Journal of Rehabilitation Medicine - Clinical Communications
Journal of Rehabilitation Medicine - Clinical Communications (JRM-CC) is an international, non-profit, Open Access journal that publishes articles of clinical relevance. It aims to fill a gap in the landscape of scientific and clinical publishing in rehabilitation medicine and affiliated fields, welcoming contributions that can develop and improve clinical practice. Owned by the Foundation of Rehabilitation Information, JRM-CC welcomes contributions from all parts of the world and from different professions in rehabilitation medicine.
All articles in JRM-CC are Open Access and, unless otherwise specified, distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/). This license permits sharing, adapting, and using the material for any purpose, including commercial use, with the condition of providing full attribution to the original publication.
Long-term efficacy of spasticity-corrective surgery and botulinum toxin injections for upper limb spasticity treatment
Objective: To evaluate the long-term efficacy of spasticity-corrective surgery and botulinum toxin treatment in patients with upper limb spasticity. Design: Pretest-posttest quasi-experimental study. Patients: Thirty-four patients with disabling spasticity. Methods: Patients were divided into 2 groups based on their treatment preference: the surgery group, which underwent tendon lengthening/release (n = 17), and the botulinum toxin injection group (n = 17). The primary outcome measure was the Modified Ashworth Scale. Secondary outcomes included range of motion, grip strength, and activity performance. Assessments were conducted at baseline for both groups, at 3 months following botulinum toxin injection, and at 6 months following surgery, with an additional peak-effect evaluation for botulinum toxin at week 5. Results: The surgery group demonstrated significantly greater reductions in composite Modified Ashworth Scale scores, with a mean change of 2.7 (SD 0.8), compared to the botulinum toxin group (1.1, SD 0.6 at peak; 0.3, SD 0.5 at long-term; p < 0.001). Surgery also led to significantly larger improvements in range of motion, grip strength, task performance, and patient satisfaction. While botulinum toxin effects were transient, surgery provided sustained benefits. Conclusion: Spasticity-corrective surgery achieves superior and longer-lasting benefits compared to botulinum toxin treatment in patients with disabling upper limb spasticity.
Copyright (c) 2025 Therese Ramström, Johanna Wangdell, Carina Reinholdt, Trandur Ulfarsson, Lina Bunketorp Käll https://creativecommons.org/licenses/by/4.0
Early team based neuro-rehabilitation after mild traumatic brain injury: a pilot study
Objective: Evaluate study design, procedure, and measurements for future study of early rehabilitation after mild traumatic brain injury. Design: A randomized controlled study was conducted. Subjects/patients: Patients from a county hospital emergency department, diagnosed with mild Traumatic Brain Injury were contacted 2 weeks post-trauma. Methods: Patients who met the inclusion criteria were randomized into 2 groups (n=28). The intervention group received early rehabilitation from a team consisting of physio- and occupational therapists. The control group received usual care. Patient-reported outcomes for measures were fatigue, anxiety and depression, health-related quality of life, physical and activity levels, and sleep after trauma. Data were collected 3 and 16 weeks after trauma. Results: Patient-reported outcomes measures showed improvement in both groups for symptoms, physical and activity levels, sleep quality and quantity. Also, improvement in the sub-scales of fatigue and health- related quality of life but worsening for general fatigue and general health at post-test in both groups. Neither group showed improvement for anxiety or depression: the intervention group rated depression higher, and the control group rated anxiety higher, post-test. Conclusion: Design, procedures, measurements and interventions were feasible but need refinement for a full-scale study.
Copyright (c) 2025 Ann-Charlotte Lindström, Katharina Stigbrant Sunnerhagen, Lena Nordeman https://creativecommons.org/licenses/by/4.0
Effects of higher- and lower-intensity exercise on fitness, cognition, motor function, and quality of life in adults with traumatic brain injury
Objective: To assess the effects of higher-intensity aerobic training (AET) and lower-intensity rapid-resisted exercise training (RET) on fitness, cognition, balance, mobility, and quality of life in sedentary adults with chronic traumatic brain injury. Design: Participants were randomized to AET, RET, or waitlist control later randomized to AET or RET. Participants: Nine adults, 25 to 65 years, completed elliptical training (AET = 4; RET = 5). Follow-up data were available for 4 AET and 2 RET. Methods: Exercise groups trained for 12 weeks. Outcomes were assessed at 0, 12, and 24 weeks. Results: Main effects from exercise included improvements in the Brief Visuospatial Memory Test, Limits of Stability excursion, fast elliptical cadence, and self-reported cognitive abilities. Improved fitness was related strongly to improved memory, balance, and quality of life. Similar fitness gains across groups indicate high individual variability in response to exercise intensity. Continuing to exercise during follow-up was associated with more cognitive benefits. Conclusion: Exercise had positive effects on multiple aspects of functioning well after traumatic brain injury and should be advocated. Differences based on exercise intensity were not identified in this small sample. Inconsistent recommendations across studies on optimal exercise parameters are likely obscured by individual differences, suggesting a personalized approach is warranted.
