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Botulinum toxin type A is a first-line treatment for post-stroke spasticity, with selective action at nerve endings and minimal effects beyond the injection site. However, concerns about potential adverse reactions due to toxin diffusion and spread can significantly influence physicians' therapeutic decisions in managing post-stroke spasticity. Current evidence shows that while the main formulations of botulinum toxin type A have different molecular weights and sizes, they do not exhibit differing diffusion profiles. Instead, the key factors determining botulinum toxin type A diffusion and spread in post-stroke spasticity management are the dose (i.e., the actual amount of 150 kDa neurotoxin protein injected), dilution, and injection volume. Other injection-related factors, such as the needle gauge and injection speed, have also been suggested to have a secondary influence on botulinum toxin type A diffusion and spread. The needs of patients with post-stroke spasticity may vary, and depending on treatment goals, botulinum toxin type A diffusion and spread can be something to avoid or may offer therapeutic benefits by reaching a greater number of nerve terminals in the target muscle, enhancing the toxin's effect. These factors should be carefully evaluated in spasticity clinics. [ABSTRACT FROM AUTHOR]

(1) Background. People suffering from brain cancer, regardless of histological tumour characteristics, often experience motor disturbances, cognitive–behavioural difficulty, language impairments, and functional and social limitations. The current treatment approach entails surgery and adjuvant therapy such as chemotherapy and radiotherapy combined with intensive rehabilitation. The primary focus of rehabilitation is usually motor and functional recovery, without specifically addressing the patient's quality of life. The present systematic review identifies and evaluates the predictors of functional and cognitive rehabilitation outcomes and their influence on quality of life in adult patients with brain cancer. (2) Methods. Three electronic databases (PubMed, Elsevier, Cochrane) were searched for reviews about functional, cognitive, and quality-of-life outcomes in patients with central nervous system tumours, including articles published between January 2018 and May 2024. (3) Results. The search retrieved 399 records, 40 of which were reviewed. Five main areas of predictive factors were identified: diagnosis, therapy, complications, outcomes (in the motor, cognitive, and quality-of-life categories), and tailored rehabilitation. (4) Conclusions. These indicators may inform integrated care pathways for patients with primary central nervous system tumours. [ABSTRACT FROM AUTHOR]

(1) Background: Alzheimer's disease (AD) accounts for 70% of dementia cases and with no effective pharmacological treatments, new rehabilitation methods are needed. Motor and cognitive activities and transcranial direct current stimulation (tDCS) have shown promise in stabilizing and enhancing cognitive functions. Objective: we want to investigate the effects of tDCS combined with motor or cognitive activity on cognitive functions in AD patients. (2) Methods: Patients with mild or moderate AD were randomized between anodic tDCS groups (MotA or CogA) and sham tDCS groups (MotS or CogS). They received two weeks of treatment (45 min, five days/week), with the first 15 min using tDCS stimulation on the dorsolateral prefrontal cortex. Cognitive assessments were conducted pre-treatment (T0), post-treatment (T1), and one week after (T2). (3) Results: Twenty-three patients were included. Statistical analysis showed significant differences between anodic tDCS groups (MotA + CogA) and sham tDCS groups (MotS + CogS) with advantages for the first in improving global cognitive status (p = 0.042), selective attention (p = 0.012), and sustained attention (p = 0.012). Further analysis indicated no differences between the two anodic tDCS groups between T0 and T1. (4) Conclusions: combined anodal tDCS with motor or cognitive activity could improve global cognitive state and attention, slowing cognitive decline in AD patients. The trial was registered on Clinical Trials: NCT06619795. [ABSTRACT FROM AUTHOR]

One of the aims of diagnostic nerve blocks is to identify the overactive muscles that lead to a specific spasticity pattern. However, to date, there is no evidence on how nerve blocks may affect botulinum neurotoxin-A (BoNT-A) dose in patients with spasticity. This case-control study aims to assess the role of diagnostic nerve block in defining BoNT-A starting dose at first treatment. Patients with upper and lower limb spasticity treated for the first time with BoNT-A were retrospectively divided into two groups: Group 1 (n = 43) was evaluated with clinical assessment and diagnostic nerve block; Group 2 (n = 56) underwent clinical assessment only. Group 1 was injected with higher BoNT-A doses in some muscles (i.e., flexor digitorum profundus, soleus), and received a higher BoNT-A cumulative dose with a larger number of injected muscles for some spasticity patterns (i.e., "clenched fist", "flexed fingers", "adducted thigh"). Diagnostic nerve block may help the clinician to optimize and personalize the BoNT-A dose since the first BoNT-A treatment. [ABSTRACT FROM AUTHOR]

