NeuroRehabilitation

Most measures of rehabilitation participation rely on self-report, excluding patients with cognitive impairment or aphasia. The observational Pittsburgh Rehabilitation Participation Scale (PRPS) allows their inclusion; however, whether rehabilitation participation assessed using the PRPS modifies improvement in activities of daily living (ADL) remains unclear.

To determine whether rehabilitation participation assessed using the PRPS modifies the association between baseline ADL and subsequent improvement after stroke.

This retrospective cohort study included 137 stroke survivors in a subacute rehabilitation ward. Admission rehabilitation participation was assessed by the PRPS. ADL improvement was evaluated using the Functional Independence Measure (FIM) motor effectiveness score. Hierarchical multiple regression analysis included age, days from onset to hospital admission, admission FIM motor and cognitive scores, and admission PRPS score in Step 1, followed by the PRPS × admission FIM motor interaction term in Step 2. Prediction plots were generated for each PRPS score.

The median admission PRPS and FIM motor effectiveness scores were 5 (interquartile range [IQR], 4–6) and 0.70 (IQR, 0.33–0.88), respectively. Adding the PRPS × FIM motor interaction term in Step 2 significantly improved the model fit (ΔR² = 0.057, ΔF(1,130) = 16.28, p < .001), resulting in a final model (R² = 0.545, p < .001). Prediction plots showed steeper slopes with higher PRPS scores.

Admission rehabilitation participation assessed by the PRPS modified the association between baseline ADL and ADL improvement. Observable participation should be interpreted in relation to baseline motor ADL rather than in isolation. Lower participation may indicate a need for additional clinical support.

Traumatic brain injury (TBI) is a leading cause of long-term disability. This study aimed to evaluate the effectiveness of a Post-Acute Care (PAC) program for patients with TBI in Taiwan and to identify the independent predictors associated with the magnitude of their functional recovery.

This retrospective cohort study included 168 patients with TBI admitted to a PAC program from a tertiary medical center. The primary outcome was the change score in the Barthel Index (BI)(ADL). The Wilcoxon Signed-Rank Test was used to assess changes in functional scores (BI(ADL), IADL, and EQ-5D) from admission to discharge.

Patients demonstrated statistically significant improvements across all functional measures after the PAC intervention, including the BI(ADL), IADL, and EQ-5D (all p < .001). After adjusting for all covariates, length of stay was the sole significant independent predictor of the BI(ADL) change score (B = 0.309, p < .001), indicating that for each additional day of PAC, a patient's BI score was expected to improve by 0.309 points.

Post-Acute Care is a highly effective intervention for improving functional outcomes in patients with TBI. These findings provide a strong evidence base for clinicians to advocate for sufficient rehabilitation time and for policymakers.

Gait variability is a sensitive marker of neuromotor function and a clinically relevant indicator of fall risk and mobility impairment in neurological and geriatric populations. The Enhanced Gait Variability Index (eGVI) has emerged as a promising composite measure that captures multidimensional gait irregularity in a single interpretable score, offering a practical advantage over single-parameter approaches. Despite growing clinical interest, the evidence base supporting its standardized implementation has not been mapped.

To characterize populations and clinical contexts where the eGVI has been applied, map assessment protocol heterogeneity, and identify methodological gaps limiting precision medicine-aligned implementation in neurological and geriatric rehabilitation.

A scoping review following PRISMA-ScR guidelines was conducted using PubMed, CINAHL, Scopus, Emcare, and Web of Science. Peer-reviewed studies reporting eGVI outcomes were included. Data were extracted on participant characteristics, gait assessment protocols, and outcomes, with attention to factors influencing clinical interpretation.

Eighteen studies involving 1,915 participants were included, predominantly examining Parkinson's disease (39%) and older adult populations (22%). The eGVI demonstrated preliminary sensitivity to neuromotor impairment, age-related gait changes, and increased task complexity during dual-task walking; findings were most consistent in Parkinson's disease, based on limited number of studies (n = 7). Substantial heterogeneity in walkway systems, walking conditions, assistive device use, and reference populations limited comparability.

