American Journal of Physical Medicine & Rehabilitation最新文献

{"title":"Effects of High-Intensity Laser Therapy on Functional Outcomes and Spasticity-Related Pain in Subacute and Chronic Stroke Patients with Plantar Flexor Spasticity: A Randomized Sham-Controlled Trial.","authors":"Yunus Emre Bildik, Tugba Atan, Eda Gurcay, Engin Koyuncu","doi":"10.1097/PHM.0000000000003161","DOIUrl":"https://doi.org/10.1097/PHM.0000000000003161","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effects of high-intensity laser therapy (HILT) on gait, spasticity-related pain, and function in subacute and chronic stroke patients with plantar flexor spasticity.</p><p><strong>Design: </strong>A prospective, randomized, sham-controlled, participant- and assessor-blinded trial. Twenty-four patients received HILT or sham laser (3 days/week for 3 weeks) with conventional rehabilitation (6 weeks). The primary outcome was the 10-Meter Walk Test (10MWT); secondary outcomes included pain, spasticity, range of motion (ROM), muscle thickness, and quality of life (QoL).</p><p><strong>Results: </strong>Twenty-two patients completed the study. A significant group-by-time interaction favored HILT for 10MWT (P=0.038) and pain (P<0.001). Between-group comparisons favored HILT for pain at weeks 3 and 6 (P<0.001) but showed no significant gait-speed difference. A post hoc covariate-adjusted analysis favored HILT in gait speed at week 3 (0.063 m/s, 95% CI 0.020-0.105; P=0.006) and week 6 (0.089 m/s, 95% CI 0.003-0.176; P=0.043). ROM and QoL improved similarly in both groups; spasticity and muscle thickness were unchanged.</p><p><strong>Conclusion: </strong>In this preliminary trial, HILT was a safe adjunct to rehabilitation, producing a large, durable reduction in spasticity-related pain, with a smaller, covariate-adjusted gait benefit of uncertain clinical magnitude. These findings are preliminary and require confirmation in adequately powered trials.</p>","PeriodicalId":7850,"journal":{"name":"American Journal of Physical Medicine & Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148966168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Practice Audit of 60-day Temporary Peripheral Nerve Stimulation: A 14-month Prospective Review of 102 Patients.","authors":"David Sherwood, Oishi Paul, R Sterling Haring","doi":"10.1097/PHM.0000000000003157","DOIUrl":"https://doi.org/10.1097/PHM.0000000000003157","url":null,"abstract":"<p><strong>Objective: </strong>To prospectively evaluate pain relief and functional outcomes through 14 months after 60-day percutaneous peripheral nerve stimulation (PNS) in a consecutive real-world cohort.</p><p><strong>Design: </strong>Prospective single-center observational cohort study of 102 consecutive patients implanted with 60-day temporary percutaneous PNS for chronic pain. Outcomes were collected at 2 weeks and 2, 5, 8, 11, and 14 months. The principal outcome measure was the proportion reporting ≥50% pain relief at each follow-up interval. Secondary outcomes included ≥80% pain relief, numeric pain rating scale (NRS), Brief Pain Inventory item 9a (BP-9a), Oswestry Disability Index, Patient Global Impression of Change (PGIC), and adverse events.</p><p><strong>Results: </strong>≥50% pain relief was reported by 49/102 (48.0%; 95% CI, 38.0-58.2%) at 2 weeks, 34/102 (33.3%; 95% CI, 24.3-43.4%) at 2 months, 16/102 (15.7%; 95% CI, 9.2-24.2%) at 5 months, 10/102 (9.8%; 95% CI, 4.8-17.3%) at 8 months, and 4/102 (3.9%; 95% CI, 1.1-9.7%) at 11 months. At 14 months, no participants met the ≥50% threshold (0/4 observed case; 0/102 under the fixed-denominator framework).</p><p><strong>Conclusions: </strong>In this heterogeneous real-world cohort, 60-day temporary PNS produced short-term benefit in a subset of patients, but durable post-explant response was uncommon.</p>","PeriodicalId":7850,"journal":{"name":"American Journal of Physical Medicine & Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Sequential Electroacupuncture Combined With Augmented Reality Gait Training on Walking Function and Neuromuscular Control in Subacute Stroke: A Randomized Controlled Trial.","authors":"Linjie Fang, Manting Cao, Xiaoqin Le, Manxue Zhou, Yi Zhong, Qianru Yan, Jian'er Chen, Xuekang Niu","doi":"10.1097/PHM.0000000000003159","DOIUrl":"https://doi.org/10.1097/PHM.0000000000003159","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the effects of sequential electroacupuncture (EA) combined with augmented reality (AR) gait training on walking function and neuromuscular control in patients with subacute stroke (onset 1-6 mo).</p><p><strong>Design: </strong>A single-blind, randomized controlled trial allocating 40 patients with subacute stroke to an experimental (EA+AR, n=20) or control group (AR alone, n=20) for 4 weeks. The primary outcome was gait speed.