Search Results (266)

Background: The optimal timing of cranioplasty (CP) after decompressive craniectomy (DC) remains debated. Early reconstruction may enhance neurological recovery through restoration of cerebral perfusion and cerebrospinal fluid dynamics, yet concerns persist regarding postoperative complications. Objective: To evaluate the impact of early versus delayed cranioplasty on neurological outcomes and postoperative complications in adults following decompressive craniectomy. Methods: A systematic review was conducted in accordance with PRISMA guidelines (PROSPERO ID: CRD420251123808). PubMed, OVID, and Web of Science were searched for studies published between January 2017 and December 2025. Eligible studies compared early and delayed CP in adults and reported neurological outcomes and/or complications. Results: Twenty-one retrospective cohort studies including 8462 patients were analyzed. Neurological improvement was observed in both groups across multiple validated scales (GOSE, GOS, GCS, mRS, BI, FIM, NIHSS, MMSE). Early CP was consistently associated with superior recovery, including higher one-year Barthel Index improvement (74.1% vs. 54.8%), greater FIM gains (7.31% vs. 4.66%), and higher composite recovery rates (95.6% vs. 80.0%). No study demonstrated superior recovery with delayed CP. Infection, hydrocephalus, and seizure rates were comparable between groups. However, hematoma (21% vs. 10.4%) and hygroma (7.49% vs. 4.73%) were more frequent after early CP, although hematoma rates were influenced by a large database study. Bone flap resorption was less frequent with early CP (1.44% vs. 6.26%). Conclusions: Early cranioplasty is associated with improved neurological recovery but carries an increased risk of select complications, particularly hematoma and hygroma, representing a clinically relevant trade-off. Delayed CP does not demonstrate overall superior safety due to higher bone flap resorption. Timing should be individualized, and prospective multicenter studies with standardized definitions are needed. Full article

Introduction: Perioperative factors can significantly accelerate the development of sarcopenia in patients with aortic dissection, weakening their metabolic and functional reserves. Progressive sarcopenia after surgery is associated with a worse prognosis, increased mortality, and a higher risk of complications, which makes its early diagnosis and prevention key elements of care for this group of patients. Methods: The study included 116 patients hospitalized from April 2022 to May 2025 due to aortic dissection. Prospective studies were conducted using standardized tools as well as clinical data. The effect of blood transfusion, grip strength as measured with a hand dynamometer, and survival of patients after aortic dissection 3 months postoperatively were evaluated. Results: In the group of patients with a high risk of stroke, completely dependent and suffering from insomnia, transfusions were used significantly more often. SGA scores, CHA2DS2-VA score, and Barthel scale scores were dependent on the level of pain at discharge. Grip strength was significantly higher among patients who survived 3 months. The differences reached statistical significance on the second postoperative day. Conclusion: The results indicate that malnutrition is a key factor in the clinical condition of patients, increasing the risk of sarcopenia, stroke, and the severity of insomnia. At the same time, a higher degree of malnutrition is associated with reduced functional independence, which in turn affects the patient’s overall condition. The study found that malnutrition is a key factor in worsening the clinical condition of patients with aortic dissection, increasing the risk of sarcopenia, stroke and exacerbation of insomnia. The relationship between lower self-reliance and higher insomnia levels underscores the complex interplay among nutritional status, physical functioning, and sleep quality. Full article

Background/Objectives: Peak cough flow (PCF) is an objective measure of cough effectiveness after stroke, but biomarkers reflecting physiological vulnerability related to reduced PCF are not well established. We investigated whether bone turnover markers (BTMs)—C-terminal telopeptide of type I collagen (CTX) and procollagen type 1 N-terminal propeptide (P1NP)—were associated with PCF in subacute ischemic stroke. Methods: In this retrospective study, 112 patients admitted within 21 days of stroke onset had fasting morning CTX and P1NP measured by electrochemiluminescence immunoassay, and PCF measured within 72 h of admission. Associations were assessed using Spearman correlation and multivariable linear regression with BTMs standardized (per 1 standard deviation increase), adjusting for age, sex, body mass index, onset-to-admission days, National Institutes of Health Stroke Scale score, Korean version of the Modified Barthel Index, estimated glomerular filtration rate, smoking status, and brainstem lesion. Results: CTX showed an inverse correlation with PCF (rho = −0.469; p < 0.001) and remained independently associated with lower PCF after multivariable adjustment (β = −42.32 L/min; 95% confidence interval, −56.12 to −28.52; p < 0.001), whereas P1NP showed weaker associations. In secondary outcome analyses, higher CTX was associated with low PCF (PCF < 160 L/min), aspiration pneumonia, and longer length of stay. Conclusions: Higher CTX levels were independently associated with lower peak cough flow and selected respiratory-related outcomes in this retrospective cohort. These findings are hypothesis-generating, do not imply prognostic validation, and warrant confirmation in prospective multicenter studies assessing incremental predictive value. Full article

