Rehabilitation Treatment Research Articles

Development of a Physiotherapist-Coordinated Interdisciplinary Rehabilitation Intervention for People with Suspected Axial Spondyloarthritis: The SPINCODE Rehabilitation Intervention

Background: People with early axial spondyloarthritis experience a diagnostic delay and a similar disease burden as people with axial spondyloarthritis at a later stage of the disease. In many European countries, patients with early axial spondyloarthritis do not have access to an interdisciplinary rehabilitation team. The objective of this study was to develop a new evidence-based physiotherapist-coordinated interdisciplinary rehabilitation intervention for individuals suspected of axial spondyloarthritis. This development of the rehabilitation intervention is part of the SPINCODE project which focusses on early diagnosis and treatment for people with axial spondyloarthritis. Methods: The development of the intervention encompasses: (i) identifying the evidence base and program theories; (ii) modeling and remodeling the intervention; and (iii) describing the developed intervention. Results: The six-month SPINCODE rehabilitation intervention is a physiotherapist-coordinated, interdisciplinary, outpatient rehabilitation intervention at a specialized rheumatology hospital. The intervention consists of: (i) individual physiotherapist-coordinated consultations with assessment, goal setting, tailored physical activity support, and the defined goals, and coordination across the interdisciplinary team at the hospital and across primary and secondary healthcare levels; (ii) group sessions, encompassing patient education and peer support; and (iii) optional individual support from the interdisciplinary team. Physiotherapists from private care working with the patient enrolled in the SPINCODE study are offered digital support from the hospital-based physiotherapists. Conclusions: The developed physiotherapist-led interdisciplinary SPINCODE rehabilitation intervention is ready for feasibility testing.

Biopsychosocial rehabilitation therapy in small fiber neuropathy: research protocol to study the effect of rehabilitation treatment

BackgroundSmall fiber neuropathy (SFN) is a chronic neuropathic pain condition that can lead to a decreased quality of life (QOL) and disability. Current pain treatment is mainly symptomatic, consisting of analgesics, with often disappointing results. There is a need for new, more effective treatment modality. Treatment based on a biopsychosocial approach on SFN-related pain may be a promising alternative. A rehabilitation treatment study protocol is presented with the following main objective: to test the effect of a tailored interdisciplinary rehabilitation treatment targeting both cognitive and psychological factors related to pain, in decreasing disability, and improving QOL in SFN.MethodsSingle-case experimental design. Ten participants with SFN will be included. Every patient will be offered a personalized program based on one of three rehabilitation treatment modules (graded activity, exposure in vivo or acceptance and commitment therapy) depending on the most prominent factor maintaining disability. Treatment will be provided for at least 8 weeks with 2 sessions a week.Discussion/conclusionThis is the first study investigating personalized rehabilitation treatment in patients with idiopathic SFN. The findings are expected to result in an effective treatment for SFN with an increase in QOL and a decrease in disability.Clinical trial registrationClinicalTrials.gov, identifier NCT05798949.

An Exercise-Based Precision Medicine Tool and Smartphone App for Managing Achilles Tendinopathy (the 'PhysViz' System): User-Centered Development Study

