Neurorehabilitation Center Research Articles

Clinical novel exploration of intractable fever in stroke rehabilitation: a single-center cross-sectional retrospective study

Fever has long been recognized as one of the earliest clinical indicators of illness and remains a leading reason for seeking medical care worldwide. It is typically classified based on its duration and underlying etiology. In clinical settings, intractable fever is as common as acute fever, particularly in patients with brain injuries. Beyond infectious causes, stroke survivors often experience recurrent intractable fever due to central or neurogenic mechanisms. This study aims to retrospectively investigate the incidence and clinical characteristics of acute and intractable fever in patients undergoing stroke rehabilitation. It explores the associations between these characteristics and the different types of fever. Additionally, the study seeks to identify potential risk factors contributing to the development of intractable fever, aiming to guide clinical management and optimize treatment strategies for stroke-related fever. This study evaluated 1,065 stroke patients in the rehabilitation phase who were admitted to the Neurorehabilitation Center between January 1, 2023, and December 31, 2023. Of these, 230 febrile patients met the inclusion criteria and were included in the analysis, comprising 194 cases of acute fever and 36 cases of intractable fever. Medical records and clinical characteristics were collected, and the data from the two groups of febrile patients were analyzed using t-tests, Mann-Whitney U tests, and chi-square tests. Logistic regression analysis was performed to identify risk factors associated with intractable fever, while receiver operating characteristic (ROC) curves were used to assess the predictive performance of individual and combined risk factors. A p-value of less than 0.05 was considered statistically significant. 15.7% of patients experienced intractable fever, which was significantly associated with brainstem lesions (P < 0.05). Compared to patients with acute fever, those with intractable fever had higher NIHSS scores (33.3% vs. 15.5%, P < 0.05), a greater incidence of consciousness disorders (66.7% vs. 28.9%, P < 0.05), and a higher rate of tracheostomy (55.6% vs. 15.5%, P < 0.05). All patients received antibiotic treatment, and gabapentin was administered to 16 cases. Patients with brainstem lesions were less likely to be treated with gabapentin (37.5% vs. 90%, P < 0.05), while those with intracerebral hemorrhage were more likely to receive gabapentin (87.5% vs. 10%, P < 0.05). Logistic regression analysis revealed that consciousness disorders and tracheostomy status were significant risk factors for intractable fever (P = 0.047, OR 6.691, 95% CI 1.030–43.478; P = 0.021, OR 5.366, 95% CI 1.282–22.465). Brainstem lesions also significantly increased the risk (P = 0.002, OR 9.617, 95% CI 2.277–40.614). Although limited in scope, this retrospective study highlights the increased risk of intractable fever during stroke rehabilitation among patients with consciousness disorders, tracheostomy, and brainstem injuries. The key risk factors identified include higher NIHSS scores, impaired consciousness, tracheostomy status, and brainstem lesions.

Assessing the fall risk with Stay Independent Questionnaire in people with stroke.

This study aimed to assess the psychometric properties of the Chinese version of the Stay Independent Questionnaire (C-SIQ) in evaluating individuals with stroke. The study adopted a cross-sectional design. The research was conducted at a university-based neurorehabilitation center. The study included a total of 100 individuals with stroke and 49 healthy older adults. On Day 1, both individuals with stroke and healthy older adults underwent assessments using the C-SIQ. Additionally, individuals with stroke were evaluated using the Fugl-Meyer Assessment of Lower Extremity (FMA-LE), ankle dorsiflexion and plantarflexion strength, Berg Balance Scale (BBS), Timed-Up and Go Test (TUG), 10-meter walk test (10 mWT), Activities-specific Balance Confidence (ABC) Scale, Stroke Impact Scale (SIS), and Community Integration Measure (CIM). On Day 2 (7 days after Day 1), individuals with stroke were reassessed using the C-SIQ. Individuals with stroke exhibited a higher C-SIQ score (6.22 ± 2.98) compared to healthy older adults (1.59 ± 2.01). The C-SIQ demonstrated good test-retest reliability (intraclass correlation coefficient = 0.847) and internal consistency (Cronbach's alpha = 0.709). The Minimal Detectable Change in C-SIQ score was calculated as 3.05. Exploratory factor analysis revealed four factors with eigenvalues ≥1.0, explaining 57.17% of the total variance. The C-SIQ score exhibited significant correlations (ranging from -0.553 to 0.362) with completion times of the TUG and 10 mWT, FMA-LE, BBS, ABC, SIS, CIM score, paretic ankle dorsiflexion strength, and 6 mWT distance. A cut-off score of 2.5 was identified as the optimal threshold for discriminating fall risk between individuals with stroke and healthy controls. The C-SIQ emerges as a reliable and valid tool for evaluating fall risk in individuals with stroke, showcasing strong correlations with key measures such as TUG times, 10 mWT, FMA-LE, BBS, ABC, SIS, CIM score, paretic ankle dorsiflexion strength, and 6 mWT distance. The C-SIQ demonstrated good test-retest reliability and internal consistency. Exploratory factor analysis revealed that this is a four factors assessment tool. The identified cut-off score of 2.5 effectively distinguishes fall risk between individuals with stroke and healthy controls.