While the eGVI shows promise as a clinical outcome measure, protocol variability and reliance on a single unvalidated normative reference limit its clinical use. Population-specific protocols and normative data consistent with a precision medicine approach, are essential for reliable adoption.

Upper extremity (UE) recovery in individuals with subacute stroke often plateaus despite conventional physical therapy (CPT). Smartphone-based virtual reality (VR) represents a low-cost, semi-immersive approach that may enhance task-specific training and neuroplasticity.

To determine whether CPT augmented with smartphone-based VR improves UE function more than CPT alone.

Fifty-seven participants (28 in the experimental group and 29 in the control group) with stroke in the subacute stage (6 weeks–6 months post-stroke) and moderate UE impairment (Fugl-Meyer Assessment–Upper Extremity [FMA-UE] score 20–50) were randomized to receive either CPT plus smartphone-based VR or CPT alone, five sessions per week for six weeks. Outcomes included motor impairment (FMA-UE), activity-level dexterity (Purdue Pegboard Test), and muscle strength (grip strength).

Both groups demonstrated significant improvements (p < 0.001). The experimental group showed significantly greater improvements across all outcomes, with large effect sizes.

Smartphone-based VR providing semi-immersive, gaze-driven interaction with virtual tasks significantly enhances UE recovery and represents a scalable adjunct to rehabilitation.

Telerehabilitation (TR) delivers rehabilitation services through digital and information technologies. Recent advances in artificial intelligence (AI) have introduced new opportunities for TR, particularly in remote monitoring and individualized treatment. This scoping review aims to examine and synthesize the current literature on the use of AI and markerless motion analysis (MMA) within TR for patients with neurological disorders, distinguishing between approaches focused on remote monitoring/assessment and those supporting AI-based TR platforms.

A scoping search conducted in March 2025 identified articles published in the last ten years in the following databases: PubMed, Embase, Scopus and Web of Science (WoS).

The initial search retrieved 290 records. After removing 67 duplicates, the remaining records were screened. Following full-text assessment, only 10 studies were included, while 208 were excluded due to wrong population (n = 93), study design (n = 89), outcomes (n = 21), or language (n = 5). Overall, the evidence for both MMA-based remote monitoring/assessment and AI-supported TR interventions remains early-stage and heterogeneous across populations, outcomes, and set-ups.

AI applications in TR and remote monitoring for neurological disorders remain early stage and heterogeneous. While current platforms remain largely experimental, AI-based TR devices and metrics can offer objective, quantitative data to support personalized care, reinforcing the essential role of remote rehabilitation and monitoring in maintaining the patient–clinician connection. Therefore, integrating AI to promote continuity of rehabilitation beyond the clinic may provide a novel way to tailor treatment intensity, adapt exercises over time, and optimize follow-up in neurological rehabilitation.

10.17605/OSF.IO/FB8TD

Evidence for structured group telerehabilitation in stroke is limited. We evaluated therapist-led group telerehabilitation effects on physical function, psychological well-being, and health-related quality of life (HRQoL) in patients with chronic stroke, and identified functional predictors of improvement.

Thirty-five patients with chronic stroke were randomized into the telerehabilitation exercise group, referred to as TEG, with eighteen participants, or the self-exercise rehabilitation group, referred to as SRG, with seventeen participants. Outcomes were assessed at baseline and post-intervention. Interaction effects between group and time were evaluated. Significance was set at p < .025 for primary outcomes, Berg Balance Scale (BBS) and Timed Up and Go Test (TUG). Functional predictors were examined via baseline-adjusted regression.

Both groups showed significant within-group improvements (p < .001). Interaction effects revealed statistically significant, though modest, gains in BBS and TUG in the TEG versus SRG. Lower-limb strength, fall efficacy, and depressive symptoms improved over time without significant between-group differences. HRQoL gains were meaningful, especially in the TEG. Regression confirmed group allocation independently predicted balance and mobility improvements (R² = 0.152 and 0.153), with no group effects for other measures.

