Motor Function Measure Research Articles

Functional Independence and Elbow Strength in Tetraplegia: Analysis of Tendon Transfers

Background Over half of spinal cord injuries result in tetraplegia, profoundly impairing daily activities (ADLs). Objective To evaluate biceps-to-triceps (B-T) and deltoids-to-triceps (D-T) tendon transfers, comparing their impacts on elbow extension strength and ADL independence. Methods Retrospective review of tendon transfers performed between 2003 and 2023 at a neurorehabilitation center. Post-surgery muscle strength was assessed using the Medical Research Council (MRC) scale and ADL independence with the motor Functional Independence Measure (mFIM). We used ANOVA to identify post-surgery associations between MRC achieved scores and performance in ADLs. Results A total of 34 individuals (42 arms) underwent B-T or D-T surgeries, predominantly at C5 level (66.7%) with 69.0% classified as AIS A. Post-surgery, 81% of B-T and 76.2% of D-T achieved antigravity elbow extension (MRC 3–4), with mean MRC scores of 3.2 for both groups. The B-T group, older at surgery (39.9 vs. 27.8 years) and with shorter time since injury to surgery (2.3 vs. 5.0 years), showed significant post-surgery improvements in Self-care, Transfers, Locomotion, and total mFIM. In contrast, significant associations between MRC scores and mFIM outcomes in D-T transfers involved Self-care, Sphincter control, Transfers, and total mFIM. Conclusions MRC scores and ADLs were positively impacted by rehabilitation tendon transfers.

Characteristics of patients diagnosed with psychogenic non-epileptic seizures (PNES) who request reinstatement of their driving privileges.

Patients who experience seizures, including PNES, are usually advised to discontinue driving, or have their driving privileges revoked until a determined period of seizure-freedom is achieved. In this retrospective study, patients with PNES who requested driving privileges or reported having resumed driving were compared to those who did not on measures of depression, anxiety, PTSD, and cognitive flexibility/motor speed. DiagnosisofPNESwasconfirmedwithvideo-EEG.Demographicand clinical dataand requests for reinstatement of driving privileges (requiring 6 or more months seizure freedom) and reports of decisions to resume driving were noted. Tests of motor speed and hand eye coordination and self-report questionnaires of depression, anxiety and PTSD administered as part of neuropsychological assessment were analyzed. A total of 403 patients with PNES evaluated in 2010-2020 were identified. Of those, 365 patients were eligible for inclusion, and of those, 60 applied for driving privileges or reported that they resumed driving. When the two groups were compared, the group that applied for driving privileges or decided to resume driving was significantly less depressed (p=0.001) when tested than the group that did not. Furthermore, a significant difference was seen in measures of motor performance between those who requested to resume driving and those who did not (DKEFS T1, p=0.006, DKEFS T2, p=0.001, DKEFS T3, p=0.002, DKEFS T4, p=0.001; GPT dominant, p=0.05, GPT non-dominant, p=0.003). Driving a motor vehicle is a useful measure of improvement for PNES because patients with seizures are required to discontinue driving until seizure-freedom is achieved. This study revealed that lower levels of depression and better fine motor functioning were associated with reported seizure-freedom and driving resumption. Depression is commonly associated with diminished performance (slower motor response times and impaired fine motor movements) on tests of motor functioning, both of which may result in less interest in pursuing permission to resume driving. These findings suggest that mood symptoms (and associated performance on measures of motor speed and coordination) may have prognostic significance in patients diagnosed with PNES. This also suggests that timely treatment of depression in newly diagnosed patients with PNES may be indicated.

Improving sensory integration in Chinese children with moderate sensory integration challenges through engaging basketball training

