Neurological Rehabilitation Research Articles

Characterization, outcomes and time to event predictors of urinary tract infections acquired during post-acute stroke inpatient rehabilitation: A comprehensive cohort study

ObjectivesTo i) compare baseline clinical and demographic characteristics of post-acute stroke inpatients who were diagnosed with first-time urinary tract infection (UTI) vs inpatients who were not ii) compare rehabilitation outcomes between both groups and iii) examine associations between time to UTI event and risk factors. DesignRetrospective observational cohort study SettingInstitution for inpatient neurological rehabilitation. ParticipantsInpatients (n=1683) admitted within 3 months post-stroke to a rehabilitation facility between 2005 and 2023. InterventionsNot applicable. Main Outcome MeasuresFunctional Independence Measure (FIM), Functional Ambulation Categories (FAC) at admission. Cox proportional hazards models analyzed the association between UTI event timing and risk factors. ResultsOf the (n=1683) included patients, 196 (11.6%) experienced a UTI. In 32.1% of cases, the UTI occurred during the first week after admission to rehabilitation and 47.9% of UTIs occurred during the first two weeks. Median (IQR) time to UTI was 16 (5-37) days since admission. Most common germs were Escherichia coli (40.5%), Klebsiella pneumoniae (23.7%) and Pseudomonas aeruginosa (6.4%). Patients who acquired a UTI had older age, higher stroke severity, higher proportion of dysphagia, hypertension, neglect, bilateral affectation, atrial fibrillation, hemiplegia, lower levels of functional independence and lower FAC. We identified no differences in sex, type of stroke (ischemic or hemorrhagic), time to admission, aphasia, diabetes, dyslipidemia, chronic obstructive pulmonary disease, dominant side affected and educational level between both groups. Patients with UTI presented significantly poorer rehabilitation outcomes including lower discharge FIM and FAC, larger LOS, lower FIM efficiency and decreased FIM effectiveness.Multivariable Cox proportional hazards identified hypertension HR=1.60(1.13-2.27), admission FIM HR=0.98(0.97-0.99), admission BMI HR=0.96(0.93-0.99) and admitted with catheter HR= 1.80(1.22-2.64) as significant predictors of time to first UTI event (Concordance-index = 0.754). ConclusionsUTIs identification, characterization, and predictive factors can support post-acute stroke mitigation strategies to minimize UTI-related complications and optimize rehabilitation outcomes.

Codesign of a Neurological Physiotherapy Student-Led Clinic With Students and Patients: An Exploratory Qualitative Study.

This study explores students' and patients' views of a UK physical therapy student-led clinic (SLC) for neurological rehabilitation and, using a codesign approach, it proposes an optimal design of a physical therapy SLC for neurological rehabilitation for patient participation and student learning. There is a paucity of literature examining experiences of neurological rehabilitation SLCs. Although research supports the utilization of codesign methodologies with patients and for curriculum development, there remains a gap regarding its application to SLCs in physical therapy for individuals with neurological conditions. Convenience sampling was used to recruit 4 patient and 4 student participants to take part in the study. This qualitative study employed exploratory codesign based on the participatory action research approach. Three online codesign workshops were facilitated by the research team. Thematic analysis of each workshop informed the outline for the next. Patients perceived that the SLC improved their overall well-being, and they highly valued being able to access rehabilitation. Students reported that they developed a range of clinical skills through participation in the SLC but would have liked a more in-depth orientation. The codesign process identified 5 key elements for the optimal design of the physical therapy neurological SLC: student support, continuity, supervision, peer-assisted learning, and orientation. Findings suggest that the SLC provides both a quality learning experience and a patient service, which is safe, effective, and sustainable. Future research should be undertaken with different stages of students and in different university settings. The codesign approach has been shown to be feasible for students and patients and could be used across other aspects of curriculum design. This novel study using codesign methodology provides initial findings of key elements to optimize SLCs in neurological physical therapy, to enhance student learning and patient experience.

