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Innovations in Neurorehabilitation
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Innovations in Neurorehabilitation

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

Deadline for manuscript submissions: 30 July 2025 | Viewed by 9732

Special Issue Editor

Dr. Syoichi Tashiro

E-Mail Website
Guest Editor
1. Department of Rehabilitation Medicine, School of Medicine, Keio University, Tokyo 160-8582, Japan
2. Department of Rehabilitation Medicine, Kyorin University School of Medicine, Tokyo 181-8611, Japan
Interests: rehabilitation; electrophysiology; physical rehabilitation; neurorehabilitation; stroke rehabilitation; regenerative rehabilitation; spinal cord injury rehabilitation; non-invasive brain stimulation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

A new era of neurorehabilitation is upon us. Researchers have determined that the physical and neurological functions themselves form the basis of our physical and neurological systems and induce plastic change. No ground-breaking treatment innovations, as represented by regenerative medicine or gene treatment, will be able to stand alone without rehabilitation, as long as that treatment requires the reorganization or maturation of the patients’ neural system. Moreover, with advancements in a variety of fields such as brain science, robotics, virtual reality, and neuro-engineering, researchers, all around the world, are currently establishing new treatment modalities. Rehabilitation is the hope for people with neurological diseases and injuries.

For this Special Issue, we invite neurorehabilitative studies and methodology reports, as well as review papers from both clinical and preclinical fields.

Dr. Syoichi Tashiro
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • clinical neurophysiology
  • neuroengineering
  • robotics
  • non-invasive transcranial brain stimulation
  • spinal stimulation
  • regenerative rehabilitation
  • neuroimaging
  • brain–computer interface
  • brain–spine interface
  • virtual reality
  • environmental control systems
  • higher level cognitive functions
  • vision rehabilitation

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Published Papers (6 papers)

