Neurorehabilitation and neural repair最新文献

{"title":"Unsupervised Data Driven Clustering of the Neurological Assessments of People With Traumatic SCI Focusing on Sensorimotor Complete Injuries.","authors":"Olga Taran, Rüdiger Rupp, Louis P Lukas, Adrian Kaufmann, Norbert Weidner, Martin Schubert, Björn Zörner, Frank Röhrich, Josina Waldmann, Yorck B Kalke, Rainer Abel, Doris Maier, Fred H Geisler, Armin Curt, Catherine R Jutzeler, Sarah C Brüningk","doi":"10.1177/15459683261454947","DOIUrl":"https://doi.org/10.1177/15459683261454947","url":null,"abstract":"<p><strong>Background: </strong>Spinal cord injury (SCI) leads to lifelong disability with highly variable neurological recovery, complicating prognostication and conceptualization of clinical trials. The American Spinal Injury Association Impairment Scale (AIS) is widely used to classify injury severity. Although AIS A injuries are considered sensorimotor complete, they show substantial heterogeneity in residual function and recovery. Data-driven approaches offer an opportunity to uncover latent subgroups beyond conventional classifications. We evaluate whether unsupervised, data-driven clustering can identify distinct subgroups within patients with traumatic SCI and characterize neurological patterns in sensorimotor complete SCI.</p><p><strong>Methods: </strong>We applied an unsupervised clustering model to International Standards of Neurological Classification of Spinal Cord Injury (ISNCSCI) examination scores from the European Multicenter Study about Spinal Cord Injury dataset (3165 patients), to derive neurological groupings independent of predefined ISNCSCI classifications. Clusters were derived from the full cohort, followed by focused analyses of individuals classified as AIS A at their first documented assessment. External reproducibility was evaluated using data from the Sygen clinical trial.</p><p><strong>Results: </strong>Six distinct clusters were identified. Patients graded as AIS A were represented in 5 clusters, which differed markedly in injury level (paraplegic vs tetraplegic) and indicators of recovery potential, including neurological sparing, upper and lower extremity motor scores, and AIS conversion rates. These patterns were consistently reproduced in the Sygen cohort.</p><p><strong>Conclusions: </strong>Proposed framework complements conventional AIS grading by revealing distinct neurological conditions related to the variability among patients with baseline sensorimotor complete injuries. Proposed data-driven framework enables more comprehensive prognostic assessments and improves patient stratification in clinical trials.</p>","PeriodicalId":94158,"journal":{"name":"Neurorehabilitation and neural repair","volume":" ","pages":"15459683261454947"},"PeriodicalIF":3.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148371495","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":"Mapping the Correlation of Everyday Physical Activity With Motor and Non-Motor Symptoms in Parkinson's Disease.","authors":"Jakob Frederiksen, Bo Biering-Sørensen, Marcus Dalsgaard Hansen, Trine Hørmann Thomsen","doi":"10.1177/15459683261442192","DOIUrl":"10.1177/15459683261442192","url":null,"abstract":"<p><p>BackgroundPeople with Parkinson's experience both motor and non-motor symptoms (NMS), with bradykinesia and dyskinesia being key motor symptoms. People with Parkinson's are typically less physically active than age matched peers, and physical inactivity is associated with more severe symptoms, reduced functional capacity, and lower quality of life. Most prior research has relied on self-reported data, which can introduce bias. Wearable technologies enable the objective assessment of physical activity (PA) and symptom severity in real world settings.ObjectiveTo examine the relationship between objectively measured PA and the severity of bradykinesia, dyskinesia, and NMS in People with Parkinson's during daily life.MethodsA cross-sectional analysis of 6 weeks of data from the Parkinson KinetiGraph. Daily PA was assessed via step count, while motor symptom severity was evaluated using Parkinson KinetiGraph-derived bradykinesia and dyskinesia scores, and NMS were assessed using the Non-Motor Symptoms Questionnaire.ResultsParticipants (n = 80, mean age = 64.3 years; 54% male) demonstrated a wide range of activity levels, with a mean daily step count of 6139 (range = 46-18.265). Higher daily step counts were moderately to strongly associated with lower bradykinesia (<i>r</i> = -.52, <i>P</i> < .001) and higher dyskinesia levels (<i>r</i> = .56, <i>P</i> < .001).ConclusionHigher PA levels are associated with reduced bradykinesia and increased mild dyskinesia. Wearable devices enable objective monitoring in daily life.Further studies should explore its relationship with specific NMS.