Objectives: This study examined the relationship between phase angle (PhA), an indicator of muscle quality, and independent walking in stroke patients. The objective was to determine the predictive value of a PhA at admission for walking independence at discharge. Methods: This study included 220 stroke patients (121 males, 99 females), categorized based on their functional independence measure (FIM) mobility scores at discharge: independent (FIM ≥6; n = 100) and dependent (FIM ≤5; n = 120). Logistic regression analysis assessed whether PhA at admission predicted ambulatory independence at discharge. Additionally, receiver-operating characteristic curve analysis determined optimal cutoff values. Results: Logistic regression analysis showed that PhA at admission and the National Institutes of Health Stroke Scale (NIHSS) were significant predictors of independent walking. The optimal cutoff values for PhA were determined to be 4.35° for men and 4.1° for women. Similarly, the cutoff scores for the NIHSS were 7.5 points for men and 5.5 points for women. Conclusions: In stroke patients, PhA and NIHSS at admission were significantly associated with ambulatory independence at discharge. Evaluation of PhA and NIHSS at admission may be useful for more accurate prediction of gait outcomes.

Objectives: The aim of this study was to investigate the relationship between fall frequency and progressive supranuclear palsy (PSP) severity, walking ability, balance function, cognitive function, and frontal lobe function in patients with PSP. Methods: The study included 54 patients with PSP. Multiple logistic regression analysis was conducted to examine whether PSP severity, walking ability, balance function, cognitive function, and frontal lobe function after discharge were associated with fall frequency (falling two or more times per month). Balance function was assessed using the Berg Balance Scale and Mini-Balance Evaluation Systems Test (Mini-BESTest), with each used as an independent variable in separate models for association analysis. The Mini-BESTest showed a significant association, and its subitems were further analyzed using multiple logistic regression analysis. Results: A significant association was observed between the Mini-BESTest and fall frequency, and among its subitems, anticipatory postural adjustments were significantly associated with fall frequency. Conclusions: In patients with PSP characterized by impaired postural reflexes, the anticipatory postural adjustment ability may be associated with fall frequency.

Objective: The relationship between pre-stroke frailty and clinical outcomes remains unclear. This systematic review aimed to examine the association of pre-stroke frailty with mortality, length of stay (LOS), and functional outcomes in people with stroke. Methods: We used several databases, including PubMed, EMBASE, and CENTRAL. We searched for studies investigating the association between pre-stroke frailty and clinical outcomes. The Quality in Prognosis Studies tool was used to assess the risk of bias in the included studies. Meta-analyses were performed using the random effects model. The certainty of evidence was assessed with the Grading of Recommendations, Assessment, Development, and Evaluation. Results: Fourteen studies (participants: 11583) were included in this review. Pre-stroke frailty is associated with higher mortality (odds ratio: 1.11; 95% confidence intervals [CI]: 1.0–1.23), longer LOS (mean difference: 0.75; 95% CI: −0.29 to 1.78), and poorer functional outcomes (standardized mean difference: 0.79; 95% CI: 0.48–1.1). The certainty of evidence is low due to risk of bias, inconsistency, and imprecision. Conclusions: These results suggest that frailty before stroke onset may be associated with higher mortality, increased LOS, and poorer functional outcomes.

Objectives: In stroke rehabilitation, the Fugl-Meyer Assessment Lower Extremity (FMA-LE) motor scale is widely used to assess consecutive recovery steps from motor paralysis and predict prognosis after stroke. However, there has been limited opportunity to refer to the useful yet few studies that evaluated the minimal important change (MIC) and the minimal detectable change (MDC) of the FMA-LE motor scale. The aims of this review were to: (1) identify studies that have estimated the MIC and MDC, (2) identify the calculated MIC and MDC values and disease phases in previous studies, and (3) assess the methodological quality of the MIC and MDC studies of the FMA-LE motor scale. Methods: A scoping review was undertaken following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) recommendations. 3 databases (PubMed, CINAHL, and Web of Science) were used for the literature search. Reports of the MIC and MDC of the FMA-LE motor scale in patients with stroke were selected. Results: 6 studies were included after confirming their eligibility. In the acute phase, inter-rater MDC was 3.23 points. In the early subacute phase, intra-rater MDC was 1.24 points. In the chronic phase, intra-rater MDC was 3.80, 4.87, and 7.98 points, inter-rater MDC was 3.57 and 5.96 points, and MIC was 6.00 points. Conclusion: No late subacute threshold was identified for the MDC, and no acute or subacute threshold was identified for the MIC. Compared with the quality of the MIC study, there is room for improvement in the quality of the MDC studies with respect to study design.

