Journal of NeuroEngineering and Rehabilitation最新文献

{"title":"In vivo estimation of motor unit intrinsic properties in individuals with spinal cord injury.","authors":"Zhihao Duan, Asta Kizyte, Emelie Butler Forslund, Elena M Gutierrez-Farewik, Pawel Herman, Ruoli Wang","doi":"10.1186/s12984-025-01659-z","DOIUrl":"10.1186/s12984-025-01659-z","url":null,"abstract":"<p><strong>Background: </strong>Individuals who have experienced spinal cord injury (SCI) may exhibit various muscle-related neurophysiological adaptations, including alterations in motor unit (MU) size and firing behavior. However, due to the technical challenges of in vivo measurement, our understanding of the alterations in the electrophysiological parameters of these MUs remains limited. This study proposed an integrated approach using high-density electromyography (HD-EMG) decomposition and motor neuron (MN) modelling to estimate the intrinsic properties of MUs in vivo and investigated alterations of these properties in persons with SCI.</p><p><strong>Methods: </strong>HD-EMG signals were recorded during submaximal isometric dorsiflexion and plantar flexion tasks on tibialis anterior (TA), soleus, and gastrocnemius medialis muscles from twenty-six participants with SCI and eighteen non-disabled controls. The HD-EMG signals were subsequently decomposed into MN spike trains and the common synaptic input to the MN pool was estimated. A simplified leaky integrate-and-fire neuron model was then used to simulate MN spiking trains, with soma size and inert period as tunning parameters, which are crucial for MU recruitment and firing patterns, respectively. These parameters were estimated by fitting the instantaneous discharge frequencies of decomposed and simulated spike trains via a genetic algorithm.</p><p><strong>Results: </strong>The results showed a prolonged inert period in the TA of the persons with SCI. This finding suggested that the MUs in the TA have a slower recovery period before becoming excitable again, which may result in a lower firing rate of MUs in the TA muscle. No significant differences were observed in the soleus and gastrocnemius medialis muscles between the SCI and control groups for either the soma size or inert period parameters.</p><p><strong>Conclusions: </strong>The simplified leaky integrate-and-fire model exhibited robustness in estimating MN parameters in vivo, offering valuable insights into personalized MU behavior monitoring. To the best knowledge of authors, this is the first study to combine HD-EMG and MU modeling to investigate MU electrophysiological changes in persons with SCI in vivo. This novel approach offers a comprehensive understanding of MU properties adaptations following neurological disorders and informs the development of novel rehabilitation strategies.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":"22 1","pages":"128"},"PeriodicalIF":5.2,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12139106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome measures of instrumented gait analysis in hereditary spastic paraplegia: a systematic review.","authors":"Veronika Koch, Alzhraa Ibrahim, Juergen Winkler, Bjoern Eskofier, Martin Regensburger, Heiko Gassner","doi":"10.1186/s12984-025-01646-4","DOIUrl":"10.1186/s12984-025-01646-4","url":null,"abstract":"<p><strong>Background: </strong>Hereditary spastic paraplegias (HSPs) comprise a group of genetic movement disorders characterized by progressive spasticity and weakness of the lower limbs leading to gait deficits. Instrumented gait measures are applied to quantify gait patterns in HSP objectively. However, there is no consensus on the most relevant HSP-specific digital outcome measures for future clinical studies.</p><p><strong>Aim: </strong>This systematic review aims to summarize outcome measures of instrumented gait analysis in HSP patients, focusing on both traditional motion capture (MOCAP) and inertial sensor systems.</p><p><strong>Methods: </strong>Following PRISMA-2020 guidelines, a comprehensive literature search was conducted in PubMed, Scopus, and Web of Science to identify studies using instrumented gait analysis in HSP. Data on participant characteristics, measurement systems, outcome measures, results, and risk of bias were systematically extracted.</p><p><strong>Results: </strong>In total, 38 studies published between 2004 and 2024, including 29 observational studies and 9 interventional studies, met the inclusion criteria. Various gait parameters were used, including spatio-temporal, kinematic, kinetic, and electromyography (EMG) parameters. Walking speed and range-of-motion (ROM) knee were identified as important parameters for differentiating HSP patients from healthy controls, but these parameters are more general rather than disease-specific. Foot lift, ROM foot, and gait variability are promising, more disease-specific parameters, as they reflect disease severity and increased balance deficits. However, a deeper understanding of all gait parameter categories is necessary, particularly for the upper body. Few studies explored sub-cohorts that exhibit different HSP gait characteristics.