</p>","PeriodicalId":94158,"journal":{"name":"Neurorehabilitation and neural repair","volume":" ","pages":"566-574"},"PeriodicalIF":3.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793372","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":"Divergent Effects of Repetitive Peripheral Stimulation in Subacute and Chronic Stroke: Results From the RESTORES Proof-of-Principle Randomized Trial.","authors":"Adriana B Conforto, Raymundo M de Azevedo Neto, Benjamim Handfas, Victoria Teixeira, Julia Zaiden, Isadora O Santos, Tiago Gava, Kathlein Pouza, Suzana B Reis, Gisele S Silva, Edson Amaro, Suzete N F da Guarda","doi":"10.1177/15459683261426351","DOIUrl":"10.1177/15459683261426351","url":null,"abstract":"<p><p>BackgroundRepetitive peripheral sensory stimulation (RPSS) delivered above the sensory threshold (RPSS_SUPRA) enhances motor performance and learning in the chronic phase after stroke. Here, we compared the effects of RPSS_SUPRA and RPSS delivered at subsensory intensity (RPSS_SUB) on motor function and levels of γ-aminobutyric acid (GABA)+ (GABA plus coedited macromolecules) measured by proton magnetic resonance spectroscopy in the ipsilesional and contralesional primary motor cortex at different stages post-stroke.MethodsIn this multicenter, randomized proof-of-principle clinical trial, 51 participants in the early subacute or chronic phases after stroke were assigned to receive a single session of either RPSS_SUPRA or RPSS_SUB of the median nerve, followed by motor training. Jebsen-Taylor test (JTT) scores were assessed before RPSS, after RPSS, and after training. GABA+ ipsilesional/contralesional ratios (GABA+_{ipsilesional/contralesional}) were calculated. The data were analyzed with generalized estimation equations with the factors INTERVENTION, GROUP, and TIME.ResultsThe percent change in JTT performance was significantly affected by TIME, with greater improvements after training than after RPSS across groups. For absolute JTT scores, there was a significant INTERVENTION × GROUP × TIME interaction. In the subacute phase, JTT performance declined significantly post-RPSS_SUPRA and improved significantly post-RPSS_SUB, whereas in the chronic phase, performance improved significantly following both RPSS_SUB and RPSS_SUPRA (<i>P</i> < .001 for all Bonferroni comparisons). GABA+_{ipsilesional/contralesional ratios} decreased significantly after RPSS_SUPRA in the subacute phase (<i>P</i> = .008) and remained unchanged in the other groups.ConclusionsSubsensory and suprasensory RPSS have distinct effects on motor performance and M1 GABA+ levels in well-recovered individuals in the subacute and chronic phases post-stroke.Trial Registration:NCT03956407 (2019/05/20).</p>","PeriodicalId":94158,"journal":{"name":"Neurorehabilitation and neural repair","volume":" ","pages":"523-536"},"PeriodicalIF":3.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147583362","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":"External Validation of the Walking Independence Prognostic Model TWIST Score After Stroke: A Multicenter, Prospective Cohort Study.","authors":"Kazuhiro Miyata, Ren Takeda, Kayo Kotajima, Yoshito Takahashi, Hiroki Akiyama, Shota Hayashi, Tatsuya Igarashi, Shuntaro Tamura, Shigeru Usuda","doi":"10.1177/15459683261418670","DOIUrl":"10.1177/15459683261418670","url":null,"abstract":"<p><p>BackgroundThe Time to Walking Independently after Stroke (TWIST) prediction tool is designed to predict the number of post-stroke weeks at which patients are expected to achieve walking independence. The external validation of the TWIST tool's clinical applicability and generalizability has been desired.ObjectiveWe performed a geographic external validation of TWIST prediction in a multicenter prospective cohort.Patients and MethodsAdult post-stroke