Search Results (119)

Background/Objectives: Ankle plantar flexor spasticity after stroke may limit mobility, especially during turning and multi-directional stepping. Evidence on performance differences and measurement properties across spasticity levels is limited. We examined whether performance on the Activities-specific Balance Confidence Scale (ABC Scale), Five Times Sit-to-Stand Test (5xSTS), Figure-of-8 Walk Test (F8WT), and Four-Square Step Test (FSST) differs by spasticity severity, and evaluated test–retest reliability, the intraclass correlation coefficient (ICC), the standard error of measurement (SEM), and the minimal detectable change (MDC). Methods: In an observational cross-sectional comparative study, 54 individuals more than 6 months post-stroke were classified into three groups by the Modified Ashworth Scale (MAS = 0, MAS = 1 − 1+, MAS ≥ 2). Participants completed the ABC Scale, 5xSTS, F8WT, and FSST. One-way analysis of variance with Bonferroni adjustment tested group differences. Reliability was quantified using ICC (2,1); SEM and MDC at the 95% confidence level indexed absolute reliability. Results: No significant differences were found for the ABC Scale or 5xSTS. F8WT and FSST differed by spasticity level (p < 0.05), with poorer performance in the highest-spasticity group versus no spasticity. ICCs were high across assessments. All SEMs were <20% of test–retest means, and all MDCs were <20% of maximum scores. Conclusion: Assessments that require directional change detected differences across spasticity levels, whereas balance confidence and repeated sit-to-stand did not. All measures showed acceptable relative and absolute reliability. Findings support selecting outcomes by spasticity severity and using SEM and MDC as reference values when interpreting change in stroke rehabilitation. Full article

Background and Objectives: Horse riding simulators (HRS) provide rhythmic, repetitive, and multidirectional movements analogous to horseback riding, which may facilitate postural control, balance, and functional abilities in children with cerebral palsy (CP). This study aimed to investigate the effects of the HRS application on the muscle tone of the lower extremity, gross motor function, trunk postural control, balance, gait functions, and functional independence in children with CP. Materials and Methods: A quasi-experimental study included 30 children with cerebral palsy (17 hemiparetic, 13 diparetic; mean age, 9.3 ± 3.2 years). All participants received Neurodevelopmental Therapy (NDT) for eight weeks, followed by eight weeks of HRS plus NDT, in a sequential design. Outcomes included the Modified Ashworth Scale (MAS), Myoton^®PRO, Gross Motor Function Measures (GMFM)-88, Pedalo^® Sensamove Balance Test (Pedalo^® SBT), Pediatric Balance Scale (PBS), Trunk Impairment Scale (TIS), gait analysis parameters, and Functional Independence Measure (WeeFIM). Assessments were made at baseline, the 8th, and the 16th week. Results: At week 16, after incorporating HRS, all MAS parameters demonstrated greater improvements compared to those achieved during the first eight weeks of NDT alone (ES: 0.728–0.931, p < 0.05). Myoton^®PRO measurements showed a significant reduction in gastrocnemius stiffness (ES = 0.672, p < 0.05) in hemiparetic children and decreases in hip adductor (ES: 0.649, p < 0.05) and gastrocnemius-soleus (ES: 0.766–0.865, p < 0.05) stiffness from week 8 to 16 in diparetic children following HRS intervention. Total scores on the GMFM-88, WeeFIM, TIS, and PBS improved significantly, with large effect sizes observed both from baseline to week 16 and from week 8 to 16 (ES: 0.771–0.886, p < 0.05). Additionally, Pedalo^® SBT scores increased following HRS intervention from baseline to week 16 (ES = 0.599–0.602, p < 0.05). Conclusions: HRS integrated with conventional NDT may improve muscle tone, motor function, balance, gait, and functional independence in children with cerebral palsy, representing a valuable adjunct to standard rehabilitation. These findings provide the first evidence that simulator-assisted interventions may benefit daily activities in children with cerebral palsy. Full article