Copyright (c) 2025 Monica E. Soliman, Cris Zampieri, Lisa M.K. Chin, Diane L. Damiano https://creativecommons.org/licenses/by/4.0
Return-to-work after acetabular fractures: the impact of injury severity on the post-rehabilitation working capacity and workload
Objective: Acetabular fractures are among the most severe injuries in trauma surgery. In younger patients, they typically result from high-energy trauma and are often associated with polytrauma. Treatment complexity and rehabilitation outcomes are influenced by overall injury severity. This study aimed to evaluate return to work (RTW) after acetabular fracture in relation to the overall injury severity score (ISS). Design/subjects/patients: A retrospective study included 22 patients treated for acetabular fractures at a Level I Trauma Centre spanning a period from January 2009 – December 2020. Methods: Patients completed a questionnaire assessing work-related factors and workload before (PRE) and after (POST) trauma (median [MD] = 126.4 ± 46.4 months POST). Based on ISS, patients were categorized as < 16 = “no polytrauma” (n = 8) and ≥ 16 = “polytrauma” (n = 14). Results: The RTW rate was 75% in both groups. However, descriptively the median workload reduction was greater in the “polytrauma” group (–50%) compared to the “no polytrauma” group (–33.3%). A shift toward sedentary work was seen in both groups, more prominently in the “polytrauma” subgroup (+40%) compared to the “no polytrauma” group (+11.4%). Conclusion: Possible workload was reduced after acetabular fracture. Despite similar RTW rates, polytrauma patients descriptively returned to less physically demanding work. Thus, ISS significantly predicts the outcome of the rehabilitations process after acetabular fractures.
Copyright (c) 2025 Anna L. Schiltenwolf, Tina Histing, Maximilian M. Menger, Christof K. Audretsch, Florian Laux, Markus A. Kueper, Steven C. Herath https://creativecommons.org/licenses/by/4.0
Long-term follow-up of functioning and life satisfaction after moderate to severe TBI – an exploratory cohort study
Objective: To examine the long-term outcomes after moderate to severe traumatic brain injury with diffuse axonal injury. Design: A follow-up study of a regional cohort with a mean follow-up period of 5 years post-injury. Subjects: Thirty-four participants were recruited from a regional neurointensive care unit. Inclusion criteria were age 16–65 years, a Glasgow Coma Scale score of 3–12, and radiologically confirmed diffuse axonal injury. Methods: Follow-up assessments conducted at least 1 year post-injury included global outcome measured by the Glasgow Outcome Scale Extended, activities of daily living assessed with the Barthel Index, and life satisfaction evaluated using the LiSat checklist. Results: More than two-thirds of participants regained independence, and approximately half returned to work or studies. A higher diffuse axonal injury stage was associated with a lower likelihood of returning to work or studies. Over half of respondents reported being satisfied or very satisfied with “life as a whole.” Return to work or study was significantly associated with life satisfaction, and there was a trend toward higher satisfaction among those living with a partner. Conclusion: These findings confirm and extend observations from previous studies, emphasizing key areas for rehabilitation and long-term outcome after moderate to severe traumatic brain injury with diffuse axonal injury.
Copyright (c) 2025 Marianne Lannsjö, Jörgen Borg, Charlotte von Seth, Per Enblad, Sami Abu Hamdeh https://creativecommons.org/licenses/by/4.0
New clinical measures of hand and wrist proprioception: a pilot study for evaluating discriminative validity and test-retest reliability in individuals with wrist disability
Objective: To evaluate psychometric properties of newly developed hand and wrist proprioception tests. Design: Cross-sectional and test-retest comparisons. Subjects/patients: Twenty-six individuals (mean age 40 years) with wrist disability (> 3 months) due to traumatic injury or general instability. Methods: Pointing acuity (with eyes open and closed), active joint position sense (in extension, flexion, radial- and ulnar deviation) and grip force reproduction were measured by 1 rater on 2 occasions, 1 week apart. The mean absolute error was calculated for each test. Discriminative validity (affected vs non-affected hand/wrist) was evaluated by paired t-test and test-retest reliability with Intraclass Correlation Coefficient (ICC). Results: The pointing acuity test with eyes closed gave higher errors for the affected hand/wrist (p = 0.08) and good ICCs (0.80–0.85), while the test with eyes open had poor discriminative ability (p = 0.32) and test-retest reliability (ICC 0.13–0.16). The active joint position sense test showed higher error in flexion for the affected wrist (p = 0.03), and the ICC was moderate (0.51). The remaining joint directions and the grip force reproduction test had poor discriminative ability (p = 0.21–0.94) and poor to moderate ICCs (0.00–0.65). Conclusion: The pointing acuity test with eyes closed and the active joint position test in flexion show-ed promising results but need further evaluation in larger samples.
Copyright (c) 2025 Maria Sontag, Ulrik Röijezon, Christina Brogårdh, Elisabeth Ekstrand https://creativecommons.org/licenses/by/4.0
Bone health post-stroke: a survey of stroke care physiatrists in Canada
Objective: People who have experienced stroke are at a high risk for falls, fractures, and osteoporosis. Bone health post-stroke is often overlooked. The goal of this study was to understand current practice perspectives and barriers to bone health care post-stroke among physiatrists. Methods: We conducted an online survey of English-speaking stroke physiatrists practicing in Canada from October 2023 to April 2024. We recruited participants through the Canadian Association of Physical Medicine and Rehabilitation newsletter and direct contact via hospital or university email. The survey included demographic and multiple-choice questions as well as open-ended queries. Data were summarized using frequencies and percentages, and open-ended questions were assessed qualitatively for themes. Results: Twenty-two physiatrists completed the survey. Female physiatrists made up 45.5% of respondents, and 36.4% were in their first 5 years of practice. Most worked in an academic hospital (81.8%). The majority (81.9%) of respondents felt there is a need for post-stroke bone health guidelines. Important themes that emerged from open-ended questions included a lack of awareness, research, and resources. Conclusions: In this study of Canadian physiatrists, most respondents feel post-stroke bone health guidelines would be beneficial. More research and resources focused upon bone health in this population is needed.