Background: Comorbidities are common among stroke survivors and may substantially influence functional recovery during rehabilitation; therefore, in this study, we aimed to evaluate the impact of individual comorbidities on functional outcomes in stroke patients after inpatient rehabilitation. Methods: In this retrospective cohort study, we included 289 patients with first-ever ischemic or hemorrhagic stroke who had undergone inpatient rehabilitation and assessed functional outcomes using the Barthel Index (BI), gait speed, Berg Balance Scale (BBS), and Action Research Arm Test (ARAT) at admission, after three weeks, and at discharge. The impact of selected comorbidities, including hypertension, diabetes mellitus, depression, cardiomyopathy, peripheral arterial disease, hyperlipidemia, and atrial fibrillation, was analyzed using multivariable logistic regression. Results: Significant improvements were observed across all functional measures (p < 0.0001). Diabetes mellitus and depression were independently associated with poorer improvement in BI, while reduced improvement in gait speed was associated with higher National Institutes of Health Stroke Scale (NIHSS) score, older age, female sex, cardiomyopathy, atrial fibrillation, and depression. Cardiomyopathy was also associated with reduced balance improvement measured by BBS, while vascular comorbidities were linked to less favorable upper limb recovery. Conclusions: Inpatient rehabilitation leads to significant functional recovery after stroke; however, specific comorbidities adversely affect rehabilitation outcomes. Targeted assessment and management of metabolic, cardiovascular, and psychological comorbidities may enhance functional recovery in stroke patients. Full article

The objective was to evaluate the impact of a 3-month comprehensive rehabilitation program on functional outcomes and caregiver burden in a 73-year-old male with end-stage Parkinson’s disease (PD) following pallidotomy. Baseline evaluation included cardiorespiratory, digestive, and neuromusculoskeletal assessments, complemented by a multidomain geriatric assessment: activities of daily living (Barthel Index), cognition (MoCA), nutrition (MNA), mental health (GDS, UCLA Loneliness Scale), sarcopenia (AWGS criteria), frailty (Clinical Frailty Scale), fatigue (FSS), mobility (De Morton Mobility Index), fall risk (Morse Fall Scale), and caregiver burden (Zarit Burden Interview). The patient then underwent a structured 3-month rehabilitation program consisting of strengthening and flexibility training, cardiopulmonary endurance exercise, functional task practice, and psychological and nutritional counseling, with monthly evaluations. At baseline, the patient presented with generalized rigidity, fatigue, low cardiorespiratory endurance, total ADL dependence, malnutrition, sarcopenia, frailty, loneliness, and high caregiver burden, but intact cognition and mood. After rehabilitation, he achieved short distance walking, improved appetite and weight gain, and reduced scores in Zarit Burden, Fatigue Severity Scale, and MNA. Functional independence (Barthel Index) and respiratory capacity (single-breath count) improved, while frailty and sarcopenia remained stable without progression. In advanced PD, comprehensive rehabilitation can yield meaningful gains in mobility, nutrition, and functional independence while alleviating caregiver burden. Frailty and sarcopenia remain strongly associated with disease progression and highlight the need for sustained multidisciplinary care for both patients and caregivers. Full article

