Search Results (243)

Background: Complex regional pain syndrome (CRPS) is a disabling post-traumatic pain condition that may occur after distal radius fracture (DRF), potentially impairing recovery and upper-limb function. Identifying effective preventive strategies after DRF is therefore clinically important. Objective: To synthesize and critically appraise interventions intended to prevent CRPS after DRF, including rehabilitation protocols and clinical prophylaxis strategies. Methods: This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses PRISMA and was registered in the International Prospective Register of Systematic Reviews PROSPERO (CRD42023408499). Five databases (PubMed, Web of Science, Scopus, ScienceDirect, and B-on) were searched for studies published from January 2013 to 22 September 2023 in English, Portuguese, or Spanish. The primary outcome was CRPS incidence after DRF. Findings were synthesized narratively due to heterogeneity in interventions and diagnostic criteria, and risk of bias was assessed using design-appropriate tools. Results: Nine studies were included (total N = 7075; CRPS cases n = 127). Interventions comprised vitamin C supplementation (2 studies), probiotics, aspirin, polarized/polychromatic light therapy plus conventional treatment, early rehabilitation/home-exercise programs, and general CRPS-prevention protocols after DRF. Probiotics and aspirin did not reduce CRPS incidence. Vitamin C showed mixed findings across the included studies and remains debated in the broader literature. Light therapy was associated with reduced CRPS occurrence in a single study, while early active home-exercise programs appeared promising but were supported by a limited number of studies. Study designs and CRPS diagnostic criteria varied, and risk of bias was moderate-to-serious in several non-randomized studies. Conclusions: Evidence remains insufficient to support a single standardized prevention protocol for CRPS after distal radius fracture. Early active rehabilitation and progressive mobilization appear promising, but the available evidence is still limited and heterogeneous. Adjunctive strategies such as vitamin C and light therapy should be interpreted with caution, as findings for vitamin C remain debated in the literature and the evidence for light therapy is currently based on a single study. Other approaches, including probiotics and aspirin, have shown inconclusive results. Full article

Background/Objectives: Stroke generates 157 million disability-adjusted life-years (DALYs) annually, making it the leading neurological cause of global disease burden. Artificial intelligence (AI) and machine learning (ML) have emerged as transformative technologies across the stroke care continuum. This narrative review maps the trajectory of AI in stroke medicine over the decade from 2015 to 2025. Methods: We conducted a narrative review with a structured, pre-specified search strategy across eight pre-specified thematic clusters using PubMed/MEDLINE (January 2015–December 2025), identifying 8549 records and including 1335 studies after screening. Inclusion criteria encompassed primary research articles, systematic reviews, meta-analyses, and RCTs reporting quantitative performance metrics or clinical outcome data for AI/ML in stroke. Results: Stroke imaging AI is the most commercially mature domain, with over 30 FDA-cleared tools. Automated ASPECTS scoring reduced radiologist reading time by 74.8% (AUC 84.97%; 95% CI: 83.1–86.8%). The only triage AI RCT demonstrated an 11.2 min reduction in door-to-groin time without significant improvement in 90-day functional independence (OR 1.3, 95% CI 0.42–4.0). Brain–computer interface rehabilitation showed significant upper limb recovery in a 17-center RCT (FMA-UE mean difference +3.35 points, 95% CI 1.05–5.65; p = 0.0045). AF detection AI is FDA-cleared and RCT-validated. LLMs and federated learning are pre-regulatory but growing exponentially. Conclusions: AI in stroke has achieved diagnostic maturity but therapeutic immaturity. Bridging algorithmic performance to patient outcomes, addressing equity gaps, and building the economic evidence base for scalable deployment are the defining challenges of the next decade. Full article

