Physical Medicine

Portable hip exoskeleton improves walking economy in chronic stroke

In seven ambulatory individuals with chronic post-stroke hemiparesis, a lightweight bilateral hip exoskeleton reduced net metabolic cost of treadmill walking by 18% versus no device. Positive biological hip work fell by 29%, indicating effective mechanical offloading of the hip joints during gait. These changes could translate into less fatigue and longer walking duration, addressing a major barrier to community ambulation. Findings support further testing of portable hip exoskeletons as an adjunct for gait training and real-world mobility support. 1

Extended home-based rehab after frailty-related hospitalization shows no physical HRQoL benefit

This multicentre RCT randomized 740 adults ≥65 years with frailty after acute hospitalization to a 24-week home-based HOPE exercise program or usual care. At 12 months, there was no superiority of HOPE over control for SF-36 physical component scores, and the program was not cost-effective. All-cause rehospitalizations were slightly higher in controls, but overall outcomes did not justify routine commissioning of extended rehab. Data argue against blanket post-discharge home exercise programs for frail older adults without better targeting or different outcome priorities. 2

AIS grade, neurological level, and diabetes predict walking recovery after traumatic SCI

This systematic review and meta-analysis of 54 studies ranked early predictors of walking recovery after traumatic spinal cord injury. Better initial AIS grade strongly increased odds of regaining ambulation, with high-certainty pooled evidence. More rostral neurological level reduced walking recovery probability, and diabetes independently lowered chances of regaining walking ability. Age and surgical timing showed inconsistent associations across cutoffs, limiting prognostic utility. Results support using AIS, neurological level, and diabetes status for early counseling and stratifying intensity of gait-focused rehabilitation. 3

Cerebellar vermis iTBS augments balance recovery in subacute stroke

In 52 subacute stroke patients with balance impairment, three weeks of cerebellar vermis iTBS plus rehab produced greater Berg Balance Scale gains than sham stimulation. Improvements were accompanied by increased trunk and proximal lower-limb muscle activation on surface EMG and persisted at six-week follow-up. Resting-state fMRI demonstrated enhanced connectivity between Vermis X and bilateral occipitotemporal cortices, which correlated with balance improvement. Subgroup analyses suggested heterogeneous cerebello-frontal and intracerebellar reorganization linked to response, hinting at patient-specific network mechanisms. 4