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Research

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11 pages, 929 KiB  
Article
Effects of Prone Posture Maneuver to Ameliorate Pusher Behavior in Acute Stroke: A Retrospective Study
by Mitsuyo Ikeda, Syoichi Tashiro, Yusuke Harada, Kohei Ishita, Akifumi Masuda, Teruyuki Hirano and Shin Yamada
J. Clin. Med. 2024, 13(24), 7805; https://doi.org/10.3390/jcm13247805 - 20 Dec 2024
Viewed by 1075
Abstract
Background: Pusher behavior after stroke is an important sequela that interferes with rehabilitation and independence in activities of daily living. As represented by visual or vestibular feedback, conventional methods require substantial assistance and time commitments, but have limited effectiveness. A recent case series [...] Read more.
Background: Pusher behavior after stroke is an important sequela that interferes with rehabilitation and independence in activities of daily living. As represented by visual or vestibular feedback, conventional methods require substantial assistance and time commitments, but have limited effectiveness. A recent case series suggests that prone posture may alleviate pusher behavior in patients with acute stroke. This study was conducted to retrospectively investigate the effects of prone posture maneuvers. Methods: This retrospective cross-sectional observational study was conducted in a stroke care unit at a university hospital. In total, 37 acute stroke cases presenting with pusher behavior were included from 787 eligible patients. Individuals with pusher behavior were conditioned with prone posturing for 10 min for 2 consecutive days, in addition to regular daily rehabilitation training. The Scale for Contraversive Pushing (SCP) values, Stroke Impairment Assessment Set (SIAS), and functional activities were assessed before, immediately after, and three days after the intervention. Results: The SCP value and the ability to roll over and sit balanced significantly improved compared with the baseline (p < 0.05) and persisted for 3 days after the intervention. Multiple regression analysis identified the SIAS motor score as a determinant of SCP changes. Conclusions: The prone posture maneuver promptly and consistently suppressed pusher behavior, particularly in patients with mild paresis, as indicated by SCP values in acute stroke cases. The uncontrolled, single-site, and retrospective features of the current study require further investigation. Full article
(This article belongs to the Special Issue Innovations in Neurorehabilitation)
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20 pages, 1803 KiB  
Article
In Myotonic Dystrophy Type 1 Head Repositioning Errors Suggest Impaired Cervical Proprioception
by Stefano Scarano, Antonio Caronni, Elena Carraro, Carola Rita Ferrari Aggradi, Viviana Rota, Chiara Malloggi, Luigi Tesio and Valeria Ada Sansone
J. Clin. Med. 2024, 13(16), 4685; https://doi.org/10.3390/jcm13164685 - 9 Aug 2024
Viewed by 1128
Abstract
Background: Myotonic dystrophy type 1 (DM1) is a rare multisystemic genetic disorder with motor hallmarks of myotonia, muscle weakness and wasting. DM1 patients have an increased risk of falling of multifactorial origin, and proprioceptive and vestibular deficits can contribute to this risk. Abnormalities [...] Read more.
Background: Myotonic dystrophy type 1 (DM1) is a rare multisystemic genetic disorder with motor hallmarks of myotonia, muscle weakness and wasting. DM1 patients have an increased risk of falling of multifactorial origin, and proprioceptive and vestibular deficits can contribute to this risk. Abnormalities of muscle spindles in DM1 have been known for years. This observational cross-sectional study was based on the hypothesis of impaired cervical proprioception caused by alterations in the neck spindles. Methods: Head position sense was measured in 16 DM1 patients and 16 age- and gender-matched controls. A head-to-target repositioning test was requested from blindfolded participants. Their head was passively rotated approximately 30° leftward or rightward and flexed or extended approximately 25°. Participants had to replicate the imposed positions. An optoelectronic system was adopted to measure the angular differences between the reproduced and the imposed positions (joint position error, JPE, °) concerning the intended (sagittal, horizontal) and unintended (including the frontal) planar projections. In DM1 patients, JPEs were correlated with clinical and balance measures. Static balance in DM1 patients was assessed through dynamic posturography. Results: The accuracy and precision of head repositioning in the intended sagittal and horizontal error components did not differ between DM1 and controls. On the contrary, DM1 patients showed unintended side-bending to the left and the right: the mean [95%CI] of frontal JPE was −1.29° [−1.99°, −0.60°] for left rotation and 0.98° [0.28°, 1.67°] for right rotation. The frontal JPE of controls did not differ significantly from 0° (left rotation: 0.17° [−0.53°, 0.87°]; right rotation: −0.22° [−0.91°, 0.48°]). Frontal JPE differed between left and right rotation trials (p < 0.001) only in DM1 patients. No correlation was found between JPEs and measures from dynamic posturography and clinical scales. Conclusions: Lateral head bending associated with head rotation may reflect a latent impairment of neck proprioception in DM1 patients. Full article
(This article belongs to the Special Issue Innovations in Neurorehabilitation)
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15 pages, 1572 KiB  
Article
Improving Movement Behavior in People after Stroke with the RISE Intervention: A Randomized Multiple Baseline Study
by Wendy Hendrickx, Roderick Wondergem, Cindy Veenhof, Coralie English, Johanna M. A. Visser-Meily and Martijn F. Pisters
J. Clin. Med. 2024, 13(15), 4341; https://doi.org/10.3390/jcm13154341 - 25 Jul 2024
Cited by 1 | Viewed by 1316
Abstract
Objective: High amounts of sedentary behavior increase the risk of cardiovascular disease. This study aimed to determine the preliminary effectiveness and feasibility of the RISE intervention to support community-dwelling people with stroke, who are highly sedentary, to reduce and interrupt sedentary time. Additionally, [...] Read more.
Objective: High amounts of sedentary behavior increase the risk of cardiovascular disease. This study aimed to determine the preliminary effectiveness and feasibility of the RISE intervention to support community-dwelling people with stroke, who are highly sedentary, to reduce and interrupt sedentary time. Additionally, the added value of including participatory support was determined. Methods: A randomized, multiple-baseline study was conducted including 14 participants. All received the RISE intervention, a 15-week blended behavioral intervention in which a primary care physiotherapist provided personalized coaching in the home setting by using behavior-change techniques and the RISE eCoaching system, including an activity monitor and app to provide real time feedback. Half of the participants (randomly allocated) received participatory support from someone from their social network (e.g., partner or close friend) who joined them in the intervention. Preliminary effectiveness was determined with significant changes in total sedentary time and fragmentation (interruption) of sedentary time using a randomization test. Feasibility was assessed by adherence with the intervention protocol, safety, and satisfaction with the intervention. Results: Participants significantly reduced total sedentary time (p = 0.01) by 1.3 h on average and increased their fragmentation (p < 0.01). Subgroup analyses showed significant improvements in both outcomes only in the group with participatory support. Thirteen (92.9%) participants completed the intervention, no related adverse events occurred, and the reported participant satisfaction was sufficient. Conclusions: The RISE intervention appears promising to support people with stroke who are highly sedentary to reduce and interrupt their sedentary time. Participatory support appears to contribute to greater results. Trial registration: ISRCTN international trial registry, 10694741. Full article
(This article belongs to the Special Issue Innovations in Neurorehabilitation)
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11 pages, 1850 KiB  
Article
Virtual Reality-Induced Modification of Vestibulo–Ocular Reflex Gain in Posturography Tests
by Jan Warchoł, Anna Tetych, Robert Tomaszewski, Bartłomiej Kowalczyk and Grażyna Olchowik
J. Clin. Med. 2024, 13(10), 2742; https://doi.org/10.3390/jcm13102742 - 7 May 2024
Viewed by 1083
Abstract
Background: The aim of the study was to demonstrate the influence of virtual reality (VR) exposure on postural stability and determine the mechanism of this influence. Methods: Twenty-six male participants aged 21–23 years were included, who underwent postural stability assessment twice [...] Read more.
Background: The aim of the study was to demonstrate the influence of virtual reality (VR) exposure on postural stability and determine the mechanism of this influence. Methods: Twenty-six male participants aged 21–23 years were included, who underwent postural stability assessment twice before and after a few minute of single VR exposure. The VR projection was a computer-generated simulation of the surrounding scenery. Postural stability was assessed using the Sensory Organization Test (SOT), using Computerized Dynamic Posturography (CDP). Results: The findings indicated that VR exposure affects the visual and vestibular systems. Significant differences (p < 0.05) in results before and after VR exposure were observed in tests on an unstable surface. It was confirmed that VR exposure has a positive influence on postural stability, attributed to an increase in the sensory weight of the vestibular system. Partial evidence suggested that the reduction in vestibulo-ocular reflex (VOR) reinforcement may result in an adaptive shift to the optokinetic reflex (OKR). Conclusions: By modifying the process of environmental perception through artificial sensory simulation, the influence of VR on postural stability has been demonstrated. The validity of this type of research is determined by the effectiveness of VR techniques in the field of vestibular rehabilitation. Full article
(This article belongs to the Special Issue Innovations in Neurorehabilitation)
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Review

