Frontiers in Rehabilitation Sciences

The role of proprioception in the management and rehabilitation of adolescent idiopathic scoliosis

2026-04-02

Ting Zhang, Qian Zhou, Lulu Shen, Song Gao

Self-management challenges and psychosocial support needs in clean intermittent catheterization: a qualitative study of individuals with neurogenic bladder and caregivers

2026-04-01

Lianyu Zou, Xiaomei Wu, Shun Chen, Shuluan Feng, Xiaohua Huang, Weiting Liu

BackgroundClean intermittent catheterization (CIC) is widely regarded as the preferred approach to bladder management for individuals with neurogenic bladder (NB). Nevertheless, a considerable gap persists between evidence and clinical practice: patients and caregivers frequently encounter self-management barriers that compromise clinical outcomes during CIC. This qualitative study explores these barriers to provide an empirical foundation for developing tailored strategies that improve quality of care.DesignA descriptive qualitative study.MethodsFrom August to October 2025, a convenience sampling method was employed to recruit 16 participants individuals with NB or their long-term caregivers from the Department of Rehabilitation Medicine at Zhangzhou Affliated Hospital of FuJian Medical University, FuJian Province. Face-to-face semi-structured interviews were conducted, and thematic analysis was employed for data analysis.ResultsThree themes and eight sub-themes were generated in this study: (1) Cognitive deficits and information dilemmas: barriers to health information delivery, a lack of personalized guidance, and cognitive biases and memory lapses; (2) Challenges in behavioral transformation: insufficient perception of risks and benefits and weakened self-management behaviors; (3) Need for an optimized health support system: greater access to psychological counseling, development of authoritative digital health education resources, and an integrated hospital-community management model.ConclusionThis study reveals the interconnected cognitive, behavioral, and psychosocial challenges that individuals with NB and their caregivers face in practicing CIC. Our findings underscore a critical need for interventions that address these specific implementation barriers. Future initiatives should focus on developing multidimensional, patient-empowering strategies that integrate personalized digital health education, ultimately to improve the quality and sustainability of CIC self-management.ImpactThis study elucidates the complex practical and psychosocial challenges encountered by individuals with NB and their caregivers during CIC. Based on these findings, we propose a multi-pronged framework for improvement, targeting cognitive, behavioral, and systemic dimensions of care. This research lays a critical foundation for designing targeted, empowerment-based interventions and offers a comprehensive, system-level roadmap to bridge the persistent evidence-practice gap in CIC self-management.Reporting methodThe research adheres to Consolidated criteria for reporting qualitative research (COREQ) guidelines.

Enabling equitable and inclusive travel experiences for dysphagia patients: a call to action for the aviation industry

2026-04-01

Anthony Cino, Unnathi Annapurna Shashikumar, Kelly Troxell, Mark A. Seeley, Dhruv R. Seshadri

Dysphagia, or difficulty in swallowing, can be the result of several etiologies such as stroke, neuromuscular disorders, head and neck injuries, or extrinsic compression of the esophagus. Patients with dysphagia are at severe risk of sequelae, such as aspiration and malnutrition, which present a severe risk of mortality. There is a significant need of implementing dysphagia -appropriate menu in commercial airlines. Among the general US population, there is a prevalent increase in dysphagia, which creates a substantial accessibility gap in commercial aviation food service. We reviewed publicly available in-flight menu options from the three largest U.S. carriers (American, United, and Delta) and classified items using the International Dysphagia Diet Standardization Initiative (IDDSI) framework. Across economy-accessible menu items identified online, 56 (American), 67 (United), and 51 (Delta) items were classified to be concentrated in thin liquids (IDDSI 0-1) and regular/easy-to-chew foods (IDDSI 6-7), with no clearly identifiable mildly/moderately thick liquid options (IDDSI 2-3) based on posted descriptions.

