -0.48], I2 = 90%). Sensitivity analyses verified the robustness of these findings.ConclusionRAT plus AT effectively ameliorates post-stroke lower limb dysfunction, demonstrating superior improvements in motor function, gait parameters, and daily living activities compared to monotherapies.

PurposeThis study aimed to investigate the safety, feasibility, and effect on hemiparetic muscle activity during sit-to-stand exercises using the lumbar type HAL in patients with acute-phase lower limb hemiparesis caused by ischemic stroke, cerebral hemorrhage, or postoperative brain tumor.MethodsThis randomized crossover study included twelve participants (ischemic stroke: 6, cerebral hemorrhage: 2, brain tumor: 4) for part 1, which assessed safety and comfort of sit-to-stand exercise using HAL, and ten participants (ischemic stroke: 4, cerebral hemorrhage: 3, brain tumor: 3) for part 2, which investigated the effect of HAL on muscle activities during sit-to-stand exercises. Participants performed either five sets (part 1) or a single set (part 2) of ten repetitions of sit-to-stand exercises under two conditions: with and without HAL assistance. Outcome included vital signs (blood pressure, heart rate, and percutaneous oxygen saturation), fatigue level in part 1. Muscle activity of bilateral gluteus maximus, biceps femoris, and vastus lateralis during the exercises were assessed in part 2. Outcomes were compared between the two conditions.ResultsThe results demonstrated that there were no significant changes in vital signs and fatigue between two conditions. Furthermore, HAL effectively increased muscle activity (μV) in the hemiparetic side vastus lateralis during the exercises (median, quartile range: 101.1, 55.8-125.9 vs. 79.9, 52.0-103.3, p = 0.03).ConclusionsThese findings suggest that the lumbar type HAL can be safely and feasibly used in patients with acute brain injury-related lower limb paresis, with potential effects on hemiparetic muscle activation. However, these results should be interpreted cautiously as exploratory observations.Registry informationClinical utility of cybernic system for patients with neurological diseases causing who need comprehensive nursing care (Clinical utility of cybernic system for patients with neurological diseases causing who need comprehensive nursing care (CUCSPND)), https://jrct.niph.go.jp/en-latest-detail/jRCTs052180074, jRCTs052180074.The effect of motor therapy using robot suit HAL for the patients with damaged brain (motor therapy using robot suit HAL), https://jrct.niph.go.jp/en-latestdetail/jRCTs052180223, jRCTs052180223.

Background: Upper extremity motor impairment is common after stroke. The Hybrid Assistive Limb single-joint type (HAL-SJ), an exoskeletal robot with biosensors, assists voluntary movement by detecting biopotential signals. While there are reports of positive effects, optimal strategies and patient selection criteria remain unclear. Objective: To map the evidence on HAL-SJ use for upper extremity recovery after stroke. Methods: A scoping review was conducted using five databases (search date: September 20, 2025). The studies included stroke patients treated with HAL-SJ and reported motor function outcomes. Reviews, abstracts, and commentaries were excluded. Results: Eight studies met the inclusion criteria. HAL-SJ improved upper limb motor function across recovery phases, with several studies reporting clinically meaningful improvements assessed by measures such as the Fugl-Meyer Assessment and Action Research Arm Test. Effective strategies included combining HAL-SJ with therapies such as botulinum toxin A and occupational therapy, and high-frequency training. Patients with moderate impairment benefited most; early intervention showed potential in severe cases. Conclusion: HAL-SJ shows potential as a rehabilitation tool for stroke-related upper extremity motor impairment. However, all included studies were conducted in Japan, which may limit the generalizability of these findings. Large-scale, multicenter studies are needed to establish optimal intervention protocols.

IntroductionSpeaking valves (SVs) restore phonation and may support airway protection in people with a tracheostomy, yet tolerance varies widely in neurological rehabilitation. We aimed to identify clinical factors associated with SV use and duration in a neurological rehabilitation setting.MethodsWe retrospectively analyzed 117 adults with neurological conditions and tracheostomy admitted to a rehabilitation center. Two internally validated multivariable models were developed: logistic regression for SV use (yes/no) and a quasi-Poisson regression for target daytime SV duration (hours/day), using routinely available bedside clinical variables.ResultsOf 117 patients, 64 (54.7%) used an SV during hospitalization. In the multivariable logistic model, higher level of consciousness (eMCS vs VS/MCS; OR 6.26, 95% CI 1.53-23.14), a positive blue dye test (OR 0.05, 95% CI 0.01-0.30), and endotracheal suction requirement (vs spontaneous cough; OR 0.07, 95% CI 0.003-0.879) were independently associated with SV use. Model performance was strong (AUC 0.856; accuracy 79.5%). Among SV users, longer daytime duration for SV use was associated with younger age, greater inspiratory and expiratory muscle strength, higher consciousness level, mild dysphagia, spontaneous cough, and neuromuscular or spinal cord injury diagnoses. In contrast, moderate-to-abundant secretions were associated with fewer hours.ConclusionIn a single-center neurological rehabilitation cohort, SV adoption and sustained tolerance were associated with bedside indicators of neurological responsiveness, secretion management, swallowing safety, and respiratory muscle strength. Findings should be interpreted as predictive associations and warrant external validation in contemporary multicenter cohorts.