ObjectiveThis study aimed to evaluate the effectiveness of combining basketball training with a traditional sensory integration therapy (SIT) vs. a SIT alone in enhancing sensory integration capability among Chinese children diagnosed with mild challenges in sensory integration and sensory processing (CSISP).MethodsThis study comprised a Control group and an Experimental group, both undergoing a 10-week intervention (4 sessions/week, 45 min/session). The Control group exclusively participated in traditional SIT for all sessions. In contrast, the Experimental group engaged in traditional SIT for two sessions per week and Basketball training for the remaining two sessions weekly. Three sensory integration measures (vestibular sensation, tactile perception, proprioception) and five gross motor performance measures (balance beam walking speed, single-leg standing with eyes closed, tennis ball throw, two-legged jump speed, 10-m shuttle run) were assessed before and after the 10-week training period. Separate 2 (Group) × 2 (Test Phases) Analysis of Variance (ANOVA) with repeated measures on the second factor were conducted for each measure. Interaction effects were further explored using Tukey's HSD test to clarify their nature.ResultsBoth groups demonstrated significant improvements in all sensory integration and gross motor performance measures following the 10-week training sessions (p < 0.001). Importantly, the group receiving the combination of basketball training and traditional SIT significantly outperformed the group undergoing SIT alone in all assessed areas.ConclusionThese results indicate that combining basketball training with traditional SIT enhances sensory integration capabilities more effectively among Chinese children aged 4–6 years with moderate CSISP compared to utilizing SIT alone.

Cell-Based Therapy for Cerebral Palsy: A Puzzle in Progress.

Cell-based therapy has shown promising outcomes in the treatment of cerebral palsy (CP). However, there is no consensus on a standard therapeutic protocol regarding the source of cells, optimal cell dose, timing and frequency of cell injections, route of administration, or the use of combination therapy. This lack of consensus necessitates a comprehensive investigation to clarify these crucial yet undefined factors in cell-based therapy for CP patients. In this commentary, we discuss and compare the trends in Gross Motor Function Measure-66 following intrathecal injection of umbilical cord blood mononuclear cells (UCB-MNCs) and umbilical cord tissue mesenchymal stromal cells (UCTMSCs) in children with CP. Our study revealed that MNC injections led to earlier improvements in gross motor function, whereas MSC applications resulted in more sustainable changes. These findings provide key insights into the efficacy of different cell types, which will be beneficial for future studies and for refining cell-based therapy protocols for CP treatment.

The Effect of Home-Based Robotic Rehabilitation on Individuals with Disabilities in Community Settings: A Pilot Study.

Background: With South Korea's growing aging population, the demand for accessible rehabilitation solutions is increasing. Home-based robotic rehabilitation presents a feasible alternative to conventional in-clinic rehabilitation. This study explores the impact of the Rebless robotic rehabilitation device in a home-based setting for people with physical disabilities and their caregivers. Methods: We prospectively collected data from individuals with brain disorders or physical disabilities living in Dongdaemun-gu, from August 2023 to March 2024. Participants completed an 8-week rehabilitation program using the Rebless robotic device. Assessments were conducted at baseline and after the eight-week program, measuring motor function, caregiver burden, and quality of life. Exercises were performed three times weekly for at least 90 min total. Results: We conducted an intervention with 26 adults with physical or neurological disabilities, of which 20 completed the program. Significant improvements were observed in upper limb function within the elbow exercise group (Fugl-Meyer assessment for upper extremity, p = 0.043) and a reduction in caregiver burden across the total groups (Zarit Burden Interview, p = 0.003). However, no statistically significant changes were found in balance and mobility measures (Berg balance scale, timed up-and-go, 10 m walk test). Conclusions: Home-based robotic rehabilitation demonstrates potential for improving upper limb function and reducing caregiver burden and mental health, proving beneficial to both patients and caregivers.

Predictors of outcome in patients with cerebral palsy following selective dorsal rhizotomy

BackgroundTo identify outcome predictors of selective dorsal rhizotomy (SDR) in children with spastic cerebral palsy (CP) using logistic regression models. MethodsA retrospective single-center study was conducted on children with spastic CP who had undergone SDR. Two outcomes were defined, one representing children not improving in motor function and spasticity and one representing children improving in motor function two years after surgery. Baseline variables were chosen based on established regressors and clinical considerations and tested for being predictors using multivariate logistic regression. ResultsWe included 96 patients (mean age [SD] 6y 9 m [2y 5 m], range 2y to 17y) in the study. Significant predictors of non-improvement in motor function and spasticity two years after SDR were higher age at surgery and higher preoperative Gross Motor Function Measure-88 (GMFM-88) score. Significant predictors of motor function improvement after SDR were lower preoperative Modified Ashworth Scale (MAS) scores, higher preoperative passive range of motion (pROM) and lower age at surgery. ConclusionsFor the first time, pROM and preoperative spasticity were identified as predictors of SDR outcome. We confirmed motor function and age as predictors. These variables will be useful for future patient selection. Adjusting for the GMFM-88's ceiling effect, children with higher motor function can still profit significantly from SDR.