</p><p><strong>Results: </strong>Generalized estimating equations (GEE) analyses revealed that the experimental group demonstrated significantly greater improvement in gait speed (Wald χ²=6.509, P=0.011) compared with controls. Significant improvements were also observed in stride length, gait symmetry, FMA-LE, BBS, and CCI (all P <0.05). No significant between-group differences were found for step width, cadence, or joint kinematics (all P >0.05). No adverse events occurred.</p><p><strong>Conclusion: </strong>The sequential EA-AR protocol significantly improved gait speed-the primary outcome-as well as stride length, gait symmetry, motor function, balance, and neuromuscular control. These findings suggest that temporally structured EA prior to AR training may facilitate motor relearning, potentially through transient neuromodulatory states induced by EA, though this mechanistic interpretation requires further confirmation.</p>","PeriodicalId":7850,"journal":{"name":"American Journal of Physical Medicine & Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148962987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adaptive Sports Introduction During Inpatient Rehabilitation: A Descriptive Study.","authors":"Catherine Marriott, Brittany MacKeen, Oluwakemi Olarotimi, Alexander Whelan","doi":"10.1097/PHM.0000000000003158","DOIUrl":"https://doi.org/10.1097/PHM.0000000000003158","url":null,"abstract":"<p><strong>Objectives: </strong>Adaptive sports (AdS) are sports which have been modified to facilitate the participation of people with disabilities. They have physical, functional, and psychosocial benefits. However, little is known about the role of introduction of AdS in the inpatient setting. The primary objectives of this cross-sectional study are to understand if patients with new disability want to be exposed to AdS in an inpatient setting, and what patient factors correlate with this desire.</p><p><strong>Design: </strong>100 inpatients were surveyed on their exposure to AdS during the admission. All patients aged 18 or older who were admitted to a tertiary rehabilitation hospital with new disability, and who could complete a paper survey were considered for inclusion.</p><p><strong>Results: </strong>Most participants had diagnoses of stroke (n=33), spinal cord injury (SCI) (n=31), and amputation (n=21). Forty-three percent wanted exposure to AdS during admission. Younger age (P<0.01), pre-admission sports participation (P<0.05), and exposure to AdS during rehabilitation (P<0.01), but not sex or type of mobility aids required at discharge, correlated positively with desire for AdS.</p><p><strong>Conclusions: </strong>Many people with new disability are interested in AdS exposure in the acute rehabilitation stage. Having multiple team members initiating these exposures in different formats may optimize exposure and participation.</p>","PeriodicalId":7850,"journal":{"name":"American Journal of Physical Medicine & Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148962969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Load-dependent Motor Cortical Activation Assessed by fNIRS Is Partially Preserved After Stroke.","authors":"Zeyu Wang, Zhi Chen, Jin Yan, Siqi Yang, Yang Liu, Yongjun Qiao, Siyu Yin, Huijia Zhou, Jixian Wang, Huijuan Pan, Qing Xie, Chuanxin M Niu","doi":"10.1097/PHM.0000000000003154","DOIUrl":"https://doi.org/10.1097/PHM.0000000000003154","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to investigate whether patients with stroke retain proportional hemodynamic cortical responses to increasing mechanical loading during upper limb exercise.</p><p><strong>Design: </strong>Twelve patients with stroke and twelve healthy control subjects participated in this cross-sectional comparative study. Patients with stroke performed repetitive upper limb lifting tasks with loads of 0, 1, and 2 kg, whereas healthy subjects lifted loads of 0, 3, and 15 pounds. Hemodynamic cortical responses were measured during four repetitions of each load condition presented in randomized blocks.</p><p><strong>Results: </strong>In patients with stroke, a significant linear relationship between load magnitude and cortical activation was observed only in the ipsilesional posterior parietal cortex (PPC). No significant proportional load-related responses were detected in other motor-related cortical regions. In contrast, healthy subjects demonstrated significant load-dependent increases in cortical activation in the contralateral primary motor cortex, supplementary motor area, premotor cortex, and PPC.</p><p><strong>Conclusions: </strong>Patients with stroke preserve proportional load-related hemodynamic responses in the PPC but not in primary motor cortical areas, suggesting a compensatory role of the PPC. These findings highlight the PPC as a potential target for monitoring cortical engagement and for neuromodulation strategies in upper limb stroke rehabilitation.