Neurorehabilitation and neural repair最新文献

{"title":"Walking Environment and Speed Differentially Change More Affected Limb Dynamic Motor Control in Children With Cerebral Palsy.","authors":"Stephanie N Mace, Joseph W Harrington, Vivek Dutt, Brian A Knarr, David C Kingston","doi":"10.1177/15459683261454950","DOIUrl":"10.1177/15459683261454950","url":null,"abstract":"<p><strong>Background: </strong>Children with cerebral palsy (CP) have impaired motor and simplified neuromuscular control during walking. Surgical interventions, conventional therapies, and real-time biofeedback result in minimal improvements in muscle synergies, highlighting the need for new strategies to enhance motor control.</p><p><strong>Objective: </strong>To assess how neuromuscular control of the more-affected limb is acutely affected across walking environments and speeds for children with CP.</p><p><strong>Method: </strong>Eight children with CP (5 males and 3 females; age: 12.58 ± 3.91 years; height: 1.52 ± 0.20 m; and weight: 54.55 ± 30.83 kg) and 15 typically developing children had 8 surface EMG sensors on the lower limbs. Muscle synergies were calculated with non-negative matrix factorization to define dynamic motor control during walking (walk-DMC) for overground, conventional treadmill, and aquatic treadmill walking. We compared walk-DMC across environment and speed conditions (slow, normal, and fast) for the more-affected limb.</p><p><strong>Results: </strong>Main effects of the aquatic environment and the slow walking speed acutely increased walk-DMC in children with CP, indicating increased neuromuscular complexity. Neither conventional treadmill nor overground environments significantly impacted walk-DMC scores.</p><p><strong>Conclusions: </strong>Walk-DMC was sensitive to acute changes in the walking environment and speed in children with CP. These findings offer new perspectives on walking rehabilitation by accounting for the interplay between task demands and motor function. However, future studies should investigate repeated exposures to aquatic gait rehabilitation environments, particularly aquatic treadmill training and slow walking speeds.</p>","PeriodicalId":94158,"journal":{"name":"Neurorehabilitation and neural repair","volume":" ","pages":"944-952"},"PeriodicalIF":3.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13297398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148311181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in Unimanual and Bimanual Upper Extremity Use During the Subacute Phase Post-Stroke Assessed in Supervised and Unsupervised Contexts.","authors":"Léandre Gagné-Pelletier, Isabelle Poitras, Marc Roig, Catherine Mercier","doi":"10.1177/15459683261454938","DOIUrl":"10.1177/15459683261454938","url":null,"abstract":"<p><strong>Background: </strong>The subacute phase post-stroke is a critical period for recovery, yet it remains unclear how spontaneous use of the paretic upper extremity (UE) increases during this period.</p><p><strong>Objective: </strong>This longitudinal study aimed to characterize changes in patterns of UE use during the subacute phase, focusing on unimanual and bimanual use, and to examine the influence of different clinical contexts on UE use.</p><p><strong>Methods: </strong>Participants (n = 41; 28.4 [8.0] days since stroke) were assessed at admission to inpatient rehabilitation, prior to discharge, and at 6 months post-stroke. UE use was measured with wrist-worn accelerometers over 7 consecutive days in 3 contexts: daily life, therapy sessions, and functional assessments. Metrics included the use ratio (UR; paretic/non-paretic) and the percentage of unimanual and bimanual use.</p><p><strong>Results: </strong>UR improved from admission to discharge (<i>P</i> < .001), reflecting a more symmetrical UE use, but no further change was observed after discharge (<i>P</i> = .09). Percentage of unimanual non-paretic use decreased while bimanual use increased across all time points (<i>P</i> ≤ .03). Percentage of unimanual paretic use remained low, with no change over time (<i>P</i> = .28). An effect of context was observed for all variables (<i>P</i> ≤ .003), showing more asymmetric UE use outside of supervised clinical contexts (therapies and assessments).</p><p><strong>Conclusions: </strong>The subacute phase is characterized by substantial improvements in bimanual UE use during rehabilitation, followed by subtler changes in UE use patterns during the late subacute phase. The discrepancy between UE use during supervised clinical contexts and spontaneous use in daily life highlights the need for accelerometry-based monitoring in clinical practice.</p>","PeriodicalId":94158,"journal":{"name":"Neurorehabilitation and neural repair","volume":" ","pages":"931-943"},"PeriodicalIF":3.