Objective: In this study, we aimed to identify factors associated with the likelihood of early discharge to home by the 7th-day assessment in patients with ischemic stroke who underwent endovascular therapy (EVT). Methods: Among the 128 patients with ischemic stroke who underwent EVT, 2 groups were identified: an early discharge to the home group and the transfer group, with patients included in the latter group needing to be transferred to rehabilitation hospitals. Variables from the 7th day were used as explanatory variables to determine the outcome. Multiple logistic regression analysis was conducted using these variables. Receiver operating characteristic (ROC) curves for the significant factors were obtained, and cutoff values were calculated. Results: There were 19 patients (14.8%) in the early discharge to the home group and 109 patients (85.2%) in the transfer group. The Stroke Impairment Assessment Set (SIAS) (odds ratio [OR]: 1.16, 95% confidence interval [CI]: 1.02–1.32, p = 0.03) and the presence of dysphagia (OR: 8.75, 95% CI: 1.55–49.45, p = 0.01) were significant factors associated with early discharge home. The area under the ROC curve of the SIAS was 0.90, with a cutoff value of 63.5 points. Conclusion: Our results suggest that SIAS scores and the presence of dysphagia within the 1st week post-onset are significant predictors of whether patients with ischemic stroke who undergo EVT can be early discharged home.

Objectives: This review aimed to examine the characteristics of patients with spinal cord injury (SCI) who experience in-hospital cardiac arrest (IHCA), as well as the timing, circumstances, and interventions associated with these events. Methods: A comprehensive literature search was conducted across multiple databases, including PubMed, Scopus, Cochrane Library, and Igaku Chuo Zasshi Web (in Japanese), for studies published up to 2024. Two independent reviewers screened the literature. Data were extracted from the selected studies regarding the characteristics of patients with SCI who experienced IHCA, the timing of IHCA, the circumstances under which it occurred, and the interventions provided. Results: A total of 56 studies met the inclusion criteria. IHCA most commonly occurs in patients with complete cervical SCI. The time frame for IHCA occurrence ranged from 1 day and 2.5 months post-injury. IHCA frequently occurs during endotracheal suctioning or postural changes. The most commonly reported intervention for IHCA was the use of a pacemaker. Conclusions: In patients with SCI, IHCA is more prevalent among those with severe cervical injuries and is often triggered by procedures such as suctioning or postural adjustments. Physical therapist needs to implement robust risk management strategies. These findings are crucial for both clinical practice and future research.

Objective: This study examined the impact of sports participation on the health status of individuals with spinal cord injuries (SCI), with emphasis on the role of health-related social capital (HRSC). Methods: This study included 65 individuals with SCI (42 who participated in sports and 23 who did not). The following information was obtained from the participants through an online questionnaire: their basic information, information regarding activities of daily life independence, physical activity, mental health, lifestyle, insomnia, and social capital. We compared the outcomes between participants with and without sports participation and examined their correlations. Multiple regression analysis with forced entry was performed to determine the association between HRSC and health outcomes. Results: Physical activity, mental health, and HRSC were significantly higher in individuals with SCI who participated in sports (p <0.01 or p <0.05) than in individuals with SCI who did not participate in sports. The HRSC of individuals with SCI with sports participation showed a significant positive correlation with lifestyle and a significant negative correlation with insomnia score (p <0.05). Multiple regression analysis revealed that higher HRSC was associated with lifestyle in individuals with SCI who participated in sports (p <0.05) compared with individuals with SCI who did not participate in sports. Conclusion: The study findings underscore the potential benefits of sports participation in individuals with SCI, including increased physical activity and development of HRSC. However, it is essential to consider the implications of sports involvement on the psychological well-being of individuals with disabilities and provide appropriate support.