Barriers and facilitators to conducting randomised controlled trials within routine care of neurorehabilitation centres: a qualitative study

BackgroundRandomised controlled trials (RCTs) are considered the gold standard for generating clinical evidence. The focus on high internal validity in RCTs challenges the external validity and generalisability of findings, potentially hindering their application in routine care. In neurorehabilitation, limited literature addresses conducting RCTs feasibly and efficiently. We investigated barriers and facilitators to conducting RCTs within routine care of neurorehabilitation centres from the perspective of stakeholders in neurorehabilitation in Germany and Austria.MethodsWe conducted semi-structured interviews with stakeholders in neurorehabilitation from four centres in Germany and Austria, informed by the Theoretical Domains Framework (TDF) and the Capability, Opportunity, Motivation and Behaviour model (COM-B). Employing a hybrid approach, the interview analysis integrated both deductive, theory-driven analysis based on the TDF domains and COM-B model and inductive, reflexive thematic analysis.ResultsTwelve stakeholders (4 physicians, 4 therapy managers, 4 therapists; 5 females, 7 males; with research experience spanning 0–40 years) were interviewed. Key barriers to conducting RCTs in neurological rehabilitation centres include limited financial, human, and time resources, high clinical workloads, and a lack of interest of some therapists. Ineffective leadership, perceived lack of research expertise, and communication issues were also significant barriers. Social influence factors such as lack of employer support and inadequate training access further contributed to the challenges. Additionally, barriers included insufficient research infrastructure, limited space, internal power struggles, and rigid cost bearer specifications. Key facilitators included physicians’ and therapists’ motivation to advance the field, contribute to knowledge, and to prioritise patient health. Support from supervisors, joint decision-making, and efficient organisation were crucial facilitators. Flexible therapy planning, mutual support, and interdisciplinary collaboration also played important roles.ConclusionOur results suggest that increasing professional development and understanding, along with providing adequate financial, human, time, and spatial resources to support research endeavours, implementing effective communication strategies to enhance interdisciplinary collaboration and coordination among team members may contribute to increased motivation and facilitate RCTs within the setting of neurorehabilitation centres.Trial registrationThis study was prospectively registered with the German Clinical Trials Register (08.04.2021 DRKSID DRKS00024982).

The meaning of organizational culture and structure for interprofessional collaboration

Abstract In Germany, early neurological rehabilitation (ENR) acts as a link between acute inpatient care and rehabilitation, aiming to restore patients’ ability to rehabilitate amid their complex clinical conditions. Interprofessional cooperation (IPC) is crucial for harmonized treatment due to patients’ vulnerability. An interprofessional team comprising medical, nursing, and various therapy professionals is essential for this purpose. To explore the meaning of organizational culture and structure to IPC, 15 group discussions in 5 clinics were conducted with n = 76 participants. 1. Weekly team meetings are used to coordinate treatment goals and outcomes, but their implementation varies from clinic to clinic. Two types of meetings were identified: those that focus primarily on billing compliance and others that address patients’ long-term perspectives. However, both require additional social service involvement and are not sufficient to adequately address daily tasks, requiring additional IPC coordination. Some clinics have therefore introduced daily meetings to improve the coordination of IPC tasks. 2. Therapy planning and therapist assignment shape IPC and task fulfillment. Three therapy planning methods were observed: centralized, block-based, and flexible, each with different therapist allocation strategies. Centralized planning with flexible allocation leads to appointment pressure and interprofessional communication challenges. Block therapy reduces therapist turnover and promotes better interprofessional coordination in patient care. Flexible therapy planning is conducted through daily interprofessional meetings with shared task allocation and planning leads to a shared understanding. Initial analysis underscores the meaning of organizational structure on interprofessional task fulfillment in ENR, emphasizing the importance of enhancing different cooperation formats which can balance stability and flexibility and integrate social services effectively in patientcare. Key messages • Morning interprofessional meetings on the ward facilitate flexible responses to daily changes in patients’ health conditions and promote interprofessional collaboration. • The consideration of occupational group-specific processes in ward organization is a necessary structural prerequisite for successful interprofessional collaboration.

Cognitive recovery of post critical care patients with and without COVID-19: differences and similarities, an observational study

