NeuroRehabilitation

Children with cerebral palsy (CP) and related neuromuscular conditions often experience barriers to physical activity due to motor and cognitive impairments. Active video games (AVG), with or without adaptive technologies (AT), have demonstrated potential to improve outcomes in these populations.

This scoping review mapped existing research on AVG and AT in pediatric CP and related neuromuscular conditions, summarizing intervention characteristics and effects on physical, cognitive, and quality of life (QoL) outcomes.

The review followed PRISMA-ScR guidelines. Four databases were searched up to November 2025 (MEDLINE, Embase, Web of Science, and IEEE Xplore), supplemented by a manual citation search using Google Scholar. Eligible studies included participants under 18 years with CP and related neuromuscular conditions, reported physical, cognitive, or QoL outcomes, employed AVG, virtual/augmented reality, or gamified interventions, and were peer-reviewed and published in English.

A total of 192 studies were included, of which 178 examined the impact of AVG and immersive technology on physical outcomes in children with either CP (n = 173), muscular dystrophy (n = 7), or CP and a mix of related conditions (n = 12). Fewer studies included cognitive (n = 17) and QoL (n = 46) outcome measures. Findings highlighted substantial heterogeneity in study design, outcome measures, gaming devices, and AT implemented, limiting comparability and generalization. Despite this variability, AVG interventions seemed to improve patient outcomes, especially in physical function.

We underscore the need for standardized measures to guide the development of gaming interventions that benefit patient outcomes.

Disorders of consciousness (DoC)—including coma, unresponsive wakefulness syndrome, and minimally conscious state—may occur following severe traumatic brain injury (TBI). Occupational therapists (OTs), physical therapists (PTs), and speech-language pathologists (SLPs) play essential roles in recovery; however, discipline-specific evidence to guide assessment and intervention remains limited.

To map existing evidence related to OT, PT, and SLP interventions aimed at improving arousal and supporting emergence in adults with DoC following TBI.

Guided by the Arksey and O’Malley framework and a pre-published protocol, ten databases, PEDro, and gray literature were searched. Eligible studies included adults with TBI-related DoC and reported OT-, PT-, or SLP-led interventions targeting arousal or emergence outcomes. Data extraction was completed independently by two reviewers, with third-party verification.

Of 54,832 records screened, 77 studies met inclusion criteria. PT-focused interventions accounted for 46.8% (n = 36) of studies, OT for 32.5% (n = 25), and SLP for 14.3% (n = 11); 32.5% (n = 25) addressed all three disciplines. Sensory stimulation was the most common intervention, followed by verticalization approaches. The Coma Recovery Scale–Revised was the most frequently used outcome measure.

Evidence supports individualized sensory stimulation and early mobilization to promote arousal and emergence; however, interventions targeting DoC have changed little over 55 years. Substantial gaps remain, particularly for self-care and SLP-specific interventions, highlighting the need for stronger discipline-specific research and standardized reporting. The trends described in this scoping review demonstrate areas where evidence is limited or only attributed to one discipline, which is important for guiding future research priorities.

Functional neurologic disorder (FND) is a disabling condition commonly managed by occupational therapists (OT), physiotherapists (PT), and speech-language pathologists (SLP). While consensus recommendations for OT, PT, and SLP provide general principles for assessment and treatment, there is limited understanding of how interventions are delivered or how outcomes are measured, particularly in the outpatient setting.

This scoping review describes the characteristics (mode, frequency, duration) of outpatient OT, PT, and SLP interventions for individuals with FND, assesses their alignment with consensus FND recommendations, and maps outcome measures to the International Classification of Functioning (ICF) model.

Three electronic databases (Medline, Embase, and CINAHL) were searched for articles that included individuals diagnosed with FND, reported characteristics of outpatient OT, PT, or SLP interventions, and were published in English.