Objective: In this study, we aimed to determine the effects of 2-week neuromuscular electrical stimulation (NMES) on quadriceps muscle atrophy and lower extremity motor score in individuals with subacute incomplete cervical spinal cord injury (SCI). Methods: This stratified randomized controlled trial, conducted in the advanced critical care center of a university hospital, comprised 49 individuals with American Spinal Injury Association (ASIA) impairment scale grade C and D incomplete cervical SCI. The participants were stratified based on the ASIA impairment scale grade and randomly assigned to the control (n = 25) or NMES (n = 24) group. The control group participants received only conventional rehabilitation; the NMES group participants received conventional rehabilitation plus NMES in the quadriceps muscles of both lower limbs. The primary endpoints were quadriceps muscle thickness and L3 ASIA lower extremity motor score (L3 motor score), measured at the study’s initiation and after 2 weeks. Results: The quadriceps muscle thickness changes on the stronger and weaker sides were –14.2% ± 11.3% and –15.1% ± 13.8%, respectively, in the NMES group and –25.7% ± 16.8% and –26.0% ± 13.3%, respectively, in the control group, indicating significantly lesser reduction on both sides in the NMES group (p <0.05). The L3 motor scores on the stronger and weaker sides were 0.8 ± 1.2 and 1.3 ± 1.4 (NMES group) and 0.4 ± 0.8 and 0.4 ± 0.8 (control group), respectively, indicating significant improvement only on the weaker side (p <0.05). Conclusions: For subacute incomplete cervical SCI, 2 weeks of NMES reduces quadriceps muscle atrophy and improves the L3 motor score values on the weaker side compared with standard treatment.

Objective: To investigate the impact of multidisciplinary team (MDT) intervention for early mobilization (EM) of patients with aneurysmal subarachnoid hemorrhage (aSAH) in the intensive care unit (ICU). Methods: A retrospective uncontrolled before–after observational study was conducted to assess patient outcomes before and after introducing MDT in the stroke care unit (SCU). Participants admitted to the SCU from April 2017 to September 2023 were categorized into conventional (April 2017 to June 2020) and MDT (July 2020 to September 2023) groups. The measured primary outcome was the days until sitting, standing, and walking commenced. Results: A total of 131 patients were screened, with 115 included in the analysis. The MDT group comprised 56 individuals (48.7%), whereas the conventional group consisted of 59 patients (51.3%). The MDT group exhibited a significantly shorter duration until sitting (4 [3–7] vs. 7 [5–17], p <0.001), standing (5 [3–7] vs. 10 [5–17], p <0.001), and walking (7 [5–10] vs. 16 [7–23], p <0.001) commenced. Furthermore, the MDT group showed a significantly higher ICU mobility scale (IMS) (8 [5–8] vs. 5 [3–8], p <0.001) at SCU discharge, shorter length of SCU stay (16 [15–17] vs. 17 [15–24], p = 0.048), and hospital stay (34 [25–48] vs. 48 [33–80], p = 0.006). Conclusion: This study suggests that MDT played a facilitative role in promoting the EM of patients with aSAH. Their involvement streamlined the mobilization process, shortening the days until the initiation of mobilization.

Objective: To verify the efficacy of smile training in improving gait disturbances in patients with Parkinson’s disease (PD) exhibiting neuropsychiatric symptoms. Methods: A single-case BAB design with three intervention periods (B1, A1, and B2) was used. During periods B1 and B2, 10 min of smile training (facial muscles training and positive thinking training) was performed before the usual exercise therapy. During the A1 period, the participant received only the usual exercise therapy. During the intervention period, the Timed Up and Go test (TUG) was performed daily in both directions. Tau-U was calculated to determine the effect size of the TUG test time and the number of steps taken during each period. Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) Part III, Hospital Anxiety and Depression Scale (HADS), 10-meter walk at maximum speed, Berg Balance Scale, and Characterizing Freezing of Gait Questionnaire (C-FOGQ) were administered on the day before the start of the intervention and the last day of each period. Results: Comparisons of A1 to B2, TUG time, and the number of steps taken on both turns revealed large reductions (Tau-U ≥0.74, p <0.01). The 10-meter walk speed and MDS-UPDRS Part III bradykinesia scores improved, whereas the frequency of gait freezing on the C-FOGQ remained unchanged. The HADS scores did not show significant changes; however, the participant made more positive statements in his reflections. Conclusion: Smile training may be an effective intervention for improving gait and other motor symptoms in patients with PD.