Background: The process and dynamics of post-stroke recovery can vary considerably across patient subgroups. However, few studies have explored long-term functional recovery profiles (an essential outcome indicator), particularly in relation to patients’ quality of life, and caregiver burden. This study aimed to identify distinct 12-month trajectories of functional recovery among stroke survivors, and to examine their associations with sociodemographic and clinical factors, as well as patient-reported outcomes. Methods: The study involved 225 patients with acute ischemic stroke, assessed at admission (T0), discharge (T1), and at 3 (T2) and 12 months (T3) post-discharge. Informal caregivers participated at T2 (n = 126) and T3 (n = 118). Functional status was measured using the modified Barthel Index, quality of life using the Stroke-Specific Quality of Life scale, and caregiver burden with the Caregiver Burden Scale. Latent growth mixture modelling (LGMM) was applied to identify recovery trajectories. Associations with sociodemographic and clinical variables, quality of life, and caregiver burden were analysed using ANOVA and χ² tests. Results: Three recovery trajectory classes were identified: Class 1 (moderate upward, 20.4%), Class 2 (low-stable, 4.9%), and Class 3 (high-functioning stable, 74.7%). Class 3 patients were younger, less impaired at baseline, and more frequently diagnosed with lacunar strokes. Class 2 comprised older, more impaired individuals and had the lowest proportion of males. Class 1 represented intermediate baseline profiles with gradual functional improvement over time. Patient-reported outcomes differed significantly between classes (p < 0.001): Class 3 had the highest quality of life and lowest caregiver burden whilst Class 2 consistently reported the poorest quality of life. Conclusions: This study demonstrates significant heterogeneity in post-stroke functional recovery and its associations with clinical, sociodemographic, and patient-reported outcomes. Identifying recovery trajectories may support more personalised stroke care and rehabilitation planning. Full article

Background/Objectives: Stroke frequently leads to balance deficits. Vestibular physical therapy (VPT) may enhance postural control through neuroplastic mechanisms. Virtual reality (VR) can provide ecologically valid environments for rehabilitation, increasing patient engagement. Methods: In this randomized feasibility study, nine individuals with chronic stroke were randomized to either a Real visuo–vestibular rehabilitation group (n = 6) or a Sham VR group (n = 3) to explore the feasibility of the protocol and randomization procedures rather than to compare clinical efficacy. Both groups were trained in immersive VR environments for 12 sessions. The Real group experienced visuo–vestibular stimuli requiring sensorimotor integration; the Sham group trained in the same environments without such stimuli. Feasibility was assessed through attendance, participation (Pittsburgh Rehabilitation Participation Scale, PRPS), and user satisfaction (USEQ). Safety and acceptability were monitored through adverse event reporting. Secondary exploratory outcomes included measures of balance—the Mini Balance Evaluation Systems Test (MiniBESTest), the Berg Balance Scale (BBS), and the Performance-Oriented Mobility Assessment (POMA)—as well as functional independence (Barthel Index), health-related quality of life (Stroke-Specific Quality of Life Scale, SSQoL), and a set of spatiotemporal and gait quality parameters derived from inertial measurement unit (IMU) data collected during the 10-Meter Walk Test and the Figure of 8 Walk Test. Results: All participants completed the protocol without adverse events. Participation, as measured by the PRPS, remained consistently high across sessions (mean ≥5.7/6), while USEQ scores indicated excellent user satisfaction (mean ≥28/30). Exploratory analyses revealed improvements in MiniBESTest and BBS scores for the Real group. Instrumental measures derived from IMUs demonstrated improvements across groups. Conclusions: Exploratory outcomes suggested positive trends in balance improvements, and the integration of clinical scales with wearable sensors proved feasible and informative. Full article