Background People with Achilles tendinopathy (AT) experience persistent pain that can limit engagement with daily occupations and negatively impact mental health. Current therapeutic exercise approaches vary in success, with many people experiencing reinjury, leading to a cycle of chronic tendinopathy often lasting years. High-magnitude precision loading may help people exit this feedback cycle, but applying these principles clinically is challenging. Objective This user-centered design case study aims to provide an overview on how the PhysViz (a prototype for a novel remote rehabilitation intervention for AT management) was developed and evaluated following the development phase of the Framework for Accelerated and Systematic Technology-Based Intervention Development and Evaluation Research (FASTER). Methods The development process engaged a multidisciplinary team comprising people with AT experiences, clinicians, and engineers. It followed the 5 stages within the FASTER development phase: empathize, define, ideate, prototype, and test. The PhysViz development and evaluation were informed by needs assessments, surveys, literature reviews, validation studies, case studies, roundtable discussions, and usability testing (some of which have been published previously). The FASTER systematically guided the integration of evidence-based features and behavior change theory. Results By using the FASTER and ensuring that the PhysViz system was underpinned by diverse stakeholder needs, this work resulted in the development of a working prototype for both the PhysViz physical exercise tool and the accompanying PhysViz software package (mobile app and web application). A variety of study designs informed user-desired features that were integrated into the PhysViz prototype, including real-time biofeedback in the form of precision load monitoring, customizable exercise programs, and pain tracking. In addition, clinicians can visualize client data longitudinally and make changes to client exercise prescriptions remotely based on objective data. The identified areas for improvement, such as upgrading the user interface and user experience and expanding clinical applications, provide valuable insights for future PhysViz iterations. Further research is warranted to assess the long-term efficacy and feasibility of the PhysViz in diverse clinical settings and its potential to improve AT symptoms. Conclusions Being one of the first technology development initiatives guided by the FASTER, this study exemplifies a systematic and multidisciplinary approach to creating a remote rehabilitation intervention. By incorporating stakeholder feedback and evidence-based features, the PhysViz addresses key challenges in AT rehabilitation, offering a novel solution for precision loading and therapeutic exercise engagement. Positive feedback from users and clinicians underscores the potential impact of the PhysViz in improving AT management outcomes. The PhysViz serves as a model for technology-based intervention development, with potential implications for other tendinopathies and remote rehabilitation strategies.

Towards a Satisfactory Future—Multiprofessional Rehabilitation for Young Persons with ADHD or ASD

There is a lack of knowledge about what kind of support should be offered in adulthood for persons with attention-deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) to promote inclusive participation in meaningful life domains. The core components of multiprofessional rehabilitation intervention for young adults are explored from the perspective of multiprofessional teams. This qualitative study adopts a pragmatic perspective on the core components of rehabilitation. Twenty-six professionals participated in vignette-based focus group interviews (n = 5), and thematic reflexive analysis was used to abductively analyze the data. A total of ten core components were identified. Nine of them were aggregated into three categories: (1) rehabilitation readiness (two core components), (2) adaptive progress in personal goals (four core components), and (3) rehabilitation continuum (three core components). The overarching tenth core component is focusing on the personal goals of daily life, work, studies, and social interaction. A collaborative relationship between the client and professional is essential to ensure adaptive progress and to foster clients’ self-determination. The focus should be on strengths and solutions instead of deficits and challenges. To establish rehabilitation continuum, it is essential to collaborate within the clients’ networks and to promote awareness and inclusive opportunities for working and studying for people with ADHD and ASD.