Gross Motor Development by Age and Functional Level in Children with Cerebral Palsy from 6 Months to 17 Years-A Norwegian Population-Based Registry Study.

Background: Cerebral palsy is a complex lifespan disability caused by a lesion to the immature brain. Evaluation of interventions for children with cerebral palsy requires valid and reliable outcome measures. Motor development curves and reference percentiles for The Gross Motor Function Measure (GMFM-66) are valuable tools for following, predicting, comparing, and evaluating changes in gross motor skills. The aims of this study were to create motor development curves with reference percentiles based on Norwegian data and compare them with published counterparts for Canadian children aged 2-21 years. Method: Prospective population-based cohort data from the Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP) for 1206 children with 3612 GMFM-66 tests between 0.5 and 17.3 years of age. Median development by Gross Motor Function Classification System (GMFCS) levels was estimated using a generalized additive regression model with smoothed parameters for location, scale, and shape (based on the R GAMLSS library). To adjust for repeated individual measurements, we report the median curve of 100 random samples with only one observation per observed child. Results: The Norwegian motor development curves for GMFCS levels I-IV increase up to 7 years of age before flattening off, while GMFCS level V curves are relatively flat. Overall, both motor development curves and GMFM-66 percentiles are very similar to Canadian counterparts. Conclusions: The existing Canadian reference curves are valid also for Norway, working well for both clinical and research applications. However, Norwegian percentiles can be used from an earlier age.

Transdiagnostic Network Localization of Social, Language, and Motor Symptoms in Patients With Frontotemporal Lobar Degeneration.

Frontotemporal lobar degeneration (FTLD) includes different clinical syndromes with distinct patterns of symptoms and neuroanatomical locations of neurodegeneration. However, FTLD is clinically heterogeneous (with overlapping symptoms across several domains) and neuroanatomically heterogeneous (with brain atrophy in different locations in different patients). Traditional methods struggle to fully account for this heterogeneity. In this study, we use a relatively new neuroimaging approach, atrophy network mapping, to localize clinical symptoms in patients with FTLD to specific brain networks transdiagnostically. Data were obtained from the Frontotemporal Lobar Degeneration Neuroimaging Initiative and 4-Repeat Tauopathy Neuroimaging Initiative. Inclusion required T1-weighted MRI and a diagnosis of behavioral-variant frontotemporal dementia (bvFTD), semantic-variant primary progressive aphasia (svPPA), nonfluent primary progressive aphasia (nfvPPA), progressive supranuclear palsy Richardson syndrome (PSP-rs), corticobasal syndrome (CBS), or normal cognition. Measures of social cognition (Interpersonal Reactivity Index, Revised Self-Monitoring Scale), language (Boston Naming Test, Animal Fluency), and motor function (Unified Parkinson Disease Rating Scale Part III, PSP Rating Scale) were correlated with neuroimaging measures, including cortical thickness, volume, and atrophy network mapping, a newer method that localizes regions connected to brain atrophy using a functional connectome from cognitively normal persons (n = 1,000). Fifty-seven patients with bvFTD (age 61.2 ± 6.8 years, 35% female), 41 PSP-rs (age 69.7 ± 7.4 years, 54% female), 39 CBS (age 66.2 ± 6.2 years, 51% female), 37 svPPA (age 63.0 ± 6.0 years, 46% female), and 36 nfvPPA (age 68.3 ± 7.3 years, 53% female) and 135 healthy age-matched controls (age 63.3 ± 7.4 years, 58% female) were included. Compared with atrophy alone, atrophy network mapping showed more consistent neuroimaging results across patients with the same clinical syndrome (Dice index mean 0.68 vs 0.11, paired t = 263.1, df = 4,452, p < 0.001), more strongly explained social cognition (F(1, 84) = 10.2, p = 0.002) and motor symptoms (F(1, 185) = 91.3, p < 0.001) across different syndromes, and showed novel neuroanatomical associations, with the temporal parietal junction relating to social cognition; Wernicke area relating to language symptoms; and association sensorimotor cortex, thalamus, and cerebellum relating to motor symptoms. Atrophy network mapping can improve understanding of brain-behavior relationships in clinically and neuroanatomically heterogeneous disorders such as FTLD.