BackgroundCoronavirus disease (COVID-19) patients treated in an intensive care unit (ICU) are at high risk of developing cognitive impairments of a “post-intensive care syndrome” (PICS). We explored whether critically ill COVID-19 and non-COVID-19 survivors differ in their post-ICU recovery course in terms of severity and affected cognitive domains.MethodsAn observational prospective study was conducted in a German post-acute neurological early rehabilitation clinic. Critically ill patients with or without SARS-CoV-2 infection (at least mechanically ventilated for one week) underwent repeated standardized assessments during their subsequent inpatient rehabilitation stay. Cognitive functions (information processing speed, learning, recognition, short-term and working-memory, word fluency, flexibility) assigned to different domains (attention, memory, executive functions) were assessed as primary outcome. Secondary outcomes included mental (depression, anxiety) and physical (Barthel index, modified ranking scale) state.ResultsOut of 92 eligible patients (screened between June 2021 and August 2023), 34 were examined, and 30 were available for analysis (15 per group). Both groups were ventilated for a similar period (COVID-19 vs. Non-COVID-19: median: 48 vs. 53 days). Patients of COVID-19 group spend on average 10 days longer at ICU and developed slightly more complications, but subsequent inpatient rehabilitation was of comparable duration (median: 36.5 vs. 37 days). On the group-level both groups showed similar cognitive dysfunctions with striking impairments (normative T-scores < 41) in information processing speed, word fluency, flexibility, and recognition memory on admission. Significant gains until discharge were only revealed for information processing speed in both groups (main effect visit, mean difference [95%CI] − 7.5 [− 13.1, − 2.0]). Physical and mental state were also similarly affected in both groups on admission, but improved over time, indicating that overall recovery for higher-order cognitive functions is slowest. Interestingly, majority of patients stated correctly being still physically disabled, while a discrepancy was found between subjective and objective evaluation of cognitive health.ConclusionsResults suggest a substantial overlap of cognitive, mental and physical dysfunction in post-acute recovery of ICU survivors independent of SARS-CoV-2 infection which warrants further monitoring to reduce the risk of long-term burden and enable a return to previous functionality.Trial registrationRetrospectively registered at https://drks.de/search/de/trial/DRKS00025523, 21.06.2021.

Transforming lives in autism spectrum disorder treatment through acupuncture: A case report

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social communication, restricted and repetitive behaviors, and narrow interests. Given the high prevalence of ASD and the lack of specific pharmacological treatments, there is a pressing need for alternative therapeutic approaches. Acupuncture has shown promise in improving the clinical symptoms of ASD. This report presents the case of a 6-year-old girl diagnosed with ASD, intellectual developmental disorder, attention deficit hyperactivity disorder, and articulation disorder. She underwent Liu&amp;rsquo;s pediatric neurological rehabilitation acupuncture therapy (PNRAT) for over 2 years. The treatment involved specific scalp acupuncture techniques targeting cognitive and linguistic rehabilitation. After the treatment course, the patient showed significant improvements in cognitive, linguistic, social, and behavioral symptoms, transitioning from limited verbal communication and marked social difficulties to thriving in a mainstream school setting. This case highlights the potential of Liu&amp;rsquo;s PNRAT as an effective intervention for ASD. The observed improvements suggest that acupuncture may offer valuable therapeutic benefits for children with ASD, contributing to the growing interest in its potential as an adjunct therapy. Further research is needed to optimize treatment protocols and explore synergies with conventional therapies.

Heart rate variability biofeedback for critical illness polyneuropathy: a randomized sham-controlled study.

Critical illness polyneuropathy (CIP) has been linked to neurocardiac dysfunction mediated by autonomic nervous system dysregulation, which increases mortality. We aimed to assess if heart rate variability (HRV) biofeedback could improve neurocardiac function in CIP. We randomly allocated (1:1) patients with electrophysiologically confirmed CIP undergoing early inpatient neurological rehabilitation to additional HRV or sham biofeedback over 14 days. We evaluated neurocardiac function via standard deviation of normal-to-normal intervals (SDNN) as the primary outcome, as well as HRV frequency domains, sympathetic cutaneous sudomotor and vasomotor functions and disability at baseline, post intervention and 4 weeks later. The study is registered on the German Clinical Trials Register (DRKS00028911). We included 30 patients with CIP (40% females, median [interquartile range] age 64.6 [56, 72] years). We observed an increase in SDNN and the predominantly parasympathetic high frequency domain post intervention (ß = 16.4, 95% confidence interval [CI] 0.2, 32.6 [p = 0.047] and ß = 1179.2, 95% CI 119.9, 2158.5 [p = 0.018]), which was sustained at the 4-week follow-up (ß = 25.7, 95% CI 6.0, 45.4 [p = 0.011] and ß = 25.7, 95% CI 6.0, 45.4 [p = 0.011]). Patients who underwent HRV biofeedback displayed a higher adjusted Barthel index, indicating less severe disability 4 weeks after the intervention compared to those in the sham group (ß = 23.3, 95% CI 5.5, 41.1 [p = 0.014]). Low frequency and sympathetic skin functions did not differ between groups (p = nonsignificant). Our study provides pilot data suggesting that, in patients with CIP, HRV biofeedback can improve neurocardiac function with a predominant effect on the parasympathetic nervous system and has a beneficial effect on functional recovery.