NCMP-19. IMPACT OF SUBVENTRICULAR ZONE INVASION ON PREOPERATIVE COGNITIVE DECLINE IN DIFFUSE GLIOMA PATIENTS

Abstract PURPOSE To determine the impact of subventricular zone (SVZ) invasion on neurocognitive dysfunction in diffuse glioma patients. MATERIALS AND METHODS We collected neuropsychological assessments of treatment-naïve WHO grade 2-4 diffuse glioma patients between 2017 to 2023. The Chi-square test determined the odds ratio (OR), and multiple linear regression identified factors related to cognitive deficits using Python 3.11.4. RESULTS Of the 129 patients, 64 exhibited SVZ invasion (SVZ+) while 65 were SVZ-. Groups were matched for WHO grading. SVZ+ was associated with more defective domains than SVZ- in both lower grade (WHO grade 2,3, 3.2 ± 2.1 vs. 2.1 ± 1.9, p=0.019) and high grade (WHO grade 4, 4.9 ± 1.6 vs. 3.6 ± 2.2, p=0.019) tumors. In lower grade gliomas, SVZ+ increased risks of language (OR 7.500, p<0.001) and visual learning impairments (OR 4.375, p=0.014). In high grade gliomas, SVZ+ rendered greater language (OR 8.556, p=0.003) and auditory learning vulnerability (OR 3.850, p=0.039). In right hemispheric tumors, SVZ+ lesions conferred worse executive (OR 6.667, p=0.006) and language function (OR 9.063, p=0.017); in left hemispheric tumors, SVZ+ lesions increased language (OR 3.125, p=0.012) and auditory learning (OR 2.889, p=0.024) impairment. Frontal horn of SVZ+ was related to working memory decline, and body part of SVZ+ was related to emotional deficits. Age and WHO grade 4 were associate with more defective domains in the SVZ+ group. In the SVZ- group, parietal lobe tumor was associate with more defective domains, while high education, temporal lobe, and WHO grade 2 were associate with fewer defective domains. CONCLUSION SVZ invasion impacts pre-operative neurocognitive function regardless of lesion laterality and WHO grade. Distinct SVZ sub-regions are linked to specific cognitive impairments. These findings highlight the need for precise tumor mapping involving the SVZ to evaluate neurocognitive outcomes and consider preventive or rehabilitative interventions.

“Optimizing Wellness and Neurorehabilitation with Mindfulness (OWNMindfulness)”: feasibility of a novel mindfulness-based rehabilitation intervention for Persisting Symptoms after Concussion

Background Persisting Symptoms after Concussion (PSaC) are common and difficult to treat. Mindfulness-based interventions can support recovery but are rarely included in rehabilitative care. We developed OWNMindfulness, an eight-week live-video mindfulness-based group for PSaC. Purpose To assess feasibility and preliminary clinical effects of OWNMindfulness. Methods Fourteen individuals with PSaC enrolled in this mixed-methods single-arm feasibility study. We assessed enrollment/retention, adherence, fidelity, instrument completion, safety, and satisfaction. We evaluated preliminary trends in the impact of the intervention on mindfulness (CAMS-R), concussion symptoms (PCSS), and QOL (WHOQOL-BREF). Qualitative analysis of exit interviews explored participants’ perceptions of the effects of the intervention, and framework analysis assessed adequacy of the quantitative measures to capture perceived effects. Results Feasibility results met a priori benchmarks. Mindfulness, concussion symptoms, and QOL scores improved (CAMS-R: adjusted p = 0.01, large effect size; PCSS: adjusted p = 0.03, moderate effect size; WHOQOL-BREF: not significant, small effect size). Qualitative analysis of interview data found benefits including validation, compassion, self-awareness, self-efficacy, concussion symptoms, resilience, life participation, social relationships, and QOL. Framework analysis demonstrated that quantitative tools captured change in concussion symptoms but did not comprehensively assess the other benefits identified through qualitative methods. Conclusions OWNMindfulness shows preliminary feasibility and promise for improving clinical outcomes. Results suggest the need for additional quantitative tools for comprehensive measurement of the effects and may point to potential mechanisms of action.

The reliability and validity of a novel clinical tool for distributing rehabilitation patients: a multicenter cross-sectional study in China

