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Rehabilitation Strategies for Neurological Disorders: Advances and Insights

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Rehabilitation".

Deadline for manuscript submissions: closed (30 April 2026) | Viewed by 11095

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Dr. Delia Cinteză

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Guest Editor

Associate Professor, Department of Physical and Rehabilitation Medicine, Carol Davila University of Medicine and Pharmacy, 050451 Bucharest, Romania
Interests: physical medicine and rehabilitation; neurorehabilitation; musculoskeletal ultrasound

Prof. Dr. Mihai Berteanu

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Guest Editor

Department of Physical and Rehabilitation Medicine, Elias Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
Interests: physical medicine and rehabilitation; neurorehabilitation; musculoskeletal ultrasound

Special Issue Information

Dear Colleagues,

Neurologic disorders lead to disability through motor, cognitive, and sensory impairments, impacting patients' independence and economic self-sufficiency. The consequences are high social costs and an underestimated psychological impact with low quality of life.

Rehabilitation medicine aims to enable people with impairments and activity limitations to reach and maintain optimal functioning in physical, intellectual, psychological, and/or social domains. There are a wide and heterogeneous range of therapeutic interventions and methodologies in addition to standard medical care. The patient's assessment and the goal-setting process are essential for an individualized neurorehabilitation plan to reduce disability, develop new skills, and adjust behaviors and environments to enhance participation. Increasing evidence suggests that intensive and repeated practice is essential to modify neural organization and facilitate the reacquisition or relearning of motor skills.

In this Special Issue, we welcome authors to submit papers on advanced therapy strategies and concepts for rehabilitation after a neurological disease. These methods aim to boost neuroplasticity and include botulinum toxin, conventional therapy, and advanced technologies, such as robotics, virtual and augmented reality, and artificial intelligence techniques. We need to evaluate these interventions' effectiveness and determine the best timing, intensity, and duration for each rehabilitation method.

Dr. Delia Cinteză
Prof. Dr. Mihai Berteanu
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

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Keywords

neurorehabilitation
physical medicine
virtual reality
AI in rehabilitation medicine
robotic rehabilitation
telerehabilitation
advanced technologies
upper neuromotor lesions
peripheral neuropathies
wearable sensor devices
assessment
goal-setting
individual rehabilitation plan

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Published Papers (7 papers)

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Research

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20 pages, 2004 KB

Open AccessArticle

Modern Upper-Limb Rehabilitation Interventions in Stroke Patients with Spasticity

by Ana Maria Bumbea, Rodica Trăistaru, Elena-Anca Târtea, Alexandra Oltea Dan, Adina Turcu-Stiolica, Daniela Matei, Simona Pătru, Bogdan Stefan Bumbea and Cristiana Octaviana Daia

J. Clin. Med. 2026, 15(4), 1560; https://doi.org/10.3390/jcm15041560 - 16 Feb 2026

Viewed by 867

Abstract

Background: Upper-limb rehabilitation is a decisive factor in improving the quality of life for patients who have experienced a stroke. Modern rehabilitation techniques promote the recovery of upper-limb functionality and prehension, contributing to a reduction in disability. Materials and Methods: This retrospective observational study aimed to highlight improvements in prehension through the application of current actual and modern rehabilitation techniques targeting key muscle groups involved in upper-limb recovery. Data from a total of 52 patients were identified and categorized into two groups based on the specific rehabilitation protocols they received during their hospitalization: a study group and a control group. Both groups underwent individualized rehabilitation, differing only in the type of electrotherapy applied: the study group received functional electrical stimulation (FES) and shock wave therapy (RSWT), while the control group received conventional electrical stimulation. Results: After adjusting for baseline differences in severity and time since stroke, patients in the study group demonstrated a significantly greater improvement in functional parameters compared to the control group. The results show us a significant improvement of functionality after RSWT and FES in the study group, with values from 0.28 ± 0.28 to 0.99 ± 0.36 (p-value < 0.001) regarding Hand Grip, suggesting that the treatment effect persists even when initial clinical advantages in the control group are accounted for. Muscle force increased from 0.39 ± 0.54 to 7.67 ± 3.89, p-value < 0.001. Conclusions: The combined application of functional electrical stimulation and shock wave therapy, as modern rehabilitation interventions, provided additional benefits in upper-limb and prehension rehabilitation compared to classical electrical stimulation alone. Our findings suggest that the combined application of RSWT and FES is strongly associated with improved upper-limb recovery, even after adjusting for baseline clinical imbalances. While these results support the integration of these modern techniques into stroke protocols, further prospective randomized controlled trials are needed to confirm the definitive treatment advantage over conventional methods. Full article