Muscle strength recovery after total hip arthroplasty and its impact on quality of life: findings from a Romanian cohort

2026-03-30

Marjan Mihajlov, Alexandru Lisias Dimitriu, Monica Georgiana Roman, Elisa Georgiana Popescu, Eduard Cătălin Georgescu, Răzvan Ene, Dragoș Ene

BackgroundMusculoskeletal disorders represent a substantial global health burden, often leading to pain, functional impairment, and reduced quality of life. Total hip arthroplasty (THA) remains a key intervention for advanced hip pathology, yet postoperative recovery depends heavily on targeted rehabilitation. This study examined muscle strength progression and quality-of-life outcomes following a structured rehabilitation program after THA.MethodsPatients who underwent primary THA were enrolled in a structured postoperative physiotherapy protocol. Muscle strength (abduction, extension, and flexion peak force) was quantified using a validated digital dynamometer (ActivForce 2). Quality of life was evaluated using the Hip Disability and Osteoarthritis Outcome Score (HOOS), including the Quality-of-Life subscale (HOOS_QL). Assessments occurred at discharge (T1), six weeks post-discharge (T2), and twelve weeks postoperatively (T3).ResultsStatistically significant longitudinal improvements in muscle strength were observed across all movement planes between T1–T2 and T2–T3 (p < 0.001). HOOS_QL scores showed a parallel increase over the same intervals. In regression analysis, hip extension peak force at T3 emerged as the only significant individual predictor of quality-of-life outcomes (p = 0.025).ConclusionParticipation in a structured postoperative rehabilitation program was associated with measurable improvements in muscle strength and patient-reported quality of life following THA. Hip extension strength was identified as an individual predictor of quality-of-life outcomes; however, the overall regression model demonstrated modest explanatory capacity, suggesting that this association warrants confirmation in larger controlled studies.

A case report of thumb weakness misdiagnosed as radial neuroma and resulting in upper limb dysfunction after surgery

2026-03-30

Zhiqi Lin, Keyun Gan, Yuanbin Yang, Longyue Yi, Wei Yao

A 37-year-old female patient was misdiagnosed with radial neuroma due to thumb weakness. After surgery, the weakness of her upper limbs worsened over 4 months. The most obvious symptoms upon admission were drooping wrists and inability to straighten the five fingers. Electromyography showed left radial nerve injury. She was preliminarily diagnosed with radial neuritis. The patient was treated with ultrasound-assisted electroacupuncture for 6 months, and the muscle strength of the upper limbs increased significantly. This case suggests that ultrasound-guided localization and electroacupuncture therapy are the key methods in treating radial neuritis.

Effects of ultrasound-guided nerve hydro-dissection on severe post stroke shoulder pain: a pilot study

2026-03-27

Yuge Zhang, Yi Guo, Xiaoli Wu

BackgroundShoulder pain is a major complication following stroke that substantially compromises patients' quality of life, despite the availability of various therapeutic options.ObjectiveThis pilot study investigates the efficacy of ultrasound-guided nerve hydrodissection in treating severe post-stroke shoulder pain.MethodsTwelve eligible subjects were randomly assigned to the nerve hydro-dissection group (n = 6) and the control group (n = 6). All participants were given standardized shoulder rehabilitation, and the intervention group underwent additional ultrasound-guided brachial plexus hydrodissection. Visual analog scale (VAS), Fugl-Meyer Assessment (FMA) motor subscores of upper extremity and Shoulder Constant-Murley score were assessed at the baseline, and day1, week1, week2, week4 after the treatment.ResultsThe VAS scores in both groups had shown a decreasing trend at the four time points and there was a significant difference between the groups (p = 0.015, 0.015, 0.004 at the later three time points). The changes in Constant-Murley scores of both groups had shown an increasing trend and there was a significant difference between the groups (p = 0.026, 0.002, 0.041 at the later three time points).ConclusionsUltrasound-guided nerve hydrodissection shows promising preliminary efficacy for post-stroke shoulder pain in this pilot study, warranting further investigation in larger, sham-controlled trials with longer follow-up.