</p>","PeriodicalId":7850,"journal":{"name":"American Journal of Physical Medicine & Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validity and Interpretation Thresholds of Habitual and fast Gait Speed for Preclinical Mobility Limitation in Middle-aged and Older Adults.","authors":"Yong-Hao Pua, Joy Mei-Ling Tan, Berend Terluin, Hong-Han Tan, Ee-Lin Woon, Julian Thumboo, Salma Bte Md Ibrahim, Ross Allan Clark","doi":"10.1097/PHM.0000000000003153","DOIUrl":"https://doi.org/10.1097/PHM.0000000000003153","url":null,"abstract":"<p><strong>Objectives: </strong>Current guidelines for preclinical mobility limitation (PCML) screening recommend habitual and fast gait speed testing; however, comparative evidence on their discriminative accuracy is limited, and empirical gait speed thresholds for PCML have not been established. We aimed to (i) compare habitual and fast gait speed on their discriminative ability and (ii) derive interpretation thresholds for PCML among community-dwelling middle-aged and older adults.</p><p><strong>Design: </strong>In this cross-sectional study, 235 participants (mean[SD], 68[7.3]years) completed the 4-metre gait speed assessment. PCML classification was based on questions regarding the use of compensatory stair gait strategy.</p><p><strong>Results: </strong>In multinomial regression, reduced habitual and fast gait speed were associated with increased odds of \"PCML likely\" (versus \"PCML unlikely\"): adjusted interquartile-range odds ratios (95%CI) were 2.6 (1.2-5.7) and 5.8 (1.5-22.5) for habitual and fast gait speed, respectively. Fast gait speed showed greater discriminative ability (pairwise AUC [95%CI], 0.80 [0.68-0.92]) than habitual gait speed (0.74 [0.62-0.87]). The interpretation thresholds (95% CI) for PCML were 1.24 m/s (1.20-1.31m/s) and 1.67m/s (1.61-1.78m/s) for habitual and fast gait speed, respectively.</p><p><strong>Conclusions: </strong>Fast gait speed was more adept than habitual gait speed in differentiating between individuals with and without PCML, and empirically-derived thresholds were estimated to complement existing cut-points for PCML.</p>","PeriodicalId":7850,"journal":{"name":"American Journal of Physical Medicine & Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148904820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sarcopenia, Nutritional Status, and the Association Between Rehabilitation Dose and Functional Efficiency After Inpatient Rehabilitation for First-Ever Ischemic Stroke.","authors":"Eo Jin Park","doi":"10.1097/PHM.0000000000003152","DOIUrl":"https://doi.org/10.1097/PHM.0000000000003152","url":null,"abstract":"<p><strong>Objective: </strong>To examine the associations of rehabilitation dose, sarcopenia, and nutritional status with functional efficiency after inpatient rehabilitation for first-ever ischemic stroke.</p><p><strong>Design: </strong>A single-center retrospective cohort included 1,036 adults with first-ever ischemic stroke. The outcome was Modified Barthel Index efficiency, defined as gain divided by inpatient rehabilitation days. Sarcopenia was defined as concurrent low skeletal muscle mass index and low non-paretic hand grip strength. Multivariable linear regression used HC3 robust standard errors.</p><p><strong>Results: </strong>Poor functional efficiency occurred in 419 (40.4%) patients. Rehabilitation dose per 30 min/day was associated with higher efficiency (β=0.17, 95% CI 0.12 to 0.21; P<0.001). Sarcopenia was associated with lower efficiency (β=-0.22, 95% CI -0.28 to -0.15; P<0.001), whereas Geriatric Nutritional Risk Index per 5-point increase was associated with higher efficiency (β=0.05, 95% CI 0.03 to 0.07; P<0.001). The dose × sarcopenia interaction was negative (β=-0.12, 95% CI -0.20 to -0.05; P=0.001), and the dose × Geriatric Nutritional Risk Index interaction was small and positive (β=0.02, 95% CI 0.00 to 0.05; P=0.039).</p><p><strong>Conclusion: </strong>Rehabilitation dose, sarcopenia, and nutritional status are associated with functional efficiency after inpatient stroke rehabilitation.</p>","PeriodicalId":7850,"journal":{"name":"American Journal of Physical Medicine & Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148904892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Future of International Spinal Cord Injury: Perspectives for Policy and Practice Implementation of the International Spinal Cord Injury Cohort Study.","authors":"Jerome Bickenbach, Diana Pacheco Barzallo, Mirja H Gross-Hemmi, Julia Engkasan, Reuben Escorpizo, James W Middleton, Vanessa K Noonan, Gerold Stucki","doi":"10.1097/PHM.0000000000003008","DOIUrl":"10.1097/PHM.0000000000003008","url":null,"abstract":"<p><strong>Background: </strong>The International Spinal Cord Injury (InSCI) Community Survey is the most comprehensive global data source describing the lived experience of persons with spinal cord injury or disease (SCI/D) living in the community. By collecting standardized, self-reported data across countries and health systems, InSCI operationalizes the World Health Organization's concept of functioning and provides a 360-degree perspective on health, participation, and social inclusion.