This study aimed to assess the reliability and validity of a novel clinical tool for distributing rehabilitation patients (DRP) for measuring a population of rehabilitation patients based on first-hand data from the field survey in China. A multi-stage sampling scheme was used to select 2512 rehabilitation outpatients from 21 medical institutions in seven cities in China. The evaluation indicators of the DRP tool consisted of five clinical indexes on multiple dysfunctions, self-care ability, vital signs, disease status, and disease course. The evaluation of rehabilitation ways of the DRP tool mainly included outpatient rehabilitation treatment, admission to primary healthcare, admission to secondary hospitals, and admission to tertiary hospitals. The mean age of participants was 54.22 years (SD:17.91), and nearly half (48.68%) were male. The majority (70.15%) were diagnosed with orthopaedic disorders. The Cronbach’s alpha (0.66), the Kendall test (Kendall coefficient = 0.86; P < 0.001), and the Kappa test (Kappa = 0.83; Agreement: 90.48%; P < 0.001) reflected acceptable consistency reliability for the indexes on multiple dysfunctions, self-care ability, vital signs, disease status, and disease course in DRP tool. The modified confirmatory factor analysis (CFA) showed the indexes of multiple dysfunctions (β = 0.31; 95%CI = 0.20–0.43), self-care ability (β = 0.99; 95%CI = 0.65–1.33), disease status (β = 0.11; 95%CI = 0.06–0.16), disease course (β = 0.15; 95%CI = 0.09–0.21), and vital signs (β = 0.15; 95%CI = 0.08–0.21) had significantly factor loadings on the rehabilitation ways. The modified CFA exhibited a satisfactory model fit (RMSEA = 0.03; CFI = 0.99; TLI = 0.95; SRMR = 0.01; AIC = 8268.51; BIC = 8373.43). This is the first study to develop a DRP tool using a relatively large sample from seven cities in China. The DRP tool had acceptable reliability and validity in measuring the rehabilitation ways of patients. Our findings provide a starting point for developing a practical tool in rehabilitation clinical practices and could provide advice on building more effective strategies and tools for other low-and middle-income countries that struggle with integrated healthcare.

Treatment Quality or Hotel Quality - What Determines more Rehab Satisfaction and Subjective Treatment Success in Psychosomatic Rehabilitation?

Rehab satisfaction and treatment success are firmly anchored in the German Pension Insurance's quality assurance program as quality criteria for medical rehab. In the field of psychosomatic rehab, there are hardly any studies in which the relative importance of treatment- and hotel-related characteristics for the prediction of these criteria has been investigated. In a secondary analysis, anonymous survey data from 25 psychosomatic rehab clinics/specialist departments were analyzed. The sample comprises around 50,000 inpatient rehabilitants from 2018-2022. The surveys were conducted using a largely standardized questionnaire for the purpose of internal quality assurance. The extent to which the two outcome criteria can be predicted from 14 predictors (assessments of partial performance areas) and from a heuristic model with three blocks of variables (KV=control variables, RB=rehabilitation treatment, HL=hotel services) was examined using regression analysis. All 14 predictors correlate significantly with both criteria and can explain a total of around 67% (rehab satisfaction) resp. 40% (treatment success). In stepwise regressions, the predictors "psychotherapeutic care" and "preparing for the time after rehab" contribute most to the prediction of the criteria. Hierarchical regressions show that the incremental share of the RB block in the prediction of both criteria, i. e. the share that can be attributed with certainty to the rehab treatment variables, is many times greater than that of the hotel services. The hierarchical regression analyses support earlier findings that characteristics of the actual rehab care (e. g. good psychotherapeutic support) play a much greater role for the rehabilitants with regard to both outcome criteria than hotel -related features. There is much to suggest that these findings are also valid for inpatient psychosomatic acute care.

Results of a Feasibility Pilot Pragmatic Trial Implementing Palliative Care in Skilled Nursing Facilities.

Background: Seriously ill older adults are admitted for post-acute care in skilled nursing facilities (SNFs) for curative, rehabilitative treatments, yet experience high rates of re-hospitalization, and death. The primary palliative care in post-acute care (PPC-PAC) intervention is an evidence-based approach designed to help people with serious illness align treatment plans with goals of care, optimize quality of life, and improve satisfaction with their care. Objectives: To conduct a preliminary study and evaluate the feasibility of implementing the PPC-PAC intervention in the post-acute care SNF setting. Design: Two-group, multisite feasibility pilot pragmatic clinical trial with a non-equivalent design. Measurements: Primary outcome measures-eligibility, enrollment, and data collection rates; consultation satisfaction; and fidelity. Effectiveness outcome measure-quality of life using the Palliative Outcomes Scale version 2. Results: Close to 70% of those who were eligible and approached by the study team (45/65) enrolled in the trial throughout 12 SNFs in the Northeast and Mid-Atlantic United States. Thirty-five were enrolled from intervention sites; 10 were enrolled from control sites (usual care). Most participants (80%) expressed general satisfaction with PPC-PAC, and 90% of clinicians implemented the PPC-PAC intervention as intended. At 21 days follow-up, there were no significant differences in effectiveness outcomes. Conclusion: Implementation of the PPC-PAC intervention proved to be feasible and acceptable among older adults and clinicians. Future research should focus on testing the effectiveness of PPC-PAC and explore strategies for optimal intervention implementation and SNF staff engagement in the post-acute care setting.