INTEGRATING ALLIED HEALTH PROFESSIONALS DURING THE ONCOLOGICAL TREATMENT PHASE FOR GLIOBLASTOMA PATIENTS: A CASE STUDY AT A UK CANCER CENTRE

Abstract AIMS Primary brain tumour patients should be offered neurological rehabilitation assessment at diagnosis and every stage of follow With only 5% of glioblastoma patients surviving more than 5 years, specialist management that spans across all phases of the Dietz rehabilitation model is required to optimise function, treatment tolerance and Quality-of-life. At Guy’s cancer centre an Allied health multi-disciplinary team (Physiotherapy, Occupational therapy and Speech and language therapy) work alongside the oncologist-led clinic to support this patient group. METHOD Case history A 54-year-old, male, was diagnosed with right parietal Glioblastoma, WHO grade 4, IDH wildtype, MGMT 5.47% methylated (August 2023) on biopsy only. He underwent chemo/radiotherapy - 60gy/90 fractions with Temozolmide (TMZ) on 3/11/2023 Currently C4 of adjuvant TMZ. Dexamethazone 2mg was discontinued on 29/11/2023, he continues with Keppra 500mg twice daily. RESULTS Dietz Intervention approach in phases: PREVENTATIVE Fatigue management was introduced prior to radiotherapy including a physical activity review, advice on pacing, sleep hygiene and relaxation techniques. Given the patient’s history of shift work and altered sleep patterns, managing risks of treatment-related fatigue was of particular importance. Restorative &amp; Supportive: A targeted and periodised exercise programme was initiated, comprising 1:1 gym based physiotherapy sessions. The aims included enhancing exercise confidence, improve balance, endurance, maintain strength, pain management and weight maintenance during chemo/radiotherapy and adjuvant TMZ. Education was deployed on adjusting activity levels based on chemotherapy cycle and day to day side effects, alongside ongoing fatigue management advice around pacing and sleep hygiene. CONCLUSION Learning and Recommendations Implementing tailored rehabilitation interventions early in the patient’s treatment pathway, enables proactive management to mitigate the impact of treatment-related side effects on their QOL. Based on our experience, early engagement with a dedicated therapy team is recommended to foster strong rapport with both the patient and their caregivers. This facilitates timely rehabilitation planning for optimal outcomes.

Assessment of wearable robotics performance in patients with neurological conditions.

While wearable robotics is expanding within clinical settings, particularly for neurological rehabilitation, there is still a lack of consensus on how to effectively assess the performance of these devices. This review focuses on the most common metrics, whose selection and design are crucial for optimizing treatment outcomes and potentially improve the standard care. The literature reveals that while wearable robots are equipped with various embedded sensors, most studies still rely on traditional, nontechnological methods for assessment. Recent studies have shown that, although quantitative data from embedded sensors are available (e.g., kinematics), these are underutilized in favor of qualitative assessments. A trend toward integrating automatic assessments from the devices themselves is emerging, with a few notable studies pioneering this approach. Our analysis suggests a critical need for developing standardized metrics that leverage the data from embedded sensors in wearable robots. This shift could enhance the accuracy of patient assessments and the effectiveness of rehabilitation strategies, ultimately leading to better patient outcomes in neurological rehabilitation.

Narrative Review of the Theoretical-Methodological Foundations of the TREINI Program.

Scientific knowledge has advanced in the implementation of safe and beneficial interventions for children and adolescents with cerebral palsy (CP). Although the importance of interdisciplinary interventions that integrate all components of the International Classification of Functioning, Disability and Health (ICF) into family-centered practices is widely recognized, this approach is not yet widely adopted. Instead, many programs remain focused on isolated domains. This study presents the theoretical and methodological foundation of TREINI, an interdisciplinary and family-centered program developed for children and youth with CP and other neurodevelopmental disorders. TREINI incorporates intervention strategies that address all ICF domains. It is grounded in the biopsychosocial model of health and utilizes principles based on the best evidence in pediatric rehabilitation, including intensive training, task-oriented training, and a naturalistic learning environment. Unlike traditional rehabilitation approaches, the care provided by the TREINI program is delivered through an intensive and interdisciplinary approach, by a team working collaboratively in a single location. In addition to including evidence-based interventions, the TREINI program features two innovative components: the "City of Tomorrow", a naturalistic learning environment, and the "TREINI Exoflex" therapeutic suit, specifically designed to address deficiencies in the body functions and structures of children with CP and other neurodevelopmental disorders. This program has been carefully designed to support the process of neurological re-education and rehabilitation for children and adolescents with neuropsychomotor developmental delays.