</p><p><strong>Objective: </strong>This paper adopts a prospective perspective and examines how InSCI data can be implemented to inform practice and policy. It explores how InSCI can support the development of evidence-based Theories of Change (ToC) to guide implementation strategies addressing unmet needs and inequities experienced by persons with SCI/D.</p><p><strong>Methods: </strong>Building on findings from the first 2 waves of the InSCI survey, conducted between 2017-2019 and 2022-2024, this paper synthesizes methodological principles for implementation, situates InSCI within contemporary implementation science, and examines real-world applications of InSCI data at the national and international levels.</p><p><strong>Results: </strong>InSCI provides a unique evidentiary foundation for ToC development by integrating biomedical, personal, social, and environmental dimensions of functioning. Its comprehensive data model enables identification of priority gaps, formulation of realistic implementation pathways, and definition of measurable indicators for monitoring change. Existing national applications, including the Swiss National Strategy for Spinal Cord Injury, demonstrate the feasibility of translating InSCI evidence into coordinated policy and system-level reforms.</p><p><strong>Conclusion: </strong>InSCI is uniquely positioned to guide evidence-informed implementation of practice, programs, and policies for persons with SCI/D. By aligning with emerging global initiatives-particularly those led by the World Health Organization-and by grounding implementation in the concept of functioning and human rights, InSCI can support meaningful progress toward full inclusion, participation, and long-term wellbeing of persons living with SCI/D.</p>","PeriodicalId":7850,"journal":{"name":"American Journal of Physical Medicine & Rehabilitation","volume":" ","pages":"844-849"},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148270090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wearable Devices for Bioelectrical Stimulation in Rehabilitation: Review of the Current State.","authors":"Jason Patrick Caffrey, Won Jae Jeong, Janet Del Rosario","doi":"10.1097/PHM.0000000000003035","DOIUrl":"10.1097/PHM.0000000000003035","url":null,"abstract":"<p><p>Advancements in electrical stimulation technology, fabrication, and device design have led to the development of wearable bioelectrical stimulation devices, enabling rehabilitation in nontraditional settings. This scoping review evaluates the effectiveness of wearable bioelectrical stimulation devices for rehabilitation, providing an overview of the current state of clinical outcomes and prototype devices. A systematic search of MEDLINE was conducted on November 11, 2024, with additional relevant articles manually included. Studies were screened based on predefined inclusion and exclusion criteria. Out of 488 identified articles, 59 met the inclusion criteria. The categories represented were stroke (N = 10), cerebral palsy (N = 6), spinal cord injury (N = 5), musculoskeletal (N = 4), fibromyalgia (N = 3), and peripheral neuropathy (N = 3), in addition to other diagnoses (N = 8), healthy participants (N = 14), and nonclinically tested devices (N = 6). Reported potential benefits of the devices included improvements in gait abnormalities, knee pain, low back pain, fibromyalgia, and bladder dysfunction, while outcomes in spasticity, neurological recovery, and circulatory augmentation remain inconclusive. Wearable bioelectrical stimulation devices have gained significant interest in the field of rehabilitation, with devices spanning many form factors to target a wide array of conditions. However, until further research provides clearer evidence, wearable bioelectrical stimulation devices should be considered an adjunct to established rehabilitation interventions.</p>","PeriodicalId":7850,"journal":{"name":"American Journal of Physical Medicine & Rehabilitation","volume":" ","pages":"856-869"},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147939877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on \"Effect of Transcranial Direct Current Stimulation at the Left Dorsolateral Prefrontal Cortex Combined With Quadriceps Strengthening Exercise in Chronic Knee Osteoarthritis: A Double-blind, Randomized, Sham-controlled Trial\".","authors":"Chakshujot Kaur, Sandeep Pattnaik","doi":"10.1097/PHM.0000000000003023","DOIUrl":"10.1097/PHM.0000000000003023","url":null,"abstract":"","PeriodicalId":7850,"journal":{"name":"American Journal of Physical Medicine & Rehabilitation","volume":" ","pages":"e121"},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148270073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}