</p><p><strong>Conclusion: </strong>While MOCAP provides valuable data in controlled hospital environments, there is a need for validated mobile sensor systems capturing the gait patterns of HSP patients in real-life without supervision. Future research must focus on better longitudinal multicenter studies with larger sample sizes to establish robust digital outcomes and monitor disease progression and therapeutic response in HSP.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":"22 1","pages":"129"},"PeriodicalIF":5.2,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12139076/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomechanical analysis of patients with mild Parkinson's disease during indoor cycling training.","authors":"Seonghyun Kang, Jin-Woo Park, Yekwang Kim, Juhui Moon, Yeji Lee, Chan-Nyoung Lee, Jaewook Kim, Seung-Jong Kim, Byung-Jo Kim","doi":"10.1186/s12984-025-01657-1","DOIUrl":"10.1186/s12984-025-01657-1","url":null,"abstract":"<p><strong>Background: </strong>Parkinson's disease (PD) is characterized by significant postural instability and gait impairments, yet many individuals with PD can continue cycling even with severe gait dysfunction. While previous research has investigated the preservation of pedaling ability, how individuals with PD regulate and adapt their balance control strategies during cycling remains largely unexplored. This study aims to identify the biomechanical adaptations in cycling balance control employed by individuals with PD and how they differ from those of healthy individuals.</p><p><strong>Methods: </strong>A total of 39 PD patients and 42 age-matched healthy controls participated in a cycling task using a steerable indoor cycling system that enables sliding and tilting motions, requiring them to actively maintain balance while following a straight-line trajectory. Cycling dynamics were analyzed using a sensor-equipped system designed to capture medio-lateral balance adjustments, including force exertion on the handlebars and saddle, lateral deviations, and pedaling speed.</p><p><strong>Results: </strong>PD patients exhibited a higher coordination of upper and lower body in the medio-lateral direction (PD: 0.47 ± 0.18 vs. Control: 0.11 ± 0.30, p < 0.001), suggesting a stronger reliance on a leaning strategy for balance control. While PD patients cycled at a significantly lower freely chosen speed (6.49 ± 1.45 km/h vs. 10.28 ± 3.00 km/h, p < 0.001), their bike deviation was lower than that of healthy controls (PD: 17.1 ± 9.9 mm vs. Control: 22.8 ± 11.7 mm, p = 0.019), indicating a more constrained and controlled cycling pattern. Additionally, force distribution patterns and bike speed showed strong correlations with physical function measures, including lower limb strength and gait velocity.</p><p><strong>Conclusions: </strong>This study identifies distinct cycling balance adaptations in PD, providing insights into how individuals with PD regulate and modify their balance control strategies during cycling. The quantitative metrics derived from this study may offer a basis for future research exploring their potential as biomechanical markers for objective functional assessment and rehabilitation monitoring in PD.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":"22 1","pages":"127"},"PeriodicalIF":5.2,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postural sway serves as a predictive biomarker in balance and gait assessments for diabetic peripheral neuropathy screening: a community-based study.","authors":"Yun-Ru Lai, Wen-Chan Chiu, Chi-Ping Ting, Yi-Fang Chiang, Ting-Yin Lin, Hui-Ching Chiang, Chih-Cheng Huang, Cheng-Hsien Lu","doi":"10.1186/s12984-025-01644-6","DOIUrl":"10.1186/s12984-025-01644-6","url":null,"abstract":"<p><strong>Background: </strong>Traditional screening methods for diabetic peripheral neuropathy (DPN) can be time-consuming in community settings. Balance and gait impairments are common in individuals with DPN, but these functional impairments are often not detectable with standard neurological examinations. This study aimed to examine whether quantitative balance and gait assessment could serve as a viable alternative screening tool for DPN.