Real-time, group-based telerehabilitation led by physical therapists serves as a clinically viable alternative that supports functional balance, mobility, and HRQoL in patients with chronic stroke. These findings demonstrate statistically significant improvements in functional outcomes compared with unsupervised exercise, suggesting that this structured remote approach, by providing superior functional benefits over unsupervised exercise, serves as a practical and accessible alternative to traditional facility-based rehabilitation is unavailable.

Hand edema is a common post-stroke complication that negatively affects function and quality of life. However, interventions for hand edema remain limited.

In this study, we investigated whether contralateral resistance handgrip exercises performed with the non-paretic hand could immediately and sustainably reduce hand edema in patients with stroke.

This study used a B–A–B single-case design to explore the effects of the intervention in inpatients more than 3 months post-stroke. During the two 8-day intervention phases, the participants performed rhythmic handgrip exercises at 30% of the maximum voluntary contraction for 5 min daily as part of their occupational therapy sessions. A baseline phase without intervention was interposed. The hand volume was measured by using water displacement before and after exercise sessions to assess immediate and sustained effects.

Four inpatients with paretic hand edema (93–110 days poststroke) participated in this study. Contralateral handgrip exercise resulted in immediate reduction in paretic hand edema in three of the four patients; however, only one patient showed a sustained effect. The intervention was simple and feasible, with responses varying across individuals.

This small single-case study suggests that contralateral handgrip exercise may contribute to reducing hand edema in some patients; however, its sustained benefits remain uncertain. This low-cost approach may serve as a candidate adjunct intervention in rehabilitation, particularly when paretic limb movements are limited. However, given the exploratory nature of this small single-case study, further investigation with larger samples and more rigorous designs is warranted.

Stroke, multiple sclerosis (MS), and Parkinson's disease (PD) cause balance and walking impairments, which increase the risk of falls and reduce quality of life. Technological advances have enabled novel reactive balance approaches.

To synthesize the current approaches of technology-based perturbation interventions during walking and their effects on physical function in stroke, MS, and PD.

A literature search was conducted in PubMed, PEDro, and ScienceDirect for studies published from January 2014 to December 2025, supplemented by citation tracking and grey literature. Eligible studies included interventional studies utilizing technology-based perturbation during walking in stroke, MS, or PD.

Ten studies were included. Participants were diagnosed with stroke (n = 83, 42%), MS (n = 77, 39%), or PD (n = 38, 19%). Most interventions used treadmill-based perturbations to induce slips, trips, or lateral balance instability. Interventions comprised a median of nine sessions over three weeks (25 min per session). Outcomes were grouped into four categories: clinical assessments, patient-reported outcomes, technology-based assessments, and assessments during walking training. Between-group differences compared to similar treatments without perturbation were inconsistent, but within-group improvements in walking speed, balance, and functional mobility were commonly reported. Adverse events were rare, and safety protocols were followed. Considerable heterogeneity in intervention protocols and outcome measures limited synthesis.

Technology-based perturbation training during walking may offer an alternative for improving physical function in stroke, MS, and PD. Evidence of superiority over non-perturbation interventions remains inconclusive due to heterogeneity and small samples. Within-group improvements suggest benefits, warranting standardized protocols and larger high-quality trials.

Stroke keeps on the rise in young and middle-aged individuals. This group may experience positive psychological changes, such as posttraumatic growth (PTG), which facilitates recovery. However, PTG in young and middle-aged stroke patients is not yet fully understood in China. This study aims to examine the associations between uncertainty in illness and PTG among young and middle-aged patients with stroke, and to explore whether coping styles and rumination are associated with this relationship.