Spinal muscular atrophy is also a disorder of spermatogenesis

BackgroundSpinal muscular atrophy (SMA) patients benefit from pre-mRNA splicing modifiers targeting the SMN2 gene, which aims to increase functional SMN production. The animal toxicity affecting spermatogenesis associated with one such treatment raised questions about male SMA patients’ spermatogenesis.MethodsThis descriptive, cross-sectional study was conducted from June 2022 to July 2023. The study involved adult male patients with genetically confirmed SMA type 2 (SMA2) or SMA3 from 13 French neuromuscular centers. The patients’ general data, motor severity, urological history, exposure to certain factors, parenthood, and spermogram results were obtained. All patients were enrolled prior to exposure to risdiplam.FindingsSixty-eight patients were enrolled ( 36 SMA2 and 32 SMA3 patients). Forty-one patients had fertility data (parenthood history and spermogram analyses) and underwent 33 spermograms. Fertility disorders were identified in 27 of the 41 patients (65·9%, 95%CI 51·3–80·4%) in particular SMA2 patients: 19 cases (90.5%, CI 77·9–100%) (SMA3: 8 cases (40%, CI 18·5–61·5%). Among the patients with available spermograms, 81% (27/33) had abnormal sperm concentration; 30% presented azoospermia. These abnormalities were significantly associated with SMA type (more prevalent in SMA2 patients, p < 0·001), disease motor severity, which included age at the loss of walking ability and wheelchair use duration (p < 0·001). The Motor Function Measure (MFM) determined that the sperm counts were also correlated with disease severity (p < 0·01).InterpretationThe fertility disorders were correlated with SMA severity and were particularly evident in SMA2 patients. In the latter, sperm concentration positively correlated with MFM. This study is the first one to link fertility disorders with spermogram abnormalities in SMA males. Understanding spermatogenesis in SMA is crucial, especially with new therapies such as risdiplam. Consequently, conducting systematic spermogram studies prior to SMA treatment is recommended.

Impact of a Nosocomial COVID-19 Outbreak on Convalescent Rehabilitation Outcomes of Post-Stroke Patients.

This study aimed to elucidate the impact of a nosocomial COVID-19 outbreak on convalescent rehabilitation outcomes of post-stroke patients. This retrospective observational study included post-stroke patients who were hospitalized in convalescent rehabilitation wards of our hospital during a COVID-19 outbreak between July 22, 2022 and August 13, 2022 (outbreak group). The control group consisted of patients hospitalized in convalescent rehabilitation wards from October 1 to December 31, 2022 (non-outbreak group). The two groups were compared in terms of motor Functional Independence Measure (FIM) effectiveness at discharge, Brunnstrom Recovery Stage, length of stay, and duration of rehabilitation therapy. Furthermore, within the outbreak group, outcomes were compared according to whether patients were infected with SARS-CoV-2. The impact of the outbreak on motor FIM effectiveness at discharge was also evaluated. There were 30 patients in the outbreak group (COVID-19, n = 18; close contacts, n = 12) and 33 patients in the non-outbreak group. Motor FIM effectiveness at discharge was significantly lower in the outbreak group, but there was no significant difference in outcomes according to SARS-CoV-2 infection status. After adjusting for SARS-CoV-2 infection, the nosocomial outbreak was significantly associated with lower motor FIM effectiveness at discharge. A nosocomial COVID-19 outbreak affected motor FIM effectiveness in convalescent rehabilitation for post-stroke patients, regardless of SARS-CoV-2 infection status.

Assessment of Affordances in the Home Environment and Neurodevelopment of Children With Congenital Zika Syndrome.