Thirty-one studies were included (PT, n = 14, SLP, n = 8, multidisciplinary n = 6, and OT, n = 3). Most studies (n = 22, 71%) included interventions that aligned with FND recommendations and commonly consisted of education, movement retraining with diverted attention, and symptom management plans. Intervention frequency ranged from daily sessions over one week to twice-monthly sessions across three months. The outcome measures were primarily patient-rated, and most frequently mapped to the body structure and function domain of the ICF.

Outpatient OT, PT, and SLP interventions predominantly included components of FND recommendations yet varied in mode, frequency, and outcome measure selection. Future research is needed to examine the optimal parameters and modes, compare specific interventions, and identify outcomes that encompass all ICF domains.

Multiple sclerosis (MS) is an autoimmune, inflammatory, progressive neurological disease. Individuals with MS frequently experience muscle weakness, limited walking endurance, and impaired balance, which collectively reduce functional independence and quality of life. Remotely supervised transcranial direct current stimulation (RS-tDCS) has emerged as a potential adjunct neuromodulation technique to enhance neuroplasticity and improve motor outcomes. However, the effectiveness of RS-tDCS on motor performance in MS remains insufficiently understood.

To systematically evaluate the effects, feasibility, and reporting quality of RS-tDCS interventions targeting motor outcomes in individuals with MS.

A systematic review of the scientific literature from 2015 to 2025 was carried out, using engines of PubMed, EBSCO, CENTRAL, and Web of Science. We identified studies that implemented RS-tDCS to improve motor function or reduce fatigue in MS population. Two reviewers independently screened studies, extracted data, and assessed risk of bias using RoB 2 and ROBINS-I. Intervention reporting quality was evaluated using the TIDieR checklist. A synthesis of the results was conducted following the Synthesis without Meta-Analysis (SWiM) guidelines.

Five studies met the inclusion criteria four randomized controlled trials and one non-randomized study, totaling 370 participants. Reports revealed improvements in gait performance, balance, and manual dexterity, whereas findings related to functional mobility and fatigue were mixed.

RS-tDCS appears feasible and may benefit select motor domains in MS; however, current evidence remains preliminary. This review highlights key methodological gaps and provides direction for future trials to establish the clinical relevance and scalability of decentralized neuromodulation in MS rehabilitation

Stroke frequently impairs balance, which critically affects mobility, independence, and fall risk during rehabilitation. However, heterogeneous patterns of balance recovery and their neural substrates remain poorly understood.

To identify inpatient balance recovery profiles using initial performance and subsequent improvement across the 14 Berg Balance Scale items, and to examine associations with lesion characteristics to inform prognostic stratification during neurorehabilitation

We used data from a retrospective cohort of 115 patients with a first-ever stroke. Berg Balance Scale item-level scores at admission and discharge were standardized, and principal component analysis was applied to identify three underlying components. Recovery patterns were then derived from initial scores and rates of improvement, followed by clustering analysis and lesion overlap analyses to characterize the neuroanatomical features of each profile.

Cluster analysis based on principal component scores identified five distinct recovery profiles. The profile with severe balance impairment at admission and minimal improvement showed extensive lesions extending from the peri-Rolandic region into the parietal area, whereas no consistent parietal involvement was observed in other profiles.

Item-level Berg Balance Scale data revealed heterogeneous inpatient balance recovery profiles after stroke. The poorest recovery profile was characterized by extensive peri-rolandic and parietal lesions, suggesting the involvement of sensorimotor regions in severe balance dysfunction. These findings may improve our understanding of heterogeneity in post-stroke balance recovery and may help inform rehabilitation planning and risk management; however, their direct implications for treatment selection remain exploratory and require prospective validation.

Ataxic cerebral palsy children have hard times controlling their movements. They exhibit tremors, shakiness and struggle with precise movements, balance as well as pattern of gait.

To examine the influence of adding lower extremity weights on balance and gait disturbances in children diagnosed with ataxic cerebral palsy.