A cross-sectional study was conducted from September 2022 to February 2023 in a tertiary hospital in Guangzhou, China, enrolling 204 stroke patients aged 18 to 59 years. Sociodemographic and clinical data were obtained via interviews and medical records. Data on PTG, uncertainty in illness, coping styles, and rumination were collected via the Posttraumatic Growth Inventory (PTGI), Mishel Uncertainty in Illness Scale for Adults (MUIS-A), Simplified Coping Style Questionnaire (SCSQ), and Event-Related Rumination Inventory (ERRI). Data were analyzed using Pearson correlation and path analysis in SPSS 26.0 and Mplus 8.3.

Totally 204 participants were included. The mean score for PTG was $52.27 ± 12.06. Uncertainty in illness was negatively correlated with PTG (β= −0.61, p < 0.01). Path analysis revealed that positive coping styles (β= −0.21, p < 0.001) and deliberate rumination (p = -0.12, p = 0.002) were significantly associated with the relationship between uncertainty in illness and PTG. These variables accounted for 44.7% and 25.9% of the total effect, respectively.

Uncertainty in illness is significantly associated with PTG among young and middle-aged stroke patients, such association was mediated by positive coping styles and deliberate rumination.

As interest in dual-task rehabilitation for stroke patients, which integrates cognitive and motor functions, continues to grow, there is increasing recognition of the need to expand cognitive assessments to include motor components.

This study aimed to evaluate the preliminary evidence for the validity of the Wireless Lighting System (WLS) as a sensor-based cognitive–motor response assessment tool in stroke patients and to investigate its relationship with motor function and activities of daily living (ADL).

Sixty-four patients with stroke were recruited from ‘G’ rehabilitation hospital. Cognitive function was evaluated using the Korean version of the Mini-Mental State Examination (MMSE-K). Motor function and ADL were assessed using a digital handheld dynamometer, the Berg balance scale, the 10-meter walk test, and the Korean version of the modified Barthel Index, respectively. Cognitive–motor response times were measured using a WLS (Witty SEM).

All WLS cognitive–motor response times were moderately negatively correlated with the MMSE-K total score (r = −0.431 to −0.469). Grip strength was only negatively related to the reaction time task (r = −0.363). However, moderate correlations with all WLS tasks were observed for balance (r = −0.512 to −0.602), gait (r = 0.399 to 0.513), and ADL (r = −0.563 to −0.650).

These findings provide preliminary evidence supporting the potential utility of the WLS as a sensor-based cognitive–motor response assessment tool in identifying combined cognitive and motor impairments. However, given this study's cross-sectional design and single-center setting, further longitudinal and validation studies are required to establish clinical applicability.

Spasticity commonly complicates upper motor neuron syndromes, reducing quality of life. While manual massage is widely used to manage muscle tone, its overall efficacy remains unquantified.

To evaluate the effectiveness of pure manual massage interventions (without instruments) for reducing spasticity in patients with stroke and cerebral palsy and clarify its clinical neurorehabilitation role.

A systematic search of multiple databases identified randomized controlled trials (RCTs) investigating manual massage for spasticity in patients with stroke or cerebral palsy. The primary outcome was spasticity measured by the Modified Ashworth Scale. Bias was assessed using RoB 2.0. We conducted a random-effects meta-analysis calculating pooled standardized mean differences (SMDs).

Four RCTs (n = 253) were included. Manual massage was associated with reduced spasticity compared with controls (SMD=0.59, 95% CI 0.31–0.87), with low-to-moderate heterogeneity (I²=35.7%). Subgroup analysis demonstrated consistent, significant improvements in children with cerebral palsy (SMD=0.56, I²=0%). Conversely, results in adult stroke populations were non-significant with substantial heterogeneity (SMD=0.78, I²=73%). Despite spasticity reductions, downstream functional outcomes were not consistently improved.

Manual massage may be considered as a preparatory adjunct for reducing spasticity, particularly in children with cerebral palsy. However, the evidence base remains limited, most included interventions were delivered alongside conventional rehabilitation, and functional benefits were not consistently demonstrated.

Spastic cerebral palsy (CP) commonly impairs cervico-mandibular mobility and motor coordination due to increased muscle tone and altered postural control, potentially affecting head stability and orofacial function.