patients with lower-limb weakness and inability to walk independently were enrolled. Each patient's TWIST score (max. score: 4 points) was calculated using age, knee-extension strength, and the Berg Balance Scale score at 1 week post-stroke. The TWIST score predicts independent walking by 4, 6, 9, 16, or 26 weeks post-stroke, and we calculated the overall fit, calibration, and discrimination at each of these timepoints to assess the model's performance.ResultsThe validation cohort consisted of 145 patients (median age 73 years, 44% women, 36% moderate-severe stroke). At 9 and 26 post-stroke weeks, 60.7% and 72.4% of the patients achieved walking independence. The overall fit explained a moderate proportion of the outcome's variance (Nagelkerke R² = 0.28-0.49), and the discrimination performance was good (c-statistic >0.75). Calibration performance showed over-prediction at all timepoints (calibration-in-the-large = -1.62 to -0.34). Higher TWIST scores (3 or 4 points) over-predicted early post-stroke; lower TWIST scores (1 or 2 points) became increasingly over-predictive over time.ConclusionsThe TWIST prediction tool optimistically predicted walking independence in Japanese patients with stroke. Further validation studies are necessary to assess this tool's precise clinical impact and generalizability.Clinical Trial Registration URL:https://www.umin.ac.jp/UMIN000050588.</p>","PeriodicalId":94158,"journal":{"name":"Neurorehabilitation and neural repair","volume":" ","pages":"472-481"},"PeriodicalIF":3.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147319363","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":"Comparative Efficacy of iTBS and rTMS in Treating Post-Stroke Cognitive Impairment: A Double-Blind Randomized Controlled Trial.","authors":"Menglin Han, Yulan Gao, Jinyan He, Longting Hu, Zhiqiang Wang, Zhuoming Chen, Kangling Wang","doi":"10.1177/15459683261426347","DOIUrl":"10.1177/15459683261426347","url":null,"abstract":"<p><strong>Objective: </strong>To compare the therapeutic effect of intermittent theta burst stimulation (iTBS) and repetitive transcranial magnetic stimulation (rTMS) on cognitive function in patients with post-stroke cognitive impairment (PSCI) and investigate underlying neuroelectrophysiological mechanisms using microstate analysis.</p><p><strong>Methods: </strong>In this randomized, double-blind, sham-controlled trial, 45 patients with PSCI were assigned 2:2:1 to iTBS, rTMS, and sham groups, with stimulation targeting the left dorsolateral prefrontal cortex. All participants also received therapist-delivered cognitive training in addition to stimulation. Outcomes were evaluated before (T0) and 10 days after (T1). The primary outcome measure was Montreal Cognitive Assessment (MoCA) score. Secondary outcomes were auditory verbal learning test, Wechsler Adult Intelligence Scale-Ⅲ digit symbol coding test and digit span test scores as well as microstate indices.</p><p><strong>Results: </strong>ΔMoCA(T1-T0) scores were significantly improved in both the iTBS (median [interquartile range]: 2.00 [1.00, 4.00]) and rTMS groups (2.00 [1.00, 3.00]) compared with sham group (<i>P</i> < .05). There was no significant difference in ΔMoCA between the 2 active protocols. Significant within-group improvements in memory and working memory were observed in the iTBS group (<i>P</i> < .05). Both iTBS and rTMS group showed significantly increased microstate C parameters between T0 and T1 (<i>P</i> < .05). Furthermore, the transition probabilities in the iTBS group showed more diversity between microstates, while the other groups showed no significant transformation.</p><p><strong>Conclusion: </strong>iTBS and 5-Hz rTMS were effective in improving overall cognitive ability in PSCI, and iTBS may represent a practical, time-efficient alternative to 5-Hz rTMS. EEG microstate suggested distinct modulation patterns, serving as a useful exploratory tool.Clinical Trial Registry Name:Effect of different transcranial magnetic stimulation protocols on cognitive function in patients with post-stroke cognitive impairment.</p><p><strong>Clinical trial registration-url: </strong>https://www.chictr.org.cn/Clinical Trial Registration Number:ChiCTR2200064233.</p>","PeriodicalId":94158,"journal":{"name":"Neurorehabilitation and neural repair","volume":" ","pages":"495-507"},"PeriodicalIF":3.