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23 pages, 1416 KiB  
Review
Neural Correlates of Alexithymia Based on Electroencephalogram (EEG)—A Mechanistic Review
by James Chmiel, Paula Wiażewicz-Wójtowicz and Marta Stępień-Słodkowska
J. Clin. Med. 2025, 14(6), 1895; https://doi.org/10.3390/jcm14061895 - 11 Mar 2025
Viewed by 735
Abstract
Introduction: Alexithymia is a multidimensional construct characterized by difficulties in identifying and describing emotions, distinguishing emotional states from bodily sensations, and an externally oriented thinking style. Although the prevalence in the general population is around 10%, it is significantly higher in clinical groups, [...] Read more.
Introduction: Alexithymia is a multidimensional construct characterized by difficulties in identifying and describing emotions, distinguishing emotional states from bodily sensations, and an externally oriented thinking style. Although the prevalence in the general population is around 10%, it is significantly higher in clinical groups, including those with autism spectrum disorders, depression, anxiety, and neurological conditions. Neuroimaging research, especially using magnetic resonance imaging, has documented structural and functional alterations in alexithymia; however, electroencephalography (EEG)—an older yet temporally precise method—remains less comprehensively explored. This mechanistic review aims to synthesize EEG-based evidence of the neural correlates of alexithymia and to propose potential neurophysiological mechanisms underpinning its affective and cognitive dimensions. Methods: A thorough literature search was conducted in December 2024 across PubMed/Medline, ResearchGate, Google Scholar, and Cochrane using combined keywords (“EEG”, “QEEG”, “electroencephalography”, “alexithymia”) to identify English-language clinical trials or case studies published from January 1980 to December 2024. Two reviewers independently screened the titles and abstracts, followed by a full-text review. Studies were included if they specifically examined EEG activity in participants with alexithymia. Of the 1021 initial records, eight studies fulfilled the inclusion criteria. Results: Across the reviewed studies, individuals with alexithymia consistently demonstrated right-hemisphere dominance in EEG power and connectivity, particularly in the theta and alpha bands, during both neutral and emotion-eliciting tasks. Many exhibited reduced interhemispheric coherence and disrupted connectivity in the frontal and parietal regions, potentially contributing to difficulties in cognitive processing and emotion labeling. Some studies have also reported diminished gamma band activity and phase synchrony in response to negative stimuli, suggesting impaired higher-order integration of emotional information. Crucially, subjective reports (e.g., valence ratings) often do not differ between alexithymic and non-alexithymic groups, highlighting that EEG measures may capture subtle emotional processing deficits not reflected in self-reports. Conclusions: EEG findings emphasize that alexithymia involves specific disruptions in cortical activation and network-level coordination, rather than merely the absence of emotional experiences. Right-hemisphere over-reliance, reduced interhemispheric transfer, and atypical oscillatory patterns in the alpha, theta, and gamma bands appear to be central to the condition’s pathophysiology. Understanding these neural signatures offers avenues for future research—particularly intervention studies that test whether modulating these EEG patterns can improve emotional awareness and expression. These insights underscore the potential clinical utility of EEG as a sensitive tool for detecting and tracking alexithymic traits in both research and therapeutic contexts. Full article
(This article belongs to the Special Issue Innovations in Neurorehabilitation)
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Other