Background/Objectives: Amyotrophic lateral sclerosis (ALS) is a clinically heterogeneous neurodegenerative disease in which bulbar involvement frequently affects speech and voice production. Although acoustic voice analysis can detect phonatory alterations in ALS, its ability to differentiate clinical phenotypes remains limited. This study investigated whether biomechanical voice parameters provide complementary information for characterizing bulbar involvement across bulbar-onset ALS (ALS-B) and spinal-onset ALS (ALS-S) and explored their association with clinical and functional measures. Methods: This cross-sectional observational study included 50 patients with ALS (20 ALS-B, 30 ALS-S) and 50 controls with non-neurological voice disorders. Sustained vowel phonation was analyzed using acoustic measures and biomechanical voice parameters derived from a standardized model of vocal fold vibration. Perceptual voice severity was assessed using the GRBAS scale, while functional status was evaluated with the ALS Functional Rating Scale–Revised (ALSFRS-R) and the Barthel Index. Associations with clinical measures were explored in secondary analyses. Results: Compared with controls, ALS patients showed significant differences in acoustic measures and several biomechanical parameters related to glottal closure and vibratory stability. Biomechanical analysis revealed significant differences between ALS-B and ALS-S, particularly in parameters reflecting vibratory asymmetry, glottal tension and cycle-to-cycle instability. Unexpectedly, ALS-B showed greater perceptual voice severity and higher Barthel Index scores than ALS-S, while no differences were observed in global ALSFRS-R total scores. Conclusions: Biomechanical voice analysis appears to capture physiologically meaningful alterations in vocal fold function in ALS and provides complementary information for characterizing bulbar motor involvement across clinical phenotypes, particularly ALS-B disease. When combined with acoustic and clinical assessments, this approach may enhance the evaluation of bulbar involvement and functional status in ALS. Full article

Objectives: The general objective of the study was to analyze the influence of sociodemographic factors and care and hygiene practices on the appearance of Incontinence-Associated Dermatitis (IAD). The specific objectives were to identify the relationship between sociodemographic variables (age, sex, comorbidities) and the incidence of IAD, and to evaluate hygiene protocols (cleaning products and absorbent use and practices) and compare time to IAD onset according to the hygiene practices used. Methods: A multicenter, prospective cohort study was conducted across 10 social health centers. The study population consisted of older institutionalized patients with urinary and/or mixed incontinence who used absorbents continuously. The variables included risk assessment using validated scales, such as the Braden scale and the Perianal Assessment Tool (PAT), as well as ad hoc questionnaires. Survival analysis of time-to-event onset was assessed using the Kaplan–Meier curve and the Log-Rank test. Results: A statistically significant association was found between the occurrence of IAD and the Braden scale (p = 0.004) and the PAT scale (p = 0.02). However, no statistically significant association was found with age, sex, or the Barthel Index. Regarding hygiene, soapy wipes were associated with the highest incidence of IAD. In contrast, dry wipes were the most effective, with the lowest cumulative risk and the longest time-to-event (p = 0.001). The brand of the absorbent used had a significant influence (p = 0.024), suggesting that the “B” brand prevented one IAD per six patients compared with the “A” brand. The frequency of absorbent changes did not show a statistically significant association. Conclusions: The risk of developing IAD was strongly linked to the scores of the Braden and PAT scales, the brand of the absorbent (“B” being more effective), and the cleaning product used, with dry wipes being the most protective compared to soapy wipes. On the other hand, factors such as age, sex, degree of dependence (Barthel), or frequency of absorbent change did not show a significant influence on the appearance of IAD. Full article

Background/Objectives: Fear of falling is highly prevalent after stroke and may interact with mobility limitations, neurological deficits, and reduced quality of life. However, few studies have examined these dimensions together during inpatient rehabilitation. This study aimed to assess fear of falling, balance and gait performance, and HRQoL in adults undergoing post-stroke inpatient rehabilitation, and to examine the interrelationships among psychological, functional, and clinical measures to support multidimensional assessment strategies. Methods: This cross-sectional study included 39 patients (51.28% women, 71.79% after ischemic stroke) undergoing post-stroke inpatient rehabilitation. The main assessments included the Falls Efficacy Scale-International (FES-I), the Tinetti Test (TT), and the Short Form-36 (SF-36). Results: High fear of falling was reported by 61.5% of participants, while a substantial proportion (35.9%) demonstrated moderate-to-high fall risk on the TT, despite the majority being classified as low risk. SF-36 domain scores indicated moderate HRQoL with substantial interindividual variability across dimensions. Strong correlations were found between SF-36 and FES-I (rs = 0.76, p < 0.001), TT (rs = −0.78, p < 0.001), Barthel Index (rs = −0.71, p < 0.001), and NIHSS (rs = 0.65, p < 0.001). Patients with greater neurological impairment and lower independence demonstrated worse HRQoL and higher fear of falling. Also, a statistically significant (p < 0.001) strong negative correlation (rs = −0.89) was found between the TT and the FES-I scores, indicating that higher fear of falling was associated with poorer mobility. Conclusions: Fear of falling, impaired balance, and reduced HRQoL are highly prevalent and strongly interconnected among post-stroke inpatients. These findings highlight the need for early multidimensional assessment and integrated interventions targeting both physical performance and psychological factors. Larger longitudinal studies are required to clarify causal pathways and optimize rehabilitation strategies. Full article