Concurrent Guillain–Barre/acute transverse myelitis overlap syndrome after COVID-19 infection in a patient with ITP: A case report

Rationale: Patients with chronic immune diseases, such as idiopathic thrombocytopenic purpura (ITP), should be alert for Guillain–Barre/acute transverse myelitis (GBS/ATM) overlap syndrome after infection with coronavirus disease 2019 (COVID-19). Patient concerns: A 65-year-old male with an ITP history, who presented with limb numbness and weakness, urinary retention, right peripheral facial paralysis, and diplopia 2 weeks after being diagnosed with COVID-19. Diagnosis: GBS/ATM overlap syndrome secondary to COVID-19. Interventions: Five days intravenous immune globulin, methylprednisolone (500 mg) was added for treatment. He was discharged with medicine and continued to take Methylprednisolone tablets (60 mg/d), Eltrombopag olamine (25 mg 1/d), Mecobalamine tablets, vitamin B1, and rehabilitation treatment outside the hospital. Outcomes: The patient significantly improved after initial treatment, he returned to normal life after 8 weeks. Five months later, he was infected with COVID-19 for the second time, exhibiting only symptoms of upper respiratory tract infection and no other discomfort. Lessons: COVID-19 infection can lead to secondary myelitis and GBS, and GBS/ATM overlap syndrome is rare, but patients are significantly better after immunization and hormone therapy.

Comparative evaluation of the effectiveness of sanatorium treatment programs on the severity of respiratory disorders in patients with postcovid syndrome

The purpose of the study. To conduct a comparative assessment of the effectiveness of various sanatorium treatment programs for patients with respiratory disorders in postcovid syndrome.Material and methods. The study involved 112 people with impaired respiratory system functions who were referred for sanatorium treatment 2–3 months after suffering a new coronavirus infection COVID-19. Of these, 74 are women and 38 are men. The programs used: physical therapy, halotherapy, inhalation of nitric oxide, electrostatic massage.Results. The use of an extended program of sanatorium treatment with the inclusion of inhalations of nitric oxide and electrostatic massage in patients with respiratory disorders with postcovid syndrome contributes to a significant reduction in the number and severity of complaints in this category of patients.Conclusion. The inclusion of nitric oxide inhalations and electrostatic massage in the programs of sanatorium treatment in patients with respiratory disorders with postcovid syndrome increases the effectiveness of rehabilitation treatment after acute infectious disease.

Training in the Use of Myoelectric Prostheses Through the Combined Application of Immersive Virtual Reality, Cross-education, and Mirror Therapy