Parkinson’s disease (PD) is now the world’s fastest-growing neurological disorder with rapidly rising prevalence and increasing demand for effective health services. Recent research has focused on the importance of early diagnosis and proactive management of physical function. Accumulating evidence indicates that reduced physical activity levels and mild pre-clinical disability are present in many people prior to a clinical diagnosis, perhaps developing over years. Early referral to a physiotherapist at the time of diagnosis is now recommended in global guidelines. Multiple forms of exercise have been found to have benefits in early and mid-stage disease across a range of motor and non-motor symptoms. Evidence from longitudinal studies confirms that disability is delayed when regular exercise is sustained over long periods. Exercise is now recognized as an essential component of treatment, in combination with medical therapies. Contemporary physiotherapy interventions now combine health behavior change techniques with physical exercise to promote the development of long-term exercise adherence. Advances in technology and digital health have progressed quickly and now offer opportunities for remote assessment and monitoring, remote exercise supervision, and support adherence through feedback and motivational strategies. Recent biomedical discoveries forecast improved earlier and more accurate diagnosis of PD, allowing opportunities for earlier interventions. Current research in progress will provide important insights into the dose and intensity of aerobic exercise in PD. Physiotherapists have important roles in advocacy and education in conjunction with care delivery to support access to evidence-based care for all people with PD.

Objectives: The Berg Balance Scale (BBS) is a core measure of balance function in patients with stroke. Latent rank theory (LRT) is a statistical method that enables the degree of functional impairment to be ranked from the sub-items of a rating scale; each rank can then be characterized. Identification of the characteristics of balance function by rank would be beneficial for interventions to improve balance function in patients with stroke. This study aims to use LRT to rank and characterize patients with stroke balance impairment. Methods: This was a multicenter retrospective analysis of 293 patients with subacute stroke. We used LRT and the BBS to estimate the optimal rankings based on the goodness-of-fit index and the information criterion. We compared the obtained ranks with the level of walking independence for each rank. Results: The evaluation of the patient’s BBS scores revealed that balance impairment could be divided into six ranks. The average BBS score for each rank rose from 27.1 for rank 1 to 53.9 for rank 6. The scores of the BBS sub-items for each rank also differed. The level of walking independence by rank ranged from rank 1 for assisted walking to rank 6 for independent outdoor walking. Conclusions: Balance function in patients with subacute stroke was ranked sixth in the BBS, with varying characteristics identified for different ranks. This result helped to determine the therapy to improve the balance function of patients with stroke.

This narrative review introduces case complexity and medical rehabilitation needs in a stroke rehabilitation setting, and proposes methods to more efficiently enhance functional recovery in the acute stage after stroke onset. Therapists may measure a construct of individual need complexity around and beyond the basic and common needs for medical necessity, and thereby screen acute patients who could benefit more from additional rehabilitation inputs. This review also describes the clinical significance of medical rehabilitation needs and challenges for efficient stroke rehabilitation. Overall, we propose that challenging research trials should be conducted to compare the effectiveness of the arrangement of rehabilitation service allocation based on needs assessment after stroke with the usual care pathway.