To compare the immediate effects of exercise- and manual therapy–based interventions on temporomandibular and cervical mobility in children with spastic CP, contrasting active versus passive rehabilitation strategies.

This single-blind, randomized crossover trial included 52 children with spastic CP (mean age 10.8 ± 2.4 years; GMFCS levels I–IV). Each received one exercise and one manual therapy session in randomized order with a one-week interval. Owing to missed second-week appointments, 44 children completed the exercise session and 48 completed the manual therapy session, resulting in partial crossover completion. Mandibular range of motion (maximal opening, lateral deviation, protrusion), cervical range of motion (flexion, extension, rotation), and craniovertebral angle were assessed immediately before and after each intervention.

Both interventions produced significant immediate improvements in mandibular and cervical mobility (p < 0.001). Exercise resulted in greater gains in selected active mandibular movements, whereas manual therapy elicited larger improvements in cervical mobility. Craniovertebral angle increased following both interventions, with no significant between-intervention difference, indicating comparable effects on head posture. Effect sizes were moderate to large, and no carryover effects were detected.

Exercise and manual therapy induce modality-specific immediate neuromechanical responses in the cervico-mandibular system in children with spastic CP. These findings reflect short-term rather than long-term effects and suggest both approaches may be considered in individualized pediatric neurorehabilitation planning.

Although several studies have examined gait changes associated with continuous intrathecal baclofen (CITB) infusion for spasticity in ambulatory patients with acquired brain injury (ABI), none has included a control group.

To assess long-term changes in gait kinematics associated with CITB infusion for post-ABI spasticity.

Forty-three consecutive ABI patients underwent gait evaluations during an ITB bolus trial, with follow-up gait data available in 17 pump recipients (re-evaluated 24 ± 17 months after implantation, dose range 95–590 µg/day) and 8 non-recipients (re-evaluated 30 ± 19 months after screening). Temporospatial gait parameters and lower extremity joint range of motion (ROM) were analyzed.

Changes in temporospatial gait parameters from baseline to follow-up did not differ significantly between pump recipients and non-recipients. Likewise, there were no significant between-group differences in changes in ROM over time except for a 7.5° increase in more-affected (MA) knee ROM during swing in pump recipients, compared with a 2.4° decrease in non-recipients (ANOVA group×time interaction, P = 0.027). Secondary analyses showed that baseline average Ashworth score in the MA leg correlated significantly with changes in MA stance time and less-affected initial double support time (r ≥ |0.56|, P ≤ 0.029) in pump recipients only.

The modest improvements in gait kinematics in pump recipients appeared to have limited clinical significance, considering no concurrent improvements in average gait speed and the study limitations. The overall results suggest that gait speed may be useful for goal setting, but it should not be considered the sole measure of CITB efficacy.

Chronic subdural hematoma (CSDH) generally has favorable outcomes; however, some patients develop balance and gait impairments, leading to prolonged hospitalization. This study examined the association between Mini-Balance Evaluation Systems Test (Mini-BESTest) scores, and length of hospital stay (LOS) after CSDH surgery.

This prospective cohort study was conducted at a single acute care hospital in Japan. Patients aged ≥ 65 years who underwent burr-hole drainage for CSDH were included. Exclusion criteria were orthopedic disease, psychiatric disease, inability to complete the Mini-BESTest, and premorbid modified Rankin Scale ≥ 4. Variables included age, sex, initial National Institutes of Health Stroke Scale, Glasgow Coma Scale, Mini-Mental State Examination–Japanese, residual hematoma thickness, premorbid modified Rankin Scale (mRS), Mini-BESTest score, and LOS. Spearman correlation and multivariable linear regression analyses were performed.