Background/Objectives: Standing training is essential for individuals with spinal cord injury (SCI), yet maintaining regular practice after acute rehabilitation remains challenging. To address the need for more practical and accessible standing equipment, we developed a novel spring-assisted standing training device designed to overcome barriers to regular standing practice. This study aimed to assess the safety and feasibility of our newly developed device in individuals with SCI. Methods: Six participants with chronic SCI (neurological level of injury T4-L3, American Spinal Injury Association Impairment Scale A-C; 2 females, mean age 41.7 ± 13.4 years) underwent a single session using our chair-based device incorporating passive gas spring mechanisms. We designed this device to enable independent sit-to-stand transitions without electrical power or complex controls. Primary outcomes included safety (adverse events) and feasibility (number of repetitions, Modified Borg Scale). Changes in Modified Ashworth Scale (MAS) scores were assessed as exploratory measures. Results: All participants successfully completed training without adverse events. Repetitions ranged from 5 to 60 (median 37), with Modified Borg Scale ratings of 0–4. Notably, the participant with T4 complete injury performed the training without requiring trunk orthosis, demonstrating the device’s inherent stability. MAS sum scores showed a reduction from median 8.75 to 4.25, though this did not reach statistical significance (p = 0.13). Conclusions: Our newly developed spring-assisted standing training device proved safe and feasible for individuals with SCI, including those with complete thoracic injuries. The device successfully enabled independent sit-to-stand transitions with low perceived exertion, potentially addressing key barriers to regular standing practice and offering a practical rehabilitation solution. Full article

Objective: Neurosurgical interventions for medically refractory hypertonia (MRH) benefit both patients and their caregivers. Concurrent severe rotatory scoliosis and fusion constructs can make traditional microsurgical rhizotomy and navigated radiofrequency ablation (RFA) peripheral rhizotomy technically infeasible. We report the first case series of lumbosacral endoscopic ventral–dorsal rhizotomy (eVDR) in patients with MRH, and highlight this novel, minimally invasive, safe, and effective technique. Material and Methods: We retrospectively reviewed our single institution series of four patients with advanced hypertonia, gross motor function classification scale (GMFCS) 5, and severe rotatory scoliosis who underwent an eVDR using a flexible endoscope. We report demographics, operative characteristics, and outcomes. Results: Four patients underwent bilateral L1-S1 eVDR. Two patients had spastic quadriplegia and two had mixed spastic and dystonic hypertonia. Mean operative time was 225 ± 11 min and mean estimated blood loss (EBL) was 28.8 ± 26.2 mLs. Average length of stay was 2.75 days (range = 1–5 days), and average follow-up was 5.75 months (range = 3–9 months). All patients had significant decrease in bilateral lower extremity modified Ashworth Scale (mAS) scores (median decrease = 3, interquartile range [IQR] = 1; Wilcoxon rank-sum test z = −2.3, p = 0.02). The median decrease in Barry–Albright Dystonia Scale (BADS) scores for both patients with dystonia was 8 (IQR = 0). Two patients had minor perioperative events; none required additional surgery. All parents reported improvement in caregiving metrics. Conclusions: eVDR offers a safe and effective approach for tone reduction in patients with MRH and severe rotatory scoliosis and/or fusion hardware, which disallows traditional approaches. Full article

Background: Aquatic therapy (AT), immersion in hot water, and supported standing are frequently used to manage spasticity, contractures, and joint retractions in children with cerebral palsy (CP). Recently, the use of exoskeletons has been offering a new treatment option for severe CP. This study aimed to compare the post-immediate effects of four treatments on spasticity, range of motion, and the heart rate of children with severe CP. Methods: Three children with spastic CP (levels IV and V GMFCS) received a single 30-min session in consecutive weeks of robot-assisted gait training (RAGT), AT, supported standing, and immersion in hot water. Post-immediate assessments included knee flexor spasticity (modified Ashworth scale, MAS, and modified Tardieu scale, MTS); knee range of motion (ROM, in degrees (°)); and heart rate (HR). Results: AT and supported standing induced greater reductions in spasticity based on MAS scores. RAGT demonstrated superior spasticity reduction using MTS and yielded the greatest improvement in popliteal angle (mean increase: 27°). AT and RAGT induced a 14 beats-per-minute change in HR, indicating moderate cardiovascular engagement. Conclusions: RAGT appears particularly effective in improving spasticity and ROM in children with severe CP. Nonetheless, conventional treatments still offer an effective option when addressing spasticity. Full article