</p><p><strong>Methods: </strong>All participants were recruited from a community-based daycare center and underwent peripheral nerve function assessments, including the Toronto Clinical Neuropathy Score (TCNS), sural nerve conduction studies (amplitude and velocity) for large fiber function, and Sudoscan testing for small fiber function. Subsequently, participants underwent balance and gait assessments, including static postural sway measurements and gait analysis of spatiotemporal parameters and joint range of motion (ROM) assessment during walking.</p><p><strong>Results: </strong>Of the 146 participants, 35 had diabetes, including 22 with DPN, while 111 were healthy controls. Participants with DPN demonstrate increased postural sway velocity and total path length, along with reduced gait speed, shorter stride length, and decreased range of motion in hip flexion and extension. The logistic regression analysis identified diabetes duration and postural sway velocity as the only significant predictors of DPN presence. Postural sway velocity demonstrated strong correlations with elevated TCNS, reduced sural sensory nerve action potential and sensory nerve conduction velocity, and lower Sudoscan values in hands and feet. Additionally, receiver operating characteristic analysis yielded a sensitivity of 68.2%, specificity of 85.5%, and an area under the curve of 0.76, with a cut-off value of 0.98 cm/s.</p><p><strong>Conclusions: </strong>Balance and gait impairments are prevalent among participants with DPN. This study supports the integration of balance and gait assessments into community-based screening protocols to facilitate early identification and intervention. Postural sway velocity emerged as a practical early biomarker for the screening of DPN.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":"22 1","pages":"123"},"PeriodicalIF":5.2,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12128393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-centered insights into virtual reality rehabilitation for stroke: a systematic review and qualitative meta-synthesis.","authors":"Kun Ding, Yan Ma, Lingling Zhang, Yufang Gu, Huixuan Pan, Zhi-E Gu, Hengzhu Zhang","doi":"10.1186/s12984-025-01641-9","DOIUrl":"10.1186/s12984-025-01641-9","url":null,"abstract":"<p><strong>Background: </strong>Virtual reality rehabilitation (VRR) is an emerging technology that offers new possibilities for stroke recovery. Understanding stroke survivors' experiences and expectations is essential for optimizing its application.</p><p><strong>Objective: </strong>This systematic review synthesizes qualitative evidence on stroke survivors' experiences with and participation in VRR to identify benefits, challenges, and areas for improvement.</p><p><strong>Methods: </strong>This systematic review follows the meta-aggregation method guided by ENTREQ and PRISMA and uses the Critical Appraisal Skills Programme (CASP) to assess the quality of included studies. We searched eight English and Chinese databases for qualitative or mixed-method studies on stroke survivors' experiences with VRR, published by May 31, 2024. Selected studies were independently reviewed, and data were synthesized into core themes.</p><p><strong>Results: </strong>Fourteen studies were included, involving a total of 133 participants aged 13 to 85 years. The analysis identified four key themes: (1) perceived self-benefits, including physical and psychological improvements; (2) facilitators, such as user engagement and supportive environments; (3) barriers, including technical and personal limitations; and (4) expectations.The quality of the included studies was assessed using the CASP tool, with scores ranging from 26 to 30, indicating moderate to high quality across the studies.</p><p><strong>Conclusion: </strong>VRR has the potential to enhance stroke rehabilitation outcomes, but its success depends on addressing individual and systemic challenges. Personalized interventions and multidisciplinary efforts are needed to develop user-friendly, adaptable VRR systems that fully leverage the advantages of this technology.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":"22 1","pages":"124"},"PeriodicalIF":5.2,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12128322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed muscle fatigue during electrical stimulation of the proximal nerve using asymmetric random high-frequency carrier pulse cluster.","authors":"Rui Yuan, Yang Zheng, Henry Shin, Guanghua Xu, Shengnuo Fan, Zhanhong Du","doi":"10.1186/s12984-025-01658-0","DOIUrl":"10.1186/s12984-025-01658-0","url":null,"abstract":"<p><strong>Background: </strong>Transcutaneous peripheral nerve electrical stimulation using high-frequency pulse clusters has been shown to relieve muscle fatigue, though its efficacy remains limited. Furthermore, this approach tends to exacerbate pain during stimulation, which constrains its clinical applications. This paper proposed a novel stimulation waveform to reduce muscle fatigue and the discomfort associated with high-frequency electrical stimulation, and compares it with previously reported high-frequency pulsed cluster stimulation.