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wearable Myoelectric Interface for Neurorehabilitation (MINT) to Recover Arm Activity After Stroke: A Randomized Controlled Trial.","authors":"Abed Khorasani, Cynthia M Gorski, Na-Teng Hung, Joel Hulsizer, Vivek Paul, Goran Tomic, Prashanth R Prakash, Sangsoo Park, Gang Seo, Ethan J Houskamp, Jessica Lanis, Megan Hunzeker, Erin King, Anya Chappel, Alix Jampol, Pooja Patel, Catherine Gallagher, Rachel Galant, Grace Rucker, Jungwha Lee, Richard L Harvey, Jinsook Roh, Marc W Slutzky","doi":"10.1177/15459683261454937","DOIUrl":"10.1177/15459683261454937","url":null,"abstract":"<p><strong>Background: </strong>Abnormal muscle co-activation impairs arm function after stroke. Home-based myoelectric interface for neurorehabilitation (MINT) was developed to reduce abnormal co-activation.</p><p><strong>Objective: </strong>Evaluate MINT feasibility and effects on arm activity in a single-blind, randomized, sham-controlled trial.</p><p><strong>Methods: </strong>Moderately-to-severely impaired chronic stroke survivors were randomized to 1 of 3 MINT groups (who played customized games requiring independent activation of 2 or 3 abnormally co-activating muscles) or a sham control group (using 1 muscle). Participants trained 90 minutes/day, 6 days/week, switching upper-arm muscle sets every 2 to 3 weeks. Feasibility was assessed using training time, repetitions, and motivation. The primary efficacy outcome was the change in Wolf Motor Function Test (WMFT) from baseline to week 6 in each MINT group compared to sham. Secondary outcomes included WMFT at week 10, WMFT subscores, Fugl-Meyer, Modified Ashworth, Motor Activity Log, reaching kinematics, co-activation, and lesion location effects.</p><p><strong>Results: </strong>Fifty-nine participants completed training (mean: 86 ± 21 minutes/day, 315 ± 85 repetitions/day). The 3-muscle group improved WMFT by 6.8 seconds at week 6 (95% confidence interval [2.1-11.6 seconds], <i>P</i> = .001); other groups did not. Combined MINT groups improved by 4.1 seconds ([1.4-6.8 seconds], <i>P</i> = .0008). In per-protocol analysis, the 3-muscle group improved significantly more than sham on WMFT (7.5 seconds; [0.1-14.9 seconds], <i>P</i> = .046), shoulder/elbow subscores, and kinematics. At week 10, all MINT groups improved significantly, unlike sham. Reduced co-activation correlated significantly with improved arm function and movement. Stroke involving the internal capsule negatively predicted MINT response. Other secondary outcomes showed no clinically important changes.</p><p><strong>Discussion: </strong>MINT conditioning is feasible, reduces co-activation, and improves arm movement and activity.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov (NCT03401762).</p>","PeriodicalId":94158,"journal":{"name":"Neurorehabilitation and neural repair","volume":" ","pages":"953-965"},"PeriodicalIF":3.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13278386/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148207374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-Stroke Abnormal Synergies Are a Resultant Behavior of the Interplay of Weakness, Spasticity, and Environmental Demands.","authors":"Manuel Portilla-Jiménez, Yuan Yang, Jinsook Roh, W Zev Rymer, Sheng Li","doi":"10.1177/15459683261469093","DOIUrl":"10.1177/15459683261469093","url":null,"abstract":"<p><p>Abnormal synergies coexist with primary motor impairments (weakness and spasticity) after stroke. They are observed during voluntary movements and are characterized by stereotyped movement patterns, a loss of independent joint control, and abnormal muscle coordination (eg, involuntary activation of distal muscles led by proximal joint movement). The structure and expression of abnormal synergies, however, are highly context-dependent (eg, influenced by gravity, body posture, and task constraints) and are not homogeneous across patients. Current evidence suggests that abnormal synergies are pathophysiologically related to damage to corticospinal tracts, upregulation of brainstem pathways (particularly the medial reticulospinal tract, but also involves the vestibulospinal tract), and maladaptive changes in spinal circuitry. These same mechanisms may overlap with those underlying spasticity and weakness. Spasticity is believed to result from overexcitability of descending excitatory brainstem pathways, the reticulospinal tract in particular, and the consequent exaggerated stretch reflexes, while muscle weakness is attributed to the reduction in corticospinal output. Recent research and clinical observations have advanced our understanding of abnormal synergies. Post-stroke abnormal synergies are not fixed motor impairments. A new framework is proposed that suggests post-stroke abnormal synergies could constitute the behavioral expression of primary impairments, including weakness and spasticity, arising from their interactions with environmental constraints, particularly antigravity control mechanisms. The term \"synergy\" has been used across various frameworks, with different definitions and quantification approaches. Identifying appropriate methods to quantify abnormal synergies is therefore essential to investigate their relationship with spasticity and muscle weakness, and evaluate potential abnormal synergy improvements following interventions, even if they primarily target other motor impairments.