Mobilization with movement is effective for improving ankle range of motion and walking ability in individuals after stroke: A systematic review with meta-analysis.

Mobilization with movement has been recommended to improve foot mobility in people with ankle impairments and could improve walking after stroke. To examine the effects of the addition of mobilization with movement to commonly used exercises in physiotherapy for improving ankle range of motion and walking in people who have had a stroke. Systematic review of randomized controlled trials. Not applicable. Ambulatory adults at any time after stroke. The experimental intervention was exercises plus ankle mobilization with movement, in comparison with exercises alone. Ankle range of motion. Walking parameters (ie., walking speed, cadence, step length). Six trials, involving 160 participants, were included. The mean PEDro score of the trials was 6 (range 4 to 7). Mobilization with movement in addition to exercises improved range of motion by 4° (95% CI 2 to 6), walking speed by 0.08 m/s (95% CI 0.05 to 0.11), cadence by 9 steps/min (95% CI 7 to 12), and step length by 5 cm (95% CI 3 to 7) more than exercises alone. The quality of evidence was low for range of motion and moderate for walking outcomes. This systematic review provided evidence that the addition of mobilization with movement to commonly used exercises in neurological rehabilitation increases ankle dorsiflexion, and benefits are carried over to improving walking speed, cadence, and step length in moderately disabled individuals with chronic stroke. PROSPERO (CRD42023405130).

Assessing the Reliability of OpenCap and OpenSim as Open Source Softwares for Biomechanical Analysis in Neurological Rehabilitation: A Case Study

The neurological rehabilitation focuses on enhancing functional recovery and improving the quality of life for people who have experienced injuries or diseases affecting the central or peripheral nervous system. This functional recovery includes a follow up of the kinematics of the patients limbs. The use of a open source software such as OpenSim, has been previously proposed as a tool for kinematic analysis, this software allows for highly specialized 3D musculoskeletal modeling, facilitates kinematic analysis and the assessment of force and angles in the lower and upper limbs of the human body. In this context, the propose of this research was to test the reliability of OpenSim for kinematic analysis during neurological rehabilitation. For this goal, the Motricity Index test was done by a group of three healthy participants, this values were used for comparison to the stroke patient who is currently undergoing neurological rehabilitation process. The results demonstrates all the limitations in the range of motion of the patient in comparison to the healthy group due his motor issues, such as muscle spasticity and weakness. This research shows the advantages and limitations of this software and its application in neurological rehabilitation. The goal is to contribute to the development of effective and personalized therapeutic strategies to improve the recovery process for these patients.

Patient experiences of a student-led physiotherapy neurological rehabilitation clinic: a mixed methods study

Background: Student-led clinics (SLCs) are becoming increasingly prevalent across allied health professions curricula; however, little is known about patient experiences of these clinics. This study explored the experiences of patients attending a physiotherapy neurological rehabilitation SLC. Methods: This study utilized a sequential explanatory mixed methods approach focusing on people with neurological conditions who voluntarily attended a SLC of 12 weeks duration. The data collection process was initiated following the conclusion of the final SLC session. The methodology employed a survey followed by semi-structured interviews to explore emerging areas in more depth. Interview data were descriptively analyzed, and reflexive thematic analysis guided the analysis of the interview data. Results: Twelve participants completed the survey, and seven also participated in a semi-structured interview. Overall, patients were very satisfied with the service received at the SLC. Three themes were identified from the interview data: patients’ perceptions of the benefits and impact of the SLC; the importance of individualized care, and patients' preferences for SLC delivery. Discussion: The findings of this study indicate that participants perceived this SLC positively in relation to care quality, student skills, and individualized rehabilitation. This suggests that SLCs of this type may potentially be acceptable and applicable across different settings, student groups, and possibly for those living with other health conditions. Future research should investigate patient experiences of SLCs with larger sample sizes, different student cohorts, stages, and patient groups and establish the effectiveness of patient clinical outcomes.