The goal-setting process is pivotal in managing patients with disabling spasticity. This case–control study assessed the role of diagnostic nerve blocks in guiding the goal-setting process within goal-targeted treatment of spasticity with botulinum neurotoxin-A. In this case–control study, patients with disabling spasticity underwent either a goal-setting process based on the patient's needs and clinical evaluation (control group) or additional diagnostic nerve block procedures (case group). All enrolled patients underwent a focal treatment with botulinum neurotoxin-A injection and a 1-month follow-up evaluation during which goal achievement was quantified using the goal attainment scaling-light score system. Data showed a higher goal achievement rate in the case group (70%) than in the control group (40%). In conclusion, diagnostic nerve blocks may help guide the goal-setting process within goal-targeted treatment of spasticity with botulinum neurotoxin-A towards more realistic and achievable goals, thereby improving the outcomes of botulinum neurotoxin-A injection. Future studies should better explore the role of diagnostic nerve blocks to further personalize botulinum neurotoxin-A according to individual patients' preferences and requirements. [ABSTRACT FROM AUTHOR]

Background: Humans often use co‐speech gestures to promote effective communication. Attention has been paid to the cortical areas engaged in the processing of co‐speech gestures. Aims: To investigate the neural network underpinned in the processing of co‐speech gestures and to observe whether there is a relationship between areas involved in language and gesture processing. Methods & Procedures: We planned to include studies with neurotypical and/or stroke participants who underwent a bimodal task (i.e., processing of co‐speech gestures with relative speech) and a unimodal task (i.e., speech or gesture alone) during a functional magnetic resonance imaging (fMRI) session. After a database search, abstract and full‐text screening were conducted. Qualitative and quantitative data were extracted, and a meta‐analysis was performed with the software GingerALE 3.0.2, performing contrast analyses of uni‐ and bimodal tasks. Main Contribution: The database search produced 1024 records. After the screening process, 27 studies were included in the review. Data from 15 studies were quantitatively analysed through meta‐analysis. Meta‐analysis found three clusters with a significant activation of the left middle frontal gyrus and inferior frontal gyrus, and bilateral middle occipital gyrus and inferior temporal gyrus. Conclusions: There is a close link at the neural level for the semantic processing of auditory and visual information during communication. These findings encourage the integration of the use of co‐speech gestures during aphasia treatment as a strategy to foster the possibility to communicate effectively for people with aphasia. WHAT THIS PAPER ADDS: What is already known on this subject: Gestures are an integral part of human communication, and they may have a relationship at neural level with speech processing. What this paper adds to the existing knowledge: During processing of bi‐ and unimodal communication, areas related to semantic processing and multimodal processing are activated, suggesting that there is a close link between co‐speech gestures and spoken language at a neural level. What are the potential or actual clinical implications of this work?: Knowledge of the functions related to gesture and speech processing neural networks will allow for the adoption of model‐based neurorehabilitation programs to foster recovery from aphasia by strengthening the specific functions of these brain networks. [ABSTRACT FROM AUTHOR]

Introduction: People with poststroke acquired brain injury (ABI) face a complex and often troubled identity reconstruction journey. The literature is rich with studies related to the psychological and neuropsychological components involved in rehabilitation, but it is lacking with respect to the investigation of the existential dimensions and the challenges associated with finding new senses and meanings for one's identity and future perspectives, body and interpersonal relationships. Methods: The aim of this study is to investigate the narrative processes of identity reconstruction after brain damage. Through a qualitative approach, 30 autobiographical narratives about self, body and the relationships with others were collected and analyzed. Semistructured interviews were used for the data collection. Narrative and positioning analysis were applied. Results: Four main positionings emerged: sanctioning a radical break with one's previous life; assuming a sense of salvation and compulsory as well as irreversible adaptation to the limitations associated with one's condition; feeling different and disabled; and considering new possibilities and active constructions of self‐being in relationship with others. These results underline the narrative processes of construction of the injury and the identity and delineate possible resources and instruments to improve the clinical practice for health practitioners. They are also valuable for other professionals who deal with neurological services and rehabilitation, such as psychological counselling and support for persons who have experienced ABI and their families. Patient or Public Contribution: This work resulted from a close collaboration between two universities and a hospital neurological rehabilitation department in the Veneto Region (Northern Italy). Three associations of people with stroke and their families living in the same area contributed to designing the research on the basis of the needs expressed by their members with the aim to identify strategies and devices to be implemented in the public service to improve the care pathway. They also participated in the interpretation of the data. [ABSTRACT FROM AUTHOR]