Application of Multidomain Cognitive Training in a Tele-Neurorehabilitation Setting for Treatment of Post-Stroke Cognitive Disorders.

Cognitive dysfunctions are still very common in the chronic phase of stroke when patients are discharged from neurorehabilitation centers. Even individuals who appear to have made a full clinical recovery may exhibit new deficiencies at home. Here, we present evidence of a novel kind of therapy at home aimed at contrasting the heterogenic evolution of stroke patients using a multidomain cognitive approach. Eighteen ischemic stroke patients were assessed in a within-subject longitudinal design (age 62.33 ± 11.1 years; eight men). Patients underwent the Tele-NeuroRehabilitation (TNR) multidomain cognitive training treatment using the Virtual Reality Rehabilitation System (VRRS) five times a week for 1 h sessions for four consecutive weeks. The protocol included the stimulation of specific cognitive functions, such as logical skills, praxis skills, attention, executive functions, memory, space time orientation and perception, and speech therapy. To determine neuropsychological changes, patients were evaluated before the sessions (T0), at the end of the sessions (T1), and after six months (T2). The multidomain cognitive training induced a significant improvement in the working memory and language abilities as well as depression symptoms and alleviated caregiver burden. Most of this cognitive enhancement persisted after six months (T2), with the exception of depression symptoms. Otherwise, a significant decline in attention abilities was reported, thus demonstrating a lack of effect in this function. Our results suggest that multidomain cognitive TNR is a suitable protocol for reducing some cognitive and behavioral alterations in patients with strokes, with a beneficial impact also on the caregivers' burden distress management. Further RCTs are warranted to validate this new kind of approach.

“More than effort, it’s dedicating time and perseverance.” experiences of physical activity and physical exercise in stroke survivor with high functional capacity: a qualitative study

Background Stroke survivors exhibit sedentary behavior, and many do not engage in physical activity and exercise for a number of reasons. Secondary prevention through physical activity is a priority to avoid a new stroke or disease. Objective To describe the experience of stroke survivors with maintained walking ability living in Spain regarding physical activity and exercise. Methods A qualitative phenomenological study was conducted. Purposive sampling was carried out to include 35 stroke survivors who had stroke more than 6 months ago from 14 neurorehabilitation centers in 24 cities in Spain. Data were collected through semi-structured interviews and researchers’ field notes. The Giorgi approach was used for the qualitative analysis of the data collected. Results Three themes emerged: a) Changes in the experience of physical activity and exercise adaptation; b) Reasons for and against the practice of physical activity and exercise; c) Experiencing tiredness and fatigue. Conclusions Our results show the individual post-stroke perception of each person, the reasons for and against the practice of physical activity and exercise, as well as the impact this has on their daily life and activity. These results will help health professionals to understand the needs of stroke survivors when prescribing physical activity and exercise included in intervention programs.

Longitudinal Goal Attainment With Repeat Injections of AbobotulinumtoxinA in Adults With Lower Limb Spasticity: Results From a Prospective Observational Study

ObjectiveTo assess longitudinal goal attainment with repeat abobotulinumtoxinA (AboBoNT-A) injections for lower limb spasticity (LLS) over 16 months. DesignProspective, longitudinal, international, multicenter, observational study (NCT04050527). SettingSpecialist neurorehabilitation centers. ParticipantsAmbulatory adults with unilateral LLS able to take ≥5 steps with/without assistance (effectiveness population, N=384). InterventionsParticipants received ≥1 AboBoNT-A treatment cycle administered in accordance with local prescribing guidelines to achieve individualized treatment goals. Main Outcome MeasuresThe primary endpoint was goal attainment as assessed using the cumulated Goal Attainment Scaling-Leg (GAS-leg) T score, across all treatment cycles for each patient. ResultsOverall, participants underwent a median of 5 lower limb injection cycles (median dose 600U, range 100-1475U) with a mean±SD injection interval of 18.3±6.1 weeks. Participants generally achieved their goals as expected over repeated cycles; the mean (95% CI) GAS-leg T score at cycle 1 baseline was 38.0 (37.7, 38.3) and the mean cumulated GAS-leg T score at 16 months was 48.2 (47.4, 48.9) (mean change from a baseline of 9.9 [9.1, 10.7]). Participants injected with a guidance technique at baseline were more likely to attain their cycle 1 primary treatment goals (odds ratio: 1.9 [95% CI 1.1, 3.1], P=.02). Overall, 56 (13.5%) participants reported ≥1 adverse event, of which 6 participants (1.4%) had a treatment-related adverse event. ConclusionsFindings from this large, international study provide evidence for the benefit of repeated cycles of AboBoNT-A for LLS. Multivariate analyses indicated that goal attainment during the first cycle was better with those injected using injection guidance than those injected without guidance.