Investigate the Principles and Applications of Task-Specific Training in Neuro-Physiotherapy Rehabilitation

In India, the third leading cause of mortality is a neurological damage known as a stroke, which happens when blood flow to the brain is interrupted. Disabilities in the hands and legs are among the most prevalent effects of stroke on humans. Exercise and rehabilitation are crucial in the healing process after a stroke. While there are a variety of exercises that may help with stroke management, job specific training is a typical recommendation. Proprioceptive Neuromuscular facilitation (PNF) is another prominent approach utilised in Proprioceptive Neuromuscular facilitation (PNF). Evidence for the efficacy of task-specific training in neurological rehabilitation is growing. Stroke patients' quality of life was the primary outcome of this research, which sought to identify the impact of an ICF model-based exercise programme that was both task- and context-based. Mann Whitney U test, intention to treat analysis, and repeated measures ANOVA with generalised estimating equations using the log link function was used to analyse the data. Patients were surveyed in a more casual setting to assess feasibility. Patients' reports of pleasure, their level of adherence to the exercise programme, and the absence of adverse events all pointed to the program's viability. Stroke patients living in the community may have benefited more from an exercise programme that focused on the structure/function, activity, and involvement domains of the ICF than from traditional physiotherapy, according to one research. So, it's clear that while creating an intervention, it's important to concentrate on all of the ICF domains. Stroke patients were able to benefit from a fitness programme that was both task and context driven.

Robotic exoskeleton-assisted gait training in patients with motor incomplete myelopathy

Objectives: To assess the effect of gait training with robotic exoskeleton-assisted rehabilitation systems on gait parameters, balance, and overall disability in motor incomplete myelopathy. Design: Prospective pre-post study. Setting: Neurological rehabilitation unit in a tertiary university teaching hospital. Participants: Thirty-four motor incomplete myelopathy patients [22 males, mean age 36.7 y (12.7)] were included in this prospective, pre-post study. Twenty-two had nontraumatic etiology, and 17 had tetraplegia. American Spinal Injury Association impairment scale suggested 23 as C and 11 as American Spinal Injury Association impairment scale-D. The mean duration of the lesion was 333 days. Intervention: Twenty-four sessions of robotic gait training (1-h session, 5–6 sessions/wk) for 4–6 weeks. Outcome measures: Gait speed was assessed using a 10-meter walk test (10MWT), endurance with a 2-minute walk test (2MWT) and 6-minute walk test (6MWT), walking ability by Walking Index in Spinal Cord Injury-walking index for spinal cord injury II, functionality using Spinal cord Independence Measure-SCIM III, and balance by Timed-up-and-go (TUG) test. Results: At baseline, 20 patients were nonwalkers-NWB, and 14 were walkers-WB. The walking index for spinal cord injury II and SCIM III suggested significant improvement in both groups by the end of the study (P&lt;0.05). Among the WB group, 10MWT, 2MWT, and TUG showed significant improvement (P=0.004, 0.02, and 0.01, respectively) with training. Patients in NWB group were able to perform 10MWT, 2MWT, 6MWT, and TUG by the end of the study. Conclusions: Gait training with robotic exoskeleton-assisted rehabilitation systems can lead to a significant improvement in gait endurance, speed, balance, and functional outcomes in individuals with incomplete myelopathy. The effect is more pronounced among already ambulatory patients.

Editorial: The role of perceptual manipulations of XR in neurological rehabilitation

Editorial: The role of perceptual manipulations of XR in neurological rehabilitation

NEUROPLASTICIDADE E REABILITAÇÃO NEUROLÓGICA: A INFLUÊNCIA DA ATIVIDADE FÍSICA EM UMA REVISÃO INTEGRATIVA

This study aims to review and synthesize the evidence on the influence of physical activity and cognitive stimulation on neuroplasticity, especially in the context of neurological rehabilitation. The integrative review included relevant scientific articles, analyzing the impact of these interventions on neural reorganization and improvement of cognitive functions in individuals with neurological conditions. The results indicate that regular practice of physical activities and cognitive stimulation are essential to promote neuroplasticity, with studies showing significant improvements in memory, attention and other cognitive aspects in populations affected by neurodegenerative diseases. In addition, physical interventions have shown benefits in regulating the "biological clock" and reaction time, particularly in the elderly. These findings reinforce the importance of integrating physical activities and cognitive stimulation in neurological rehabilitation programs to improve the quality of life of patients and suggest the development of new therapeutic strategies based on these principles.