Sixty children with ataxic cerebral palsy aged from 7 to 12 years participated in this trial after the eligibility assessment. They were randomly allocated to two equal sized groups. The standard care group underwent a designed treatment protocol, while the added weight group received the same designed treatment protocol along with adding lower extremity weights. Children in both groups underwent the same treatment protocols three times per week for a duration of three consecutive months. Biodex balance system and 3D motion analysis (3DMA) were used to evaluate stability indices as primary outcome (overall, mediolateral and anteroposterior), and spatiotemporal gait parameters as secondary outcome (speed, cadence, base width, step length, stride length, step time, and percentage of double support) respectively in both groups at the beginning and after three months of intervention.

Post intervention findings demonstrated a significant reduction in stability indices, base width, step time, and percentage of double support, as well as significant increase in walking speed, cadence, step length, and stride length, in both groups in favor of added weight group (P < 0.05).

Adding small fixed lower extremity weights was associated with improvements in balance and reduced gait disturbances in ambulant ataxic cerebral palsy children.

Although telerehabilitation has emerged as a promising and accessible alternative to traditional in-person therapy, robust evidence supporting its clinical effectiveness across multiple functional domains remains limited. We tested the non-inferiority of synchronous multi-domain telerehabilitation for motor, cognitive, language, and disability outcomes in stroke survivors.

Bicentric, single-blind (assessor-blinded), randomized controlled non-inferiority trial.

Fifty-six participants were randomized to home-based telerehabilitation or conventional outpatient therapy. Both groups completed twenty real-time supervised sessions over four weeks. The primary outcome was change in Fugl–Meyer Assessment upper-extremity motor score (0–66); secondary outcomes included Fugl–Meyer Assessment lower-extremity motor (0–34), Aachen Aphasia Test (Italian version) naming/written language/comprehension, Oxford Cognitive Screen orientation and memory subtests, and Barthel Index. Non-inferiority was evaluated using a prespecified margin (Δ=−5.2) and confidence-interval–based linear mixed-effects models (per-protocol primary, intention-to-treat sensitivity); non-inferiority was concluded if the lower bound of the 95% CI for the adjusted between-group contrast at T1 (telerehabilitation minus conventional) was > −Δ.

The adjusted between-group difference in change for the primary outcome was compatible with non-inferiority at post-treatment, with consistent results in sensitivity analyses. No significant between-group differences were observed in language, cognitive, or functional independence outcomes, and findings were similar at one-month follow-up.

Synchronous multi-domain telerehabilitation appears feasible and yields short-term motor recovery comparable to standard outpatient rehabilitation within a prespecified non-inferiority framework. Interpretation is limited by the short follow-up and restricted cognitive outcome coverage.

To identify patient-centered selection criteria for exoskeletal wearable robot-assisted gait training (RAGT) by investigating predictors of satisfaction in subacute stroke survivors.

In this subgroup analysis of an international, multicenter, randomized controlled trial, 58 inpatients completed a 4-week RAGT program (20 sessions). Satisfaction was assessed using a modified 15-item QUEST 2.0 questionnaire across five domains (appropriateness, effectiveness, convenience, conformance, reliability). Predictors of the mean satisfaction score were analyzed using multiple linear regression.

The overall satisfaction questionnaire score was 3.9 ± 0.6 (out of 5). The effectiveness domain was rated significantly higher than other domains (p < 0.05). Age was the only significant independent predictor of satisfaction (β = -0.269; 95% CI −0.315 to −0.007; p < 0.05). Participants aged <65 years reported significantly higher overall satisfaction than those aged ≥65 years (p < 0.05). This difference was driven by the appropriateness domain, where older adults reported lower comfort scores (p < 0.05).

RAGT received high user ratings, particularly for effectiveness. However, younger age predicted greater satisfaction, primarily due to discomfort in older adults. Selection criteria should consider age, and strategies to mitigate discomfort in older adults are needed to maximize adherence.