Copyright (c) 2025 Jamie Fleet, Nicole Billias, Alexandria Roa Agudelo, Ujjoyinee Barua, Sydney Knight, Robert Teasell, Kristin Clemens https://creativecommons.org/licenses/by/4.0
Attitudes and practice patterns of Canadian physiatrists regarding medical cannabis
Objective: To assess practice patterns and attitudes of Canadian physiatrists, given their expertise in pain management and spasticity, conditions in which medical cannabis (MC) should be considered. Design: A 24-item, survey questionnaire was sent to physiatrists across Canada. Subjects: One hundred and nine physiatrists responded. Methods: A structured web-based survey distributed to members of Canadian Association of Physical Medicine and Rehabilitation. Inferential statistical analysis was conducted. Results: A majority of respondents acknowledged the medicinal value of MC, with 61% of respondents feeling comfortable discussing it, whereas only 31% felt comfortable authorizing MC. Years of work experience did not impact comfort regarding discussions of MC, but those with 21+ years of experience authorized MC more frequently. A significant relationship was observed between subspecialty and MC prescribing; most prescriptions authorized for neuropathic pain, musculoskeletal pain and spasticity. Most respondents agreed that medical school and residency programs provided insufficient education on MC, and that governmental and institutional guidelines remained unclear. Conclusion: Addressing cannabinoids in medical school and residency is important to improve the therapeutic and counselling aspects of patient care in addressing safety and preventing misuse. With clearer guidelines and more research on MC efficacy, physiatrists will be more knowledgeable and better able to improve patient lives.
Copyright (c) 2025 Karen Ethans, Harpal Chaudhary, Alan Casey, Colleen O'Connell, Mayur Nankar, Avni Khandelwal https://creativecommons.org/licenses/by/4.0
Improving the prediction of functional recovery in older adults with stroke in geriatric rehabilitation using an inertial measurement unit combined with the Utrecht Scale for Evaluation of Rehabilitation (USER)
Background: Prediction of functional recovery in older adults recovering from stroke is typically based on observational scales, such as the Utrecht Scale for Evaluation of Rehabilitation (USER). Objectively measuring postural sway using inertial measurement devices (IMU) may complement or improve conventional approaches. The aim of this study was to evaluate whether integrating an IMU with USER data enhances the accuracy of predicting functional recovery at discharge. Methods: This prospective cohort study includ-ed older adults (≥ 65 years) recovering from stroke. Postural sway was assessed using an IMU during 2 different balance conditions and analysed using principal component analysis (PCA). Using 3 different regression models, percentage explained variance was compared to assess predictive performance on functional recovery of USER vs an IMU. Results: The 71 patients included had a mean age of 78 (SD 7.6) and a median time since stroke of 16 days (IQR 19–60). Of the 71 patients, 12 (16.9%) were unable to perform balance condition 2 due to insufficient balance. Of 35 postural sway features displaying reliability for both balance conditions, 12 were selected for PCA. Incorporation of principal components for both balance conditions in the final model increased the explained variance compared to a model in which only USER-mobility at admission was used to predict delta-USER at discharge (R2 = 0.61 vs 0.30). Conclusions: Sitting and standing balance as measured by an IMU improves the prediction of functional recovery at discharge compared to USER alone.
Copyright (c) 2025 Jules J.M. Kraaijkamp, Margot W.M. de Waal, Niels H. Chavannes, Wilco P. Achterberg, Eléonore F. van Dam van Isselt, Michiel Punt https://creativecommons.org/licenses/by/4.0
Is one month of exercise-based cardiac rehabilitation sufficient after surgical aortic valve replacement? A feasibility study of a randomized controlled trial
Objective: To study whether there were differences in terms of change in the level of physical activity and functional exercise capacity between 1 month and 3 months of training after surgical aortic valve replacement. Design: A feasibility study of a randomized controlled trial. Subjects: After drop-out, a total of 30 patients with aortic stenosis participated in the 2 interventions. Methods: Group A received 1 month and group B 3 months of cardiac rehabilitation after surgical aortic valve replacement. Feasibility was measured in terms of recruitment, adherence and retention rate, adverse events and the ability to collect primary and secondary outcome measurements. Results: Regarding feasibility, the recruitment rate was low (55%), but the adherence and retention rates were good (group A 81%/94%, group B 64%/79%). The outcome assessment collection was good, and there was only 1 adverse event. Significant differences were found regarding physical activity and self-perceived health in favour of group B. Conclusion: This feasibility study showed that although the recruitment rate was low, other measures were satisfactory. Results indicate that a shorter supervised programme may be sufficient and possibly facilitate more effective use of resources.