Objective: The study aim was to investigate the association between initiating mobilization within 7 days after onset and symptomatic cerebral vasospasm (SCV) in patients with aneurysmal subarachnoid hemorrhage (aSAH). Methods: This was a retrospective multicenter case-control study in Japan. Patients with a diagnosis of aSAH who underwent physical therapy with/without occupational therapy were included and categorized into 2 groups according to the presence or absence of SCV. Initiating mobilization was defined as sitting on the bed edge (at least once, with/without assist, regardless of duration) within 7 days after aSAH onset. Cox proportional hazards regression analysis was performed to evaluate the association between initiating mobilization within 7 days after onset and SCV. Results: The analysis included 510 patients. Among all included patients, 57 (11.2%) patients had SCV. In the univariate Cox proportional hazards regression analysis, initiating of mobilization was not associated with SCV (hazard ratio [HR] = 0.78; 95% confidence interval [CI] = 0.45–1.32). In the multivariate analysis, only the modified Fisher scale was significantly associated with SCV (HR = 26.23; 95% CI = 1.21–571.0). Conclusion: Initiating mobilization within 7 days after aSAH onset was not associated with SCV in patients with aSAH.

Objective: This study aimed to reveal the chronic pain prevalence in spinal muscular atrophy (SMA) patients and identify the clinical characteristics of these patients with chronic pain. The pain status was also investigated in SMA patients with chronic pain. Methods: This cross-sectional study was conducted between July 2018 and December 2018. SMA type II and type III patients in Japan were mailed a survey questionnaire. The survey items were chronic pain prevalence, clinical characteristics, and motor function. Patients with chronic pain also answered questions on various pain status parameters: pain intensity, frequency, duration, location using body map, and factors that exacerbated and relieved pain. Results: The questionnaire recovery rate was 61.1%. Sixty-four type II (mean age 17.3 ± 11.7 years) and 22 type III (mean age 44.9 ± 21.6 years) patients were eligible for inclusion. The prevalence of chronic pain in type II and III patients was 40.6% and 40.9%, respectively. Type II patients with chronic pain were more likely to report the inability to sit without manual support than those without pain (p = 0.03). Pain intensity in SMA patients was mild, but pain usually occurred daily, for prolonged durations, most often in the neck, back, and lower extremities. Sitting and high physical activity exacerbated pain the most. Conclusion: The percentage of patients with SMA with chronic pain was high, at above 40%. Moreover, the pain experienced by patients with SMA was low in intensity but frequent and most common in the lower extremities.

Impairments resulting from stroke lead to persistent difficulties with walking. Subsequently, an improved walking ability is one of the highest priorities for people living with stroke. The degree to which gait can be restored after a stroke is related to both the initial impairment in walking ability and the severity of paresis of the lower extremities. However, there are some patients with severe motor paralysis and a markedly disrupted corticospinal tract who regain their gait function. Recently, several case reports have described the recovery of gait function in stroke patients with severe hemiplegia by providing alternate gait training. Multiple studies have demonstrated that gait training can induce "locomotor-like" coordinated muscle activity of paralyzed lower limbs in people with spinal cord injury. In the present review, we discuss the neural mechanisms of gait, and then we review case reports on the restoration of gait function in stroke patients with severe hemiplegia.

Objective: Several strategies have been designed to improve balance after stroke. Although recent studies have suggested that the balance training in stroke should include exercises that are performed in different sensory conflict conditions, little attention has been paid to manipulation of visual input. This study aimed to compare effects of balance training on an unstable surface with balance training under visual deprivation conditions in persons with stroke. Method: Forty-five stroke patients were randomized into three groups: the visual deprivation- stable based training (VD-SBT); unstable based training (UBT); and control (C) groups. Subjects of the VD-SBT group performed balance training on a stable surface with closed eyes. The UBT group performed balance training on an unstable surface with open eyes. Patients were assessed before and after interventions for Timed Up and Go (TUG), Four Square Step (FSS) and Five Times Sit to Stand (FTSS) tests. Result: There was a significant difference in pre- post intervention time of TUG, FSS and FTSS tests in all three groups. In a comparison of three groups, the UBT and VD-SBT groups had a significant improvement in time of all tests but significant improvement in time of all tests was observed in the VD-SBT group in comparison with the UBT group. In the field of balance training, the manipulation of visual input was more effective than the manipulation of standing surface to reweighting the sensory information. Conclusion: We recommended balance rehabilitation programs after stroke performed under conditions to stimulate the use of underused sensory input.