Introduction to Guitar Techniques and Genres for the Utilization in Improvised Active Music Therapy

Abstract Guitar is a popular instrument for music therapy clinicians and students because it is portable and musically versatile. Guitar training is increasingly shared through music therapy literature, professional conferences, and workshops. However, there is still a lack of literature regarding the use of guitar improvization techniques for beginner and intermediate-level music therapists. The purpose of this manuscript is to provide the first simplified and standardized guitar methodological system for beginner and intermediate-level music therapy students and clinicians for the use in Improvised Active Music Therapy sessions in neurological rehabilitation. Improving guitar skills is important to increase confidence among students and clinicians and to enhance clinical outcomes. The manuscript is divided into two groups of exercises. The first group consists of four exercises with chord progressions. The second group consists of six strumming exercises. The strumming exercises should be combined with the chord progressions in the first group to expand upon the first position and aesthetic qualities. The exercises incorporate extended, chromatic, and suspended chords in Rock &amp; Roll, Blues, Hip-Hop and rap, Reggae, folk, country, Latin American, and Spanish styles in key of E major. The goal is to stimulate the skill of music therapy students and clinicians, and perhaps add some extra motivation and ideas for guitar improvization skills to enhance clinical outcomes.

Side-effect expectations are associated with disability, physical fitness, and somatic symptoms 3 months after post-COVID neurological inpatient rehabilitation

IntroductionThe COVID-19 pandemic, caused by SARS-CoV-2, has led to long-term health issues known as post-COVID-19 condition, including fatigue and cognitive disruptions. Despite its recognition as a public health concern, the efficacy of therapeutic interventions, especially in neurological rehabilitation, remains unclear. This study examines how treatment expectations are associated with psychological and physical outcomes in post-COVID-19 condition neurological rehabilitation. MethodsIn an observational cohort study 61 patients with confirmed post-COVID-19 condition were included. Baseline (T0) data on treatment and side effect expectations were collected, before participants underwent a 4–6 week multidisciplinary rehabilitation program. Primary outcome was illness-related disability (Pain Disability Index). Secondary outcomes included depressive symptoms (PHQ-9), anxiety levels (GAD-7), functional status (PCFS), fatigue (CFS), and physical fitness (6MWT). Regression models analyzed the associations of baseline expectations with outcomes at the end of rehabilitation (T1) and three months post-rehabilitation (T2). ResultsAfter adjusting for multiple testing, higher baseline side-effect expectations were associated with greater illness-related disability (β = 0.42, p = 0.007), reduced physical fitness (β = − 0.24, p = 0.04), and more somatic symptoms (β = 0.33, p = 0.006) at follow-up (T2). Positive treatment expectations were associated with poorer functional status (β = 0.35, p = 0.011) at T2. ConclusionThis study highlights the associations of side-effect expectations with post-COVID-19 condition rehabilitation outcomes. Higher side-effect expectations were associated to poorer outcomes, indicating a nocebo effect. Surprisingly, positive expectations were linked to worse outcomes, possibly due to unrealistic optimism. Managing patient expectations realistically and addressing side-effect concerns seems crucial for optimizing rehabilitation outcomes.

Opportunities, Risks, Strengths and Weaknesses of Robotic Systems in Early Neurological Rehabilitation.

Given the conference's focus on innovative healthcare solutions, our investigation into robotic assistance systems highlights crucial advancements in early motor rehabilitation, aligning closely with emerging healthcare priorities. In combination with conventional therapy, the assistance systems offer new possible therapy programs. They can be used to mobilize and move patients as early as possible. The paper discusses the possibilities that arise from their use and considers the obstacles that arise. As part of a qualitative survey, nine expert interviews from different fields were conducted to guide them on robotic assisted living systems. The results obtained were summarized by coding into categories and evaluated. Our analysis of 148 coding points from nine expert interviews reveals significant insights into the strengths and weaknesses of robotic systems in neurorehabilitation. Each point was meticulously categorized to reflect its impact on both practice and patient outcomes, highlighting the practical implications of our findings. The results of the survey and the literature indicate a positive effect of robotic assistance systems in early rehabilitation. Their use requires intensive monitoring and studies on the long-term application of the systems.