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).

Survival and clinical characteristics of patients with disorders of consciousness in a developing country between 2002 and 2018

ABSTRACT Objective Describe the survival, sociodemographic and clinical characteristics of subjects with disorders of consciousness in a reference rehabilitation center, in a developing country. Methods Patients with disorders of consciousness (DoC) caused by acquired neurological injuries, admitted between the years 2002–2018 in a neurorehabilitation center. Extracted data covered demographics, clinical details, survival time, and discharge information. Cox proportional hazard model and Kaplan-Meier analysis were used to reveal, associations with survival. Result Out of 5064 neurological cases, 159 patients were diagnosed with DoC. The demographic data showed a male dominance (65%), with an average injury age of 42 years. The most common causes were traumatic (41%), anoxic (36%), and vascular (10%), with traffic accidents accounting for 71% of traumatic injuries. The study found that 75% of patients remained in a vegetative state (VS), and 25% in a minimally conscious state (MCS), with an average survival of 2110 days. Conclusion There were no significant differences in survival days between patients in MCS and VS. Patients with traumatic injuries showed a higher survival rate than those with non-traumatic injuries. Age and etiology were identified as factors associated with a higher risk of death.

THE EFFECT OF THE REHABILITATION AND PHYSICAL THERAPY PROGRAM ON THE FUNCTIONAL STATUS OF POST-STROKE PATIENTS

The article examines the impact of a physical rehabilitation program on the functional state of the musculoskeletal system in elderly patients who have suffered an intracerebral stroke and are in the conditions of a neurorehabilitation center in the early post-stroke period. Before the implementation of the program, post-stroke patients have pronounced walking disorders and a pronounced dependence on external assistance. The aim of the articale is to reveal the effectiveness of the physical rehabilitation program for post-stroke patients in the early recovery period. Results. Features of hemodynamic adaptation in post-stroke patients in the conditions of the rehabilitation center were revealed. Conclusion. As a result of the research, it was found that post-stroke patients had concomitant diseases: chronic heart failure and arterial hypertension in all studied patients, diabetes – in 20% of patients. All these conditions were taken into account during the selection of optimal means of the program physical rehabilitation. After completing the program, patients became more independent and needed less daily assistance, and also mastered such a vital and necessary skill as walking. This is confirmed by tests of functional status (Bartel index, Rivermead) and assessment of independent walking (Hauser walking index). The level of disability according to the Rankin scale decreased by 20%, the Rivermead mobility index increased by 50.6%, the Barthel index of daily activity increased by 13.5%, the Hauser walking index increased by 31.8%, the range of motion in the joints of the limbs also increased, the level of spasticity according to the modified Ashworth scale decreased by 22.5% in the in the upper and lower extremities, the strength according to the MRCS scale increased, in the extremities by 20%. Thus, after completing the rehabilitation program, all patients observed a increase in paretic muscle strength, decreased muscle spasticity tone, and improved range of motion in the joints. Implementation of the physical rehabilitation program resulted in a significant increase in MRCS muscle strength in the limbs by 20% (p &lt; 0.01). After completing the program, patients became more independent and needed less daily assistance, as well as mastered such a vital and necessary skill as walking. This is confirmed by tests of functional status (Bartel index, Rivermead) and assessment of independent walking (Hauser walking index). The level of disability according to the Rankin scale decreased by 20%, the Rivermead mobility index increased by 50.6%, the Barthel daily activity index increased by 13.5%, the Hauser walking index increased by 31.8%, the range of motion in the joints of the upper and of the lower limbs also increased, the level of spasticity according to the modified Ashworth scale decreased by 22.5% in the upper limb and by 20% in the upper and of the lower limbs, the strength according to the MRCS scale increased, in the limbs by 20%. Patients were able to move with little resistance. The effect of the rehabilitation program and physical therapy is evident in the increase in paretic muscle strength, reduction in spasticity, and increase in joint range of motion. Most patients regained the ability to walk, which contributed to increasing their level of independence. In general, the research results obtained after the implementation of the selected means of physical rehabilitation indicate the effectiveness of such a program.