Background and Purpose: Lateral elbow pain represents a common musculoskeletal disorder, mostly non‐specific and benign. In rare cases, it can be the first symptom of a severe disease such as Ewing's sarcoma (ES). ES is the second most common primary malignant bone tumor in the young population, with a high probability of an unfavourable prognosis. Case Presentation: This case report presents the history of a young man presenting to the physical therapist with a diagnosis of "epicondylitis" in the right elbow, which was later revealed to be an aggressive ES of the ulna. Findings raising clinical doubts were (a) constant pain even at night and not dependent on load, (b) significant loss of function, (c) patient's young age, and (d) a palpable mass in the elbow. Results: After diagnosis, the patient received medical (chemotherapy, radiotherapy and surgery) and a rehabilitation program. After treatment, the patient improved elbow function, decreased disability and returned to social participation, maintaining positive outcomes at the 2‐year follow‐up. Discussion: In summary, this case report emphasizes the importance of differential diagnosis and screening for referral of red flags in physical therapy. Moreover, it describes the rehabilitation of a patient with ES, enriching the scientific literature in the field. [ABSTRACT FROM AUTHOR]

Introduction: Fractures are common bone injuries, which have a great burden on global health. Fracture healing is a long-term process that may be influenced by a number of factors. The 10-15% of all bone fractures may be complicated by an impaired healing (i.e. delayed union or non-union). The application of weak electromagnetic fields has been proposed to have different effects on bones such as enhancing proliferation - orientation - migration of osteoblast-like cells and supporting osteogenic differentiation in bone marrow-derived mesenchymal stem cells. Despite the amount of evidence on cellular and histological effects, to date the application of pulsed electromagnetic fields has not achieved univocal consensus in daily practice. The purpose of this systematic review update is to research, select, analyze and summarize the most recent scientific evidence regarding the effects of pulsed electromagnetic fields in the treatment of acute bone fractures., Evidence Acquisition: A systematic review using the following MeSH terms (Magnetic Field Therapy; Electromagnetic Fields; Bone and Bones; Fractures, Bone; Fractures Healing) and strings {("Magnetic Field Therapy [mh]" OR "Electromagnetic Fields [mh]) OR "magnetotherapy" OR "pulsed electromagnetic field") and ("Fractures, bone [mh]" OR "Bone and Bones [mh]") and ("Fractures Healing [mh]")} was conducted on PubMed, Cochrane Library, Epistemonikos and Scopus electronic databases. Only full articles published in English between January 2014 and December 2022 were considered. Eligibility criteria were defined according to the Population, Intervention, Comparison, Outcomes, and Study (PICOS) design framework. Case reports, case series, uncontrolled studies and expert opinions were excluded. All articles were checked for quality and risk of bias., Evidence Synthesis: Three randomized controlled trials were included (197 patients in total). None of the studies found significant effects of pulsed electromagnetic fields on the acute bone healing process. Contradictory results about pain relief emerged. Only one study showed a transitory positive effect of pulsed electromagnetic fields on strength and range of motion recovery in patients with acute bone fracture., Conclusions: This systematic review update does not support the use of pulsed electromagnetic fields for improving the bone healing process in patients with acute fractures. Controversial evidence was found about the effects of pulsed electromagnetic fields on pain and functional recovery. Considering the scant and heterogenous literature published to date, which represents a limit for our conclusion, further studies with rigorous and high-quality methodology are needed.