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147476772","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":"Effect Of Inspiratory Muscle Traınıng on Diaphragm Functıon and Activıty Performance in Subacute Ischemıc Stroke Patıents: A Sıngle-Blind Randomized-Controlled Trial.","authors":"Sümeyye Akçay, Dudu Kübra Akyol, Ümit Erkut, Dilber Karagözoğlu Coşkunsu, Zuhal Kunduracilar, Arsida Bajrami, Arzu Dinç Yavaş","doi":"10.1177/15459683251412282","DOIUrl":"10.1177/15459683251412282","url":null,"abstract":"<p><strong>Background: </strong>Respiratory dysfunction is common after stroke and may negatively affect functional recovery. Inspiratory muscle training (IMT) has been proposed to enhance diaphragmatic function and activity performance in this population.</p><p><strong>Objective: </strong>To investigate the effects of IMT on diaphragm function and activity performance in patients with subacute ischemic stroke. <i>Methods</i>: In this randomized controlled, single-blind trial, 26 patients with subacute ischemic stroke (>1 month post-onset) were randomly allocated to an intervention group (IG, n = 13) or control group (CG, n = 13). Both groups received standard neurorehabilitation, aerobic training, and the Active Cycle of Breathing Technique (ACBT). The IG additionally underwent IMT, 5 days per week for 6 weeks (30 sessions). Assessments included maximal inspiratory and expiratory pressures (MIP, MEP), diaphragmatic thickness (Ti, Te) and excursion via ultrasonography, 6-minute walk test (6MWT), and Canadian Occupational Performance Measure (COPM).</p><p><strong>Results: </strong>Twenty-two participants completed the study (IG = 11; CG = 11). Significant within-group improvements were observed in both groups for MIP, MEP, Ti, TF, excursion, 6MWT, and COPM scores (<i>P</i> < .05). Between-group analyses showed significantly greater improvements in the IG for ΔMIP (<i>P</i> < .001), ΔMEP (<i>P</i> = .003), affected-side ΔTi (<i>P</i> = .007), ΔTF (<i>P</i> = .008), and Δexcursion (<i>P</i> = .005). No significant differences were found for 6MWT and COPM (<i>P</i> > .05).</p><p><strong>Conclusions: </strong>IMT effectively improves respiratory muscle strength, diaphragmatic thickness, and excursion in subacute ischemic stroke and may be a valuable addition to post-stroke rehabilitation programs.</p><p><strong>Registration: </strong>URL: https://www.</p><p><strong>Clinicaltrials: </strong>gov; Unique identifier: NCT06210516.</p>","PeriodicalId":94158,"journal":{"name":"Neurorehabilitation and neural repair","volume":" ","pages":"431-447"},"PeriodicalIF":3.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146055684","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":"Brain Network Connectivity During Resting-State and a Visuospatial Task as a Biomarker for Spatial Neglect in Stroke Patients.","authors":"Golnaz Haddadshargh, Richard Gall, Emily S Grattan, Sarah Ostadabbas, George F Wittenberg, Murat Akcakaya","doi":"10.1177/15459683261419423","DOIUrl":"10.1177/15459683261419423","url":null,"abstract":"<p><p>BackgroundSpatial neglect (SN) is a common visual attention deficit affecting stroke patients due to large-scale disruptions within brain networks. Most studies have focused only on resting-state, but effective rehabilitation requires a clearer understanding of how brain networks change during visuospatial tasks.ObjectiveThis study aims to identify network disruptions associated with neglect by comparing resting-state and task-based electroencephalography (EEG) connectivity patterns in stroke patients with and without neglect.MethodsWe recorded EEG data from 28 stroke patients using the augmented reality (AR)-based EEG-guided neglect detection system (AREEN) during resting-state and a visuospatial task. Connectivity was measured using coherence in delta, theta, alpha, and beta bands for both conditions, with gamma-band coherence assessed only during the task. Graph-based metrics were applied to model network-level disruptions. Classification models evaluated the significance of connectivity features to find patterns predictive of neglect.ResultsThe neglect group showed reduced connectivity in frontal and right parieto-occipital (ParOcc) regions, primarily in beta and