Effects Of Video Gaming And Conventional Physical Therapy On Upper Limb Rehabilitation In Stroke Patients: A Randomized Controlled Trial From Rafsan Neuro Rehabilitation Center, Peshawar

Effects Of Video Gaming And Conventional Physical Therapy On Upper Limb Rehabilitation In Stroke Patients: A Randomized Controlled Trial From Rafsan Neuro Rehabilitation Center, Peshawar

The Foundation to Advance Brain Rehabilitation: Organization, History, and Collaborative Database.

To describe the history, organization, goals, and data management procedures of the Foundation to Advance Brain Rehabilitation (FABR). Postacute brain injury rehabilitation following acute inpatient care. FABR was incorporated in 2019 with a primary mission to advance brain rehabilitation through scientific and strategic analysis of industry-wide data. Contributing FABR member organizations include Bancroft NeuroRehab, Collage Rehabilitation Partners, On With Life, Pate NeuroRehabilitation, and Shepherd Center. These organizations contribute demographic, admission, discharge, and follow-up data on persons served in 5 types of intensive posthospital brain injury rehabilitation programs (neurobehavioral residential, neurorehabilitation residential, home and community neurorehabilitation, day treatment, and outpatient) and 3 types of supported living programs (neurobehavioral residential, residential, and community-based) to a collaborative database managed by Inventive Software Solutions. Inventive Software Solutions provides FABR researchers with a dataset that is de-identified both for participant and organizational identifying information.

Quality of life of families and siblings of children with cerebral palsy treated at a reference neurorehabilitation center in Brazil

ObjectivesTo investigate the associations between caregivers’ burden, family quality of life (QoL), and siblings’ QoL in Brazilian families of children with cerebral palsy, and to analyze siblings’ QoL using as a parameter the QoL of typically developed Brazilian children. MethodsIt was a cross-sectional study. The 212 families, 212 caregivers and 131 siblings completed the Family Quality of Life Scale, Burden Interview, and KIDSCREEN-27 Child and Adolescent Version and Parents Version questionnaires at a neurorehabilitation center in southeast Brazil. Univariable and multivariable models were used. ResultsFamily QoL significantly worsened as caregivers’ burden increased (95 % CI -0.66 to -0.38). Caregivers’ burden was significantly lower with increasing family QoL scores (95 % CI -0.52 to -0.30). Self-reported siblings’ QoL was significantly worse than that of their typically developed peers (95 % CI -7.6 to -3.6). Self-reported siblings’ QoL was significantly lower as siblings’ age (95 % CI -2.52 to -0.59) and caregivers’ burden (95 % CI -0.35 to -0.05) increased. Parent-reported siblings’ QoL was significantly lower with increasing caregivers’ burden (95 % CI -0.45 to -0.16) and higher as family QoL increased (95 % CI 0.09 to 0.37). ConclusionsThe cross-sectional nature of these data precludes any statement of causality. Family QoL worsened with higher caregivers’ burden levels. Lower caregivers’ burden scores were associated with a higher family QoL. Siblings’ QoL was impaired as compared to typically developed peers, worse among older siblings, and as caregivers’ burden increased and better with higher family QoL levels. Future multicenter studies may validate the generalizability of the present findings.

PHYSICAL REHABILITATION OF DISABLED PEOPLE WHO HAVE SUFFERED A STROKE (EARLY PERIOD)