Background: Upper-limb impairment is a major contributor to chronic disability after stroke. Conventional recovery protocols frequently suffer from poor adherence, limited accessibility, and insufficient intensity for prolonged rehabilitation. Methods: We performed a systematic analysis of randomized controlled trials (RCTs) and non-randomized designs published between 2019 and 2024, assessing virtual reality (VR) interventions for upper-limb stroke rehabilitation. Participant characteristics, VR intervention details, primary and secondary outcomes, and adherence rates were analyzed in accordance with PRISMA guidelines. The review is registered in PROSPERO (CRD420251150877). We searched PubMed, Embase, Wiley, Scopus, and Cochrane databases. Study quality was assessed using the RoB 2 and ROBINS-I tools. This review received no funding. Results: Forty-one trials met the inclusion criteria. High variability in study methodology, VR devices, intervention protocols, and outcome measures limited direct comparability. Dropout rates were low and were frequently attributed to factors unrelated to the VR intervention. Adverse events were uncommon, supporting the feasibility and safety of VR-based rehabilitation. Conclusions: While VR is a safe and feasible modality, large-scale, multicenter clinical trials with standardized protocols and long-term follow-up are essential to define the role of VR in routine stroke care. Full article

Background: Statistics show that the number of patients suffering from stroke and living with disability as a result has increased significantly worldwide between 1990 and 2021. This implies the necessity of continuous improvement of both treatment methods and rehabilitation, which is essential in the treatment process. According to the International Classification of Functioning (ICF), as many as 88% of patients do not regain functionality in their affected upper limbs six months after a vascular incident, which negatively affects their quality of life. Upper limb rehabilitation using robots is a progressive approach to restoring not only lost limb function, but above all, independence in activities of daily living. Aim of the study: The aim of this review is to determine the actual effects of rehabilitation using various robots in patients after cerebrovascular accidents and to compare these effects with those achieved by patients who participated in a non-robotic rehabilitation program. Methods: Studies published between 2019 and 2025 were included in the analysis. The analysis was written according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Results: Studies have shown improvement in upper limb function in patients exercising both with and without the use of a robot, but statistical data clearly show better results in patients undergoing therapy with robots. Conclusions: Studies have shown that the use of a rehabilitation program involving robots brings measurable improvements in many different aspects of upper limb function, and evidence confirming the effectiveness of this therapy encourages further research, refinement, and dissemination of this method and technology. Full article

Background: Women with endometriosis frequently experience mobility limitations that affect daily functioning. A specific tool to assess these restrictions would help clinicians to better understand patients’ functional challenges, facilitating more effective communication and shared decision making. Addressing this gap is essential for strengthening patient–professional dialogue and improving individualized care. Objective: To develop the new instrument MobEndo and to perform initial psychometric testing of the tool. Methods: The initial domains and items were generated through semi-structured interviews with patients and based on experts’ advice. Guided by the International Classification of Functioning, Disability, and Health (ICF) framework, exploratory factor analysis was conducted on data from patients diagnosed with endometriosis. Internal consistency was assessed using Cronbach’s alpha, considering values ≥ 0.70 as acceptable. Test–retest reliability was examined using intraclass correlation coefficients (ICCs), and ICC values were judged as excellent if >0.75. Construct validity was evaluated through concurrent, discriminant, and known-groups validity. For the known-groups validity hypothesis, participants were categorized by baseline pain levels. Results: The final questionnaire included 18 items, developed from responses from 301 women (mean age 38.96 ± 6.85). Factor analysis revealed two components—transitioning between body positions and performing movements requiring stabilization and executing load-bearing tasks involving the upper limbs—with the model explaining 71.78% of the total variance. Reliability was excellent, with a Cronbach’s alpha of 0.977. The ICC for the total score was 0.976 (95% CI 0.949–0.988), with similarly high values for each component. Concurrent validity correlations were significant, while discriminant validity showed no relevant associations. Known-groups analyses showed clear differences across pain-level groups. Conclusions: The questionnaire is a valid and reliable tool for capturing women’s perceived mobility limitations in endometriosis. Full article