</p><p><strong>Methods: </strong>We evaluated our waveform experimentally and through model simulations. During the experiment, two distinct high-frequency narrow pulse clusters were applied to the proximal segment of the median/ulnar nerve bundles: asymmetric random (aSymR) and previously reported symmetric (Sym) stimulation, both with a carrier frequency of 10 kHz. The two stimulation modes aimed to elicit the same contraction level and were maintained for 5 min to induce muscle fatigue. Finger force, high-density electromyographic (EMG) signals of the flexor muscles and the pain score were recorded. In addition, we developed a finite element model of the upper arm and a motor fiber model to simulate motor axon activation of the peripheral nerve induced by the two electrical stimulation modes.</p><p><strong>Results: </strong>Compared with the Sym stimulation, the aSymR stimulation resulted in less pain and a significant reduction of muscle fatigue rate, which was characterized by slower force decay rate, less absolute force decay, greater plateau force, and ultimately greater force output. In addition, the simulation results showed that the delay for different fibers to reach the threshold was increased by the aSymR mode. Consistent with this, the experiment study showed that the EMG amplitude under the aSymR stimulation condition was smaller before fatigue onset, indicating the less synchronized activation of different muscle fibers.</p><p><strong>Conclusions: </strong>Compared with the Sym stimulation, the aSymR stimulation can significantly relieve muscle fatigue possibly by reducing the synchronous activation across different fibers. This proposed aSymR stimulation mode not only reduces fatigue but also relieves pain, potentially contributing to the wide application of electrical stimulation in motor function rehabilitation for people with stroke.</p><p><strong>Trial registration: </strong>Ethics committee of the Medical College of Xi'an Jiaotong University, 2021 - 1550. Registered 4 November 2021.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":"22 1","pages":"125"},"PeriodicalIF":5.2,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12128545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using machine learning to identify Parkinson's disease severity subtypes with multimodal data.","authors":"Hwayoung Park, Changhong Youm, Sang-Myung Cheon, Bohyun Kim, Hyejin Choi, Juseon Hwang, Minsoo Kim","doi":"10.1186/s12984-025-01648-2","DOIUrl":"10.1186/s12984-025-01648-2","url":null,"abstract":"<p><strong>Background: </strong>Classifying and predicting Parkinson's disease (PD) is challenging because of its diverse subtypes based on severity levels. Currently, identifying objective biomarkers associated with disease severity that can distinguish PD subtypes in clinical trials is necessary. This study aims to address the clinical applicability and heterogeneity of PD using PD severity subtypes classification and digital biomarker development by combining objective multimodal data with machine learning (ML) approaches.</p><p><strong>Methods: </strong>We analyzed datasets that combine clinical characteristics, physical function and lifestyle data, gait parameters in motion analysis systems, and wearable sensors collected from persons with PD (n = 102) to perform clustering for subtype classification.</p><p><strong>Results: </strong>We identified three PD severity subtypes, each exhibiting different patterns of clinical severity, with the severity increasing as it progressed from clusters 1 to 3. We found significant mutual information between all/single modalities and the unified PD rating scale scores, identifying potential modalities with high feature importance using ML. Among all modalities, the principal components of gait parameters derived from wearable sensors were identified as the most associated indicators of PD severity. A model utilizing the first principal component of the left and right ankle achieved perfect classification with an area under the curve of 1.0, accurately distinguishing clinically severe subtypes from mild subtypes of PD. These findings suggest that gait features in both ankles can reflect asymmetry factors associated with PD severity subtypes, which contributes to high classification performance.</p><p><strong>Conclusions: </strong>Digital biomarkers obtained from wearable sensors attached bilaterally to body segments demonstrate potential for classifying PD severity subtypes and tracking disease progression. Our findings emphasized the clinical value of sensor-based gait analysis in PD management, which suggested its integration into personalized monitoring systems and therapeutic interventions for persons with PD.