(This article belongs to the Special Issue Rehabilitation Strategies for Neurological Disorders: Advances and Insights)

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16 pages, 915 KB

Open AccessArticle

Patient-Centred and Daily Life-Oriented Botulinum Toxin Treatment for Stroke Survivors with Upper Extremity Spasticity—Effects and Practical Aspects

by Sybille Roschka, David Punt and Thomas Platz

J. Clin. Med. 2025, 14(23), 8339; https://doi.org/10.3390/jcm14238339 - 24 Nov 2025

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Abstract

Background/Objectives: To investigate the impact of a routine botulinum toxin type A (BoNT-A) injection in combination with outpatient therapy on the daily activities of stroke survivors with upper extremity spasticity and to facilitate patient-centred assessment focusing on individual needs during daily life. Methods: Design: Observational study across one treatment cycle (3 months). Setting: Spasticity outpatient clinic of a neurorehabilitation hospital in Germany. Participants: Adult stroke survivors (n = 27) with upper extremity spasticity receiving routine BoNT-A treatment. Interventions: Participants received one BoNT-A injection and outpatient therapies as part of their routine management. Augmented assessment was conducted directly before the injection (T0), and at 4 to 6 weeks (Tmax1) and 12 to 14 weeks (T2) following the injection. Main outcome measures: The Canadian Occupational Performance Measure (COPM), Goal Attainment Scaling (GAS), and Arm Activity Measure (ArmA). Secondary outcome measures: The Resistance to Passive Movement Scale (REPAS), Motricity Index (MI), SF-12v2 Health Survey (SF-12v2), Global Clinical Impression (GCI), and importance of and satisfaction with the BoNT-A treatment. Results: Performance of individually selected daily activities and satisfaction with their performance (COPM), passive care tasks (ArmA, part A), and resistance to passive movement (REPAS) significantly improved from T0 to Tmax1. Improvements largely remained at T2. Individual goals were all set at the activities and participation levels of the International Classification of Functioning, Disability and Health. These improved for 75% of participants and were fully attained by 33.3% at Tmax1. Responder analysis indicated that COPM and ArmA improvements were clinically significant for up to 50% of participants. Active upper extremity use (ArmA, part B), health-related quality of life (SF-12v2), and upper extremity strength (MI) remained unchanged. Conclusions: Our results indicate that BoNT-A in combination with routine outpatient therapy positively influenced the individually valued daily activities of stroke survivors. COPM, GAS, and ArmA are suitable for facilitating a patient-centred and daily life-oriented spasticity management post-stroke. Full article

(This article belongs to the Special Issue Rehabilitation Strategies for Neurological Disorders: Advances and Insights)

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19 pages, 930 KB

Open AccessArticle

Botulinum Toxin A for Elbow Flexor Spasticity: A Non-Randomized Observational Study of Muscle-Specific Injection Strategies

by Miruna Ioana Săndulescu, Delia Cinteză, Daniela Poenaru, Claudia-Gabriela Potcovaru, Horia Păunescu and Oana Andreia Coman

J. Clin. Med. 2025, 14(11), 3864; https://doi.org/10.3390/jcm14113864 - 30 May 2025

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Abstract

Introduction: Elbow flexor spasticity is a common and debilitating consequence of stroke, significantly impacting patients’ quality of life. Botulinum toxin A (BoNT-A) injections have emerged as an effective treatment, but the optimal muscle selection strategy remains unclear. This study investigates the impact of different BoNT-A injection strategies targeting specific elbow flexor muscles in post-stroke patients. Materials and Methods: A non-randomized observational study was conducted on 52 participants with upper limb spasticity (pattern IV) following a stroke. Participants were divided into three groups based on the elbow flexor muscles injected with BoNT-A: biceps brachii (n = 15), brachialis (n = 9), and brachialis plus brachioradialis (n = 28). Assessments included spasticity angle, paresis angle, and active supination range of motion (ROM) measured using the Tardieu Scale and goniometry at baseline and at 4-week follow-up. Non-parametric statistical analyses were employed to compare outcomes between groups. Results: While all groups showed a general trend of decreased spasticity and improved motor control, analysis revealed statistically significant differences across the groups at baseline. The brachialis plus brachioradialis group demonstrated the most substantial improvement in paresis angle and active supination ROM. Notably, this group also exhibited greater capacity for the improvement of the paresis angle. The biceps brachii group showed comparable improvements in the paresis angle and the greatest effect on improving passive extension at slow velocity with increasing stroke onset but required higher pronator teres BoNT-A doses overall. Discussion: These findings suggest that individualized muscle selection strategies are crucial in BoNT-A treatment for elbow flexor spasticity. The superior outcomes observed in the brachialis plus brachioradialis group may be attributed to the synergistic action of these muscles in elbow flexion and forearm positioning. The higher pronator teres BoNT-A doses required in the biceps brachii group may reflect compensatory mechanisms or differences in muscle fiber recruitment patterns. Conclusions: Combining brachialis and brachioradialis muscles in BoNT-A injections appears to offer superior benefits for supination and motor control in post-stroke patients with elbow flexor spasticity, particularly those with significant elbow flexion and pronation. Full article