Congenital Zika syndrome (CZS) is characterized by brain abnormalities caused by in utero exposure to the Zika virus (ZIKV), resulting in significant neurodevelopmental, motor and visual impairments in affected children. These impairments hinder their ability to engage in social interactions and explore their surroundings. However, personalized and continuous sensory stimulation, particularly within the home environment, may play a crucial role in supporting motor and visual development in these children. Therefore, this study aimed to explore the relationship between sensory stimulation in the home environment and the motor and visual development of children with CZS. This cross-sectional study included children with CZS. The Affordances in the Home Environment for Motor Development (AHEMD) instrument was administered to caregivers to assess motor stimulation opportunities at home. All children underwent neurodevelopmental milestone assessments using the Brazilian Portuguese version of the Bayley Scales of Infant Development-Third Edition (BSID-III). Gross motor function was further assessed with the Gross Motor Function Measure (GMFM), and functional vision was evaluated by using the functional vision developmental milestones test (FVDMT). Eighty-five children with a mean age of 39.9 ± 2.3 (24.0-42.0) months were included. Forty-one children (48.2%) lived in homes with 'very weak' environmental stimulation. The children showed profound developmental delays in all domains of the BSID-III with an average neurodevelopmental age of 39.9 ± 2.3 (24-42) months. On the GMFM, over 90.0% of children could not initiate or maintain the required movements and postures for sitting, crawling, standing, walking, running and jumping. A significant positive correlation was found between the variety of home sensory stimulation with the AHEMD and the scores at the BSID-III motor scales as well as the GMFM. More fine motor materials in the home context correlated with better gross motor scores on the BSID-III (p = 0.016), increased likelihood of passing the 'sitting' (p = 0.041) and 'standing' (p = 0.019) items of the GMFM. Children with less visual impairment in parameters of the FVDMT ['eye contact' (p = 0.032), 'social smile' (p = 0.031) and 'movements to achieve' (p = 0.007)] had more stimulating home environment. Nearly half of the children with CZS who exhibited neurodevelopmental delays lived in homes lacking appropriate sensory stimulation. This study suggests that motor and visual development, including fine and gross motor skills as well as functional vision, may be benefited by the quantity and quality of play and stimulation opportunities available at home.

The effects of telerehabilitation-based motor imagery training on motor imagery ability, motor function and physical performance in Duchenne muscular dystrophy

Purpose To explore the effects of telerehabilitation-based motor imagery (Tele-MI) training on motor imagery ability (MI), motor function, and performance in children with Duchenne muscular dystrophy (DMD). Methods The research involved twenty-three children with DMD and twelve healthy children. DMD cohort were randomized into two groups: treatment [Tele-MI training and telerehabilitation-based physiotherapy program (Tele-PTP), n = 12] and control (Tele-PTP, n = 11). MI ability [Kinesthetic and Visual Imagery Questionnaire-10 (KVIQ-10), Motor Imagery Questionnaire for Children (MIQ-C), mental chronometry tests], motor function [Motor Function Measure (MFM), North Star Ambulation Assessment, Four Square Step Test] and timed performance were assessed at baseline and after 8-week training. Results MI ability scores of DMD cohort were lower than healthy children. A large interaction effect was found for KVIQ-10 visual and total, MIQ-C internal visual and kinesthetic scores, and delta time of 10–meter walk test of mental chronometry (η2 > 0.14). The small-medium interaction effect was found in motor function and ambulation results (η2<0.14). Conclusions This study demonstrated that Tele-MI training improved MI ability of DMD cohort. The small-to-medium effects of Tele-MI training on motor function, particularly those involving the trunk, have demonstrated its potential as a complementary approach in rehabilitation to improve motor functions in children with DMD. Clinical Trial Registration Number and URL NCT06109103 (https://clinicaltrials.gov/study/NCT06109103?term=merve%20bora%20zereyak&rank=1)

Random uncertain motor parameters identification combining fourth-order moment and trust region

In random uncertain motor parameter identification field, there is low identification efficiency and ill-conditioned data coming from the second iteration involved in the uncertainty propagation and surrogate model between the motor parameters and the performance response. In this paper, the fourth-order moment method and trust region model management technology are combined to reduce the dependence of the surrogate model accuracy and improve the computational efficiency. In the framework, the inner layer calculates the cumulative probability under different motor performance response thresholds based on the fourth-order moment method, and obtain the probability density function of the calculated motor performance response. The outer layer transforms the random uncertain motor parameters identification into a deterministic optimization problem by minimizing the probability distribution between the calculated and the measured motor performance response. In the outer layer optimization, the trust region model management technology is used to divide the search interval of the entire parameter to be identified into a series of trust regions, construct a surrogate model on the trust region to calculate the motor performance response, and continuously update the trust region by comparing the response residuals between the calculated and measured motor performance response, so that the motor parameters to be identified continue to approach the interval where true values are located. At the same time, the genetic intelligent technology is introduced to further reduce the calculation cost. Finally, the probability distribution of random uncertain motor parameters is obtained according to the identified mean, standard deviation, skewness and kurtosis coefficients. The numerical results in the example verify that the random uncertain motor parameter identification can be effectively achieved by the proposed method.