Background: The present study aimed to determine whether the protocolized use of pneumatic splints within neurodevelopmental therapeutic approaches produces a positive effect on sensorimotor impairments of the hemiplegic upper extremity in patients. Methods: A randomized clinical single-blind trial was conducted. Stroke patients were recruited and randomized into an experimental group, which completed a treatment protocol of splinting plus physiotherapy for 45 min per session, two sessions per week for four weeks; or a control group, which received the same type of conventional physiotherapy treatment for the same period of time. The patients were evaluated by Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) and the Trunk Control Scale. Secondary variables were Mini-BEStest, the modified Ashworth scale for ankle flexors, and computerized measurements of upper limb functional parameters performed by Armeo Spring^® robotic systems and Amadeo^®. All variables were measured pre- and post-treatment. Results: Twenty stroke patients with subacute and chronic stroke completed the protocol. Mann–Whitney U tests showed statistically significant differences between groups for the FM sensation variable (Z = −2.19; p = 0.03). The rest of the variables studied in the comparison between the two study groups did not present statistically significant differences (p > 0.05). Conclusions: The use of air splints in combination with physiotherapy treatment produced improvements in exteroceptive and proprioceptive sensitivity in post-stroke adult patients in the subacute and chronic phases. Full article

Background/Objectives: Spasticity in children with cerebral palsy (CP) can impair motor-related functions. The objective of this exploratory, prospective study was to examine if transcutaneous electrical nerve stimulation (TENS) in a whole-body suit leads to changes in spasticity and other related effects. Methods: Thirty-one children with CP GMFCS III–V, with a median age of 11.0 years (age range of 7–17 years), were consecutively included, and they used the suit with TENS for 24 weeks. The primary outcome was spasticity measured using the Modified Ashworth Scale (MAS). Functional motor-related tasks were evaluated by the Goal Attainment Scale (SMART GAS). The Modified Tardieu Scale (MTS), passive Range of Motion (pROM), GMFM-66, and Posture and Postural Ability Scale (PPAS) assessments were performed. Results: Seventeen subjects (17/31) completed the 24 weeks. Dropout was due to difficulty in donning the suit. The level of overall spasticity, most pronounced in the proximal arms and legs, was reduced according to the MAS, but not the MTS or pROM. Subject-relevant motor-related goals improved significantly in standing/walking and hand/arm function. Changes in the GMFM-66 and PPAS were not significant. Conclusions: Although there were statistically significant but underpowered changes in the MAS after 24 weeks, there were no clinically relevant effects. Exploratorily, we found observer-reliant motor-related functional improvements, which, however, we were unable to detect when trying to quantify them. Donning the suit led to dropout throughout the study. Caregivers need to allocate time, mental capacity and have the physical skill set for donning the suit for long-term use. Full article

Upper-limb impairments after stroke significantly affect patients’ quality of life and require effective rehabilitation strategies. Rehabilitation devices play a vital role in enhancing motor recovery. This study evaluated the efficacy of the Arm Booster, a bilateral arm-training device, in improving upper-limb impairment in patients with chronic stroke. Eighteen participants were randomly assigned to two groups: a device group (n = 9), using the Arm Booster; and a conventional physiotherapy group (n = 9). Both groups performed six bilateral upper-limb exercises (32 repetitions each) three times per week for eight weeks. Participants were further classified into mild spasticity (n = 5) and moderate-to-severe spasticity (n = 4) subgroups. The primary outcome was motor impairment, assessed using the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE). Secondary outcomes included spasticity, measured by the Modified Ashworth Scale (MAS), and daily functional use of the arm, assessed with the Motor Activity Log (MAL). Both groups showed significant improvements in FMA-UE scores and overall arm movement. The conventional group demonstrated additional gains in hand and wrist function and coordination. Notably, in the moderate-to-severe spasticity subgroup, the device group exhibited improvements in upper-limb movement and a trend toward reduced spasticity. These findings suggest that the Arm Booster may support motor recovery, encourage the use of the affected arm, improve movement control, and provide an efficient means for patients to exercise more frequently on their own. Full article