ABSTRACT Introduction During the rehabilitation process (RHB) of the patient with traumatic upper-limb amputation, the use of immersive virtual reality (IVR) facilitates the incorporation of the prosthesis into the body schema. This reinforces and enhances sensorimotor and cognitive stimulation to improve motor learning and motor patterns, while normalizing global gestures. Objectives The aims of this study were to implement retraining of gestural acquisition and prosthetic control in patients with upper-limb injuries and amputations through IVR, and to then incorporate this in the normalization of functional patterns in activities of daily living (ADLs) with the work of “cross-education” as well as the therapy of observation of actions—mirror therapy to enhance the joint effect of the approach with IVR. Methods Standard sessions were established for transradial and transhumeral trauma patients with upper-limb amputation and traumatic injuries within the rehabilitation treatment. During the sessions, games and virtual environment were used. The software ran in desktop mode using a “Leap Motion” or for immersive versions of 3D glasses (Oculus Rift S). Results The application of IVR in combination with conventional treatment obtained significant benefits for functionality. These included learning correct motor execution as well as motivational and emotional state with distal traumatic injuries and upper-limb amputations with or without myoelectric prosthesis, obtaining 5.6 on average on the GROC (global rating of change) scale. Conclusions Immersive virtual reality shows benefit for the normalization of motor learning of functional patterns in DLA and on the emotional, motivational level of the patient. Clinical Relevance The integrated combination of cross-education, mirror therapy, and immersive virtual reality may represent greater acquisition of motor patterns in the prosthetic training of patients with upper-limb amputation.

A longitudinal analysis of psychological, physiological, and rehabilitation outcomes in basketball players following acute sports injuries

This cross-sectional study examines psychological behavior, biological factors, and rehabilitation treatment concerning acute sports injuries involving basketball players. Psychological trauma is also prevalent whereby athletes develop anxiety, depression and or fear that slow down their healing process and inability. The present study is a naturalistic cohort design where 50 basketball players with an injury completing self-report measures such as DASS-21 (Depression, Anxiety and Stress Scale) and biological markers, cortisol level at monthly intervals for 12 months. Qualitative data in the form of interviews conducted after treatment, or quantitative data from neuropsychological examinations, are employed to determine therapeutic impacts of CBT and/or specified individual rehabilitation plans in changing psychological effects, regain biological functions, and the speed of physical rehabilitation. Current data analyzed evidence lower level of stress, cortisol, beneficial shifts in cardiovascular, respiratory patterns, and aspects of rehabilitation outcomes in the player receiving both psychological and physical-motor interventions in comparison to the group receiving only physical-motor treatment. Based on the developed arguments it can be seen that the mental health and the biological issues also matter thus boosting the believably of better rehabilitation for athletes.

Potential Role of Soundscape and Music Interventions in post-Intensive Care Rehabilitation

Background Post Intensive Care Unit (ICU) survivors face physical, psychological, and cognitive impairments during their recovery phase, adversely affecting their quality of life. Given the scarcity and barriers to access to post-ICU care worldwide, patient-centered adjuncts are worth exploring. Although music interventions have gained recognition as non-pharmacological approaches in the acute phase of critical illness; exploration of their potential benefits in the post-ICU is scarce. Objective This paper examines the potential of sound and music interventions as an adjunct therapeutic modality to improve the well-being of adults post-ICU patients, through a narrative overview of published research evidence regarding post-ICU recovery and other relevant post-acute conditions, such as post-traumatic disorder and anxiety. Results The effectiveness of sound/ music interventions on several key outcomes including reduced anxiety, stress, pain, and PTSD, improved sleep, and enhanced mood and emotional well-being have been studied. Research indicates that music-based approaches to physical and psychological well-being reduce emotional distress, foster connectedness, and improve overall well-being. The importance of tailoring sound and music interventions to the individual needs and preferences of post-ICU patients is emphasized. Conclusion The potential benefits of sound and music interventions, both in terms of physiological and psychological well-being, encourage further investigation into their potential application and implementation into post-ICU care and rehabilitation. Ultimately, this therapeutic approach could contribute to enhancing the overall quality of life and empowerment of post-ICU patients on their path to recovery.

Telemedicine and Virtual Interventions in Cancer Rehabilitation: Practical Application, Complications and Future Potentials.