Background/Objectives: Stroke is among the leading causes of disability in adults, as hemiparesis affects motor function and daily activities. Constraint-induced movement therapy (CIMT) has proven effective in functional recovery through intensive use of the affected limb. This study aimed to assess the impact of CIMT on upper limb (UL) rehabilitation in stroke patients, with a focus on motor recovery, integration into activities of daily living (ADLs), and overcoming clinical implementation barriers. Methods: A systematic review was conducted by searching PubMed, Scopus, and Web of Science from their inception to March 2026. Systematic reviews and meta-analyses evaluating the effectiveness of CIMT in adult patients after stroke were included. The outcome variables included motor function, movement quality, independence in ADLs, and quality of life (QoL). Results: Twenty-five systematic reviews and sixteen meta-analyses were included. The participants were adults who had suffered a stroke at acute, subacute, or chronic stages and were aged between 18 and 95 years. With respect to upper limb motor function, ten studies reported statistically significant results in favor of CIMT. With respect to ADLs, four studies reported significant differences in favor of CIMT, with strong effects in intensive interventions. With respect to QoL, three studies reported significant improvements after the intervention. Conclusions: The results of this umbrella review support the effectiveness of CIMT in UL rehabilitation after stroke, especially in the subacute and chronic phases. CIMT, alone or in combination with adjuvant therapies, contributes to improving motor function, independence in ADLs, and QoL in patients. Full article

Carpal Tunnel Syndrome (CTS) is the most common upper-limb entrapment neuropathy and remains a major contributor of work-related disability. While Carpal Tunnel Release (CTR) reliably improves symptoms, functional recovery is less consistently reported. Return-to-Work (RTW) has emerged as a practical functional outcome, but definitions and reporting remain heterogeneous. We conducted a narrative review of English-language studies reporting RTW or work-absence outcomes following open, endoscopic, ultrasound-guided, ultraminimally invasive, and microinvasive CTR techniques. Due to variability in study design and RTW definitions, findings were synthesised descriptively. Across the literature, RTW durations progressively shortened as procedural invasiveness decreased. Open CTR commonly reported RTW at four to six weeks, endoscopic techniques at two to four weeks, and ultrasound-guided approaches at approximately 10–21 days. Recent ultraminimally invasive and microinvasive systems frequently reported RTW within one to two weeks when performed under local anaesthesia. These findings highlighted RTW as a meaningful functional benchmark and underscore the role of imaging-guided access minimisation in accelerating postoperative recovery. Full article

Background: Disability progression in multiple sclerosis (MS) is increasingly recognized as a consequence of large-scale brain network disruption rather than isolated regional damage. Although diffusion tensor imaging (DTI) is the reference method for assessing structural connectivity, its limited availability restricts widespread clinical application. There is therefore a critical need for alternative approaches capable of capturing network-level alterations using routinely acquired MRI data. Objective: This study aimed to determine whether synthetic structural connectivity matrices derived from standard regional volumetric MRI can capture clinically meaningful network alterations in MS and predict subsequent functional progression, particularly upper limb decline. Methods: Regional brain volumetry was obtained from routine T1-weighted MRI using an automated, clinically approved volumetric pipeline. Synthetic structural connectivity matrices were generated by integrating principles of structural covariance, distance-dependent connectivity, and disease-specific vulnerability patterns. Graph-theoretical network metrics were extracted to characterize global and regional topology. Machine learning models including logistic regression, support vector machines, random forests, and gradient boosting were trained to predict clinical progression defined by worsening on the 9-Hole Peg Test. Dimensionality reduction was performed using principal component analysis, and model performance was evaluated using balanced accuracy, AUC-ROC, and resampling-based validation. Feature importance analyses were conducted to identify network vulnerability patterns. Results: Synthetic connectivity networks exhibited biologically plausible properties, including preserved but attenuated small-world organization. Global efficiency showed a strong inverse correlation with disability severity (EDSS). Patients with clinical progression demonstrated marked reductions in network integration and segregation, alongside increased characteristic path length. Machine learning models achieved robust prediction of upper limb functional decline, with ensemble-based methods performing best (balanced accuracy > 80%, AUC-ROC up to 0.85). A limited subset of connections accounted for a disproportionate share of predictive power, predominantly involving frontoparietal associative networks, thalamocortical pathways, and inter-hemispheric connections. In a longitudinal subset, network-level alterations preceded measurable clinical deterioration by several months. Conclusions: Synthetic structural connectivity derived from routine volumetric MRI captures clinically relevant network-level disruption in multiple sclerosis and enables accurate prediction of functional progression. By bridging network neuroscience with widely accessible imaging data, this framework provides a pragmatic alternative for connectomic analysis when diffusion imaging is unavailable and supports a network-based understanding of disease evolution in MS. Full article