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":"22 1","pages":"126"},"PeriodicalIF":5.2,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12131740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of oral care combined with neuromuscular electrical stimulation on clinical outcomes in the acute phase of acute ischemic stroke: a pilot randomized controlled trial.","authors":"Yi-Ting Huang, Chia-Chun Tang, Chen-Chih Chung, Chi-Hsiang Chung","doi":"10.1186/s12984-025-01652-6","DOIUrl":"10.1186/s12984-025-01652-6","url":null,"abstract":"<p><strong>Background: </strong>Stroke-associated dysphagia significantly increases the risk of pneumonia in persons with acute ischemic stroke (AIS), yet effective early interventions remain limited. This pilot randomized controlled trial examined the feasibility and clinical effects of a nurse-delivered combined intervention involving neuromuscular electrical stimulation (NMES) and comprehensive oral care-including toothbrushing using the Bass method, tongue cleaning, and moisturizing twice daily-during the acute stroke phase.</p><p><strong>Methods: </strong>This randomized, parallel group pilot trial assigned persons with AIS into three groups: (i) oral care only, (ii) oral care + NMES, and (iii) standard care (control). Interventions began within 48 h of stroke onset and continued twice daily for five days, starting within 48 h of stroke onset. Outcome measures, including the Revised Oral Assessment Guide (ROAG) and Gugging Swallowing Screening (GUSS), were assessed at baseline, day 4, and day 8 post-stroke. Statistical analysis employed one-way analysis of variance (ANOVA), chi-square tests, and generalized estimating equations (GEE) to analyze group differences and longitudinal trends.</p><p><strong>Results: </strong>Among 35 participants (mean age 68.3 ± 12.5 years; 51.4% men), both intervention groups demonstrated significant improvements in swallowing and oral health outcomes over time, compared to standard care (p < 0.05). Although this pilot study was not powered to determine superiority between the two intervention groups, the oral care + NMES group demonstrated the greatest improvements in GUSS and ROAG scores.</p><p><strong>Conclusion: </strong>Findings from this pilot trial support the feasibility of nursing staff implementing combined oral care and NMES within 48 h of AIS onset. The results highlight the potential for meaningful clinical benefits, particularly in settings with limited access to specialized rehabilitation. Larger, blinded, multi-center trials are warranted to further evaluate the efficacy and broader applicability of this early intervention strategy.</p><p><strong>Registration: </strong>The study protocol was registered in the Protocol Registration and Results System (PRS) under ID N202108021 as a supplementary registration due to initial unfamiliarity with PRS registration requirements, with the registration date recorded as 11/14/2024.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":"22 1","pages":"122"},"PeriodicalIF":5.2,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12123995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative efficacy of robotic exoskeleton and conventional gait training in patients with spinal cord injury: a meta-analysis of randomized controlled trials.","authors":"Shengye Liu, Fangyuan Chen, Jianqiao Yin, Guanqi Wang, Liyu Yang","doi":"10.1186/s12984-025-01649-1","DOIUrl":"10.1186/s12984-025-01649-1","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this meta-analysis was to investigate the effects of Robotic exoskeleton gait training (REGT) on lower limb mobility, walking balance, functional scores and respiratory function in patients with spinal cord injury (SCI).</p><p><strong>Data sources: </strong>The PubMed, Embase, Cochrane Library databases were systematically searched from inception until December 24, 2024.</p><p><strong>Study selection: </strong>Eligible randomized controlled trials contained information on the population (SCI), intervention (REGT), and outcomes (walking speed and distance, walking balance, functional scores for SCI rehabilitation, respiratory function). Participants in the REGT intervention group were compared with those in conventional physical gait training (CPT) groups. Two independent researchers conducted the research,screened the articles, and assessed their eligibility.</p><p><strong>Data extraction: </strong>Two independent researchers extracted key information from each eligible study. The authors' names, year of publication, setting, total sample size, REGT, CPT training schedule, baseline/mean difference (MD), and 95% confidence interval (CI) were extracted using a standardized form, and the methodological quality was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system.