Background/Objectives: Therapeutic exercise (TE) has been shown to be an effective tool for slowing physical and cognitive decline in patients with dementia. However, its true impact on physical and functional variables, as well as the duration of its effects once therapy is discontinued, remains unclear. The aim was to analyze the short- and medium-term effects of a structured and monitored TE program on motor function in patients with dementia. Methods: A pre–post clinical trial was conducted in individuals with a medical diagnosis of mild-to-moderate cognitive impairment (Mini-Mental State Examination scores between 10 and 23) who had not engaged in regular exercise during the previous 6 months. The study variables and their measurement tools included general motor function (Short Physical Performance Battery), trunk control (Trunk Control Test), balance (Berg Balance Scale), overall mobility and gait (Timed Up and Go Test), and degree of independence in activities of daily living (ADLs) (Barthel Index). Participants completed a 12-week TE intervention at moderate intensity, 3 days per week for 45 min sessions. The program included aerobic training and strength, coordination, flexibility, and balance exercises. TE intensity was monitored through heart rate and dynamic maximal resistance. Assessments were conducted at baseline (t0), immediately after the program (t1), and 6 months after completion (t2). Results: Significant global longitudinal effects of time were observed for general motor function, balance, trunk control, and mobility and gait, whereas no significant global effect was detected for independence in activities of daily living. Post-intervention changes were non-significant; however, several pairwise comparisons showed moderate-to-large effect sizes. Follow-up assessments revealed shifts in performance distributions consistent with functional decline. Conclusions: A structured TE program performed at moderate intensity may help slow or attenuate the physical decline experienced by individuals with dementia. Full article

Background/Objectives: The impact of stroke on upper extremity function in the older adult population underscores the need for accurate recovery prediction. Motor evoked potential (MEP) has been explored as a predictor of upper extremity function recovery in patients with stroke. However, research specifically targeting the geriatric population remains limited. Therefore, this study focused specifically on patients aged 65 years and older to investigate correlations between MEP parameters and upper extremity function. This study investigates correlations between MEP parameters (amplitude and latency) and upper extremity function-related measures, including Medical Research Council (MRC) scale, the Korean version of the Modified Barthel Index (K-MBI), and the Hand Function Test (HFT), including grip strength, pinch strength, the Box and Block Test, and the 9-Hole Peg Test, in older adults with stroke. Methods: A multiple linear regression model predicts upper extremity outcomes using initial MEP parameters, time, and function. The dataset includes 90 patients with stroke categorized by timing of the first MEP assessment: ≤3 months (n = 42) or >3 months (n = 48). Results: MEP amplitude and latency were significantly correlated with upper extremity function in both groups. No significant correlations were found between MEP amplitude or latency and outcome measures. Regression analysis showed that initial MEP amplitude had a limited association with outcomes, whereas latency was significantly associated with grip strength (β: −10.205, 95% CI: −19.374~−1.036) and the Box and Block Test (β: −10.204, 95% CI: −20.254~−0.154). Initial upper extremity parameters were significantly associated with K-MBI and HFT follow-up results (p < 0.05). Conclusions: Larger MEP amplitude and faster initial MEP latency were associated with improved upper extremity function in patients with stroke. In older patients, MEP latency, rather than amplitude, demonstrated greater predictive value for upper extremity function recovery, possibly due to age-related muscle atrophy, a factor not fully addressed in existing prognostic frameworks such as PREP2. These findings support the integration of MEP latency assessment into geriatric stroke prognostication, complementing existing frameworks such as PREP2, and may guide personalized rehabilitation planning to optimize functional recovery and independence. Full article