</p>","PeriodicalId":94158,"journal":{"name":"Neurorehabilitation and neural repair","volume":" ","pages":"970-983"},"PeriodicalIF":3.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148681667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional Motor Change Across Time and Phenotypes in Patients With Amyotrophic Lateral Sclerosis: A Descriptive Study.","authors":"Elissa C Held-Bradford, Elisabeth DeMarco, Samantha Zocher, Kate Weaver, Kathryn Forsman, Ghazala Hayat, Divya S Subramaniam, Meghan Doherty","doi":"10.1177/15459683261445435","DOIUrl":"10.1177/15459683261445435","url":null,"abstract":"<p><strong>Purpose: </strong>Progressive disability occurs in persons with amyotrophic lateral sclerosis (pALS), but change over time across phenotypes remains understudied, limiting clinical decision-making. This descriptive study describes functional motor change with detailed measures across ALS phenotypes to enhance clinical decision making.</p><p><strong>Materials and methods: </strong>Electronic health record data from an interdisciplinary ALS clinic (n = 109 pALS, 2018-2022) including demographics, disability (ALS Functional Rating Scale-[ALSFRS-R]), and functional motor scores (10 m Walk, Handheld dynamometry [grip and ankle]) was utilized. Phenotype groups were defined by site of onset (bulbar, limb onset; upper limb or lower limb). Analysis was conducted using R and included changes scores and measures of central tendency in 3-month intervals.</p><p><strong>Results: </strong>PALS included n = 43 bulbar, n = 32 upper limb, n = 34 lower limb onset, age 65, 60 to 71 (median, interquartile range). ALFSRS-R decline was greatest in bulbar, and similar in upper and lower limb. Patterns of change within motor scores suggest greatest loss of grip strength in bulbar and upper limb, ankle strength in upper limb, walking speed in lower limb, and preservation of community ambulation in upper limb.</p><p><strong>Conclusion: </strong>While ALSFRS-R scores were similar in upper and lower limb, detailed functional motor measures indicated differences in groups. These patterns provide insight to guide clinical decision making and future research to enhance care in pALS.</p>","PeriodicalId":94158,"journal":{"name":"Neurorehabilitation and neural repair","volume":" ","pages":"903-916"},"PeriodicalIF":3.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148213877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional Electrical Stimulation Combined With Reactive Balance Training for Individuals With Incomplete Spinal Cord Injury: A Randomised Clinical Trial.","authors":"Matthew G Heffernan, Katherine Chan, Jonguk Lee, Lovisa Cheung, Elizabeth L Inness, Kei Masani, Kristin E Musselman","doi":"10.1177/15459683261454942","DOIUrl":"10.1177/15459683261454942","url":null,"abstract":"<p><strong>Introduction: </strong>Individuals with motor incomplete spinal cord injury (iSCI) have difficulty eliciting reactive steps when balance is lost, increasing fall risk. Functional electrical stimulation (FES) applied to the common fibular nerve elicits a flexor withdrawal response, potentially assisting reactive stepping. Combining reactive balance training with FES (Reactive Balance Training [RBT] + FES) may enhance reactive balance control. This study compared the efficacy of RBT + FES to RBT alone in individuals with chronic, motor iSCI.</p><p><strong>Methods: </strong>Twenty-two individuals (63.9 ± 14.8 years; 3.8 ± 2.8 years post-injury) were randomly assigned to RBT + FES or RBT alone. They completed 18 1-hour training sessions over 6 weeks. Outcome measures were assessed pre-, immediately post- and 6 months post-intervention, and included the behavioural response of the Lean-and-Release test (single-step, 2-step, ≥3-step, or fall) and clinical measures of balance, balance confidence, fall concern, lower limb strength, and proprioception of the ankle. A 2-way mixed analysis of variance assessed group differences over time. Fall incidence was monitored via an online survey for 6 months following training.</p><p><strong>Results: </strong>Significant improvements over time were observed for single-step and fall responses during the Lean-and-Release test, and on all clinical outcomes (<i>P</i> ≤ .01) with the exception of ankle proprioception. No significant group or group × time interactions were found, suggesting similar improvements between groups. There were no significant between-group differences in fall tracking data.