The aim - is to increase the effectiveness of the physical therapy program for patients with the consequences of a hemorrhagic stroke with the help of differentiated application of rehabilitation measures depending on the severity of the neurological disorder and concomitant diseases. Materials and methods. 100 patients were observed in the neurorehabilitation center of the Ivano-Frankivsk Regional Clinical Hospital. (50 men and 50 women, average age 63.57 ± 0.43 years) in the early post-stroke recovery period. All patients were clinically and neurologically examined according to a specially developed protocol according to modern scales - NIHSS, mRS on the 10th, 30th, 90th and 180th day of the disease and differentiated treatment in accordance with the standards and protocols of care for patients who have suffered a stroke. The patients were divided into four groups of 25 patients each. The first group included patients with hemorrhagic stroke, among whom the severity of post-stroke disorders was mild (NIHSS score ≤ 7 points), without concomitant diseases. The second group consisted of patients with a mild degree of post-stroke disorders (NIHSS score ≤7 points) and concomitant pathology (heart pathology, diabetes, chronic obstructive pulmonary disease of the II stage). The third group included patients with intracerebral stroke, among whom the severity of post-stroke disorders was moderate and obvious (NIHSS score &gt; 7 points), without concomitant pathology. The fourth group consisted of patients with moderate severity of post-stroke disorders (NIHSS status &gt; 7 points) and accompanying pathology. A statistical analysis of the use of descriptive statistics methods was carried out. The relationship between qualitative features was assessed using the χ2Pearson test. The results. According to the results of treatment, among the patients of group I, 20 patients (80.0%) (mRS index 0–2) had a favorable course. In group I, a relatively favorable result (mRS index ≥3 points) was achieved only in 5 patients (20.0%); in the II group, a positive result was achieved in 17 patients (72.0%), a relatively favorable result was achieved in 8 (28.0%); in group III - a favorable result was achieved in 15 patients (60.0%), relatively favorable - in 10 (40.0%), and in group IV - a favorable result was found only in 14 patients (56.0%), relatively favorable – in 11 (44.0%).&#x0D; Conclusions. The assessment of the functional state of disabled people in the early period of a stroke made it possible to establish that the basis of their low motor activity lies in: walking disorders (41% of disabled people), balance functions (35.9%), a decrease in the strength and endurance indicators of muscle groups that have preserved their functionality, low level of adaptive potential of the circulatory system (56.4%), dysregulation of neuropsychological processes&#x0D; Differentiated application of the program of rehabilitation and physical therapy in post-stroke patients in different groups, taking into account the severity of neurological disorders of the recovery period and the selection of methods and methods of treatment, leads to a significant increase in the effectiveness of rehabilitation measures.

Team functioning in Neurorehabilitation: a mixed methods study

ABSTRACT The objective of this study was to enhance understanding of team functioning in a neurorehabilitation team by identifying the factors that impede and facilitate effective interprofessional team collaboration. We focused on team identification, psychological safety, and team learning, and conducted the research at a neurorehabilitation center treating young patients with severe acquired brain injury in the Netherlands. A mixed-methods approach was employed, integrating quantitative data from questionnaires (N = 40) with qualitative insights from a focus group (n = 6) and in-depth interviews (n = 5) to provide a comprehensive perspective on team dynamics. Findings revealed strong team identification among participants, denoting a shared sense of belonging and commitment. However, limited psychological safety was observed, which negatively affected constructive conflict and team learning. Qualitative analysis further identified deficiencies in shared mental models, especially in shared decision-making and integrated care. These results highlight the crucial role of psychological safety in team learning and the development of shared mental models in neurorehabilitation settings. Although specific to neurorehabilitation, the insights gained may be applicable to enhancing team collaboration in various healthcare environments. The study forms a basis for future research to investigate the impact of improvements in team functioning on patient outcomes in similar settings.

Incidence of Multiple Sclerosis in Uruguay: A Prospective Population-Based Study

Background: The worldwide incidence of multiple sclerosis (MS) is estimated at 0.5–10 cases per 100,000 person-years and is probably increasing. In 2014, a previous study estimated the incidence of multiple sclerosis in Uruguay at 1.2 cases per 100,000 person-years. Objectives: We conducted an observational, prospective, population-based study to determine MS incidence from diagnosis in Uruguay. Methods: The population studied included people older than 18 years of age who were living in Uruguay between July 1, 2019, and June 30, 2021. The diagnosis was based on 2017 McDonald criteria. Multiple data sources were employed including neurologists, magnetic resonance imaging centers, laboratories performing oligoclonal band testing, neurophysiology laboratories, neurorehabilitation centers, the institution Fondo Nacional de Recursos, and the MS Patients’ Association of Uruguay (EMUR). The capture-recapture method was used to estimate incidence. Results: 155 new MS cases were confirmed after review. The median age was 35 (range 18–62). Thirteen patients (8.38%) were diagnosed with late-onset MS. The crude incidence rate was 2.89 cases per 100,000 person-years, 3.95 among females, and 1.72 among male patients. The incidence rate estimated using the capture-recapture method was 3.18 (95% CI: 3.02–3.34). Conclusions: According to the Atlas of MS, Uruguay has a low incidence rate (2.0–3.99), even though it is one of the highest in Latin America. Our country aligns with the global trend of increasing incidence. Age and sex distribution were similar to other studies, with a high incidence of patients with late-onset multiple sclerosis. The capture-recapture method confirms the exhaustivity of our investigation.