Trial details: ClinicalTrial.gov Identifier NCT05157347 (first registration (10/12/2021)).

Patients with mild stroke often regain basic mobility, however, subtle postural control deficits may persist, increasing the risk of falls. The Mini-Balance Evaluation Systems Test (Mini-BESTest) is a sensitive measure for detecting such impairments. This study aimed to clarify postural control characteristics and temporal changes by classifying patients with subacute stroke into supratentorial and infratentorial lesion groups.

In this prospective longitudinal observational study, 38 patients were assessed using the Mini-BESTest at baseline and at 1 month. A three-way mixed-design ANOVA examined lesion location (between-subjects), time, and Mini-BESTest subscales (anticipatory, reactive, sensory orientation, and dynamic gait) (within-subjects). Post-hoc analyses were performed using Shaffer’s modified sequentially rejective Bonferroni procedure.

A significant interaction between lesion location and subscales was observed (F(2.42, 80.73) = 6.21, p = .002, η_p² = .14). The supratentorial group demonstrated significantly lower scores in reactive postural control compared with other subscales (p < .001), and this deficit persisted at 1 month despite overall balance improvements. In contrast, the infratentorial group showed balanced improvements across all subcomponents, with no significant domain-specific deficits. Both groups showed significant improvement over time.

The Mini-BESTest is a sensitive tool for identifying lesion-specific postural control deficits, even in high-functioning patients. Although the supratentorial category encompasses functionally heterogeneous structures (e.g., thalamus and putamen), these findings highlight the importance of using the Mini-BESTest to detect residual impairments in reactive postural control in supratentorial stroke, highlighting the need for targeted interventions, such as reactive balance training, to reduce fall risk.

Cerebellar lesions commonly induce executive dysfunction; however, the underlying neuroplastic mechanisms remain unclear. The fronto-cerebellar diaschisis model, where focal cerebellar damage disrupts widespread frontal networks, offers a compelling hypothesis. Given the pre-supplementary motor area (pre-SMA)'s established role in executive functions, we investigated its specific contribution to post-stroke impairment and its potential function as a dynamic compensatory node during recovery.

We employed a multimodal approach: resting-state SPECT imaging assessed brain perfusion, and f-NIRS quantified pre-SMA oxygenated hemoglobin ([oxy-Hb]) during a phonemic verbal fluency task (VFT) in 11 patients and 12 age-matched controls. Patients were stratified into Good (N = 6) and Poor (N = 5) recovery subgroups based on VFT performance to isolate the compensatory process. Longitudinal f-NIRS data tracked neural activity changes concurrent with cognitive recovery.

SPECT revealed widespread perfusion abnormalities consistent with diaschisis. Patients exhibited significantly impaired VFT performance. Crucially, the Good Recovery subgroup exhibited a significantly augmented [oxy-Hb] response in the pre-SMA compared to controls, supporting a specific compensatory mechanism. This pre-SMA augmentation was statistically independent of the strong confounding effect of age (F(1,15) = 5.164, P = 0.038). Consistent with a transient compensatory effort, longitudinal data demonstrated a reduction in pre-SMA activity concurrent with subsequent cognitive recovery, suggesting increased neural efficiency.

This study provides preliminary evidence that verbal fluency deficits post-cerebellar stroke are linked to fronto-cerebellar diaschisis. Our findings suggests that the pre-SMA serve as a pivotal compensatory node supporting functional recovery. These results provide a hypothesis-generating basis for future targeted rehabilitation strategies and neuromodulatory interventions.

To systematically characterize the cortical dynamics underlying fine hand motor impairment in patients with acute ischemic stroke (AIS) using a multidimensional task-state electroencephalography (EEG) analysis framework.