An occupational therapy lens on microbiota–gut–brain modulation in ASD and ADHD

2026-03-23

Anas, Syed Suhaib Ahmed, Inamul Hasan Madar

Research on the microbiota gut brain axis has expanded rapidly, with growing interest in its potential relevance to neurodevelopmental conditions such as autism spectrum disorder and attention-deficit hyperactivity disorder. Systematic reviews increasingly report associations between gut microbial alterations and behavioral features in these populations, yet causal mechanisms remain unconfirmed and translational relevance for rehabilitation remains limited. Much of the existing literature prioritizes microbial composition, inflammatory markers, and neurochemical correlates, with comparatively little attention to everyday functioning, participation, and lived experience. This Perspective argues that microbiota gut brain interactions should be conceptualized within rehabilitation sciences as contextual physiological modulators, referring to internal bodily processes that shape readiness and engagement without determining occupational performance outcomes, and influencing occupational readiness and regulatory capacity rather than acting as etiological drivers of participation restrictions. Drawing on ecological and occupation-centered models of function, including the International Classification of Functioning framework and occupational therapy theories of performance and participation, we propose a reframing that preserves functional orientation while integrating emerging neurophysiological insights. The paper outlines implications for rehabilitation assessment, intervention planning, and interdisciplinary collaboration, and advances programmatic directions for future research that prioritize participation-based outcomes and ecological validity, defined here as the extent to which outcomes reflect real-world participation and everyday functioning rather than laboratory-based or symptom-only change. Repositioning microbiota gut brain research within a participation-focused rehabilitation framework may enhance translational value and support function-oriented, interdisciplinary care for children with autism spectrum disorder and attention-deficit hyperactivity disorder.

Case Report: A period-based upper limb rehabilitation program using a degrees-of-freedom constraint strategy in severe post-stroke hemiparesis

2026-03-23

Norikazu Hishikawa, Koshiro Sawada, Yuki Iwasaki, Satoru Kakoyama, Yu Iitsuka, Yoshiaki Komatsu, Hiroshi Maeda, Yasuo Mikami

BackgroundSevere upper limb hemiparesis after stroke is often characterized by impaired motor function, increased flexor tone, and abnormal motor coordination, resulting in limited functional reaching. Because reaching requires coordinated control of joints, conventional task-oriented training may not sufficiently address motor control deficits arising from excessive or poorly regulated joint degrees of freedom (DoF). This case report describes a period-based upper limb rehabilitation program incorporating a constraint strategy targeting DoF to facilitate motor recovery in a patient with severe post-stroke hemiparesis.Case descriptionA 50-year-old man with left upper limb hemiparesis secondary to right putaminal hemorrhage (163 days post-onset) presented with severe impairment (Fugl–Meyer Assessment for Upper Extremity motor score, 12 points) and spasticity (Modified Ashworth Scale 2–3 in shoulder internal rotators, elbow flexors, and wrist flexors). Insufficient selective motor control and increased spasticity resulted in a dominant upper limb flexion synergy pattern, limiting his ability to perform forward reaching.Therapeutic interventionA structured, period-based program was implemented over 21 consecutive days (60 min/day) with a proximal-to-distal progression and progressive release of movement constraints from the shoulder to the elbow and then to the wrist and fingers. Gravity-load management and DoF constraints were provided using an arm support device and a wrist–hand–finger orthosis in the early periods. As proximal voluntary control emerged, the wrist–hand–finger orthosis was replaced by a dynamic finger extension orthosis. In addition, neuromuscular electrical stimulation was applied to facilitate selective muscle activation across training periods.Follow-up and outcomesSpasticity of the paretic upper limb decreased progressively over the training period, with early reductions in proximal muscle tone followed by later reductions in distal spasticity. Improvements in passive joint range of motion and consistent reductions in joint pain were observed throughout the intervention. Subsequently, motor function improved, as reflected by an increase in the Fugl–Meyer motor score to 16 points, with reduced synergistic movement patterns and more controlled reaching during tasks.ConclusionAn upper limb rehabilitation framework incorporating a DoF constraint strategy may support the recovery of coordinated motor control through a structured, period-based approach in individuals with severe post-stroke hemiparesis.

Integrated disability evaluation in low back pain: feasibility and multidomain profiling from the EL DORADO cohort