Of 49 patients, 32 were analyzed after exclusions due to comorbidities, inability to complete the assessment, or premorbid disability. Twenty-five patients were men and the mean age was 81.8 ± 5.0 years. The median LOS was 8.5 (interquartile range [IQR] 8–11) days, and the Mini-BESTest was 18.5 (IQR 13.8–23.3). LOS was negatively correlated with Mini-BESTest (r = −0.499) and positively with initial NIHSS (r = 0.376). In multivariable regression, Mini-BESTest (β = −0.488) and initial NIHSS (β = 0.377) scores were associated with LOS.

Early postoperative balance function may be associated with LOS in patients with CSDH. Early Mini-BESTest assessment may help identify patients at risk for prolonged hospitalization and guide rehabilitation and discharge planning.

Dual-task and augmented reality (AR)–based interventions have been used to improve balance and gait in patients with stroke; however, evidence for AR programs developed using accessible approaches such as ChatGPT-assisted programming remains limited.

This study aimed to investigate the effects of ChatGPT-assisted AR dual-task training on muscle strength, balance, gait parameters, and fall-related self-efficacy in patients with chronic stroke.

Twenty-eight patients with chronic stroke were randomly assigned to an experimental group receiving ChatGPT-assisted AR dual-task training or a control group receiving lunge training combined with a throwing task. Both groups trained for 10 min per session, five times per week for four weeks. Primary outcomes were lower-limb strength and balance (static and dynamic). Secondary outcomes included gait parameters and fall-related self-efficacy. Gait speed and step length were measured using the GAITRite system, and step-length symmetry was calculated using a symmetry index derived from paretic and nonparetic step lengths. Group × time interactions were analyzed using mixed-design ANOVA.

Significant group × time interactions were observed for most primary and secondary outcomes (p < 0.05), in favor of the experimental group; however, the interaction for paretic step length was not statistically significant. Notably, improvement in dynamic balance, as assessed by the timed up and go test, exceeded the minimal clinically important difference in the experimental group.

ChatGPT-assisted AR dual-task training improved muscle strength, balance, gait performance, and fall-related self-efficacy more than conventional dual-task training, providing preliminary evidence of short-term benefits for ambulatory patients with chronic stroke.

The study aimed to identify the most accurate protocol for measuring stride-count in post-stroke and healthy individuals, by comparing different wearable-sensors, their placement and data processing against a gold-standard instrumented treadmill.

Eighteen post-stroke and 18 healthy adults walked at multiple speeds on an instrumented treadmill equipped with force plates. Participants wore six ActiGraph accelerometers (wrists, hips, ankles), and pressure insoles. Stride counts from each sensor configuration were estimated using a custom raw-acceleration peak-detection algorithm and the manufacturer's algorithm (ActiLife^®). Accuracy and agreement with the gold standard were assessed across walking speeds and sensor locations using the concordance correlation coefficient (CCC) and linear mixed-effects model.

Stride count accuracy was influenced by walking speed across all wearable configurations, improving with gait velocity. Pressure-sensing insoles demonstrated the highest accuracy and agreement with the gold standard in both groups across speeds (CCC = 0.999 for healthy subjects; 0.996 for post-stroke). The custom peak-detection algorithm applied to ankle-worn accelerometers provided accurate and robust stride estimates across speeds (CCC = 0.986 in healthy subjects; 0.990 post-stroke). In contrast, the manufacturer's algorithm consistently misestimated stride counts in both groups. No side-to-side differences were observed for any sensor placement.

Pressure insoles and our custom raw-acceleration algorithm applied to ankle-worn accelerometers yielded the highest stride-count accuracy across walking speeds in both populations.

ClinicalTrails.gov (Registration ID: NCT06943014)

The International Classification of Functioning, Disability and Health (ICF) is widely used as a framework for post-stroke rehabilitation, but its clinical application requires further synthesis.

This narrative review examined the current applications of ICF in post-stroke rehabilitation, benchmarked against the United Kingdom Stroke Guideline (UK Guideline).

The review followed the Scale for the Assessment of Narrative Review Articles. ICF-based assessments and interventions described by the original study authors from selected studies were extracted.