Background and Objectives: Phase angle (PhA) derived from bioelectrical impedance analysis reflects muscle quality and cellular integrity and has been associated with functional outcomes after stroke. However, its relationship with functional status at hospital admission and potential sex-based differences remains unclear. This study investigated the association between PhA and functional status at admission in post-stroke patients undergoing convalescent rehabilitation. Materials and Methods: This retrospective study included 250 post-stroke patients admitted to a convalescent rehabilitation hospital. PhA was measured at admission and classified into high and low groups using sex-specific cutoffs. Functional status was assessed using the Berg Balance Scale (BBS), Functional Ambulation Category (FAC), and the Korean version of the Modified Barthel Index (K-MBI). Sex-stratified logistic regression analyses were conducted to examine associations between functional variables and low PhA. Results: Patients with low PhA showed significantly poorer balance, ambulation, and activities of daily living (ADL) than those with high PhA. In men, low balance (BBS < 41) and low ambulation ability (FAC < 3) were independently associated with low PhA. In women, low ADL performance (K-MBI < 75) was independently associated with low PhA, while balance and ambulation were not. Conclusions: PhA was significantly associated with functional status at admission in post-stroke patients, with distinct sex-specific patterns. PhA may serve as a simple and non-invasive adjunct indicator of functional vulnerability when interpreted with consideration of sex differences. Full article

Background and objectives: In older and frail patients, in-hospital cardiac arrest (IHCA) is associated with high mortality. Early warning scores such as the National Early Warning Score 2 (NEWS2) are widely used to detect clinical deterioration, but their predictive accuracy in frail populations remains uncertain. This study aimed to assess whether integrating frailty measures with NEWS2 could better describe elderly IHCA patients. Materials and Methods: We conducted a single-center, retrospective observational study in adult and frail patients (≥18 years) admitted to medical and surgical wards of the University Hospital of Siena who experienced IHCA between January 2022 and January 2024. Data on demographics, such as last NEWS2 before IHCA, Clinical Frailty Scale (CFS), Barthel Index (BI), and Charlson Comorbidity Index (CCI) were retrospectively collected and analyzed. Patients were stratified into three categories, according to NEWS2: Stable (A), Potentially Unstable or Unstable (B), and Critical (C). Results: Seventy patients were analyzed (mean age 76.9 ± 11.0 years; 56% male). The mean pre-IHCA NEWS2 score was 6.0 ± 3.5, with 41% of patients classified as NEWS2-C, 48% classified as NEWS2-B, and 11% classified as NEWS2-A. The NEWS2-A category showed higher BI and lower CFS than NEWS2-B and NEWS2-C (p < 0.01), while CCI and age did not significantly differ. Conclusions: The association of NEWS2 with frailty scores could identify some elderly patients with limited pre-arrest physiological derangements but high frailty who suffered from IHCA. These findings provide descriptive insights that may inform monitoring strategies for “at-risk” elderly patients to help prevent IHCA. Full article

Background: Diabetes mellitus is known to affect the prognosis of critically ill patients; however, its impact on independence in activities of daily living (ADL) at hospital dis-charge remains unclear. This study aimed to investigate whether preexisting diabetes is associated with reduced ADL independence at hospital discharge among critically ill patients. Methods: In this prospective cohort study, 423 adult intensive care unit (ICU) patients who were admit-ted for ≥48 h were enrolled and categorized by the presence or absence of diabetes. Primary outcomes included time to achieve walking independence (unassisted walking over 50 m) and the Barthel Index at discharge. Secondary outcomes were handgrip strength, ICU length of stay, and highest ICU Mobility Scale (IMS) scores. Multivariable analyses adjusted for age, illness severity, and other confounders. Results: Among the 101 patients with diabetes, time to achieve walking independence at discharge was significantly longer compared to those without diabetes (p = 0.013). The diabetes group also had a lower Barthel Index (p = 0.020), longer ICU stays (p = 0.003), weaker handgrip strength (p = 0.041), and lower maximum IMS scores (p = 0.002). Multivariable analysis confirmed that diabetes was independently associated with reduced ADL independence and poorer physical function at discharge. Conclusions: Preexisting diabetes is an independent predictor of impaired ADL independence in critically ill patients. These findings highlight the importance of early and individualized rehabilitation strategies for patients with diabetes in the ICU. Full article