Journal of Neurologic Physical Therapy最新文献

{"title":"The Minimal Detectable Change for Balance and Balance Confidence After Chronic Spinal Cord Injury.","authors":"Lindsay Heffron Griffin, Abbey Plawecki, Jennifer Lotter, Lindsay Shoger, Christina Voigtmann, T George Hornby, Christopher Henderson","doi":"10.1097/NPT.0000000000000555","DOIUrl":"10.1097/NPT.0000000000000555","url":null,"abstract":"<p><strong>Background and purpose: </strong>Balance and balance confidence are often impaired in ambulatory individuals with incomplete spinal cord injury (iSCI) and can increase the risk for falls. The Berg Balance Scale (BBS) and the Activities-specific Balance Confidence (ABC) Scale assess balance and balance confidence, respectively, although clinically significant changes in these outcomes are uncertain. Accordingly, the goal of this study was to determine the minimal detectable change (MDC) for the BBS and ABC Scale in individuals after iSCI.</p><p><strong>Methods: </strong>Individuals >6 months after C1-T10 iSCI with walking speeds <1.0 m/s were recruited and self-identified as community ambulators or community wheelchair users. Using a population-specific standardization protocol, the BBS and ABC Scale were administered twice by varied assessors. Test-retest reliability was assessed using the intraclass correlation coefficient with absolute agreement. The MDC was calculated with 95% confidence and stratified by the primary means of community mobility.</p><p><strong>Results: </strong>Of the 50 individuals included, 52% identified as community ambulators. Both the BBS and ABC Scale demonstrated excellent test-retest reliability. Overall, the MDC 95 for the BBS was 8.0 points and lower for self-identified community ambulators (5.4 points) than for community wheelchair users (10.3 points). Observed MDC 95 for the ABC Scale was 16.6% and was similar for community ambulators (15.6%) and community wheelchair users (17.5%).</p><p><strong>Discussion and conclusions: </strong>Using a population-specific standardization protocol, the BBS and ABC Scale demonstrated excellent test-retest reliability in iSCI. The obtained MDC for the BBS is slightly higher than those reported in other neurologic populations, although the MDC for the ABC Scale is similar.</p>","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":" ","pages":"174-179"},"PeriodicalIF":3.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Movement Through Time: The Evolution of Treatment for People With Parkinson Disease.","authors":"Terry Ellis","doi":"10.1097/NPT.0000000000000566","DOIUrl":"10.1097/NPT.0000000000000566","url":null,"abstract":"<p><strong>Background and purpose: </strong>Parkinson disease (PD) is the fastest-growing neurological disorder worldwide, projected to affect approximately 25 million people by 2050. Despite effective pharmacologic management of motor symptoms, patients consistently identify walking, mobility, and balance as their greatest challenges. This Special Interest paper, based on the 2026 Anne Shumway-Cook Lectureship, summarizes a program of research aimed at building the evidence base for rehabilitation in PD and translating that evidence into improved real-world outcomes.</p><p><strong>Background and purpose: </strong>Four interrelated themes are addressed: (1) the historical development of the evidence base, from 11 randomized controlled trials in 2001 to more than 240 today; (2) the capacity-performance gap and the importance of targeting real-world walking, not only clinic-based function; (3) complementary intervention approaches, including cognitive-behavioral strategies, closed-loop rhythmic auditory stimulation, and soft-robotic assistance for freezing of gait, that address psychological, neural, and biomechanical barriers to everyday mobility; and (4) a proposed secondary-prevention model of care that initiates rehabilitation at diagnosis and sustains it longitudinally.</p><p><strong>Recommendations for clinical practice: </strong>Taken together, this body of work argues for a fundamental restructuring of physical therapy for people with PD: from a reactive, late-stage response to a proactive, lifelong strategy that reduces disability, preserves independence, and improves healthspan.</p>","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":"50 3","pages":"124-133"},"PeriodicalIF":3.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148279561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Dose of Targeted Rehabilitation Exercises for Vestibular (T-REV) Impairments following mTBI on Dizziness Handicap: A Randomized Clinical Trial.","authors":"Patrick J Sparto, Anthony P Kontos, Anne Mucha, Susan L Whitney, Aaron J Zynda, Charity G Patterson, Clair N Smith, Courtney Perry, Joseph M Furman, Selena A Bobula, Jamie N Hershaw, Christy Mote, Steven M Wilcox, Alan L Peterson, Stacey Young-McCaughan, Scot D Engel, Sean Suttles, Michael W Collins","doi":"10.1097/NPT.0000000000000547","DOIUrl":"10.1097/NPT.0000000000000547","url":null,"abstract":"<p><strong>Background and purpose: </strong>To evaluate the effect of intensity and frequency of vestibular rehabilitation exercises over time on dizziness handicap and secondary outcomes in adults with vestibular impairments following mild traumatic brain injuries (mTBI).