A total of 546 assessments were mapped to the ICF across 166 studies, overlapping with more than 80% of the UK Guideline topics. These assessments appeared to be primarily Body Function-based (40.7%) and Activity-based (27.1%). For ICF-based interventions, 247 interventions were identified across 66 studies and covered fewer than half of the UK Guideline topics. Mapping based on intervention content covered 36% of the combined Activity and Participation component. Both assessment and intervention mapping allocated less attention to the Participation component and Contextual Factors (CF), indicating limited specificity to community reintegration after stroke.

To promote the holistic ICF framework in post-stroke rehabilitation, more work is needed to address the assessment-intervention mismatch in current practice, particularly for Participation and CF. Resources, such as clinician training and service-level support, should also be mobilized to support the routine clinical application of the ICF.

Exercise is the only established disease-modifying intervention in Parkinson's disease (PD), and continued exploration of innovative and engaging exercise modalities may further enhance outcomes for individuals living with PD. Table tennis (TT) is a cognitively engaging, task-specific activity integrating visuospatial processing, anticipatory motor planning, and dynamic postural control.

To examine the feasibility, including attendance, retention, and safety, and effects of a 12 week TT-based program, NeuroPong^TM, on motor and non-motor symptoms in individuals with PD.

In this single-arm pilot study, 30 participants were enrolled and 26 completed 12 weeks of twice-weekly, 2-h TT sessions. The primary outcome was the Movement Disorders Society-Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS III). Secondary outcomes included the Berg Balance Scale (BBS), Timed Up and Go (TUG), Six-Minute Walk Test (6MWT), Montreal Cognitive Assessment (MoCA) and several patient-reported outcomes. Pre-post comparisons were conducted using paired T-tests.

Improvements were observed in the MDS-UPDRS Part III (mean change −5.73, 95% CI −9.02 to −2.44, p = 0.0014), BBS (mean change +3.08, 95% CI 1.987 to 4.17, p < 0.0001), TUG (mean change −1.04, 95% CI −1.69 to −0.38, p = 0.0032), and 6MWT (mean change 66.77, 95% CI 49.82 to 83.71, p < 0.0001). Self-reported depression decreased (Hospital Anxiety and Depression Scale, HADS-D mean change −1.12, 95% CI −1.97 to −0.26, p = 0.0129). Attendance averaged approximately 90%, and no adverse events were reported. No significant changes were observed in other outcomes.

A 12-week TT-based program, NeuroPong™, was feasible and associated with improvement in motor function, balance, walking endurance and self-reported depression in PD. The multidimensional motor and cognitive demands of table tennis may contribute to these observed benefits. Larger randomized controlled trials are warranted.

Gait kinematic analysis is essential for evaluating walking quality and efficacy of interventions. Spastic gait varies among individuals, even when they present similar postural gait patterns. While previous studies have reported functional gait improvements following repeated botulinum toxin-A (BT-A) injections, effects on gait kinematics remain unclear.

This prospective cohort study assessed sagittal gait kinematics in adults with chronic stroke-related multifocal spasticity, who received three cycles of progressively higher doses of Inco BT-A (400, 600, and 800 U). Quantified gait analysis (QGA) was performed before and after the first injection cycle and after the last. To account for inter-individual variability, sagittal kinematic variables that best reflected individual postural gait patterns were identified.

Twenty-five participants were included. Sagittal kinematic improvements were not observed after the first injection cycle but became apparent after the third. Significant improvements were observed in two postural gait patterns: pes equinus during stance, with a mean increase in ankle dorsiflexion of 3° (SD = 6°, p = 0.008), and stiff knee gait, with a mean increase in knee flexion during swing of 7° (SD = 7°, p < 0.001).

This study showed effects of progressively higher doses of BT-A on sagittal knee and ankle kinematics in individuals with multifocal spasticity after chronic stroke, suggesting that three cycles of progressively higher doses are necessary to achieve measurable kinematic improvements. These results align with functional gains from our larger study, underscoring the importance of individualized gait assessments in clinical decision-making on post-stroke spastic gait.