(This article belongs to the Special Issue Rehabilitation Strategies for Neurological Disorders: Advances and Insights)

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Review

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17 pages, 2010 KB

Open AccessReview

Deep Brain Stimulation as a Rehabilitation Amplifier: A Precision-Oriented, Network-Guided Framework for Functional Restoration in Movement Disorders

by Olga Mateo-Sierra, Beatriz De la Casa-Fages, Esther Martín-Ramírez, Marta Barreiro-Gómez and Francisco Grandas

J. Clin. Med. 2026, 15(2), 492; https://doi.org/10.3390/jcm15020492 - 8 Jan 2026

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Abstract

Background: Deep brain stimulation (DBS) is increasingly understood as a precision-oriented neuromodulation therapy capable of influencing distributed basal ganglia–thalamo–cortical and cerebellothalamic networks. Although its symptomatic benefits in Parkinson’s disease, essential tremor, and dystonia are well established, the extent to which DBS supports motor learning, adaptive plasticity, and participation in rehabilitation remains insufficiently defined. Traditional interpretations of DBS as a focal or lesion-like intervention are being challenged by electrophysiological and imaging evidence demonstrating multiscale modulation of circuit dynamics. Objectives and methods: DBS may enhance rehabilitation outcomes by stabilizing pathological oscillations and reducing moment-to-moment variability in motor performance, thereby enabling more consistent task execution and more effective physiotherapy, occupational therapy, and speech–language interventions. However, direct comparative evidence demonstrating additive or synergistic effects of DBS combined with rehabilitation remains limited. As a result, this potential is not fully realized in clinical practice due to interindividual variability, limited insight into how individual circuit architecture shapes therapeutic response, and the limited specificity of current connectomic biomarkers for predicting functional gains. Results: Technological advances such as tractography-guided targeting, directional leads, sensing-enabled devices, and adaptive stimulation are expanding opportunities to align neuromodulation with individualized circuit dysfunction. Despite these developments, major conceptual and empirical gaps persist. Few controlled studies directly compare outcomes with versus without structured rehabilitation following DBS. Heterogeneity in therapeutic response and rehabilitation access further complicates the interpretation of outcomes. Clarifying these relationships is essential for developing precision-informed frameworks that integrate DBS with rehabilitative strategies, recognizing that current connectomic and physiological biomarkers remain incompletely validated for predicting functional outcomes. Conclusions: This review synthesizes mechanistic, imaging, and technological evidence to outline a network-informed perspective of DBS as a potential facilitator of rehabilitation-driven functional improvement and identifies priorities for future research aimed at optimizing durable functional restoration. Full article

(This article belongs to the Special Issue Rehabilitation Strategies for Neurological Disorders: Advances and Insights)

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28 pages, 1522 KB

Open AccessReview

Toward Precision Post-Stroke Rehabilitation Medicine: Integrating Molecular, Imaging, and Computational Biomarkers for Functional Outcome Prediction

by Roxana Nartea, Simona Savulescu, Claudia Gabriela Potcovaru and Daniela Poenaru

J. Clin. Med. 2025, 14(22), 8077; https://doi.org/10.3390/jcm14228077 - 14 Nov 2025

Cited by 1 | Viewed by 2032

Abstract

Ischemic stroke remains a leading cause of mortality and long-term disability worldwide, with prognosis influenced by heterogeneous biological and neuroanatomical factors. In the past decade, numerous possible biomarkers—molecular, imaging, and electrophysiological—have been investigated to improve outcome prediction and guide rehabilitation strategies and main objectives. Among them, neurofilament light chain (NFL), a cytoskeletal protein released during neuroaxonal injury, has become an effective marker of the severity of the neurological condition and the integrity of the neurons. Additional circulating biomarkers, including thioredoxin, netrin-1, omentin-1, bilirubin, and others, have been linked to oxidative stress, angiogenesis, neuroprotection, and regenerative processes. Meanwhile, innovations in electrophysiology (EEG and TMS-based predictions) and neuroimaging (diffusion tensor imaging, corticospinal tract lesion load, and functional connectivity) add some additional perspectives on the possibility for brain recovery. This work is a narrative synthesizing evidence from PubMed, Scopus, and Web of Science between 2015 and 2025, including both clinical and experimental studies addressing stroke biomarkers and outcome prediction. The review outlines a framework for the integration of multimodal biomarkers to support precision medicine and individualized rehabilitation in stroke. Full article