Fifteen patients with AIS and sixteen age- and sex-matched healthy controls were enrolled. EEG signals were recorded while participants performed three standardized fine motor tasks, including fist clenching, index finger pointing, and thumb-finger opposition. Source localization, time-frequency analysis, and brain network topology analysis were jointly applied to extract multidimensional electrophysiological features. Correlation analyses were further conducted to examine the relationships between EEG-derived metrics and clinical measures, including muscle strength grading, National Institutes of Health Stroke Scale (NIHSS) scores, and Activities of Daily Living (ADL) scores.

Compared with healthy controls, patients with AIS showed abnormal spatiotemporal cortical dynamics during fine hand movements. These abnormalities included delayed movement-related potentials, a shift of alpha- and beta-band event-related desynchronization from contralateral dominance toward more bilateral and diffuse activation, and altered brain network organization characterized by reduced network efficiency and changes in nodal centrality. In addition, EEG-derived features were significantly associated with clinical measures. Specifically, several event-related desynchronization/event-related synchronization (ERD/ERS)-related amplitudes and small-world properties were significantly correlated with muscle strength grading, NIHSS scores, and ADL scores after false discovery rate correction.

Multidimensional task-state EEG analysis can characterize cortical activation abnormalities and network reorganization associated with fine hand motor impairment in patients with AIS. The identified EEG-derived metrics may serve as objective markers for post-stroke motor function assessment and recovery monitoring, and may help support individualized rehabilitation evaluation and planning.

The longitudinal effects of combining intensive speech therapy (ST) with two separate courses of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) for aphasia remain unclear. This study retrospectively investigated longitudinal changes in language function in patients who underwent this combined protocol.

Sixteen patients with chronic aphasia underwent two courses of 2-week inpatient treatment combining fMRI-guided HF-rTMS and intensive ST between April 2018 and February 2025. The Standard Language Test of Aphasia (SLTA) total and modality-specific raw scores were assessed at four time points: at the 1st admission, 3 months after the 1st discharge, at the 2nd admission, and 3 months after the 2nd discharge.

The mean SLTA total raw score significantly improved over time: 147 ± 51.6 at the 1st admission, 157 ± 49.9 at 3 months after the 1^st discharge, 159 ± 48.8 at the 2nd admission, and 163 ± 50.2 at 3 months after the 2nd discharge. Significant improvements in speech function were observed in the Overall, Fluent Aphasia, and Non-fluent Aphasia groups. Notably, therapeutic effects were maintained without decline between the two admissions.

Two courses of HF-rTMS combined with intensive ST may be effective for the long-term improvement of language function, particularly speech function, in patients with chronic aphasia.

Anxiety symptoms are common after traumatic brain injury (TBI), and its impact over time may be influenced by demographic and injury-related factors. Specifically, there is a need to characterize post-injury anxiety symptom trajectories after TBI in understudied racial/ethnic groups.

To examine demographic and injury-related predictors of anxiety trajectories over the first 10 years following TBI in an Asian American and Pacific Islander (AAPI) sample.

Participants were 272 individuals enrolled in the U.S. TBI Model System study. Participants self-identified as AAPI and completed the Generalized Anxiety Disorder-7 scale (GAD-7) at 1, 2, 5, and/or 10-year post-injury follow ups. Over the 10-year period, unconditional growth models assessed curvature of GAD-7 score trajectories, and hierarchical linear modeling (HLM) identified baseline predictors of those trajectories. Secondary HLMs assessed changes in anxiety trajectory slopes over time as a function of significant baseline predictors.

Clinically significant anxiety symptoms affected 10.9–13.4% of the participants across the four time points. Over 10 years, anxiety was characterized by a linear, flat/stable, low-level trajectory. A higher overall anxiety trajectory was predicted by lower educational attainment and pre-injury history (vs. no such history) of mental health treatment, with no significant interactions between these predictors over time.

Educational background and pre-injury mental health history are risk factors in the development and maintenance of anxiety symptoms in AAPIs with TBI and should be considered in culturally responsive screening and intervention. The disaggregation of AAPI subgroups may be help reframe and target treatment efforts in this heterogeneous population.