Background: Motor Function Disorders (MFDs) are common conditions in children with cerebral palsy and closely related to muscle spasticity. Catgut Embedment in Acupoint (CEA) has shown promise as an important adjunctive therapy but current evidence remains insufficient. The aim of this study was to evaluate the efficacy and safety of CEA in Pediatric-Cerebral-Palsy Motor Function Disorders (PCPMFDs). Methods: PubMed, Cochrane Library, Embase, Web of Science, four Chinese databases and two clinical trial registries were searched to include randomized controlled trials of patients with PCPMFDs treated with CEA combined with conventional rehabilitation. Meta-analysis was performed using Review Manager 5.4, Stata 18 and R Studio software 2025, and risk of bias was assessed for the included studies using the Cochrane Collaboration Network tool. Results: A total of 17 papers were included, including 1106 PCPMFDs patients with a wide range of conditions, age ≤ 9 years, and rehabilitation training mostly using Bobath/Vojta therapy. Meta-analysis showed that CEA was effective in improving MFDs with the Gross Motor Function Measure Scale (SMD, 0.90 [95% CI, 0.57 to 1.23], p < 0.0001) and the modified Ashworth Scale (MD, −0.40 [95% CI, −0.58 to −0.23], p < 0.0001). Preliminary results suggested that a treatment regimen, which consisted of three monthly sessions and lasted for one to two months, was most effective. Conclusions: CEA is an effective complementary treatment for patients with PCPMFDs with mild adverse effects. However, due to the relatively new perspective of this study, only a small number of researchers have focused on this area and conducted studies, resulting in fewer included studies meeting requirements, which is a direct result of the fact that this study, although informative, still requires a significant amount of research before clear evidence-based recommendations can be developed. Full article

Background: Spasticity, a hallmark of quadriplegic cerebral palsy (CP), severely impacts mobility and quality of life. While exercise is known to enhance fitness and motor function in individuals with CP, its specific efficacy in reducing upper extremity spasticity remains insufficiently studied. This research investigated the effects of weight-resistance exercise (RE), hand cycle bike exercise (BE), and aquatic exercise (AE) on upper extremity spasticity in an adult with quadriplegic CP. Method: The participant was a 35-year-old individual with quadriplegic spastic CP, presenting severe spasticity in the right upper extremity and lower limbs, and milder left arm involvement. Dependent on a power wheelchair, they were cognitively intact, college-educated, and had participated in a community exercise program for five years. Over nine weeks, the participant completed 18 sessions—6 per modality of RE, BE, and AE—with each session held twice weekly for 50 min. Spasticity was assessed using the Modified Ashworth Scale (MAS) before and after sessions, with comprehensive pre- and post-intervention evaluations. Result: Total MAS scores decreased significantly from 2.76 to 2.33 (p < 0.05). AE yielded the largest reduction (2.81 to 2.10), followed by BE (2.75 to 2.36) and RE (2.72 to 2.54). ANOVA confirmed AE’s superior efficacy (F(2,15) = 27.20, p < 0.001, ηp² = 0.78), with a 0.33 reduction overall. Conclusions: AE was most effective, likely due to buoyancy, followed by BE, with RE showing the least impact. These findings highlight aquatic interventions as promising for spasticity management in CP, necessitating further longitudinal, multi-participant research. Full article

Background/Objectives: The objective of this study was to expose the ability of neurophysiotherapeutic management to reduce spasticity through a modified Ashworth Scale. Methods: The sample, consisting of 102 subjects divided into control and study groups, was selected from an initial pool of N = 1007 patients diagnosed with stroke by a neurosurgeon that was later confirmed with imaging (MRI, CT). The study scheme included statistical differentiation between the study and control groups before and after applying specific rehabilitation programs and statistical differentiation within these groups before and after their rehabilitation procedures. Results: The results of this study revealed statistically significant improvements in reducing spasticity, as assessed by the Ashworth scale, within the group that participated in the neurorehabilitation program. It also confirmed that using neurophysiological methods is a highly effective approach to managing spasticity in post-stroke patients. Conclusions: Using neurophysiological methods in the standard physiotherapy treatment of spasticity is very effective for managing post-stroke spasticity. Full article

Background: Post-stroke equinovarus foot (EVF) impairs gait stability, increases the risk of secondary injuries, and contributes to elevated healthcare costs. However, effective targeted interventions for EVF remain limited. Patient concerns: Two patients with chronic EVF—a 63.5-year-old male (9.7 months post-stroke) and a 35.7-year-old female (24.5 months post-stroke)—presented with ankle deformity, gait asymmetry, and impaired balance, all of which interfered with daily activities. Intervention and outcomes: Both patients underwent ultrasound-guided acupotomy targeting spastic ankle muscles, administered over four sessions within two weeks. A quantitative gait analysis revealed substantial improvements in step length ratios (Case 1: 0.61 → 0.86; Case 2: 0.67 → 0.88), as well as enhancements in walking velocity, lateral symmetry, postural balance, and Modified Ashworth Scale scores. No adverse events were reported. Protocol proposal: Based on these observations, a prospective randomized controlled trial is planned to compare ultrasound-guided acupotomy plus conventional therapy versus conventional therapy alone. Outcomes will be assessed quantitatively using gait analysis. Lessons and implications: Ultrasound-guided acupotomy may offer a minimally invasive, targeted approach to releasing spastic muscles while preserving neurovascular structures, thereby improving gait function in patients with post-stroke EVF. Full article