Copyright (c) 2025 Malin Schlyter, Eva Ekvall Hansson https://creativecommons.org/licenses/by/4.0
Long-term benefits of a tailored strength training intervention on arm function in chronic stroke survivors: a follow-up study
Objective: We showed that a tailored strengthening intervention based on the size of motor evoked potentials (MEPs) in the affected arm was effective in improving function in chronic stroke survivors. Here, we investigated whether the short-term gains in arm function were maintained at 1-year follow-up. Subjects: Twenty-five participants at the chronic stage of a stroke. Methods: Participants were classified in the light (LI; MEPs 50–120 μV, n = 8) and high (HI; MEPs > 120μV, n = 17) intensity training groups. The strengthening protocol consisted of adjusted exercises for the affected arm (3X/week; 4 weeks). The Fugl-Meyer Stroke Assessment (FMA), Grip strength (GS) and Box and Block test (BBT) were assessed at baseline, post-intervention and at 1-year follow-up. Changes in clinical measures were compared using repeated-measures ANOVA. Results: A significant effect of time was noted on all outcome measures [FMA: p < 0.001; BBT: p = 0.05; GS: p < 0.001], but the LI group improved more on the FMA (p = 0.003) and maintained their gains at 1-year follow-up (p = 0.527) than the HI group. Conclusion: The size of MEPs in the affected arm could be a significant factor in influencing responses to strengthening exercises post-stroke and allow gains to be maintained up to 1 year post-intervention.
Copyright (c) 2025 Marie-Hélène Milot, Stephania Palimeris, Yavuz Shahzad, Hélène Corriveau, François Tremblay, Marie-Hélène Boudrias https://creativecommons.org/licenses/by/4.0
Patient-reported outcomes after permissive weight bearing in surgically treated trauma patients with displaced intra-articular calcaneal fractures: a multicentre, retrospective cohort study
Objective: The current aftertreatment for surgically treated patients with displaced intra-articular calcaneal fractures (DIACFs) consists of restricted weight bearing (RWB) for 8–12 weeks. This study aimed to assess whether permissive weight bearing (PWB) results in improved patient-reported outcomes (PROMs) after a minimum of 2 years -follow-up, compared to RWB. Design: Multicentre, retrospective cohort study. Patients: Surgically treated patients with isolated unilateral DIACFs. Methods: Foot and ankle function was measured using the American Orthopaedic Foot and Ankle Society (AOFAS) Score and the Maryland Foot Score (MFS). Health-related quality of life was assessed using the Short Form-12 (SF-12) and the EuroQoL EQ-5D-5L (EQ-5D). Additionally, radiographic parameters and complications were recorded. Results: Fourteen patients followed the PWB and 18 followed the RWB protocol (n = 32). The PWB group had similar outcome scores on the AOFAS Score (83.4 vs. 71.1, p = 0.13) and MFS (86.3 vs. 77.6, p = 0.20) compared to the RWB group. PWB showed similar outcomes on the EQ-5D (0.86 vs. 0.80, p = 0.26) scores. Radiographic parameters and complication rates were comparable for both groups. Conclusion: This study suggests that PWB and RWB yield comparable PROMs in foot and ankle function without radiographic failures and similar complication rates in surgically treated patients with isolated, unilateral DIACFs.
Copyright (c) 2025 Coen Verstappen, Pishtiwan H.S. Kalmet, Cherelle V. Maduro, Raoul van Vugt, Jan Bernard Sintenie, Alexander van der Veen, Michael J.R. Edwards, Martijn Poeze, Erik Hermans, Mitchell L.S. Driessen https://creativecommons.org/licenses/by/4.0
Pilot study of combined transvertebral magnetic and transcutaneous stimulation for the rehabilitation of combat acute spinal cord injuries
Aim of the study: To improve the effectiveness of neurorehabilitation in patients with severe combat spinal cord injury by combining spinal cord repetitive transvertebral magnetic stimulation (rTvMS) and non-invasive transcutaneous electrical stimulation (TcES) of peripheral nerves. Clinical rationale for study: For the best recovery from severe combat spinal cord injury, neurorehabilitation must start in the acute phase. Only technologies targeting sensorimotor conduction and functional improvement can confirm the potential of the time factor. Non-invasive neuromodulation has been shown to work for combat spinal cord injury of varying severity. Material and methods: We have analysed 154 cases of severe combat spinal cord injury, followed continuously for at least 12 months from the start of neurorehabilitation. A unified «end-to-end» protocol combined rTvMS of the spinal cord with simultaneous TcES of peripheral nerves in different modes was developed for non-invasive spinal cord neuromodulation. Results: The combination of these parameters produced the most positive results in post-traumatic sensory-motor disorders: (i). rTvMS, level ThX-LI: 2000 pulses per set, 100 pulse packages, 5–10 Hz, intensity “+ 30––40%” of the threshold of the evoked motor potential; TcES n. tibialis or n. peroneus: 5–10 Hz, pulse intensity corresponded to the threshold of the motor response, functional electrical stimulation (FES) mode. (ii). rTvMS, level CII-ThII: 2000 pulses per set, 50 pulse packages, 5–7 Hz, intensity + 20–30% of the threshold of the evoked motor potential; TcES n. medianus or n. ulnaris; n. tibialis or n. peroneus: 5–10 Hz, pulse intensity corresponded to the threshold of the motor response, FES mode. Approximately 28% of patients in group A (FRANKEL/ASIA) moved to a higher level of function after 3 courses of neurorehabilitation intervention (90 working days). Conclusions and clinical implications: Electro-magnetic stimulation of the spinal cord excitatory cell conduction system according to the principle of “end-to-end: as in Hebb’s theory,” combined with physical movement, led to an increase in spinal cord conduction in the acute phase of combat spinal cord injury. This was manifested by neurological and functional improvement.