(This article belongs to the Special Issue Rehabilitation Strategies for Neurological Disorders: Advances and Insights)

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Other

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24 pages, 1195 KB

Open AccessSystematic Review

Is Balance Training Using the Stabilometric Platforms Integrating Virtual Reality and Feedback Effective for Patients with Non-Diabetic Peripheral Neuropathy?—A Systematic Review

by Diana-Maria Stanciu, Oana-Georgiana Cernea, Laszlo Irsay, Viorela-Mihaela Ciortea, Mădălina-Gabriela Iliescu, Mihaela Stanciu and Florina-Ligia Popa

J. Clin. Med. 2025, 14(22), 8049; https://doi.org/10.3390/jcm14228049 - 13 Nov 2025

Cited by 2 | Viewed by 1264

Abstract

Background: Peripheral neuropathy (PN) refers to a spectrum of symptoms resulting from dysfunctions of the peripheral sensory, motor, and autonomic neurons. PN is associated with significant balance impairments and an increased risk of falls, contributing to reduced functional independence and quality of life. Although diabetic PN has been extensively investigated, there remains a lack of synthesized evidence regarding rehabilitation approaches for individuals with non-diabetic PN. This systematic review aims to evaluate the effectiveness of stabilometric platforms incorporating virtual reality (VR) and feedback (FB) in improving balance and related outcomes in patients with PN of various etiologies. Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the protocol registered in PROSPERO (CRD420251086625). Seven major databases (PubMed, Scopus, ScienceDirect, Cochrane, Web of Science, Springer, and Wiley) were searched from inception to April 2025. Studies including adult patients with non-diabetic PN undergoing balance rehabilitation using stabilometric platforms with VR and FB were considered. The methodological quality of the included studies was assessed using the PEDro scale, RoB2, and ROBINS-I V2 tools. Results: A total of six studies met the inclusion criteria, encompassing 133 participants with non-diabetic PN. Interventions involving specialized balance training platforms incorporating VR and FB demonstrated significant improvements in both static and dynamic balance and postural control, as well as a reduction in the risk of falling. These systems also showed favorable adherence rates to rehabilitation programs. However, variability in intervention protocols and outcome measures limited the ability to perform direct comparisons across studies. Conclusions: The use of stabilometric platforms appears to be a promising approach for balance rehabilitation in patients with non-diabetic PN. Despite the limited number of included studies, the results support their integration into rehabilitation programs for this patient population. Further large-scale, high-quality studies are needed to establish standardized protocols and confirm long-term efficacy. Full article

(This article belongs to the Special Issue Rehabilitation Strategies for Neurological Disorders: Advances and Insights)

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11 pages, 376 KB

Open AccessSystematic Review

Multiple Sclerosis: Enhancing Botulinum Toxin Effects in Spasticity Management, a Systematic Review

by Daniela Poenaru, Miruna Ioana Sandulescu, Catalin Furculescu and Claudia Gabriela Potcovaru

J. Clin. Med. 2025, 14(15), 5252; https://doi.org/10.3390/jcm14155252 - 24 Jul 2025

Cited by 1 | Viewed by 2381

Abstract

Background/Objectives: The objective of this review is to document the modalities to enhance the neuromuscular effects of botulinum toxin (BoNT) injection in spastic patients with multiple sclerosis (MS). Methods: We conducted a literature review focusing on studies involving BoNT administration for MS-related spasticity and the use of adjunctive therapies aimed at reducing dosage and increasing injection intervals. Results: The findings revealed a limited number of studies specific to MS patients, addressing only a few adjunct techniques, including electrical stimulation, vibration therapy, physical exercise, and extracorporeal shock wave therapy. Conclusions: These preliminary findings highlight the need for further research into integrative therapeutic strategies tailored specifically to the MS population. Full article

(This article belongs to the Special Issue Rehabilitation Strategies for Neurological Disorders: Advances and Insights)

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