The purpose of this review is to provide an overview of the practical applications of comprehensive cancer rehabilitation services through telemedicine. Telemedicine has been shown to be an effective platform leading to positive outcomes and high patient/provider satisfaction for several forms of skilled therapy and cancer physiatry visits. Several survivorship resources are also available through telemedicine in recent years. Telemedicine can increase accessibility to geographically sequestered services including cancer physiatry, skilled therapy and survivorship resources. In certain situations and for specific services, telemedicine can be effective, however, in other situations such as the evaluation of new neurologic deficits or when providing manual therapies, in-person visits should take precedence.

Non-pharmacological interventions to support the cognitive rehabilitation of patients admitted to the intensive care unit: An umbrella review.

Critically ill patients experience cognitive impairment throughout their intensive care unit trajectory, in the acute phase and the long-term alike. Cognitive impairment may negatively impact patients' quality of life and rehabilitation outcomes. To provide an overall examination of literature concerning non-pharmacological interventions that can enhance cognitive functioning in critically ill patients or facilitate their rehabilitation pathway during and after their intensive care unit stay. This study was conducted as an umbrella review. A systematic search was conducted in CINAHL, Embase, PubMed and PsychINFO, including all types of peer-reviewed research syntheses published between 2008 and 2023. Eligible studies had to describe interventions capable of improving adult patients' cognitive functioning or supporting their cognitive rehabilitation process throughout the intensive care unit trajectory. All eligible research syntheses were screened systematically; those included were critically appraised. Based on 13 research syntheses, this review summarizes rehabilitative interventions that may be delivered during different phases of critical illness and recovery, in relation to content, delivery and timing. Interventions were: (1) cognitive activities and training, (2) mobilization and physical exercises, (3) emotional, psychological and social support and (4) information. Due to limited evidence, no definitive conclusion can be drawn about which type of intervention is most supportive or effective. Additionally, no recommendations can be made about the optimal timing for intervention delivery. Clinicians involved in developing and implementing cognitive rehabilitation measures should consider designing individualized, multicomponent interventions with a focus on content, delivery and timing.

Muscle structure assessment using synchrotron radiation X-ray micro-computed tomography in murine with cerebral ischemia.

Muscles are crucial for balance and walking, activities which depend specifically on the lower extremity muscles. Therefore, the evaluation of stroke induced atrophy and paralysis is essential; however, determining the extent of damage in the days after its occurrence remains challenging. In this study, we evaluated ischemic stroke-induced soleus muscle damage in gerbils using synchrotron radiation X-ray micro-computed tomography (SR-µCT), comparing a control group (n = 3), animals 7 days after stroke (7 d, n = 3), and animals 14 days after stroke (14 d, n = 3). The left muscle was paralyzed, whereas the right muscle was not. Subsequently, we quantified the assessment by segmenting the soleus muscle based on the extracellular space/matrix and fiber region to determine the degree of damage. The muscle fiber-to-extracellular space/matrix ratio were significantly damaged due to paralysis on the left side (control vs. 14 d, P = 0.040). Muscle area was significantly different at 14 d between the left and right sides (P = 0.010). Additionally, the left local fascicle surface area, thickness, global pennation angle, and local fascicle angle were significantly different between the control and 14 d groups (P = 0.002, P = 0.007, P = 0.005, and P = 0.014 respectively). These findings underscore the potential of post-stroke animal studies in improving rehabilitation treatment for the central nervous system by assessing the degree of muscle recovery.

Fluctuation of physical function during chimeric antigen receptor T‐cell therapy during rehabilitation intervention: Real‐world data and risk factor analyses