Copyright (c) 2025 Oleksandr Kulyk, Ivan Mazurchuk, Valeriia Polousova, Anna Pshenychna, Oksana Yarmolenko https://creativecommons.org/licenses/by/4.0
An intelligible AI-driven decision support system for poststroke mobility assessment
Objective: Long-term mobility impairment is a sequel of stroke victims which requires intensive medical and physiotherapeutic care. Detailed assessment of therapeutic success is relevant to achieving efficacy, but requires expert knowledge, since mobility disorders are complex. Increasing shortage of qualified staff and larger numbers of patients are thus major problems in this field. To meet these challenges, we show that machine learning algorithms can reproduce expert mobility assessment from gait data with acceptable accuracy, supporting poststroke evaluation while giving intelligible feedback into how the assessments were generated. Methods: A total of 100 hemiparetic stroke patients received clinical examinations followed by instrumented gait analysis and were assigned a Stroke Mobility Score by an interdisciplinary expert board. From each measured stride pair, 680 features were extracted. After removing non-discriminating features, two regression models were trained: a decision tree and a multilayer perceptron artificial neural network. Results: The models yielded good to very good (Cohen) coefficients of determination. The interpretable decision-trees and the explanations obtained from the neural network unveiled key features supporting the mobility assessments. Conclusion: The automated assessments agree well with those of the experts. Synergistic interactions between system, and experts via the computed key features may improve quality in diagnosis and objectify therapeutic targets.
Copyright (c) 2025 Jin Cheng Liaw, Dominik Raab, Malte Weber, Mario Siebler, Harald Hefter, Dörte Zietz, Marcus Jäger, Andrés Kecskeméthy, Francisco Geu Flores https://creativecommons.org/licenses/by/4.0
Long-term outcomes of moderate to severe diffuse axonal traumatic brain injury: a prospective study
Introduction: Traumatic brain injury (TBI) with diffuse axonal injury (DAI) necessitates significant medical and rehabilitation interventions. The late long-term outcome is variable with potential for neurodegenerative development and deterioration. This study evaluates the late long-term outcomes of moderate to severe TBI with DAI. Methods: Patients aged 16–65 with moderate to severe TBI and DAI were included. From 2006 to 2018, 30 patients (mean age 34; 21 males, 9 females) were enrolled. Outcomes were assessed using the Glasgow Outcome Scale Extended (GOSE) at 6 months and ≥ 1-year post-injury. Results: At 6 months, 10 patients had a favourable outcome (GOSE 6–8), increasing to 12 at ≥ 1-year post-injury. Patients with unfavourable outcomes were older (mean 40) than those with favourable outcomes (mean 24, p < 0.001). DAI stage correlated with outcomes (p = 0.003). GOSE remain-ed unchanged in 15 patients, improved in 9 and deteriorated in 6 between the 6 months and the ≥ 1-year follow-up. Discussion: Approximately one-third of TBI patients with DAI achieved favourable long-term outcomes, and the outcome changed in half of the patients between 6 months and ≥ 1 year follow-up. Age and DAI stage were significant predictors of outcome. Further studies are required to enhance prognostic accuracy and explore rehabilitation’s impact.
Copyright (c) 2025 Marianne Lannsjö, Jörgen Borg, Anders Lewén, Charlotta von Seth, Per Enblad, Sami Abu Hamdeh https://creativecommons.org/licenses/by/4.0
Swedish translation, cultural adaptation and testing of the Prosthetic Upper Extremity Functional Index-2
Objective: We aimed to translate, culturally adapt and test the Prosthetic Upper Extremity Functional Index-2 for a Swedish context. Subjects: Ten children with congenital upper limb deficiency with an upper limb prosthesis and their parents. Methods: The translation and cultural adaptation of the Prosthetic Upper Extremity Functional Index-2 was conducted according to the International Society for Pharmacoeconomics and Outcomes Research Principles of Good Practice for cross-cultural adaptation of patient-reported outcome measures; this comprises 10 steps, including Preparation, Forward Translation, Reconciliation, Back Translation, Back Translation Review, Harmonization, Cognitive Debriefing, Review of Cognitive Debriefing Results and Finalization, Proofreading and Final Report. Result: The new translated version, tested on 10 children, 4 boys and 6 girls, 3–14 years showed good relevance for the Swedish context, the questions were easy to understand, and response options were easy to interpret. It was also easily accessible on computers and mobile devices. Conclusion: The Swedish version of the Prosthetic Upper Extremity Functional Index-2 is user-friendly and provide information of the child’s self-reported prosthesis use in a Swedish context. Children’s right to express their opinions, is crucial, and using the questionnaire prior to their clinic visits gives children the opportunity to participate in goal setting and treatment planning.
