Physical Medicine

Early exoskeleton-assisted upper limb therapy boosts impairment-level recovery after subacute stroke

This multicenter RCT randomized 94 early subacute stroke inpatients with moderate-to-severe upper limb impairment to exoskeleton-assisted therapy or conventional rehab. Both groups had 25 sessions over 5 weeks, integrated into usual inpatient rehabilitation, with blinded outcome assessment. The robotic group achieved a markedly larger FMA-UL motor gain, with a median between-group difference of 22 points (P<0.001). Clinically important improvement (≥10 FMA-UL points) occurred in 68.4% of robotic vs 31.8% of control patients (OR 4.64; 95% CI 1.83-11.8). 1

tSCS plus robot-assisted gait enhances balance and mobility in incomplete SCI vs tSCS plus conventional PT

This double-blind RCT enrolled 20 adults with AIS B–D incomplete SCI randomized to robot-assisted gait training plus tSCS or conventional PT plus tSCS. Both groups completed 40 sessions over 8 weeks, including 20 minutes of tSCS with identical stimulation parameters each session. The RAGT+tSCS group showed significantly greater improvements in Berg Balance Scale, Timed Up and Go, WISCI-II, and ASIA motor score than CPT+tSCS. At 8 weeks, adjusted BBS was higher by 7.67 points and TUG faster by 10.91 seconds in the RAGT+tSCS arm. 2

Bayesian network meta-analysis ranks exercise modalities for post-stroke motor recovery

This systematic review and Bayesian network meta-analysis included 317 RCTs with 14,464 stroke patients across multiple exercise modalities. Electrical stimulation plus exercise produced the largest 6-minute walk distance gains over routine care (MD 53.4 m; 95% CI 14.27-92.58). Lower limb training yielded the greatest gait speed improvement (MD 0.18 m/s; 95% CI 0.14-0.23), with task-oriented and mind-body training also beneficial. Core stability training ranked highest for balance, while functional training showed the largest pooled effect on total FMA scores. 3

More in-hospital rehabilitation for older ICU survivors correlates with more days alive at home

This national US cohort linked NHATS data with Medicare claims for 884 ICU hospitalizations among community-dwelling adults aged 65 years or older discharged alive. Median patient age was 81 years, and median DAAH100 after discharge was 95 days, with wide interpatient variability. Patients received a median of 4 units, roughly one hour, of PT/OT delivered over 6 hospital days. In proportional odds models adjusting for demographics, frailty, baseline function, and hospitalization characteristics, each rehab hour increased odds of higher DAAH100 by 8% (OR 1.08; 95% CI 1.04-1.08). 4