</p><p><strong>Methods: </strong>The Targeted Rehabilitation Exercises for Vestibular (T-REV) impaiments randomized clinical trial was conducted from February 2020 to May 2024. Adult (18-50 years) civilian and military service members within 8 days to 1 year of mTBI with vestibular impairments participated. The sample size target was 252 participants. Exercises prescribed by a physical therapist were performed at home for 4 weeks at an intensity of 30% or 70%, and a frequency of once or twice daily. The Dizziness Handicap Inventory (DHI) and secondary outcomes were assessed at baseline, 2 and 4 weeks, and DHI at 12 weeks. Least square mean differences and 95% confidence intervals were calculated from a linear mixed model to examine the effects of intensity, frequency, time, and their interactions.</p><p><strong>Results: </strong>A total of 120 participants completed baseline assessment (69 F, 51 M; 73 civilians, 47 military service members; mean (SD) age: 29 (9) years). Group differences in DHI and secondary outcomes over time due to intensity or frequency were equivocal. For all participants, mean improvement in DHI from baseline to 4 weeks was 16 points (95% CI: 13-19 points, P < .0001), and most secondary outcomes significantly improved across 4 weeks. Adverse events occurred in 20% of the participants.</p><p><strong>Discussion and conclusions: </strong>The dose of vestibular rehabilitation for individuals with mTBI-related vestibular impairments can be individualized based on patient goals and symptom burden.</p>","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":" ","pages":"134-146"},"PeriodicalIF":3.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146041970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical Therapist Involved Physical Activity Interventions: A Systematic Review and Meta-Analysis.","authors":"Bridget Fowler King, Carmen Capo-Lugo, Elizabeth Strehlow, Michelle C Walaszek, Elizabeth L Gray, Elizabeth Rossi Pierobon, Allen W Heinemann, Miriam R Rafferty","doi":"10.1097/NPT.0000000000000546","DOIUrl":"10.1097/NPT.0000000000000546","url":null,"abstract":"<p><strong>Background and purpose: </strong>Little is known about the delivery of physical therapy services to promote physical activity (PA) for adults with neurologic conditions. This systematic review aimed to: (1) identify the roles of physical therapists (PTs) in the delivery of PA interventions, (2) describe PA intervention types, and (3) explore the efficacy of physical therapy PA interventions.</p><p><strong>Methods: </strong>This systematic review included randomized controlled trials of interventions including physical therapy, PA or exercise, and PA health promotion in adults with neurologic conditions. Database searches included: PubMed MEDLINE, Embase, CINAHL, PsycINFO, and CENTRAL. Meta-analyses were performed for accelerometry-based and self-report measures of PA; meta-regressions explored moderators.</p><p><strong>Results: </strong>Sixty articles met the inclusion criteria, representing 54 unique trials with 15,874 participants. Most articles had a moderate quality of reporting (85%) and a high risk of bias (RoB) (90%). PA interventions led to small, but significant effects on direct measures of PA (effect size [ES] = 0.18, CI 95% , 0.01, 0.35). Small-moderate effects were present when articles with high RoB were excluded (n = 6, ES = 0.36, CI 95% , 0.05, 0.67). Meta-regressions suggested that interventions including both PA and behavior change techniques were more positive than either intervention alone (β = 0.43, CI 95% , 0.23, 0.62).</p><p><strong>Discussion and conclusions: </strong>PTs used direct and supervisory roles to deliver effective PA interventions, particularly using interventions combining PA and behavior change techniques. However, heterogeneity of PA measures limits the interpretation of the meta-analyses. Further research should develop consensus on feasible direct measures of PA outcome measures to use in research and clinical practice for adult neurologic populations.</p>","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":" ","pages":"180-197"},"PeriodicalIF":3.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13281973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146183269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the Relationship Between Cutaneous Sensation, Balance, and Falls in People With Multiple Sclerosis.","authors":"Daniel S Peterson, Soubhagya Nayak, Hyunglae Lee, Jessie Huisinga, Andrew Hooyman","doi":"10.1097/NPT.0000000000000554","DOIUrl":"10.1097/NPT.0000000000000554","url":null,"abstract":"<p><strong>Background and purpose: </strong>Falls remain an important and undertreated outcome in people with multiple sclerosis (PwMS). Understanding the paths through which neurophysiological changes contribute to altered balance and falls can improve our understanding of and ability to treat falls in this group. The purpose of this analysis was to assess the relationship between specific aspects of balance (reactive balance and sway) in PwMS and to assess whether balance deficits mediate relationships between neurophysiological changes (cutaneous sensation at the foot) and falls.