Background: Deep brain stimulation (DBS) has traditionally followed diagnosis-driven, nucleus-centered targeting paradigms. Increasing evidence supports a circuit-based framework in which clinical outcomes depend on modulation of symptom-relevant networks rather than diagnostic labels alone. This approach is particularly relevant in mixed movement disorder phenotypes such as dystonic tremor, where the most disabling symptom may not align with the conventional surgical target. Methods: We report a clinically illustrative single case treated using a symptom-oriented, connectome-informed DBS strategy. Clinical phenotype, tremor severity, functional impairment, prior medical and botulinum toxin treatments, and longitudinal outcomes were systematically reviewed. DBS target selection prioritized the dominant, treatment-refractory symptom rather than the underlying dystonia diagnosis. Surgical planning incorporated high-resolution MRI with patient-specific thalamic segmentation using Brainlab Brain Elements^®, followed by postoperative lead localization and volume of tissue activated visualization with the SureTune™ platform. Results: A 54-year-old left-handed woman with long-standing cervical dystonia developed a severe, markedly asymmetric dystonic tremor predominantly affecting the left upper limb, resulting in profound functional disability. Instead of conventional bilateral globus pallidus internus DBS, unilateral right ventral intermediate nucleus (VIM) DBS was selected to engage tremor-related cerebellothalamic circuits. Rapid and marked improvement was observed, with tremor severity reduced to mild levels within 15 days after stimulation onset. At 6-month follow-up, overall tremor severity improved from 49 to 13 points on the Fahn–Tolosa–Marin Tremor Rating Scale, corresponding to a 73.5% reduction. This improvement was associated with restoration of legible handwriting, independent feeding and drinking, and recovery of bimanual fine motor function. Clinical benefit remained stable throughout follow-up, without stimulation-related adverse effects. Conclusions: This case illustrates the feasibility of a symptom-oriented, connectome-informed DBS strategy in selected patients with dystonic tremor. When symptom expression and network involvement are markedly asymmetric, selective unilateral modulation of the tremor-dominant circuit may achieve meaningful and durable functional improvement. Further studies are needed to assess the generalizability of this approach. Full article

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

Stroke frequently results in persistent upper limb impairments, which are often accompanied by compensatory movement strategies that are not fully captured by conventional clinical assessment scales. Quantitative kinematic analyses may provide more objective and sensitive measures of motor dysfunction. In this study, we propose a probabilistic, distribution-based analysis of upper limb kinematics to quantify motor disability in post-stroke patients. We analyzed reaching movement data acquired with a markerless Kinect V2 system from 36 post-stroke patients and age-matched healthy controls. Wrist velocity profiles were characterized using distribution metrics, including variance, skewness, kurtosis, and entropy, and divergence measures (Hellinger distance, Kullback–Leibler divergence, and Jensen–Shannon divergence). Group differences between patients and controls, as well as across impairment levels stratified by the Fugl-Meyer (FM) score, were evaluated. Several distribution metrics significantly discriminated patients from controls and scaled with motor impairment severity. In particular, divergence-based measures showed a strong association with FM scores, indicating increasing deviation from normative movement patterns with greater impairment. These findings demonstrate that distribution-based metrics focusing on kinematic analysis provide a clinically meaningful, objective descriptor of motor dysfunction and complement conventional biomechanical assessments, offering a sensitive framework for quantifying motor disability after stroke. Full article