Copyright (c) 2025 Cathrine Widehammar, Lis Sjöberg https://creativecommons.org/licenses/by/4.0
Retrospective analysis of patients with immediate decannulation in severe acquired brain injury (RAPID-SABI)
Objective: To examine an early decannulation protocol in adult severe acquired brain injury (SABI) patients. Design: Retrospective, observational cohort study. Subjects/patients: Tracheotomized SABI patients ≥ 18 years admitted to a neurorehabilitation unit. Methods: Primary outcome measure was difference in survival rate within first year of discharge. Secondary outcome measures were respiratory infections treated with antibiotics, rate of re-cannulation, time from admission to decannulation, length of stay, difference in rate of re-admission due to pneumonia within first year of discharge and difference in rate of tracheal tube dependency within first year of discharge. Results: No statistical significance in survival rate within the first 12 months from discharge was found. Median time from admission to decannulation was 32 days (interquartile range [IQR] 14–61) vs 9 days (IQR 0–13) in the control and intervention group, respectively (p < 0.0003). Median length of stay was 66 days (IQR 54–92) in the control group vs 60 (IQR 48–75) days in the intervention group (p = 0.168). Conclusion: A new early decannulation protocol omitting evaluation of tolerance to tracheostomy tube capping and fiberoptic endoscopic evaluation of swallowing was non-inferior to previous procedures in survival rate within first year of discharge. The early decannulation protocol allowed for significantly earlier decannulation.
Copyright (c) 2025 Robbert-Jan van Hooff, Mette Lindelof, Emma Ghaziani, Trine Hørmann Thomsen, Christina Kruuse, Christian Gunge Riberholt, Charlotte Rath https://creativecommons.org/licenses/by/4.0
Nelarabine-associated central nervous neurotoxicity inducing Guillain-Barre-like/myelopathy: inpatient rehabilitation and functional outcomes
Objective: Nelarabine is an antineoplastic agent used in the treatment of acute T-cell lymphoblastic lymphoma with inadequate clinical response to prior chemotherapeutic treatments. While the most common side effects are mild to moderate haematologic events, there are known severe neurologic side effects including induced myelopathy. Due to the sparsity of cases, there is a lack of literature to guide inpatient rehabilitation programs for patients with neurological toxicity. Design: Case report. Patient: A 30-year-old woman with a history of T-cell lymphoblastic lymphoma presenting with tetraplegia after treatment with nelarabine and treated with intravenous immunoglobulin and plasma exchange therapy. Methods: After medically stabilized, she was admitted to acute inpatient rehabilitation centre with therapy program incorporating strengthening and endurance training, robot-assisted training and respiratory muscle strength training. Results: The patient demonstrated marked improvement in functional independence and manual motor testing on discharge. With ongoing participation in out-patient therapies, she achieved full independence with bed mobility and activities of daily living at a 6-month follow-up. She continues to use a wheelchair in the community, demonstrates modified independence with ambulation and is capable of climbing stairs at home. Conclusion: This case report details the functional improvements following intensive rehabilitation of a patient with severe nelarabine-associated neurotoxicity.
Copyright (c) 2025 Rachel M. Santiago, Grace Hartl, Cono Cirone, Laura White, Erin Y. Harmon https://creativecommons.org/licenses/by/4.0
Orthopaedic manual physical therapy for post-stroke shoulder pain: two case reports including clinical assessments and participants’ experiences
Objective: To descriptively evaluate Orthopaedic Manual Physical Therapy – a novel intervention for post-stroke shoulder pain – by use of clinical assessments and the participants’ experiences. Design: Two case reports. Methods: Two individuals with mild to moderate upper extremity impairments and persistent post-stroke shoulder pain, underwent Orthopaedic Manual Physical Therapy for 12 weeks. The intervention comprised a thorough clinical examination, joint mobilization, stretching, and exercises targeting the affected structures and incorrect movement patterns. Participants were clinically assessed pre- and post-intervention and followed up 4–5 months later. They also answered interviews about their experiences of the intervention and perceived effects. Results: After Orthopaedic Manual Physical Therapy, both participants showed decreased pain intensity during movements and increased range of motion. One of the participants also experienced decreased resistance to passive movements, improved motor function, grip strength, and upper extremity daily activities after the intervention and at follow-up. Interviews revealed that the participants tolerated the therapy well and were satisfied with the intervention and long-lasting results. Conclusion: Orthopaedic Manual Physical Therapy may be a useful method to reduce post-stroke shoulder pain in persons with mild to moderate upper extremity paresis after stroke. To confirm the results, further studies are warranted.
Copyright (c) 2025 Ingrid Lindgren, Arne G. Lindgren, Håkan Carlsson, Tobias Lundgren, Christina Brogårdh https://creativecommons.org/licenses/by/4.0
Correlation between traumatic brain injury, obesity and insulin-resistance – a case report
Introduction: Traumatic brain injury is a significant global health concern. It often results from high-velocity accidents and leads to diffuse axonal injury, causing consciousness disorders and potentially permanent cognitive and behavioural changes. Individuals with traumatic brain injury often exhibit weight gain, potentially leading to obesity. This weight increase is influenced by cognitive dysfunction, reduced physical activity and metabolic changes. Case report: A 23-year-old woman suffered a traumatic brain injury after a traffic accident, with an initial Glasgow Coma Scale score of 5/15. Positive neurological improvement was observed during her stay in the intensive care unit and the neurosurgical department. Subsequently, she was transferred to the rehabilitation department, where she faced significant challenges, including mood fluctuations, cognitive impairments and substantial weight gain. Her body mass index (BMI) increased from 23 kg/m2 pre-accident to a maximum of 36 kg/m2, despite interventions like medications and lifestyle changes. Blood tests revealed insulin-resistance and metformin initiated a successful weight reduction. Conclusion: Managing weight gain following traumatic brain injury requires effective interventions that acknowledge its complexity and multifaceted nature, including lifestyle modifications, behavioural therapy and potentially pharmacotherapy or bariatric surgery. Further research is essential to better understand underlying mechanisms and evaluate intervention effectiveness in this specific patient population.