</p><p><strong>Methods: </strong>In this observational, cross-sectional study, cutaneous sensation, reactive balance, and standing sway data were collected in 121 PwMS and 48 controls. Correlation analyses assessed relationships between reactive and standing balance. Single and multiple mediator models determined the individual and joint mediating effect of sway and reactive stepping on the cutaneous sensation-falls relationship.</p><p><strong>Results: </strong>Significant correlations were observed between reactive step latency (but not length) and multiple standing sway outcomes in PwMS. Statistically significant relationships were not observed in controls. Mediation models showed a significant mediating effect of reactive step latency and sway on the cutaneous sensation-falls relationship in PwMS.</p><p><strong>Discussion and conclusions: </strong>Results indicate that the latency (but not length) of reactive stepping is related to standing sway, cutaneous sensation, and (via previous analyses) falls. Further, mediation analyses suggest that poor sensation leads to greater sway and slower reactive steps, which lead to greater fall risk. Together, these results inform links between balance outcomes and quantitatively confirm previous hypotheses regarding possible pathways through which sensory deficits contribute to falls.</p>","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":" ","pages":"157-165"},"PeriodicalIF":3.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introducing the Anne Shumway-Cook Lectureship to JNPT.","authors":"Lori Quinn","doi":"10.1097/NPT.0000000000000567","DOIUrl":"https://doi.org/10.1097/NPT.0000000000000567","url":null,"abstract":"","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":"50 3","pages":"123"},"PeriodicalIF":3.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148279355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Memoriam: Michelle Elizabeth Ploughman, PT, PhD, Associate Editor, Journal of Neurologic Physical Therapy.","authors":"","doi":"10.1097/NPT.0000000000000563","DOIUrl":"https://doi.org/10.1097/NPT.0000000000000563","url":null,"abstract":"","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":"50 3","pages":"199"},"PeriodicalIF":3.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148279350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-Controlled Feedback on Motor Learning and Neuroplastic Changes in People With Parkinson Disease.","authors":"De-Jun Lim, Chun-Hwei Tai, Shu-Ya Chen, Cheng-Ya Huang, Ya-Yun Lee","doi":"10.1097/NPT.0000000000000553","DOIUrl":"10.1097/NPT.0000000000000553","url":null,"abstract":"<p><strong>Background and purpose: </strong>People with Parkinson disease (PD) experience impaired motor learning. Although numerous studies have shown that self-controlled feedback can facilitate motor learning in healthy young adults, whether similar benefits can be observed in people with PD has been less investigated. This study thus aimed to examine whether self-controlled feedback could benefit motor learning for individuals with PD, and to determine the associated behavioral and neurophysiological mechanisms.</p><p><strong>Methods: </strong>Thirty-two participants with PD, matched in pairs, were recruited into a self-control group (SELF) and a yoked group (YOKE) to practice a finger-pressing trajectory-matching task. All participants visited the laboratory on day 1 (D1) and day 2 (D2) to practice the trajectory-matching task. The SELF group could decide when to receive feedback, whereas the YOKE group received feedback based on their counterparts' choices. Retention tests were performed on D2 after practice and on day 7 (D7). Additionally, motivation questionnaires, error estimation ability, and corticomotor excitability were examined.</p><p><strong>Results: </strong>Both groups showed improvements in the trajectory-matching task throughout practice. On D7, the SELF group retained its trajectory-matching task performance and showed an increase in corticomotor excitability, whereas these changes were not observed in the YOKE group. There were no significant group differences in the motivation questionnaire or error estimation results.</p><p><strong>Discussion and conclusions: </strong>Self-controlled feedback facilitated motor learning accompanied by increased corticomotor excitability in people with PD. Clinicians may consider incorporating self-control practices into the PD rehabilitation regimen to enhance training benefits.</p><p><strong>Clinicaltrialgov id: </strong>NCT05960331.</p>","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":" ","pages":"166-173"},"PeriodicalIF":3.