Background: In para-sports, like Cerebral Palsy (CP) Football, athletes must meet a minimum impairment level to ensure fair competition. The classification process traditionally relies on subjective tools like the modified Ashworth Scale, but there is a need for more objective methods. Surface electromyography (EMG) offers quantifiable data on muscle activation, which could enhance the accuracy and fairness of classification in this sport. Objective: The aim of this study is to analyze muscle activation patterns in international CP football players compared to healthy controls, using surface electromyography (EMG). Methods: A cross-sectional, observational case–control study (following STROBE guidelines) was carried out. The final sample consisted of 40 subjects (20 subjects with CP from the Spanish National Team and 20 semi-professional able-bodied football players). The muscle activation of the soleus, adductor magnus, and biceps femoris was evaluated at baseline and in maximum isometric contraction in both dominant/unaffected and non-dominant/affected lower limbs. Results: The main result of this study was that the affected lower limbs of the experimental group showed higher muscle activation at baseline compared to those of the control group (p < 0.001). On the other hand, when a maximum isometric contraction was requested, muscle activation was greater in the control group in both lower limbs. There was greater asymmetry between both muscle groups in the experimental group. Conclusions: Surface electromyography could be a useful tool to be used in the assessment of muscle activity in subjects with CP with an applicability in para-sport, making it possible to obtain differences between both hemispheres when there is upper motor neuron involvement. Full article

Background/Objectives: Functional electrical stimulation (FES) has been used to improve the quality of life of patients with stroke. Rehabilitation programs focus on standing and walking, which are vital to functional independence and keystone ingredients in functional competency. To examine the effects of simultaneous continuous ongoing FES of gluteus medius (GMed) and tibialis anterior (TA) muscles at isometric contraction during standing and walking in patients with stroke. Methods: Short- and long-term FES management programs of GMed and TA muscles during different conditions have been used in patients with stroke. FES was applied to hip abductors and dorsiflexor muscles of the affected limb during four different conditions: passive hip abduction and ankle dorsiflexion, respectively (condition 1), sit-to-stand (condition 2), 10 m walk test (condition 3), and walking on C-mill treadmill (condition 4). The Modified Ashworth Scale (MAS), Five Times sit-to-stand test (FTSST), 10-m walk test (10-MWT), and C-mill treadmill were used to assess spasticity in the hip adductor and calf muscles, sit-to-stand performance, and temporal–spatial characteristics, respectively. Results: Short- and long-term FES management programs significantly reduced spasticity in the hip adductor and calf muscles and improved sit-to-stand performance, gait speed, and gait temporal–spatial characteristics. Conclusions: Short- and long-term FES management programs of GMed and TA muscles can quickly and effectively improve the spasticity and ambulation of patients with stroke. Further research incorporating gait analysis with randomized controlled samples is needed. Full article

Introduction: Reliable objective and non-invasive assessments of myotendinous alterations in patients with muscle tone disorders secondary to brain damage represent an important challenge in health science. The aim of this study was to observe the relationship between the skin temperature and the functional response in the triceps suralis of hemiplegic patients in relation to the healthy control group. Methods: A descriptive observational study was conducted based on the STARD recommendations. A total of 26 volunteers, 13 participants with unilateral motor impairment and 13 healthy patients, participated and completed the study. Intragroup and intergroup clinical thermography tests were performed, and the results were compared in relation to the timed up and go test, pain threshold to pressure, and modified Ashworth scale. Results: Statistically relevant differences (p < 0.01) could be observed between the two groups in each test performed. Thermographic analysis revealed a difference in temperature between the healthy and affected sides in the inter- and intra-group comparisons. It was possible to observe statistically significant differences (p < 0.01) between limbs in the brain damage group (the side affected was at a lower temperature), while no such differences were observed between limbs in the healthy control group (p > 0.05). Conclusions: Our results confirmed that clinical thermography could be a potentially useful tool in the assessment of both structural and functional alterations of the musculoskeletal system in patients with chronic brain damage. Full article