Background: Spastic equinus (plantar flexed) foot is a common postural pattern in patients who suffer from post-stroke spasticity. To date, some clinicians use the Silfverskiöld Test in their practice to differentiate between gastrocnemius and soleus muscle overactivity in patients with spastic equinus (plantar flexed) foot. This use of the Silfverskiöld Test goes beyond its original aim, which was to distinguish isolated gastrocnemius contracture in patients with equinus deformity., Aim: The aim of this study was to investigate the Silfverskiöld Test validity for evaluating spastic equinus (plantar flexed) foot (i.e., differentiation between gastrocnemius and soleus muscle overactivity) by checking its outcome against those of selective diagnostic nerve block of tibial motor nerve branches to the soleus, gastrocnemius and tibialis posterior muscles., Design: The design of the study was retrospective observational., Setting: The study was set in a university hospital., Population: Sixty-seven adult stroke patients with spastic equinus (plantar flexed) foot., Methods: Each patient underwent selective diagnostic nerve block of tibial motor nerve branches to the soleus, gastrocnemius and tibialis posterior muscles. All patients were evaluated before diagnostic nerve block by means of the Silfverskiöld Test which was considered positive when ankle joint passive dorsiflexion was greater with the knee flexed than extended. Furthermore, they were assessed before and after nerve block by means of the modified Ashworth Scale and the Tardieu Scale., Results: Our sample included 41 males and 26 females (mean age 57.6 years) suffering from spastic equinus (plantar flexed) foot due to chronic stroke (mean time from onset 2.4 years). Forty-eight patients out of 67 presented with positive Silfverskiöld Test. The χ 2 test showed no association between the Silfverskiöld Test and spastic overactivity of the gastrocnemius (P=0.253), soleus (P=0.605) and tibialis posterior (P=0.462) muscles as evaluated by serial selective diagnostic block of the tibial nerve motor branches., Conclusions: Our findings do not support the Silfverskiöld Test as a valid tool for evaluating spastic equinus (plantar flexed) foot to differentiate between gastrocnemius, soleus and tibialis posterior spastic muscle overactivity in adult patients with stroke., Clinical Rehabilitation Impact: The choice for an appropriate management of spastic equinus (plantar flexed) foot in adults with stroke should not be mainly defined on the base of Silfverskiöld Test.

Objective: The aim of this study was to provide a classification of the upper limb patterns in patients with upper limb spasticity due to multiple sclerosis., Design: Pilot observational study., Patients: Twenty-five adult patients with multiple sclerosis suffering from upper limb spasticity who underwent one segmental (i.e., proximal and distal upper limb) botulinum toxin treatment cycle were recruited., Methods: Patients remained in a sitting position during the evaluation. Upper limb spasticity postures (i.e., postural attitude of a single joint/anatomical region) were evaluated and recorded for the shoulder (adducted/internally rotated), elbow (flexed/extended), forearm (pronated/supinated/neutral), wrist (flexed/extended/neutral) and hand (fingers flexed/thumb in palm)., Results: On the basis of the clinical observations, 6 patterns (i.e., sets of limb postures) of upper limb spasticity have been described according to the postures of the shoulder, elbow, forearm, and wrist., Conclusion: The patterns of upper limb spasticity in patients with multiple sclerosis described by this pilot study do not completely overlap with those observed in patients with post-stroke spasticity. This further supports the need to consider the features of spasticity related to its aetiology in order to manage patients appropriately.

Objectives: Parkinson's disease is characterized by motor and non-motor symptoms. Tremor is one of the motor symptoms that can affect manual skills and have an impact on daily activities. The aim of the current study is to investigate the effect of upper limb training provided by a specific vibratory device (Armshake®, Move It GmbH - Bochum, Germany) on tremor and motor functionality in patients with Parkinson's disease. Furthermore, the training effect on global cognitive functioning is assessed., Design: An uncontrolled before-after clinical trial., Patients: Individuals with diagnosis of Parkinson's disease, motor upper limbs deficits, and absence of dementia., Methods: Participants underwent a 3-week programme (3 times a week) and was evaluated before, after, and at 1 month follow-up by motor (Fahn Tolosa Marin Tremor Rating Scale, Unified Parkinson's Disease Rating Scale - part III, Purdue Pegboard Test, Disability of the Arm, Shoulder and Hand Questionnaire) and cognitive (Montreal Cognitive Assessment) scales., Results: Twenty subjects are included. After treatment a statistically significant improvement in tremor, manual dexterity and activities of daily living was found. The data indicated no effects on global cognitive functioning., Conclusion: These findings suggest positive effects of vibratory stimulation training on upper limb motor symptoms in Parkinson's disease.