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Influence of Motor and Nonmotor Factors on Ambulatory Activity in People With Parkinson Disease.","authors":"Cielita Lopez-Lennon, Jennifer Hale, Anson Rosenfeldt, Erin Suttman, A Elizabeth Jansen, Angela Weston, Blessing S Ofori-Atta, Jay Alberts, Leland E Dibble","doi":"10.1097/NPT.0000000000000573","DOIUrl":"10.1097/NPT.0000000000000573","url":null,"abstract":"<p><strong>Background and purpose: </strong>Reduction in ambulation levels has been described as a clinical \"red flag\" that represents the emergence of disability in individuals with Parkinson disease (PD). Multiday ambulatory activity measures may capture disability not detected by standard clinical assessments. However, the influence of disease severity and nonmotor symptoms on ambulatory activity remains unclear. This study aimed to examine the association between daily ambulatory activity and motor disease severity, assessed in both medication states, and to identify which non-motor symptoms were associated with daily step accumulation in individuals with mild to moderate PD.</p><p><strong>Methods: </strong>Mean daily steps were calculated over 7 days in 198 participants with PD. Motor and nonmotor symptoms were characterized using Movement Disorders Society-Unified Parkinson Disease Rating Scale (MDS-UPDRS) Part I, III, and IV. Descriptive statistics were calculated at baseline to characterize participant demographics and clinical characteristics. Linear regressions modeled the association between motor/nonmotor signs/symptoms and ambulatory activity, adjusting for age, race, and body mass index.</p><p><strong>Results: </strong>Median daily step count was 5180 (interquartile range: 3521-7199). Standardized off-medication MDS-UPDRS III scores were significantly associated with fewer mean daily steps, while on-medication scores were not, though the magnitude of this association was modest. Among nonmotor symptoms, a self-reported complaint of lightheadedness upon standing was associated with approximately 2000 fewer mean daily steps.</p><p><strong>Conclusion: </strong>A self-report of lightheadedness upon standing showed a clinically meaningful association with reduced ambulatory activity, while motor severity, even assessed in the standardized off-medication state, showed only a modest association. These findings highlight the value of nonmotor symptom assessment, particularly cardiovascular autonomic screening, in understanding real-world disability in PD.</p>","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148340711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Group Exercise Outcomes Differ by Baseline Physical Activity in Individuals With Spinal Cord Injury: An Exploratory Analysis.","authors":"Margaret A Finley, Laura A Baehr, Michael Bruneau, Shivayogi V Hiremath, June Maloney, Martha Childress, James Morrison, Emelia Perry","doi":"10.1097/NPT.0000000000000572","DOIUrl":"https://doi.org/10.1097/NPT.0000000000000572","url":null,"abstract":"<p><strong>Background and purpose: </strong>Nearly 50% of individuals with spinal cord injury (SCI) report no regular physical activity (PA). We developed a novel group tele-exercise program for individuals with SCI to address barriers to exercise and influence individual determinants of PA behavior. The purpose was to compare outcomes of exercisers versus non-exercisers based on self-reported PA at baseline following participation in an 8-week program, Tele-Exercise to promote Empowered Movement in individuals with SCI (TEEMS).</p><p><strong>Methods: </strong>Individuals with chronic SCI (n = 51, 24 non-exercisers) participated. Primary outcomes (Exercise Self-Efficacy Scale for SCI, Multidimensional Outcome Expectations for Exercise, Leisure Time PA Questionnaire for SCI, Subjective Quality of Life) and secondary outcomes (sleep, pain interference, domains of SCI Quality of Life) were assessed pre-, post-, and 8 weeks following program completion (retention).</p><p><strong>Results: </strong>Pre-program non-exercisers reported lower exercise expectations (P = 0.02), weekly minutes of moderate- to high-intensity PA (P < 0.001), total weekly PA (P < 0.001), and self-esteem (P = 0.01) compared with exercisers. Non-exercisers improved in exercise self-efficacy (P = 0.02) and increased moderate- to high-intensity PA (P = 0.01), eliminating the group difference. Non-exercisers demonstrated large effects for greater participation in social roles (d = 0.92), satisfaction with social roles (d = 1.0), and self-esteem (d = 0.92) post-program. Self-evaluative expectations of exercise improved in non-exercisers and exercisers (P < 0.001) with no difference between groups. Changes were maintained at retention.</p><p><strong>Discussion and conclusions: </strong>For individuals with SCI, especially non-exercisers, participation in Tele-Exercise to promote Empowered Movement in individuals with SCI positively impacted personal determinants of PA behavior, along with improved self-esteem and social participation. Improved exercise self-efficacy, influenced by exercise knowledge gained during program participation and increased expectations of internal exercise outcomes, was found.</p>","PeriodicalId":49030,"journal":{"name":"Journal of Neurologic Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148340697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}