Contemporary issues in neuro rehabilitation

Stroke is prevailing as the third most common neurological condition on a global scale and an estimated 25.7 million people are those who have survived it. Stroke is one of the overburdening conditions in about 33% of all individuals affected by permanent disability. Because of the high incidence of risk factors especially in Asia (including Pakistan) with an approximation of 250 cases per one lac persons. Occurrence is mostly seen in the older population and is often found with certain other co-morbidities such as dementia. To enhance the post-stroke quality of life in the geriatric population, especially the ones with existing co-morbidities. Physical rehabilitation of stroke plays a vital role[1]. Studies have demonstrated that the rehabilitation of patients with stroke is a lifelong process during which the survivors sequentially develop new physical habits, and transform their activities of daily living[2]. Stroke rehabilitation treatment protocol lasts quite a long. Therefore, it is sometimes tiresome for the patients and their families because of frequent visits to healthcare settings. Additionally, due to a shortage of skilled and specialized rehabilitation professionals, there is a scarcity of quality treatment protocols and as a result, the objectives of most of the rehab programs are not practical and achievable. Thus, preventing the patients from making a significant recovery[3]. The evidence does not support guidelines that are being followed in the healthcare systems of our country regarding stroke management. While working with individuals recovering from stroke and other neurological disorders, rehabilitation generally focuses on strength training[4]. Despite the fact, that the urban population in developing nations like Pakistan has now access to medical facilities such as stroke rehabilitation, the country's rising population is resulting in an overburdening of the healthcare system leading to sloppiness of all the medical services including rehabilitation[3]. Although most rehabilitation professionals and physical therapists know the fact that the traditional techniques used in neuro rehab are not always effective, still they use them on their patients, this lack of evidence-based practice may be due to inaccessibility to authentic clinical practice guidelines and other physiotherapy databases[4]. For instance, relying on outdated techniques such as range of motion exercises and stretching exercises for treating stroke patients is not as effective as using proprioceptive neuromuscular facilitation exercises to improve the coordination and functional ability of patients, thereby improving motor function along with balance and gait[5]. Conventional approaches in rehabilitation management particularly in the domain of neurology are becoming ineffective due to the huge demand that chronic neurological illnesses are placing on our healthcare system. New creative techniques, including integrated care pathways, are needed to obtain better outcomes[6]. The process of governing skillful clinical and administrative pathways is needed to overcome situations associated with a rise in the number of admissions and long stays in hospitals or healthcare resources. Implementing more innovative approaches by management can achieve better outcomes with a reduction in admissions and shortened hospital stays. It will cohesively lead to effective treatment guidelines, greater patient satisfaction, and improved quality of life. Most of European countries are regulated by integrated rehabilitation services to help patients navigate healthcare services more effectively for an impressive, person-centered approach to rehabilitation care[6]. Unified rehabilitation at the current regional and national level with updated approaches and action plans along with evidence-based clinical practice guidelines is required to safeguard the delivery of person-centred rehabilitation care. Thus, we can conclude that there is a dire need to promote the development and implementation of standardized care in neuro-rehabilitation centers for enhancement in the quality of rehabilitation services. In addition to the use of digital media platforms for spreading awareness among the general masses, regulation and periodic reviews of rehabilitation services are also required.

Prefrontal activation in response to a plantar contact task under open and closed eye conditions in patients with cerebral infarction.

This study investigates the effect of a bilateral (paralyzed side, healthy side) plantar contact task on dorsolateral prefrontal activation in patients recovering from cerebral infarction under open and closed eye conditions. We selected 10 patients with cerebral infarction, admitted to the neurorehabilitation center of Beijing Rehabilitation Hospital, affiliated with Capital Medical University, from January 2019 to July 2020, who met our established criteria. Under open-eye and closed-eye conditions, the paralyzed and healthy sides performed the plantar contact tasks separately. The dorsolateral prefrontal region was monitored simultaneously with functional near-infrared spectroscopy (fNIRS), and activation was analyzed according to the curve-type changes of oxyhemoglobin and deoxyhemoglobin changes in the dorsolateral prefrontal cortex with 560 near-infrared monitoring channels. After stratifying the data based on the eyes-open and eyes-closed conditions, some degree of heterogeneity was observed between the layers. Under the eyes-closed condition, the Pearson χ2 was 0.142, with a p value of 0.706, indicating no significant impact of the eyes-closed condition on the activation of the dorsolateral prefrontal cortex during the plantar task, whether performed on the paralyzed or the healthy side.In contrast, the Pearson χ2 value was 15.15 for the eyes-open condition, with a p value of 0.002. This suggests that carrying out the plantar task, either on the paralyzed or the healthy side, with eyes open significantly influenced the activation of the dorsolateral prefrontal cortex. Furthermore, activation of the dorsolateral prefrontal cortex was 1.55 times higher when the task was executed with the paralyzed side compared to the healthy side. This implies that the paralyzed side was more likely to activate the dorsolateral prefrontal lobe when performing the plantar contact task under eyes-open conditions. Observations via fNIRS revealed that the plantar contact task elicited dorsolateral prefrontal cortex activation. Moreover, the activation effect was intensified when performed on the paralyzed side under eyes-open conditions. Therapeutic methods that leverage these findings-namely cognitive-motor therapies that promote the recovery of motor functions by activating cognitive control brain regions via perception (information construction)-may hold promise.