Nemaline Myopathy Type 6 Caused by Variants in the KBTBD13 Gene: A Cross-Sectional Study of 24 Patients.

Nemaline myopathy type 6 (NEM6) is the most prevalent type of nemaline myopathy in the Netherlands. Because a detailed clinical characterization is not available yet, we here provide a detailed assessment of 24 patients. In this cross-sectional study, we performed a full clinical assessment (medical history and neurologic examination) in patients with NEM6. Patient demographics, causative variants in the KBTBD13 gene, creatine kinase levels, and the results of previous muscle biopsies were collected. We evaluated experienced health-related quality of life, fatigue severity, prevalence of falls, balance control (Mini-Balance Evaluation Systems Test [Mini-BESTest]), functional motor score (Motor Function Measure [MFM]), and 6-minute walk distance. We used transcranial magnetic stimulation to assess muscle relaxation kinetics. Twenty-four patients were included (19 women [19-76 years]; 5 men [25-57 years]). Key patient-reported symptoms since childhood were muscle weakness (n = 23; 96%), slowness of movements (n = 23; 96%), and difficulties with running (n = 20; 83%). Axial, proximal, and distal muscles showed mild weakness in most patients. Health-related quality of life was significantly lower, and there was a significantly increased fatigue severity compared with controls. Prospectively, in a period of 100 days, 8 patients (33%) fell at least 1 time, of whom 5 patients (21%) fell 2 times or more. The median total score on the Mini-BESTest was 24 (21.0-26.0 [interquartile range]) of 28 and the median total percentage on the MFM was 91% (83.5-95.3), both considered to be mildly abnormal. The 6-minute walk distance was below the lower limit of normal in 4 patients (17%). All patients with NEM6 showed a markedly reduced muscle relaxation rate with a median of 6.5 [4.9-8.1] s-1 (lower limit of normal is 10.1 s-1). This cross-sectional study in patients with NEM6 shows a relatively mild clinical phenotype and mildly abnormal functional tests. However, patients report an important impact on the daily activities, which is illustrated by functional difficulties, reduced quality of life, increased fatigue severity, and increased prevalence of falls. This might be related to delayed muscle relaxation. This study provides a comprehensive overview of the clinical presentation and functional limitations in patients with NEM6.

EFFECTIVENESS OF VIRTUAL REALITY-BASED REHABILITATION VERSUS TRADITIONAL PHYSICAL THERAPY IN IMPROVING MOBILITY AND REDUCING PAIN AMONG CHILDREN WITH LOWER LIMB DISABILITY

Background: Children with lower limb disabilities often face challenges related to mobility, chronic pain, and functional independence, which hinder their ability to participate fully in daily activities. Traditional physical therapy has demonstrated effectiveness in improving these outcomes but often lacks engagement, reducing adherence in pediatric populations. Virtual reality-based rehabilitation offers an innovative and interactive approach to therapy, enhancing participation while providing measurable improvements in physical function and pain management. Objective: To evaluate the effectiveness of virtual reality-based rehabilitation versus traditional physical therapy in improving mobility and reducing pain among children with lower limb disabilities. Methods: A randomized clinical trial was conducted on 40 children aged 6–16 years at the Children’s Hospital Faisalabad and Allied Hospital Faisalabad from April 2024 to September 2024. Inclusion criteria required participants to have a confirmed lower limb disability, sufficient cognitive ability for VR interactions, and chronic pain (Wong-Baker FACES Pain Scale score ≥3). Exclusion criteria included children classified as GMFCS Levels IV or V, those unable to stand, and those with severe visual impairments or uncontrolled seizures. Participants were randomly allocated into two groups: Group A received virtual reality-based rehabilitation consisting of task-oriented exercises for 30–45 minutes, three times per week for six weeks, while Group B underwent traditional physical therapy focusing on stretching, strengthening, and functional mobility. Outcomes were measured using the Pediatric Evaluation of Disability Inventory (PEDI), Timed Up and Go (TUG) test, Wong-Baker FACES Pain Scale, and Gross Motor Function Measure (GMFM-66). Data analysis was performed using SPSS Version 20. Results: Significant within-group improvements were observed for all outcomes in both groups (p &lt; 0.001). The VR group showed a mean PEDI score improvement of 7.4 ± 2.5 compared to 3.1 ± 1.7 in the traditional PT group, with a between-group difference of 4.6 (p &lt; 0.001). TUG test times improved by 3.4 ± 1.2 seconds in the VR group versus 1.6 ± 1.0 seconds in the PT group, with a between-group difference of 1.7 seconds (p &lt; 0.001). Pain scores decreased by 3.0 ± 0.9 points in the VR group compared to 1.8 ± 0.8 points in the PT group, with a between-group difference of 1.1 points (p &lt; 0.001). GMFM-66 scores improved by 13.0 ± 2.6 in the VR group versus 6.8 ± 1.7 in the PT group, reflecting a between-group difference of 6.7 (p &lt; 0.001). Conclusion: Virtual reality-based rehabilitation demonstrated superior effectiveness compared to traditional physical therapy in improving mobility and reducing pain among children with lower limb disabilities. These findings support the integration of VR into pediatric rehabilitation for enhanced therapeutic outcomes.