</p><p><strong>Data synthesis: </strong>Of 595 studies identified, 15 randomized controlled trials (n = 579) were included for meta-analysis. Compared with conventional physical gait training (CPT), REGT showed no significant efficacy in walking speed (10-Meter Walk Test, WMD (95%CI) = - 0.03 (- 0.06, 0.00) m/s, P = 0.08) and walking distance, (6-Minute Walk Test, WMD (95% CI) = -1.83 (- 14.48, 10.83) meters, P = 0.78). REGT showed statistically significant efficacy in walking stability (Timed Up and Go, WMD (95%CI) = 6.62 (0.35, 12.88) s, P = 0.04) and functional scores such as Walking Index for Spinal Cord Injury Version II (WMD (95%CI) = 2.17 (1.05, 3.29), P = 0.0001) and Lower Extremity Motor Score (WMD (95%CI) = 1.33 (0.58, 2.07), P = 0.0005). Additional Significant efficacy was also found in terms of respiratory function (forced expiratory volume in one second, WMD (95%CI) = 0.60 (0.05, 1.16) L, P = 0.03).</p><p><strong>Conclusions: </strong>This meta-analysis discovered the evidence that robotic exoskeleton gait training can improve the walking balance, strength of lower limbs, functional scores and respiratory function in the patients with spinal cord injury (SCI) compared to conventional gait training (CPT). No obvious evidence showed that REGT has more advantages than CPT in improving walking speed and distance. REGT combined with CPT are more recommended in the discovery of walking speed and distance of patients above 6 months after SCI.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":"22 1","pages":"121"},"PeriodicalIF":5.2,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12121209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of electroencephalography-based motor imagery neurofeedback on mu suppression during motor attempt in patients with stroke.","authors":"Seungwoo Cha, Kyoung Tae Kim, Won Kee Chang, Nam-Jong Paik, Ji Soo Choi, Hyunmi Lim, Won-Seok Kim, Jeonghun Ku","doi":"10.1186/s12984-025-01653-5","DOIUrl":"10.1186/s12984-025-01653-5","url":null,"abstract":"<p><strong>Objective: </strong>The primary aim of this study was to explore the neurophysiological effects of motor imagery neurofeedback using electroencephalography (EEG), specifically focusing on mu suppression during serial motor attempts, and to assess its potential benefits in patients with subacute stroke.</p><p><strong>Methods: </strong>A total of 15 patients with hemiplegia following subacute ischemic stroke were prospectively enrolled in this randomized cross-over study. This study comprised two experiments: neurofeedback and sham. Each experiment included four blocks: three blocks of resting, grasp, resting, and an interventional task, followed by one block of resting and grasp. During the resting sessions, participants fixated on a white cross on a black background for 2 min without moving their upper extremities. In the grasp sessions, participants were instructed to grasp and release their paretic hand at a frequency of about 1 Hz for 3 min while maintaining fixation on the white cross. During the interventional task, the neurofeedback presented a punching image using the affected upper limb, corresponding to the mu suppression induced by imagined movement for 3 min. In contrast, the sham presented an image based on mu suppression data from randomly selected participants. EEG data were recorded throughout the experiment, and data from electrodes C3/C4 and P3/P4 were analyzed to compare the degree of mu suppression between the neurofeedback and sham experiments.</p><p><strong>Results: </strong>Significant mu suppression was observed in the bilateral motor and parietal cortices during the neurofeedback experiment compared with the sham across serial sessions (p < 0.001). Following neurofeedback, real grasping sessions showed progressive strengthening of mu suppression in the ipsilesional motor cortex and bilateral parietal cortices compared to sessions following sham (p < 0.05). This effect was not observed in the contralesional motor cortex.</p><p><strong>Conclusions: </strong>Motor imagery neurofeedback significantly enhances mu suppression in the ipsilesional motor and bilateral parietal cortices during motor attempts in patients with subacute stroke. These findings suggest that motor imagery neurofeedback could serve as a promising adjunctive therapy to enhance motor-related cortical activity and support motor rehabilitation in patients with stroke.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":"22 1","pages":"119"},"PeriodicalIF":5.2,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12117778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}