Personalized Integrated Care Promoting Quality of Life for Older People: Protocol for a Multicenter Randomized Controlled Trial.

Alzheimer disease (AD) and Parkinson disease (PD) are the 2 most common neurodegenerative diseases affecting millions of people worldwide. The Personalized Integrated Care Promoting Quality of Life for Older People (PC4L) project proposes an integrated, scalable, and interactive care ecosystem that can be easily adapted to the needs of several neurodegenerative and chronic diseases, care institutions, and end user requirements. The study protocol developed within the framework of the PC4L project aims to iteratively test the integrated platform and its modules, and focuses primarily on assessing the impact of the proposed solution (ie, the PC4L platform) on patients' quality of life, as well as its usability and feasibility on a large-scale sample size in 3 different scenarios (home, neurorehabilitation, and day care centers). A prospective multicenter clinical study is conducted in 5 European countries (Germany, Italy, Portugal, Romania, and Spain) at 6 different pilot centers, for 3 months, in patients with PD, Parkinsonism, AD, and other dementias (ODs). Patients were randomized in a ratio of 1:1 to the intervention group (use of the PC4L system) or the control group (no intervention). The PC4L system consists mainly of a wristband for monitoring parameters such as steps and levels of physical activity, and the PC4L app, which includes different engaging functionalities. Both groups are assessed through baseline and end-of-study clinical evaluations, including assessment of quality of life through the EQ-5D-3L scale. The study protocol is part of a project approved and funded by the European Commission Horizon 2020 (grant agreement number 875221). The ethics committees of all involved centers reviewed and approved the study protocol. The study began with the recruitment phase in September 2022, and enrollment ended in February 2023. Recruitment is now closed (April 2023). The results of this study are expected to be published in summer 2023. A total of 558 patients, 279 per study group, were recruited. The results will allow to clarify the impact of PC4L on quality of life, will assess the empowerment of patients and the medical resources use, as well as the usability of the final version of the PC4L system. It will also provide information on the support of the system as a tool to facilitate the decision-making process. The PC4L project intends to test a technology-based, integrated, scalable, and interactive care platform on patients with neurodegenerative diseases and proposes a good coordinated care model between all involved actors. Future developments of the PC4L solution may involve caregivers and socio-health professionals in the decision-making process in order to facilitate efficient communication between all stakeholders and ensure reliable and protected access to data within Europe. ClinicalTrials.gov NCT05538455; https://clinicaltrials.gov/study/NCT05538455. DERR1-10.2196/47916.

Combined optokinetic stimulation and cueing-assisted reading therapy to treat hemispatial neglect: A randomized controlled crossover trial.

Hemispatial neglect is a disabling cognitive disorder following stroke and effective therapies are required. To evaluate the effects of combined optokinetic stimulation (OKS) and cueing-assisted reading therapy (READ) on the remission of hemispatial neglect following stroke. Randomized, controlled, two-period, crossover trial conducted at a German neurorehabilitation center. Twenty participants with left neglect following right hemispheric stroke (mean age 66 years (SD 11), mean time since stroke 50 days (SD 33)) finished the trial (12 received OKSREAD first, 8 CONTROL first). The intervention consisted of 15 daily sessions of OKS (20 min) and text reading assisted by a therapist providing cues (20 min). The control treatment was a same-number, same-length neuropsychological treatment not targeting visuospatial attention. Primary outcomes were the change in performance of a customized neuropsychological test battery for neglect (0% worst - 100% best) and a test of neglect-related functional disability (Catherine Bergego Scale, 0 no impairment - 30 severest impairment), assessed before and after each treatment period. Secondary outcomes were performance in the 6 single tests composing the battery (e.g., omissions in text reading, center of cancellation in the Bells test, spatial bias of fixations when freely viewing photographs) and a clinical test of anosognosia. Overall performance in the neglect test battery improved slightly more after OKSREAD than after CONTROL (d=6%; p=0.002). The remission of neglect-related functional disability did not differ between treatments (d=-2; p=0.291). Ipsilesional fixation bias during free viewing was the only secondary outcome that was improved by OKSREAD as compared to CONTROL (d= -2.8°; p=0.005). At the applied intensity, the combined OKSREAD intervention slightly attenuated the ipsilesional attention bias in persons with neglect, but it did not improve neglect-related functional disability, anosognosia, or other neglect symptoms to a clinically meaningful degree. URL: http://www. gov. Unique identifier: NCT04273620.