A comprehensive review of rehabilitation strategies post-orthopedic intervention in pediatric cerebral palsy

Cerebral palsy (CP) often requires orthopedic surgery to address musculoskeletal issues such as contractures and joint dislocations. Effective post-surgery rehabilitation is crucial for improving functional outcomes and quality of life in pediatric CP patients. This narrative review identifies and evaluates rehabilitation strategies for post-orthopedic surgery in children with CP. A search of databases (PubMed, Google Scholar, and Cochrane Library) focused on articles from the past 20 years using keywords such as “cerebral palsy,” “pediatric rehabilitation,” “post-orthopedic surgery,” and “functional outcomes.” Key rehabilitation components include pre-surgical preparation, acute post-surgical management, sub-acute interventions, and long-term maintenance. Evidence highlights the benefits of a multidisciplinary approach involving physical and occupational therapy. Functional improvements are measured using tools such as the gross motor function measure and the pediatric evaluation of disability inventory. Effective rehabilitation for pediatric CP patients requires a tailored, multidisciplinary approach. Best practices include early mobilization, personalized exercises, and long-term strategies. Future research should optimize protocols and explore innovative techniques to enhance outcomes.

Timing of single-event multilevel surgical interventions on long-term motor outcomes in children and adolescents with cerebral palsy: A systematic review and meta-analysis

BackgroundThe aim of this meta-analysis was to evaluate the impact of the timing of single-event multilevel surgery (SEMLS) on long-term motor outcomes in children and adolescents with cerebral palsy (CP). MethodsA systematic review and meta-analysis were conducted by searching PubMed, Cochrane Library, Embase, and Web of Science databases for studies up to April 2024. Twelve eligible studies were included, from which we examined patients’ gait, stride length, walking speed, and the gross motor function measure (GMFM66). ResultsGait analysis showed significant improvements in CP patients after SEMLS, which included an increased gait deviation index (p < 0.001), reduced Gillette gait index (p < 0.001), and reduced gait profile score (p < 0.001). Subgroup analysis showed that age at surgery (<12 years old vs. 12−18 years old) was not a factor affecting patients’ gait. Spatial and temporal parameters such as stride length (p < 0.001) and walking velocity (p = 0.02) also improved significantly after surgery. However, there were only trends towards broader motor function gains measured by the GMFM66 (p = 0.39). ConclusionsSEMLS effectively improved key gait and mobility parameters in children and adolescents with CP, and was not affected by younger or older surgical ages (<12 years old or 12−18 years old). However, these gait improvements do not uniformly translate into broader motor function gains.