Copyright (c) 2025 Laura De Wilde, Charlotte De Ruysscher, Kristine Oostra https://creativecommons.org/licenses/by/4.0
Paraparesis following peripheral and central nervous system lesions after a lightning strike – a case report
Objective: To describe a case of paraparesis caused by both peripheral neuropathy and spinal cord injury following a lightning strike, highlighting imaging findings and neurophysiological results to improve understanding and management. Design: A case report. Patient: A 29-year-old male without significant medical or surgical history, struck by lightning. Methods: Neurological evaluation, imaging of the spinal cord, electromyography studies, and somatosensory evoked potential assessments were performed. Imaging findings and peripheral nerve evaluations were compared to the existing literature on lightning-related injuries. Results: Spinal cord imaging showed hyperintensities with a quadrifocal white matter involvement. Neurophysiological study revealed peripheral motor impairment. Conclusion: This case documents paraparesis resulting from both central and peripheral nervous system damage following a lightning strike. Unique spinal cord imaging results and neurophysiological studies contribute to the understanding of nerve damage mechanisms. Given the increasing frequency of lightning strikes, these findings may help refining clinical management and patient education strategies.
Maria Ciravegna Fonseca De Melo Bandeira
Copyright (c) 2025 Zoé Moyaux, Maria Ciravegna Fonseca De Melo Bandeira, Idil Gunes Tatar, Gautier Randour, Mathilde Massardier, Vincent van Pesch, Thierry Lejeune https://creativecommons.org/licenses/by/4.0
Stepwise cardiac rehabilitation adjustment after exercise-induced implantable cardioverter defibrillator shock: a case report
Objective: To report an in-hospital cardiac rehabilitation strategy after exercise-induced implantable cardioverter defibrillator shock. Case report: A 72-year-old man with heart failure, peripheral artery disease, a history of percutaneous coronary intervention and coronary artery bypass surgery, exercise-induced ventricular fibrillation, and an implantable cardioverter defibrillator was hospitalised after experiencing recurrent ventricular fibrillation while walking, which triggered implantable cardioverter defibrillator shock. While hospitalised, his medication regimen was adjusted. After passing the 200-m walking test, he started in-hospital cardiac rehabilitation. During cardiopulmonary exercise testing, he experienced non-sustained ventricular tachycardia. Percutaneous coronary intervention was performed to relieve ischaemia; however, ventricular tachycardia recurred during walking, causing another implantable cardioverter defibrillator shock. After further medication adjustments and setting heart rate limits, he gradually resumed cycling and low-intensity resistance exercises, followed by walking, and was subsequently discharged without ventricular tachycardia recurrence. Discussion: Peripheral artery disease-associated pain and increased heart rate may have contributed to ventricular tachycardia. A stepwise exercise programme involving heart rate monitoring and medication therapy adjustments enabled safe exercise resumption after implantable cardioverter defibrillator shock in a patient with multiple comorbidities. Conclusion: This case emphasises the importance of personalised exercise strategies that consider both arrhythmic risk and comorbidities for patients at high risk of exercise-induced arrhythmias.
Copyright (c) 2025 Hidetoshi Yanagi, Harumi Konishi, Saori Yamada, Kazuya Yamamoto, Fumiyuki Otsuka https://creativecommons.org/licenses/by/4.0
Combining transcranial direct current stimulation and robotic-assisted training to address upper extremity deficits in acute disseminated encephalomyelitis: a case report
A 45-year-old woman with persistent acute disseminated encephalomyelitis sequelae participated in a 4-week robotic-assisted training program of her affected arm combined with transcranial direct current stimulation. Clinical indicators such as range of motion, motor function of the affected arm, fatigue, pain, spasticity, and quality of life were assessed pre/post-intervention. The results demonstrated clinical benefits post- intervention, with an improvement in range of motion and affected arm motor function, fatigue, and quality of life of the patient. Although preliminary, the results of this case report support the development of innovative technologically assisted rehabilitative strategies for individuals with acute disseminated encephalomyelitis sequelae, including a robot-assisted rehabilitation program coupled with neurostimulation sessions. Further large-scale randomized controlled trials are needed to confirm these findings and rigorously assess the efficacy of this approach in acute disseminated encephalomyelitis individuals.
Copyright (c) 2025 Maureen Ahiatsi, Matthieu Vincenot, Christian Bocti, Guillaume Léonard, Marie-Hélène Milot https://creativecommons.org/licenses/by/4.0
Inpatient rehabilitation for a patient with COVID-19 exacerbation of pulmonary fibrosis: a case report
Objective: To evaluate the benefits of inpatient rehabilitation for a patient with post-COVID-19 pulmonary fibrosis and to provide guidance for rehabilitation professionals, as many conventional therapeutic interventions are not tolerated and are poorly defined. Design: A case report. Subjects/patients: A 72-year-old man with a COVID-19-related idiopathic pulmonary fibrosis exacerbation. Results: The patient was admitted to inpatient rehabilitation with hypoxia and poor endurance for functional activities. Rehabilitation activities were focused on providing patient/family education, energy conservation, low level activities to build strength, problem solving for mobility, and discharge planning within safe medical parameters. Rehabilitation therapies were graded to meet the patient’s physiologic needs and focused on patient and family training. The patient made limited functional gains and continued to have high oxygen needs but achieved his goal of returning home. Conclusion: Patients with COVID-19-related idiopathic pulmonary fibrosis exacerbations can be treat-ed in acute rehabilitation effectively. With more patients developing post-COVID-19 pulmonary fibrosis, appropriate rehabilitation strategies are important for safe discharge planning. Prioritizing patient/family education may allow these more medically fragile patients to return home.