OBJECTIVE: Adequate physical activity after stroke is critical for cardiovascular health. Although sex is a potential factor associated with post-stroke physical activity, its mechanism remains unclear. This study aimed to examine sex differences in human physical activity following stroke. METHOD: A cross-sectional study with 62 participants (men: 42, women: 20) was conducted. Physical activity was measured for three consecutive days using a step activity monitor. The walking durations per day in light physical activity, moderate-to-vigorous physical activity, and total physical activity were calculated. Sex differences in walking duration were compared using Welch's t-tests or Mann-Whitney U tests. RESULTS: Women had a significantly greater walking duration in light physical activity and in total than did the men. In contrast, no significant differences were found in moderate-to-vigorous physical activity. CONCLUSION: This study reported sex differences in the walking duration after stroke. Moreover, it found that women spent more time in low intensity physical activity than men. Our results will be useful for planning interventions to increase physical activity and decrease sedentary behavior after stroke.

Background: Diabetic peripheral sensorimotor polyneuropathy (DPSP) has been treated with sketchy outcomes and available approaches are not applicable for self-administration. This study developed protocol for managing symptoms of DPSP and assessed its comparative efficacy. Methods: Study developed Lagos Neuropathy Protocol (LNP) through existing concept in DPSP and tested its safety, clinical applicability, and ease of self-administration. Its efficacy was compared with Buerger-Allen Exercise (BAE) by involving 31 (11males) with DPSP, randomized into LNP and BAE and treated for 10-week. Toronto Clinical Scoring System was used to diagnose DPSP while Diabetic Neuropathy Examination was used to diagnose distal polyneuropathy. Sensory/pressure perception was assessed using 10 g-monofilament while Short Physical Performance Battery, Bergs Balance Scale and Visual Analogue Scale was used to assess functional performance, strength and balance, and pain respectively. Results: LNP has three domains: sensory/pressure/proprioception, strength/balance, and pain/swelling. Most (80%) of the participants rated the LNP as excellently safe while the rest (20%) rated as very good in safety. All the participants rated LNP excellent in terms of self-administration and suitability for clinical use without adverse effect. The mean age of the participants for the comparative phase was 66.20±9.48years while their length of diagnoses of diabetes was 15.80±13.35years. About a third (32.5%) had DPSP. Both LNP and BAE had significant improvement (p<0.05) in sensory/pressure perception, pain, strength and balance, and functional performance but LNP had better significant improvement. Conclusion: LNP is safe, good for self-administration, clinically applicable and efficacious in improving sensory/pressure perception, balance, pain and functional performances in individuals with DPSP.

Objective: We explore the effects of body weight-supported (BWS) treadmill training, including the change of cortical activation, on a patient with post-stroke hemidystonia. Patient: The patient was a 71-year-old man with left thalamus hemorrhage. His motor symptoms indicated slight impairment. There was no overactive muscle contraction in the supine, sitting, or standing positions. During his gait, the right initial contact was the forefoot, and his right knee showed an extension thrust pattern. These symptoms suggested that he had post-stroke hemidystonia. Methods: The patient performed BWS treadmill training 14 times over 3 weeks. The effects of the BWS training were assessed by a step-length analysis, electromyography and functional magnetic resonance imaging (fMRI). Results: The patient's nonparetic step length was extended significantly in the Inter-BWS (p<0.001) and Post-BWS (p=0.025) periods compared to the Pre-BWS session. The excessive muscle activity of the right gastrocnemius medialis in the swing phase was decreased at the Inter-BWS, Post-BWS, and follow-up compared to the Pre-BWS session. The peak timing difference of the bilateral tibialis anterior muscle became significant (p<0.05) on the first day of the intervention. The fMRI revealed that the cortical areas activated by the motor task converged through the intervention (p<0.05, family-wise error corrected). Conclusion: These results suggest that there was improvement of the patient's symptoms of post-stroke hemidystonia due to changes in the brain activity during voluntary movement after BWS intervention. Body weight-supported treadmill training may thus be an effective treatment for patients with poststroke hemidystonia.