theta bands, during both conditions, with additional gamma-band connectivity differences in the task condition, compared to the non-neglect group. Conversely, connectivity was greater in central and midline regions, which may indicate a maladaptive shift in network organization. Classification models accurately classified patients into neglect and non-neglect groups (resting-state: 87.0% ± 0.7%; task: 80.9% ± 16.0%). Feature importance analysis identified eigenvector and closeness centrality within frontal, right ParOcc, and central regions as key predictors.ConclusionsNetwork disruptions can effectively identify SN and provide potential targets for connectivity-based rehabilitation. Future studies should investigate whether these interventions improve attention and recovery in stroke patients.This study was registered at ClinicalTrials.gov under ID NCT04187131.</p>","PeriodicalId":94158,"journal":{"name":"Neurorehabilitation and neural repair","volume":" ","pages":"482-494"},"PeriodicalIF":3.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13201892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147345864","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":"Optimizing the Approach to Calculating CST Lesion Load in Ischemic Stroke Patients for Understanding Motor Outcomes.","authors":"Brady J Williamson, Tyler Behymer, Anne Schwarz, Achala Vagal, Carolee J Winstein, Michael R Borich, Colleen Hanlon, Michael Dimyan, Adriana B Conforto, Fabrizio Piras, Daniela Vecchio, Brenton Hordacre, Lara A Boyd, Jennifer K Ferris, Jessica M Cassidy, Sophia I Thomopoulos, Neda Jahanshad, Paul M Thompson, Mahir Khan, Sook-Lei Liew, Steven C Cramer","doi":"10.1177/15459683261417241","DOIUrl":"10.1177/15459683261417241","url":null,"abstract":"<p><p>IntroductionCorticospinal tract lesion load (CST-LL) is a biomarker used for studying motor outcomes after stroke. However, the optimal method for calculating this metric is unknown.MethodsThis is a cross-sectional study of a large ischemic stroke cohort from the ENIGMA Stroke Recovery Consortium (n = 221; mean age = 59.8 years, 56% male) to compare 4 lesion load metrics across 3 CST templates. We then validate these findings in another large, independent stroke cohort (n = 125; mean age = 64.6 years, 54% male).ResultsResults indicate that variance in behavioral outcome was best explained using the maximum weighted cross-sectional overlap between lesion and the CST (Max-WLL), and when using an age-appropriate normative CST template (generated from the HCP Aging study). This was true both when the outcome was motor impairment, measured using the Fugl-Meyer Upper Extremity scale (FMUE, relative explained variance (REV) = 58.9%), and when it was global function, measured using the Barthel Index (BI, REV = 60%). In the validation cohort, FMUE results were replicated (REV = 47.6%).ConclusionThe findings indicate that Max-WLL, which represents the proportion of transected CST fibers, most accurately captures CST injury as it relates to motor and functional outcomes after stroke. Additionally, results suggest the importance of an age-appropriate template, a key consideration given that stroke is largely a disease of the elderly. Together, these findings provide an independently validated tool to optimize future research examining CST injury after stroke.</p>","PeriodicalId":94158,"journal":{"name":"Neurorehabilitation and neural repair","volume":" ","pages":"448-460"},"PeriodicalIF":3.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12958443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147328988","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":"Toward Accessible and Multimodal Diagnosis of Disorders of Consciousness: Integrating Clinical and Autonomic Markers.","authors":"Lucia Francesca Lucca, Maria Daniela Cortese, Maria Ursino, Francesco Riganello","doi":"10.1177/15459683261442142","DOIUrl":"10.1177/15459683261442142","url":null,"abstract":"<p><strong>Background: </strong>Disorders of consciousness (DoC) remain among the most challenging conditions in neurorehabilitation, with misdiagnosis rates approaching 40% and major implications for treatment planning, prognosis, and ethical decision-making. Current European and American guidelines recommend standardized behavioral assessments and, where available, advanced neuroimaging and neurophysiology. However, cost, limited access, and patient instability constrain implementation, leaving advanced assessments largely restricted to specialized centers. This diagnostic gap underscores the need for complementary approaches beyond behavioral scales or advanced imaging alone. Bedside behavioral tools, although indispensable, may fail to capture covert awareness or cognitive-motor dissociation. Conversely, reliance on high-technology investigations risks exacerbating inequities in structurally constrained healthcare systems.