2026-03-18

Anders Hansen, Steen Harsted, Casper Nim, Kieran O’Sullivan, Søren O’Neill

Disability evaluation in low back pain (LBP) has traditionally relied on patient-reported outcomes (PROs), which alone incompletely capture functioning. This study tested the feasibility of embedding a multidomain disability evaluation protocol into routine secondary care, integrating PROs with performance-based measures, kinematic analysis, quantitative sensory testing (QST), and electronic health record (EHR) data, without performing formal multidomain profiling or subgroup identification. In this proof-of-concept study, 542 patients referred for advanced LBP assessment at the Spine Center of Southern Denmark underwent multidomain evaluation, including PROs (ODI, EQ-5D-5L, NPRS, STarT Back), functional capacity tests, markerless kinematic motion capture, QST, and EHR extraction; a subgroup provided 60-week SMS follow-up. Feasibility outcomes, including workflow integration, data completeness, acceptability, and adverse events, were evaluated overall and after the first 100 participants to guide protocol refinement. The assessment battery was completed in a mean of 22 min with over 95% data completeness, high acceptability, acceptable patient burden, and only two minor adverse events. PROs indicated moderate disability (ODI 34/100) and poor health (EQ-5D VAS 55/100), while functional and kinematic measures revealed substantial impairments, and QST showed widespread pain sensitivity with minimal conditioned pain modulation. EHR linkage was achieved for all participants, with MRI data available in 88%, and SMS follow-up retention was 75% at 60 weeks. These findings demonstrate that integrating PROs, performance-based tests, QST, kinematic assessment, and EHR data into routine secondary care is feasible, safe, and acceptable. The resulting multidomain dataset provides an infrastructure for future research on prognosis, subgrouping, and disability evaluation in LBP.

Rating scales to inform balance exercise difficulty during rehabilitation for individuals with neurological disorders

2026-03-18

Brooke N. Klatt, Tian Bao, Kathleen H. Sienko, Carrie W. Hoppes, Patrick J. Sparto, Susan L. Whitney

Appropriate exercise dosing is essential for optimizing functional outcomes in rehabilitation for individuals with neurological disorders. While guidelines for aerobic and resistance training intensity are well established, comparable standards for balance exercise remain limited, despite its central role in reducing falls and promoting safe mobility. Clinically feasible approaches to quantifying balance exercise difficulty are needed to support safe progression and individualized prescription. This exploratory study explored the relationship between participants perceived balance difficulty and clinician-rated assistance during progressive balance training. Sixteen adults (68.1 ± 8.0 years old; 69% female) with balance disorders (peripheral vestibular hypofunction, peripheral neuropathy, or age-related balance impairment) completed an 18-session balance rehabilitation program over 6-weeks. Participants and clinicians rated each exercise using standardized scales, yielding 1,658 rating comparisons. Agreement between participant-perceived difficulty and clinician-rated assistance was moderate [Cohen's kappa (k) = 0.42, 59% exact agreement, p < 0.001], with higher agreement observed using weighted analysis (linear weighted k = 0.58; quadratic weighted k = 0.74, both p < 0.001). Most rating discrepancies (85%) differed by only one category, suggesting clinically minor disagreements. These preliminary findings indicate that participant-perceived difficulty may provide a clinically accessible indicator of balance exercise challenge. However, validation in larger samples with independent rating procedures and examination of relationships between difficulty ratings and functional outcomes are needed before clinical implementation. This work provides initial evidence for incorporating participant feedback into balance exercise prescription as part of individualized, patient-centered rehabilitation approaches.

Posture evaluation and treatment in adolescents through wearable technology: a systematic review

2026-03-18

Sara Liguori, Antimo Moretti, Viviana Andreozzi, Claudio Catalano, Gabriele Pontillo, Luca Maresca, Michele Riccio, Giovanni Breglio, Marco Paoletta, Francesca Gimigliano, Giovanni Iolascon

IntroductionPostural health is crucial during adolescence, a period marked by rapid physical growth and increased susceptibility to postural deformities due to sedentary lifestyles. Wearable technologies offer a promising solution for spinal posture monitoring and correction, utilizing sensors, inertial measurement units (IMUs), and artificial intelligence to provide real-time biofeedback. However, current wearable devices face limitations, including inconsistent methodologies, sensor attachment issues, and the absence of immediate corrective feedback. This systematic review aims to determine the status of clinical and experimental research in the area of wearable technology designed for spinal monitoring in adolescents.MethodsFollowing PRISMA guidelines, we searched multiple databases for relevant studies published until December 31, 2024, identifying studies about technology/ies able to monitor posture of the spine in the adolescents. The Systematic review protocol is available in the International Prospective Register of Systematic Reviews (PROSPERO) with the following number: CRD42024532328.ResultsThree studies have been identified including a total of 103 participants, comprising 58 males and 45 females Findings indicate that while existing wearable systems can track posture, they often lack methodological rigor, real-time feedback capabilities, and comprehensive evaluation protocols.DiscussionThere is a critical need for innovative digital health solutions that integrate real-time monitoring and personalized interventions to address postural issues effectively. Despite their potential, wearable technologies face challenges related to usability, effectiveness, and evidence quality. Future research should focus on developing user-friendly designs, strengthening methodological approaches, and integrating multiple monitoring techniques to enhance spinal health in adolescents.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/recorddashboard, PROSPERO CRD42024532328.