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28 pages, 1717 KiB  
Systematic Review
Effectiveness of Robotic Devices for Medical Rehabilitation: An Umbrella Review
by Kei Kiyono, Shigeo Tanabe, Satoshi Hirano, Takuma Ii, Yuki Nakagawa, Koki Tan, Eiichi Saitoh and Yohei Otaka
J. Clin. Med. 2024, 13(21), 6616; https://doi.org/10.3390/jcm13216616 - 4 Nov 2024
Cited by 1 | Viewed by 3513
Abstract
Background/Objectives: Clinical trials have investigated the efficacy of rehabilitation robotics for various pathological conditions, but the overall impact on rehabilitation practice remains unclear. We comprehensively examined and analyzed systematic reviews (SRs) of randomized controlled trials (RCTs) investigating rehabilitative interventions with robotic devices. Methods: [...] Read more.
Background/Objectives: Clinical trials have investigated the efficacy of rehabilitation robotics for various pathological conditions, but the overall impact on rehabilitation practice remains unclear. We comprehensively examined and analyzed systematic reviews (SRs) of randomized controlled trials (RCTs) investigating rehabilitative interventions with robotic devices. Methods: Four databases were searched using term combinations of keywords related to robotic devices, rehabilitation, and SRs. The SR meta-analyses were categorized into “convincing”, “highly suggestive”, “suggestive”, “weak”, or “non-significant” depending on evidence strength and validity. Results: Overall, 62 SRs of 341 RCTs involving 14,522 participants were identified. Stroke was most frequently reported (40 SRs), followed by spinal cord injury (eight SRs), multiple sclerosis (four SRs), cerebral palsy (four SRs), Parkinson’s disease (three SRs), and neurological disease (any disease causing limited upper- and lower-limb functioning; three SRs). Furthermore, 38, 21, and 3 SRs focused on lower-limb devices, upper-limb devices, and both upper- and lower-limb devices, respectively. Quantitative synthesis of robotic intervention effects was performed by 51 of 62 SRs. Robot-assisted training was effective for various outcome measures per disease. Meta-analyses offering suggestive evidence were limited to studies on stroke. Upper-limb devices were effective for motor control and activities of daily living, and lower-limb devices for walking independence in stroke. Conclusions: Robotic devices are useful for improving impairments and disabilities in several diseases. Further high-quality SRs including RCTs with large sample sizes and meta-analyses of these RCTs, particularly on non-stroke-related diseases, are required. Further research should also ascertain which type of robotic device is the most effective for improving each specific impairment or disability. Full article
(This article belongs to the Special Issue Innovations in Neurorehabilitation)
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