This study proposes a video-based approach for quantitatively evaluating upper-limb joint abnormalities in individuals with brain lesions during resistance exercises. While the Fugl–Meyer Assessment (FMA) is a reliable clinical tool, its use is limited by the need for expert involvement and repeated assessments. To address this issue, skeletal joint data were extracted from RGB exercise videos using OpenPose, and joint abnormalities were identified by learning normal movement patterns from non-disabled participants. A total of 26 non-disabled individuals and 12 individuals with brain lesions performed chest press, shoulder press, and arm curl exercises. Joint movement patterns were analyzed using correlation analysis and a long short-term memory (LSTM) autoencoder. Only joints relevant to each exercise were evaluated, and joint-level results were integrated to compute arm-level abnormality rates. The correlation-based abnormality rate showed a significant negative correlation with FMA scores (r = −0.7789, p = 2.83 × 10⁻³), while the LSTM autoencoder-based abnormality rate exhibited a stronger correlation(r = −0.8454, p = 5.33 × 10⁻⁴). In addition, affected-side classification accuracy reached 78.0% and 83.3% for correlation analysis and the LSTM autoencoder, respectively. These results indicate that the proposed method is consistent with clinical assessments and can serve as a non-invasive, cost-effective tool for video-based rehabilitation evaluation. Full article

Purpose: In this systematic review, we compare the effectiveness of high-intensity laser therapy (HILT) and extracorporeal shockwave therapy (ESWT) in treating lateral elbow tendinopathy (LET). Methods: A comprehensive search of PubMed, the Cochrane Library, and EMBASE was conducted from database inception to 23 June 2025 to identify randomized controlled trials (RCTs) comparing the two interventions. The primary outcome was pain intensity (visual analog scale or numeric rating scale). Secondary outcomes included upper-limb disability (qDASH), grip strength (pain-free or maximal), ultrasound-measured common extensor tendon thickness, and safety (adverse events and withdrawals). Two reviewers independently extracted data and assessed methodological quality using the Physiotherapy Evidence Database (PEDro) scale; the certainty of evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Effects were synthesized as SMD (95% CI) using random- or fixed-effects models based on heterogeneity (I²). Significance was set at p < 0.05. Results: Four RCTs met the inclusion criteria and 169 participants were included. Methodological quality was moderate, with moderate-quality evidence indicating a significant improvement in short-term and medium-term upper-limb function in favor of HILT (SMD = −0.42; 95% CI: −0.73 to −0.12 and SMD = −0.50; 95% CI: −0.94 to −0.06, respectively). Evidence ranging from low to moderate quality showed no significant differences between the HILT and ESWT groups in terms of short-term or medium-term resting pain (SMD = −0.50; 95% CI: −1.15 to 0.16 and SMD = −0.42; 95% CI: −1.06 to 0.22, respectively), short-term or medium-term activity pain (SMD = −0.38; 95% CI: −1.05 to 0.29 and SMD = −0.73; 95% CI: −1.65 to 0.19, respectively), short-term or medium-term grip strength (SMD = 0.24; 95% CI: −0.20 to 0.67 and SMD = 0.20; 95% CI: −0.16 to 0.55, respectively), or short-term or medium-term common extensor tendon thickness (SMD = 0.04; 95% CI: −0.50 to 0.59 and SMD = −0.00; 95% CI: −0.55 to 0.55, respectively). Conclusions: HILT appears to offer significant benefits in improving upper-limb function at short-term (<1 month) and medium-term (1–3 months) follow-up. Regarding pain, grip strength, and tendon thickness, the pooled effects did not show clear between-group differences. Evidence certainty ranged from low to moderate, demonstrating that trials with a follow-up period beyond 3 months are needed to evaluate long-term efficacy. Systematic review registration number: PROSPERO: CRD420251026387. Full article