</p><p><strong>Discussion: </strong>Both RBT + FES and RBT alone led to significant improvements in reactive stepping ability, balance control, balance confidence, fall concern, and lower limb strength. However, the FES protocol applied in this study did not provide additional benefit.</p>","PeriodicalId":94158,"journal":{"name":"Neurorehabilitation and neural repair","volume":" ","pages":"917-930"},"PeriodicalIF":3.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148255188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Where Would You Stimulate?\" Beliefs About Anatomical Relevance for Enhancing Motor Performance With Non-Invasive Electrical Stimulation.","authors":"Bernardo Villa-Sánchez, Andrew Hooyman, Seth A Hays, Sydney Y Schaefer","doi":"10.1177/15459683261456659","DOIUrl":"10.1177/15459683261456659","url":null,"abstract":"<p><strong>Background: </strong>While non-invasive electrical stimulation is used clinically to enhance motor performance, its efficacy and mechanisms remain unclear. Studies show that personal factors, such as beliefs and expectations of stimulation, can impact how much a person benefits from the stimulation itself. Furthermore, beliefs related to the \"closeness is strength of effect\" have been observed outside of electrical stimulation contexts, suggesting that the location of stimulation (eg, head and neck) for improving motor performance may impact how much they believe the stimulation will work. This exploratory study investigated beliefs about the optimal target region of stimulation for maximizing the effect of stimulation itself.</p><p><strong>Methods: </strong>Eighty participants (39 females; 46.9 ± 12.6 years) completed an online spatial mapping task in which they were asked to indicate where they would place the electrodes for electrical stimulation to hypothetically enhance specific functions: \"hand movement,\" \"arm movement,\" \"leg movement,\" and \"attention/concentration.\" Participants selected their placement by clicking a blank human figure in anatomical position. Information about prior use/knowledge of non-invasive stimulation was also collected.</p><p><strong>Results: </strong>Optimal target region of stimulation was significantly associated with the body movement/function to be enhanced (<i>P</i> < .001). This association was independent of prior non-invasive stimulation knowledge (<i>P</i> = .242) and sex (<i>P</i> = .923).</p><p><strong>Conclusions: </strong>These findings suggest a pre-existing belief of spatial proximity for electrical stimulation in which placing electrodes closer to the body region of interest would maximize improvement hypothetically.</p>","PeriodicalId":94158,"journal":{"name":"Neurorehabilitation and neural repair","volume":" ","pages":"966-969"},"PeriodicalIF":3.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148255159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Machine Learning Model With Temporal Validation for Predicting Walking Ability in Nontraumatic Spinal Cord Injury.","authors":"Anni Tong, Jiekai Guo, XiaoE Cai, Lifan Wang, Mengqi Chen, Yang Gao, Shugeng Chen, Shuai Tong, Wenting Wang","doi":"10.1177/15459683261493914","DOIUrl":"https://doi.org/10.1177/15459683261493914","url":null,"abstract":"<p><strong>Background: </strong>Walking ability is the priority for spinal cord injury (SCI) patients. Nontraumatic SCI (NTSCI) is increasing with aging populations, yet its prognosis remains understudied. Early predictionF using admission clinical indicators could facilitate decision-making and rehabilitation planning.</p><p><strong>Objective: </strong>To preliminarily develop and validate a machine learning model using early admission clinical indicators for predicting post-rehabilitation walking ability probability (with a classification threshold of 0.5) in patients with NTSCI.</p><p><strong>Methods: </strong>This retrospective study included model development and temporal external validation. We enrolled 148 NTSCI patients, randomly allocating them into training (80%) and internal test (20%) sets. Four feature sets were constructed from objective clinical measures. Nine algorithms were compared; Gradient Boosting Decision Tree (GBDT) was selected based on AUC, recall, and F2-score, followed by hyperparameter tuning. The final model was validated independently on a cohort of 37 NTSCI patients (July 2025 to May 2026). Ethical approval (M202616) and consent waiver obtained; retrospectively registered (MR-11-26-021748); no patient involvement.</p><p><strong>Results: </strong>The GBDT-based model outperformed all others. On internal testing, it achieved an AUC of 0.91 (95% CI: 0.77-1.00), recall 0.92 (95% CI: 0.71-1.00), and accuracy 0.90 (95% CI: 0.77-1.00). Key predictors included total lower limb muscle strength, age, and others. On temporal external validation, it showed encouraging performance with accuracy 0.81 (95% CI: 0.68-0.92) and recall 0.70 (95% CI: 0.40-1.00).