Copyright (c) 2025 Heather McKenna, Erin Y. Harmon https://creativecommons.org/licenses/by/4.0
The Swedish needs assessment project to enhance life for people living with spinal cord injury: synthesized evidence of needs to be met, researcher priorities, and knowledge gaps
Objective: The aim of this report is to describe the aggregated insights and key findings from a Swedish need assessment project. The project comprised 3 parallel studies identifying [a] needs to be met, [b] research questions, and [c] knowledge translation gaps related to enhancing the lives of people with spinal cord injury (SCI). Methods: The project included people living with SCI, their relatives, health professionals, and personal care assistants. Analyses were conducted with the aim of identifying commonalities and connections between the results of the 3 individual studies. Results: The aggregated insights and key findings from this project can be summarized into 3 themes. First, a well-functioning healthcare, rehabilitation, and supporting system must have a holistic perspective on what it means to live with SCI. Second, aging is about living with the SCI and getting old with the SCI. Third, when family members receive their own support, they can provide good support to the person living with SCI. Conclusion: New evidence from the Swedish needs assessment project reveals the needs that currently have the greatest impact on improving the lives of people with SCI, which can guide researchers, healthcare providers, and knowledge translators.
Copyright (c) 2025 Jeanette Melin, Emelie Axwalter, Gunilla Åhrén, Katharina S. Sunnerhagen, Åsa Lundgren Nilsson, Johanna Wangdell https://creativecommons.org/licenses/by/4.0
Incidence and associations of unplanned acute care unit readmissions of primary brain tumour patients during rehabilitation: a retrospective study
Objective: To examine incidence and associations for unplanned Acute Care Unit Readmissions (ACURs) in Asian primary brain tumour patients. Design: A retrospective single-centre cohort study. Patients: A total of 173 Asian primary brain tumour patients undergoing inpatient rehabilitation in a tertiary rehabilitation centre. Methods: Primary outcome was unplanned ACUR. Logistic regression analysis was used to determine associations with patients who had an unplanned ACUR. Results: Altogether, the majority of patients had low-grade (World Health Organization Class I and II) tumours (76.9%), whilst 32 (18.5%) patients had glioblastoma multiforme tumours. Unplanned ACUR occurred in 27 (15.9%) patients, with the 2 most common causes being neurosurgical complications (37.0%) and non-neurosurgical infections (25.9%). Significant risk factors for ACUR patients were a longer acute hospitalization stay (odds ratio = 1.024; 95% confidence interval [CI] = 1.01–1.04; p = 0.007), whereas a higher admission motor Functional Independence Measure was protective against unplanned ACUR (odds ratio = 0.945; 95% CI = 0.915–0.977; p = 0.001). Conclusions: Despite rehabilitation goals of prevention of complications, patients with primary brain tumours undergoing inpatient rehabilitation continue to demonstrate significant unplanned ACUR rates (15.9%) with neurosurgical complications being common. These findings underscore the importance of continued vigilance, access to and coordination of neurosurgical care and management beyond the acute surgical phase, in order to ensure optimal outcomes.
Copyright (c) 2025 Matthew Rong Jie Tay, Justin Desheng Seah, Karen Sui Geok Chua https://creativecommons.org/licenses/by/4.0
Early surgery in rare knee heterotopic ossification leads to successful functional outcome: a case report
Background: Heterotopic ossification is a common complication after joint replacement surgery, such as hip or knee arthroplasty. In the intensive care unit, it is most commonly associated with traumatic brain injury or spinal cord injury. To prevent recurrence, surgical resection of heterotopic ossification is recommended once the ectopic bone has fully matured, which is estimated to occur after at least 12 months. Case presentation: This case describes a young woman with no relevant previous medical history who developed severe bilateral heterotopic ossification on the anteromedial sides of her knees after an intensive care unit stay. Passive flexion of both knees was limited to 50°. X-ray was a simple diagnostic tool. Predisposing factors were extended immobilization, prolonged systematic inflammatory condition and mechanical ventilation. Due to the failure of initial conservative therapy, the heterotopic ossification was resected early, 4 months after onset of first symptoms. Following an intensive rehabilitation program, a normal, pain-free gait and full range of motion of both knees were achieved 9 months after surgery. Conclusion: This case report demonstrates that early resection of heterotopic ossification can result in a good clinical and functional outcome.
Copyright (c) 2025 Stijn Pierreux, Samar M. Hatem, Stijn Roggeman, Marc Schiltz https://creativecommons.org/licenses/by/4.0
Lower-extremity constraint-induced movement therapy in individuals with stroke – improvements, experiences and health-related quality of life
On November 24, 2023 Ingela Marklund defended her thesis Lower-extremity constraint-induced movement therapy in individuals with stroke – improvements, experiences and health-related quality of life at the Umeå University, Umeå, Sweden. Supervisors: Maria Klässbo, Brynjar Fure, Britt-Marie Stålnacke, Xiaolei Hu.
Copyright (c) 2025 Ingela Marklund https://creativecommons.org/licenses/by/4.0