Plant-derived cannabinoids for treatment of spasticity in children and adolescents with severe cerebral palsy: Double-blind, placebo-controlled trial

BackgroundTo assess the efficacy, safety, and tolerability of full-spectrum cannabis oil (FSCO) (CBD:THC ratio of 10:1) for the treatment of spasticity in individuals with spastic cerebral palsy (CP) grades IV and V. MethodA pilot trial to assess the feasibility of FSCO in seven CP patients was followed by a prospective double-blind, placebo-controlled parallel trial, with 53 participants aged 5–25 years, randomised in a 1:1 ratio. The double-blind phase lasted six weeks, followed by the open-label phase of six weeks’ duration. The primary endpoint was a change in spasticity measured by the modified Ashworth Scale. Secondary outcomes were changes in motor function (Gross Motor Function Measure 88 scale), quality of life, safety, and tolerability. ResultsThere was no significant difference in spasticity, motor function, and quality of life parameters between patients receiving FSCO or placebo. Patients in the FSCO group were significantly drowsier compared to the placebo group. Adverse events were mild to moderate; there were no life-threatening events. InterpretationThis trial suggests FSCO treatment in children with CP is generally well tolerated and safe. It might have benefits on quality of life. No significant change in spasticity was demonstrated with FSCO treatment compared to the placebo.

Risdiplam: therapeutic effects and tolerability in a small cohort of 6 adult type 2 and type 3 SMA patients

BackgroundRisdiplam is a validated treatment for adult SMA patients, but clear guidelines concerning functional assessment at baseline and during the follow-up are still limited, especially in terms of sensible and validated outcome measures able to capture minimal changes in motor performances induced by therapy. The aim of this work is to describe the effect of Risdiplam on a cohort of 6 adult type 2 and type 3 SMA patients, using Motor Function Measure (MFM32) as a standardized scaleto quantify the motor improvements induced by therapy.ResultsRisdiplam at the dose of 5 mg/daily was administered to a population of 6 (4 F;2 M) type 2 (N = 4) and type 3 (N = 2), adult SMA patients. Two patients were previously treated by Nusinersen, later suspended due to side effects. At baseline, all patients received a neuromuscular evaluation and a MFM32 assessment. After the beginning of treatment, we evaluated MFM32, patient reported outcomes (PROs), and adverse events over 7–27 months of follow-up. The MFM32 showed an increased score ranging from + 2.16% to + 7.29% in 4 patients. The improvement was maintained overtime, with two patients presenting the longest follow-up period of 24 and 27 months respectively. Subdomain D3 was ameliorated in 66.6% of patients. Two patients previously treated with Nusinersen maintained the pre-Risdiplam scores. The HFMSE was also performed and failed to show significant improvements after treatment. All patients reported subjective ameliorations. The commonest PROs were improvements in breath fatigue, voice’s intelligibility, hand strength and dexterity. Adverse effects were mild and decreased over time.ConclusionsRisdiplam is a well-tolerated treatment in our cohort of adult type 2 and type 3 SMA patients and resulted in improvement or stabilization in motor functions. MFM32 proved to be sensitive to detect changes induced by therapy. Subjective meaningful improvements were sustained overtime especially in bulbar functions, breath fatigue and distal motor abilities.

Combinations of Independent Motor Functional Independence Measure Items Associated With Home Discharge in Stroke Patients in Post-acute Rehabilitation Wards: An UpSet Plot Analysis.

Objectives Home discharge is a crucial goal for stroke patients in convalescent rehabilitation wards. While previous studies have identified relationships between Functional Independence Measure (FIM) scores and home discharge outcomes using conventional statistical methods, these analyses have limitations in visualizing combinations of independent FIM items. This study aimed to identify combinations of independent motor FIM items associated with home discharge in stroke patients using UpSet plots. Methods We analyzed 205 stroke patients admitted to a convalescent rehabilitation ward between April 2018 and March 2021. Independence in motor FIM items was defined as a score of 6 or higher. We used UpSet plots to visualize combinations of independent motor FIM items at discharge and identified major combinations (occurring in >7% of cases) in the home discharge group. Results Among 136 patients discharged to home, four major combinations of independent motor FIM items were identified: independence in all 13 items (22 patients, or 16.2%), independence in 12 items excluding stairs (18 patients, or 13.2%), independence in 10 items excluding bathing, tub transfer, and stairs (14 patients, or 10.3%), and dependence in all items (11 patients, or 8.1%). These combinations accounted for 47.8% of home discharge cases. Conclusions The visual analysis using UpSet plots revealed that, while higher levels of activities of daily living (ADL) independence increased the likelihood of home discharge, complete independence was not required. Dependence on specific items, such as bathing, tub transfer, and stairs, could be compensated through care services and environmental modifications. These findings provide practical insights for developing rehabilitation strategies and discharge planning.