BackgroundHemiplegia resulting from a stroke frequently causes considerable difficulties in hand function. Virtual reality (VR) therapy has evolved as an innovative and engaging method to facilitate sensorimotor rehabilitation.ObjectiveThis meta-analysis assessed the efficacy of VR-based therapies on hand function in post-stroke hemiplegic patients. The study evaluated the impact of treatment duration, type of VR (immersive, semi-immersive, non-immersive), and stroke stage (subacute versus chronic) on outcomes.MethodsA comprehensive search of six databases until September 2024 identified randomized controlled trials (RCTs) that compared VR therapy with conventional rehabilitation or sham control. The primary outcomes consisted of validated, hand-specific performance metrics, including the Fugl-Meyer upper extremity subscale, Action Research Arm Test, Box and Block Test, Jebsen-Taylor Hand Function Test and Box and Block Test.ResultsTwenty-five RCTs involving 844 participants were evaluated. VR therapy significantly enhanced hand function (SMD = 0.68; 95% CI: 0.41-0.95; p < 0.00001), while there was considerable heterogeneity (I2 = 71%). Subgroup analysis indicated that semi-immersive VR had the most significant benefit (SMD = 1.03), whereas interventions with a cumulative training duration beyond 12 h, along with those administered to subacute patients, demonstrated greater effect size in hand function relative to shorter interventions (pooled SMD for >12 h = 0.94; 95% CI: 0.66-1.23).ConclusionThis meta-analysis suggests that semi-immersive VR therapy improves hand function in post-stroke patients, especially when the total cumulative treatment duration exceeds 12 h. Future research should determine the principal treatment elements, establish uniform dosing methods, and evaluate long-term results, including activities of daily living and quality of life.

BackgroundEmotional consequences are a major area of interest in the field of acquired brain injury (ABI), yet less studied than the other consequences of ABI, despite particularly deleterious consequences on quality of life.Objectives and methodsThis study assessed the relevance of the French version of Difficulties in Emotion Regulation Scale-16 and developed a model of emotional dysregulation in ABI through four studies.ResultsStudy 1 confirmed the unidimensional structure and internal consistency (Cronbach's α = 0.95) of DERS-16 in non-clinical controls. Study 2 established a cutoff of 33.5 for pathological emotional dysregulation and found significantly higher DERS-16 scores in ABI participants compared to non-clinical controls but lower than in borderline personality disorder (BPD) participants (p < 0.001). Study 3 demonstrated consistency between clinical assessments and DERS-16 results, characterizing emotional dysregulation in ABI. Study 4 showed DERS-16 sensitivity to changes (mean DERS-16 difference of 1.21 [0.42; 2.00] per month, p = 0.003).ConclusionsDERS-16 is a valuable scale for screening and monitoring emotional dysregulation in ABI, highlighting the importance of addressing emotional difficulties in rehabilitation programs. The proposed model highlights organic, cognitive, psychological, environmental, vulnerability factors and general population factors contributing to emotional dysregulation in ABI.

IntroductionStroke is a leading cause of disability worldwide. This study uses Machine Learning models to investigate factors influencing modified Rankin Scale scores at discharge and three months post-discharge.MethodsData from 116 stroke patients were analyzed using four predictive models: Logistic Regression, Support Vector Machine, Random Forest, and Extreme Gradient Boosting (XGB). Shapley Additive Explanations (SHAP) were also employed to interpret factor significance.Results and discussionThe XGB model achieved an Area Under the Curve of 79% at discharge and 87% three months post-discharge. SHAP analysis revealed changing factor significance over time. The National Institutes of Health Stroke Scale was most critical at discharge, while post-discharge destination became more significant at three months. Age, time metrics, thrombolysis therapy, and management of long-term health issues also proved influential.ConclusionsFindings highlight the complex, evolving nature of stroke recovery. The shift in factor importance from clinical interventions to broader health management issues emphasizes the need for time-sensitive, multifaceted approaches to stroke care. This study contributes to understanding stroke recovery by identifying key influencing factors and demonstrating the value of SHAP for model interpretation. The insights gained have practical implications for rehabilitation practices. By identifying evolving predictors of recovery, the proposed framework may support early stratification of rehabilitation needs, assist clinicians in tailoring rehabilitation intensity and modality, and inform discharge destination decisions.

BackgroundPost-stroke depression is common yet frequently underdiagnosed, substantially hindering rehabilitation engagement and functional recovery. Understanding its impact from the clinician's perspective is critical to optimizing care.ObjectiveThis study aimed to explore how post-stroke depression affects patient autonomy and rehabilitation processes from the viewpoint of occupational, physical, and speech therapists.MethodsAn observational mixed-methods study was conducted via an online survey of 111 neurorehabilitation therapists. Quantitative data were analyzed descriptively; qualitative responses from open-ended questions underwent thematic analysis.ResultsTherapists reported that post-stroke depression profoundly influences rehabilitation through: (1) reduced patient motivation and collaboration; (2) the consequent need for adapted therapeutic strategies (e.g., modified goal-setting and relational approaches); (3) significant professional challenges in patient engagement; and (4) an increased emotional burden on therapists. Consequently, interventions are routinely modified, requiring more time, interdisciplinary coordination, and psychological support.ConclusionsThis study underscores that post-stroke depression necessitates a fundamentally adapted, team-based rehabilitation approach tailored to motivational deficits. The findings highlight the importance of early screening, therapist training in motivational and relational skills, and structured support for clinicians to improve both patient outcomes and therapist well-being.