Action Observation Treatment for Upper Limb Rehabilitation in Patients With Stroke: Protocol for a Multicenter Randomized Controlled Trial

In the last few years, new noninvasive strategies have emerged as rehabilitative treatments for patients with stroke. Action observation treatment (AOT) is a rehabilitation approach based on the properties of the mirror neuron system with a positive impact on modifying cortical activation patterns and improving the upper limb kinematics. AOT involves the dynamic process of observing purposeful actions with the intention of imitating and then practicing those actions. In recent years, several clinical studies suggested the effectiveness of AOT in patients with stroke to improve motor recovery and autonomy in activities of daily living. However, a deeper knowledge of the behavior of the sensorimotor cortex during AOT seems to be essential. The aim of this clinical trial, conducted in 2 neurorehabilitation centers and in patients' homes, is to investigate the effectiveness of AOT in patients with stroke, confirming the translational power of a tailored treatment. Particular emphasis will be placed on the predictive value of neurophysiological biomarkers. In addition, the feasibility and impact of a home-based AOT program will be investigated. A 3-arm, assessor-blinded, randomized controlled trial will be performed by enrolling patients with stroke in the chronic stage. A total of 60 participants will be randomly allocated to receive 15 sessions of AOT with different protocols (AOT at the hospital, AOT at home, and sham AOT), 3 sessions per week. The primary outcome will be assessed using the Fugl-Meyer Assessment-Upper Extremity scores. Secondary outcomes will be clinical, biomechanical, and neurophysiological assessment. The study protocol is part of a project (project code GR-2016-02361678) approved and funded by the Italian Ministry of Health. The study began with the recruitment phase in January 2022, and enrollment was expected to end in October 2022. Recruitment is now closed (December 2022). The results of this study are expected to be published in spring 2023. Upon completion of the analyses, we will examine the preliminary effectiveness of the intervention and neurophysiological outcomes. This study will be used to evaluate the effectiveness of 2 different AOT scenarios (ie, AOT at the hospital and AOT at home) in patients with chronic stroke and to assess the predictive value of neurophysiological biomarkers. Specifically, we will attempt to induce the functional modification of the cortical components by exploiting the features of the mirror neuron system, demonstrating relevant clinical, kinematic, and neurophysiological changes after AOT. With our study, we also want to provide, for the first time in Italy, the AOT home-based program while assessing its feasibility and impact. ClinicalTrials.gov NCT04047134; https://clinicaltrials.gov/ct2/show/NCT04047134. DERR1-10.2196/42094.

Concussed patients with visually induced dizziness exhibit increased ocular torsion and vertical vergence during optokinetic gaze-stabilization

Visually Induced Dizziness (VID) is a common post-concussion sequalae that remains poorly understood and difficult to quantify. The present study aims to identify biomarkers for VID in the form of gaze-stabilizing eye movements. Nine patients with post-commotio VID and nine age-matched healthy controls were recruited by physiotherapists at a local neurorehabilitation centre. Torsional and vergence eye movements were recorded while participants viewed a series of optokinetic rotations where the central- and peripheral regions moved coherently, incoherently, or semi-randomly. Results showed that vergence and torsional velocities were increased in VID patients, reflecting increased oculomotor gain to visual motion, and that responses correlated with symptom severity. Coherent stimulation produced fastest torsional slow-phases across all participants; when faced with confliction directional information, eye movements tended to follow the direction of the central visual field, albeit at slower velocities than during coherent motion, meaning that while torsion was sensitive to visual content of the entire visual field it expressed directional preference to the central stimulation. In conclusion, post-commotio VID was associated with faster slow-phases during optokinetic gaze-stabilization, with both vergence and torsion being correlated to symptom intensity. As torsional tracking remains inaccessible using commercial eye-trackers, vertical vergence may prove particularly accessible for clinical utility.