</p><p><strong>Conclusion: </strong>This preliminary model may have potential for predicting walking ability in patients with NTSCI; however, these findings are exploratory and require confirmation in larger, multicenter cohorts before any clinical application can be considered.</p>","PeriodicalId":94158,"journal":{"name":"Neurorehabilitation and neural repair","volume":" ","pages":"15459683261493914"},"PeriodicalIF":3.7,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World, Device-Based Peak Cadence Metrics in Black and White Adults With Multiple Sclerosis.","authors":"Robert W Motl, Trinh L T Huynh, Jeffer Sasaki, Peixuan Zheng","doi":"10.1177/15459683261493910","DOIUrl":"10.1177/15459683261493910","url":null,"abstract":"<p><strong>Background: </strong>Walking performance is worse in Black than White adults with multiple sclerosis (MS), and that difference might extend into real-world, device-based measurements.</p><p><strong>Objective: </strong>The current study examined peak 30-minute cadence (Peak-30_CAD) and peak 1-minute cadence (Peak-1_CAD) in Black and White adults with MS.</p><p><strong>Methods: </strong>Participants with MS who self-identified as Black (n = 43) or White (n = 96) completed the Timed 25-Foot Walk (T25FW) and 6-Minute Walk (6MW), and wore an accelerometer on a belt around the waist during the waking hours of the day for a 7-day period.</p><p><strong>Results: </strong>Peak-30_CAD and Peak-1_CAD along with T25FW and 6MW were significantly lower in Black than White participants when controlling for imbalances in age, sex, education, and disease duration, with the differences approaching a moderate magnitude. The differences in Peak-30_CAD and Peak-1_CAD were smaller and non-significant in additional sensitivity analyses further controlling for number of days of valid accelerometer data. Peak-30_CAD and Peak-1_CAD had strong correlations with T25FW and 6MW in Black and White participants.</p><p><strong>Conclusion: </strong>Peak-30_CAD and Peak-1_CAD were associated with laboratory-based walking performance in both Black and White adults with MS and may provide complementary real-world mobility metrics.</p>","PeriodicalId":94158,"journal":{"name":"Neurorehabilitation and neural repair","volume":" ","pages":"15459683261493910"},"PeriodicalIF":3.7,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149140030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individualized Prediction of Upper Limb Strength Recovery After Cervical Spinal Cord Injury: Development and Validation of Simple Prognostic Models.","authors":"Leonardo Furlan, Thiago Luiz Russo","doi":"10.1177/15459683261448463","DOIUrl":"10.1177/15459683261448463","url":null,"abstract":"<p><strong>Background: </strong>Early accurate prediction of upper limb strength recovery after cervical spinal cord injury (SCI) can optimize rehabilitation and research practices. However, no adequately validated, individualized prognostic model exists.</p><p><strong>Objective: </strong>To develop and validate individual prognostic models for predicting Upper Extremity Motor Score (UEMS) recovery after cervical SCI.</p><p><strong>Methods: </strong>We developed and internally validated prognostic models using data from 423 patients from the European Multicenter Study about Spinal Cord Injury (EMSCI) collaboration. Predictors included UEMS at week 1/week 4 and American Spinal Injury Association Impairment Scale (AIS) category. Ordinal regression models to predict UEMS at 4, 12, 24, and 48 weeks were developed and internally validated using bootstrap-based stability plots. External validation of the 12-week model was performed using a North American cohort of 365 patients. Performance metrics included overall fit and calibration.</p><p><strong>Results: </strong>Internal validation showed stable predictions, good and stable calibration curves, and low prediction errors for all models. At external validation, the model demonstrated good overall fit (<i>R</i>² = .81, 95% confidence interval [CI] [0.77 to 0.85]; MAPE = 4.77, 95% CI [4.28 to 5.28]), and good calibration (intercept = 1.10, 95% CI [-0.08 to 2.41]; slope = 1.01, 95% CI [0.97 to 1.05]). The calibration curve indicated a minor underestimation of UEMS for lower predicted values.</p><p><strong>Conclusions: </strong>Simple individualized prognostic models based solely on AIS category and early UEMS allow accurate predictions of upper limb strength recovery after cervical SCI. Our models contribute to expanding the existing literature on motor recovery patterns and prognosis/prediction after cervical SCI. If further validated, these models can inform early clinical decision-making, patient referral and counselling, and clinical trial eligibility.</p>","PeriodicalId":94158,"journal":{"name":"Neurorehabilitation and neural repair","volume":" ","pages":"823-835"},"PeriodicalIF":3.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147978363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}