Patient-centered goal-setting in stroke rehabilitation: a scoping review

2026-03-17

Inge Ris, Mille Nabsen Marwaa, Rikke Westengaard Nielsen, Palle Larsen, Hanne Kaae Kristensen

BackgroundPatient-centered goal-setting is an important part of the rehabilitation process. The guidelines for stroke rehabilitation in adults recommend setting goals that are meaningful and relevant for the patient, focusing on activity and participation, and involving the patient. Patient-centered goal-setting is to improve rehabilitation outcomes. However, patient-centered goal-setting occurs partly or not at all. There is also a lack of continuity in goal-setting across sectors.ObjectiveThis study aimed to identify existing research-based knowledge on procedures used in patient-centered goal-setting processes in stroke rehabilitation.MethodsA scoping review was conducted by searching PubMed, CINAHL Complete, EMBASE, APA PsycINFO, Scopus, and Cochrane databases for studies involving adults receiving or clinicians delivering stroke rehabilitation and focusing on patient-centered goal-setting processes. The included studies were analyzed using inductive content analyses and linked to five domains in goal-setting processes: person-centeredness, collaboration with healthcare professionals and patients, coordination across sectors, monitoring, and evaluation.ResultsEighteen studies were included. Inductive content analysis identified elements related to goal-setting processes, mainly occurring at the beginning of the rehabilitation. Linking the studies to five domains revealed gaps in cross-sectoral coordination, monitoring, and evaluation.ConclusionPatient-centered goal-setting in stroke rehabilitation is practiced variably, and there is no overall agreement about the procedures to ensure that goal-setting is patient-centered. Therapist- and team-led goal-setting processes are used. Evaluation procedures and cross-sectoral coordination are rarely described.

References values and standardized testing protocols for performance-based and patient-reported outcome measures among individuals with lower limb amputation

2026-03-13

Matthew McGuire, Sara Nataletti, Rachel Maronati, Shenan Hoppe-Ludwig, Anushua Banerjee, Amber Wacek, Juan Cave, John M. Looft, Christopher L. Dearth, Brad D. Hendershot, Arun Jayaraman

IntroductionReliable reference data and standardized administration procedures for outcome measures are critical to guide rehabilitation, justify prosthetic prescription, and evaluate treatment outcomes in individuals with lower limb amputation (LLA). Although numerous performance-based and patient-reported measures are used in this population, few studies provide both population-specific reference values and detailed testing protocols. This study describes standardized administration procedure and presents reference values for commonly used outcome measures categorized by functional K-level and amputation level to support consistency in clinical and research applications.Materials and methodsData was collected from the initial visit of a larger longitudinal study across three medical research centers. Participants included 58 adults (aged 18–89) with unilateral or bilateral transtibial or transfemoral amputation, all using at least one definitive prosthesis for ≥6 months and classified at K2 level or higher. Participants completed 8 performance-based and 11 patient-reported outcome measures.ResultsData was reported by K-level and amputation level (unilateral transtibial, unilateral transfemoral, bilateral). Some discrepancies were observed in various assessments compared to prior studies, possibly due to methodological and demographic differences. 10 Meter Walk Test speeds reported here were up to 31% faster than previous studies, potentially due to differences in track length and calculation methods.ConclusionThis study provides standardized administration guidelines and population-specific reference values for widely used performance-based and patient-reported outcomes in adults with LLA. Although these data are not intended to establish formal normative values due to limited sample size, they provide clinically relevant benchmarks for contextualizing individual performance, and support goal setting. By detailing test procedures and observed score distributions, these findings promote methodological transparency, improve comparability across studies, and support evidence-based prosthetic care and rehabilitation.Clinical Trial Registrationhttps://clinicaltrials.gov/study/NCT03930199, identifier NCT03930199.