</p><p><strong>Objective: </strong>We propose a hybrid clinical-physiological assessment model combining standard behavioral assessments, including the Coma Recovery Scale-Revised, Motor Behavior Tool-Revised, and Nociception Coma Scale, with autonomic and neurophysiological markers of central autonomic network function.</p><p><strong>Methods: </strong>The structured workflow, consolidated in clinical practice, includes baseline autonomic recordings before and during standardized behavioral testing, repeated weekly during the first month and biweekly thereafter. Family involvement at scheduled intervals contextualizes behavioral responses and informs communication strategies.</p><p><strong>Results: </strong>By fostering cross-modal convergence, this complementary framework enhances diagnostic certainty, supports tailored rehabilitation, and strengthens ethical transparency.</p><p><strong>Conclusions: </strong>While not yet validated as a formal protocol, it offers a scalable, cost-effective strategy adaptable across healthcare settings. Multicenter validation is recommended to confirm its generalizability and promote equitable integration of bedside physiological assessment into DoC care.</p>","PeriodicalId":94158,"journal":{"name":"Neurorehabilitation and neural repair","volume":" ","pages":"508-520"},"PeriodicalIF":3.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147848266","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":"Temporal External Validation of the TWIST Prediction Tool for Time to Independent Walking after Stroke.","authors":"Marie-Claire Smith, Benjamin J Scrivener, Cathy M Stinear","doi":"10.1177/15459683261417638","DOIUrl":"10.1177/15459683261417638","url":null,"abstract":"<p><strong>Background: </strong>The TWIST tool uses clinical measures at 1 week post-stroke to predict whether patients will achieve independent walking by 4, 6, 9, 16 or 26 weeks post-stroke. TWIST was developed with 93 participants from 2 hospitals and was at least 83% accurate at all timepoints. Validation of TWIST is necessary before implementation into clinical practice.</p><p><strong>Objective: </strong>The study aimed to perform temporal external validation of the TWIST prediction tool in a single hospital site.</p><p><strong>Methods: </strong>Adults with stroke were recruited if they had new lower limb weakness and were unable to walk independently. A TWIST score out of 4 was calculated for each participant using age, knee extension strength and Berg Balance Test score at 1 week post-stroke. Discrimination and calibration of TWIST were calculated for each timepoint and the model was refined as required.</p><p><strong>Results: </strong>There were 89 participants in this validation cohort (43% women, median age 69 years, 56% moderate-severe stroke). Predictions were valid for most TWIST scores at most timepoints. The TWIST tool was too optimistic for participants with TWIST scores of 0 and 2 at 16 and 26 weeks, and a TWIST score of 3 at all timepoints. The TWIST tool and clinical interpretations were refined. Discrimination of the TWIST tool is good (C-statistic > 0.8) for all timepoints.</p><p><strong>Conclusions: </strong>TWIST is a temporally externally validated prediction tool that combines routine tests at 1-week post-stroke to predict the probability of an individual patient achieving independent walking by 4, 6, 9, 16 or 26 weeks post-stroke.</p>","PeriodicalId":94158,"journal":{"name":"Neurorehabilitation and neural repair","volume":" ","pages":"461-471"},"PeriodicalIF":3.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13201889/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146159983","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}