Background: Persistent pain following orthopaedic trauma is common, often disproportionate to structural healing, and increasingly interpreted as reflecting centrally mediated pain mechanisms. However, the mechanisms, clinical features, diagnostic approaches, prognostic indicators, and management strategies relevant to trauma-related central sensitisation (CS) remain poorly understood. Objective: To map and synthesise existing evidence on CS following orthopaedic trauma, addressing mechanistic pathways, clinical manifestations, epidemiology, assessment methods, management approaches, and health system implications. Methods: A scoping review was conducted in accordance with PRISMA-ScR. Twenty-one studies met the eligibility criteria, comprising nine primary trauma cohorts and 12 contextual mechanistic or review studies relevant to trauma-associated CS. Data were charted across six prespecified domains of mechanistic processes, clinical presentation and diagnostic features, epidemiology and prognosis, assessment tools and outcome measures, interventions, and health system and care delivery considerations. Results: Mechanistic studies demonstrated trauma-induced neuroimmune activation, altered cortical and spinal excitability, and molecular pathways consistent with sensitisation. Clinical studies have identified neuropathic features, widespread pain, and heightened sensory responsiveness following fractures and other injuries. Neurophysiological evidence has indicated early cortical disinhibition following upper limb trauma, whereas epidemiological cohorts have reported persistent pain and disability years after major trauma. Measurement studies have highlighted the limited reliability and specificity of current tools in trauma populations, including quantitative sensory testing and self-report instruments. Early predictors of adverse trajectories include severe acute pain, neuropathic descriptors, psychological distress, and opioid-dominant analgesia. Evidence regarding early intervention, rehabilitation strategies, and system-level screening pathways remains limited. Conclusions: Central sensitisation (CS)–consistent mechanisms after orthopaedic trauma are suggested by convergent mechanistic, neurophysiological, and clinical findings. However, trauma-specific diagnostic criteria, prognostic models, and management frameworks remain underdeveloped. High-quality longitudinal research is needed to clarify early trajectories, refine assessment methods, and establish targeted interventions to reduce long-term pain and disability. Full article

Background: Manual dexterity (MD) impairment is a frequent and disabling feature in patients with Parkinson’s disease (PD) and paranoid schizophrenia (PS), significantly affecting functional independence and activities of daily living. However, rehabilitation strategies specifically targeting fine motor control remain insufficiently integrated into routine physiotherapy (PT). Objective: This study investigated the effects of a structured, progressive PT program incorporating targeted MD training on upper limb function in patients with PD and PS. Methods: A prospective, exploratory, interventional study was conducted in 30 patients, allocated to either an experimental group (EG, n = 20) or a control group (CG, n = 10). Participants had PD (Hoehn and Yahr stages II–III) or chronic, clinically stable PS. MD was assessed using the Purdue Pegboard Test, Coin Rotation Task, and Kapandji opposition score. The EG completed a four-phase, 40-week dexterity-oriented rehabilitation program, while the CG received standard disease-specific PT. Between-group differences in change scores were analyzed using one-way ANOVA. Results: The EG showed significantly greater improvements than the CG in thumb opposition, psychomotor processing speed, and unilateral and bilateral fine motor performance (p < 0.001 for all), with large to very large effect sizes (η² = 0.45–0.76). No significant between-group differences were observed for complex sequential assembly tasks. Conclusions: Integrating targeted MD training into structured PT programs significantly improves fine motor performance in patients with PD and PS, supporting its inclusion in rehabilitation protocols for residential and outpatient care settings. Full article