AbstractIntroductionPatients undergoing chimeric antigen receptor (CAR) T‐cell therapy face prolonged treatment timelines and are prone to cytokine release syndrome (CRS) and immune effector cell‐associated neurotoxicity syndrome (ICANS) after infusion. Disabilities in physical function and the importance of rehabilitation during CAR‐T‐cell therapy to maintain physical function have been poorly documented.MethodWe performed a retrospective cohort study to assess changes in exercise tolerance via differences in a 6‐min‐walking distance (Δ6MWD) and factors influencing it.ResultsA total of 77 patients who underwent rehabilitation during CAR‐T‐cell therapy were enrolled, and their 6MWD was 450 m (median, range 180–705 m) before and 450.5 m (107.0–735.0 m) 30 days after CAR‐T treatment. No significant alteration in Δ6MWD was observed overall (11.0 m, 95% confidence interval, −56.1 to 88.2 m). Multiple regression analyses indicated that age (over vs. under 65 years) revealed no notable differences in Δ6MWD (20 vs. 10 m), while ΔHb (β = 0.24, p = 0.03), moderate/severe CRS (grade 1 with continuous fever or grade ≥2; β = −0.25, p = 0.03), and ICANS (any grade; β = −0.22, p = 0.04) were significantly associated with lower Δ6MWD.ConclusionThis real‐world study indicated that CAR‐T‐cell therapy is less likely to reduce physical function even in older patients if rehabilitation is properly performed, whereas CRS and ICANS can be risk factors to deprive exercise tolerance.

Effectiveness of Robotic Devices for Medical Rehabilitation: An Umbrella Review

Background/Objectives: Clinical trials have investigated the efficacy of rehabilitation robotics for various pathological conditions, but the overall impact on rehabilitation practice remains unclear. We comprehensively examined and analyzed systematic reviews (SRs) of randomized controlled trials (RCTs) investigating rehabilitative interventions with robotic devices. Methods: Four databases were searched using term combinations of keywords related to robotic devices, rehabilitation, and SRs. The SR meta-analyses were categorized into “convincing”, “highly suggestive”, “suggestive”, “weak”, or “non-significant” depending on evidence strength and validity. Results: Overall, 62 SRs of 341 RCTs involving 14,522 participants were identified. Stroke was most frequently reported (40 SRs), followed by spinal cord injury (eight SRs), multiple sclerosis (four SRs), cerebral palsy (four SRs), Parkinson’s disease (three SRs), and neurological disease (any disease causing limited upper- and lower-limb functioning; three SRs). Furthermore, 38, 21, and 3 SRs focused on lower-limb devices, upper-limb devices, and both upper- and lower-limb devices, respectively. Quantitative synthesis of robotic intervention effects was performed by 51 of 62 SRs. Robot-assisted training was effective for various outcome measures per disease. Meta-analyses offering suggestive evidence were limited to studies on stroke. Upper-limb devices were effective for motor control and activities of daily living, and lower-limb devices for walking independence in stroke. Conclusions: Robotic devices are useful for improving impairments and disabilities in several diseases. Further high-quality SRs including RCTs with large sample sizes and meta-analyses of these RCTs, particularly on non-stroke-related diseases, are required. Further research should also ascertain which type of robotic device is the most effective for improving each specific impairment or disability.

Utility of Electroencephalograms for Enhancing Clinical Care and Rehabilitation of Children with Acquired Brain Injury

The objective of this literature review was to present evidence from recent studies and applications focused on employing electroencephalogram (EEG) monitoring and methodological approaches during the rehabilitation of children with acquired brain injuries and their related effects. We describe acquired brain injury (ABI) as one of the most common reasons for cognitive and motor disabilities in children that significantly impact their safety, independence, and overall quality of life. These disabilities manifest as dysfunctions in cognition, gait, balance, upper-limb coordination, and hand dexterity. Rehabilitation treatment aims to restore and optimize these impaired functions to help children regain autonomy and enhance their quality of life. Recent advancements in monitoring technologies such as EEG measurements are increasingly playing a role in clinical diagnosis and management. A significant advantage of incorporating EEG technology in pediatric rehabilitation is its ability to provide continuous and objective quantitative monitoring of a child’s neurological status. This allows for the real-time assessment of improvement or deterioration in brain function, including, but not limited to, a significant impact on motor function. EEG monitoring enables healthcare providers to tailor and adjust interventions—both pharmacological and rehabilitative—based on the child’s current neurological status.