Search Results (724)

Background: Irreversible brachial plexus injury can leave patients with a painful, insensate, and nonfunctional flail limb, often after failed reconstructive attempts and with limited remaining surgical options. This study describes a modified transhumeral amputation technique incorporating a passive biceps brachii traction sling to improve residual limb stability and prosthetic readiness in this challenging setting. Methods: This retrospective, uncontrolled five-case series assessed the feasibility, perioperative safety, descriptive clinical outcomes, and early prosthetic integration of transhumeral amputation with a biceps brachii-based traction sling. Eligible patients had irreversible brachial plexus palsy, complete loss of useful upper-limb function, chronic shoulder instability or traction-related symptoms, pain, and persistent distress related to the paralysed limb as a burdensome nonfunctional appendage. Outcomes included the Disabilities of the Arm, Shoulder and Hand (DASH) score, Visual Analog Scale (VAS) for pain, and SF-36 Physical Functioning and Emotional Well-Being domains. Results are reported descriptively as individual values and medians without hypothesis testing. Results: All five patients completed follow-up, which reached 30 months. After combined transhumeral amputation, biceps sling construction, RPNI, rehabilitation, and prosthetic fitting, patient-reported scores changed in this small uncontrolled series as follows. The median DASH score changed from 64 preoperatively to 50 postoperatively; in this context, DASH reflects global perceived disability and may be influenced by pain relief, altered expectations, prosthetic compensation, psychosocial adaptation, and the removal of a burdensome limb rather than restoration of upper-limb function. Median VAS pain score changed from 7 to 0; VAS captured overall pain intensity only and did not separately measure phantom limb pain, mechanical pain, neuropathic pain, deafferentation pain, or traction-related symptoms. SF-36 Physical Functioning changed from 75 to 100, and Emotional Well-Being from 75 to 100. Four patients were fitted with a myoelectric prosthesis, and one elected to use a cosmetic prosthesis. No postoperative surgical complications, socket-related complications, prosthesis abandonment, clinical shoulder dislocation, or obvious failure of the construct were observed. Two Paralympic athletes returned to competitive sport after rehabilitation. Conclusions: The combined procedure was technically feasible in five highly selected patients and was not associated with observed surgical or prosthetic complications during follow-up. After combined transhumeral amputation, biceps sling construction, RPNI, rehabilitation, and prosthetic fitting, patient-reported scores improved in this small uncontrolled series. The specific contribution of the biceps sling relative to amputation itself, RPNI, prosthetic rehabilitation, and patient selection remains unknown. Larger prospective studies with objective assessment of shoulder and stump stability are needed to validate these preliminary findings and refine patient-selection criteria. Full article

Background: Total knee arthroplasty (TKA) is a common procedure to relieve pain and restore function in osteoarthritis patients. Postoperative rehabilitation is essential to address pain, swelling, reduced range of motion, and functional limitations. Hydrotherapy, using water buoyancy and resistance, may enhance recovery, but evidence on its effectiveness after these surgeries remains limited. Methods: A systematic literature search was conducted across six databases: PubMed, ProQuest, Science Direct, Google Scholar, Scopus, the Cochrane Library, and PEDro, covering studies published up to 30 November 2025. Only prospective randomized controlled trials were considered for inclusion. Studies such as case reports, uncontrolled case series, and those focused on outcomes other than postoperative pain and decreased muscle strength in patients undergoing total knee arthroplasty were excluded. This review was registered in PROSPERO (CRD420251164054). Results: Pooled analysis showed no statistically significant difference between hydrotherapy and land-based or usual-care rehabilitation in Visual Analogue Scale (VAS)-measured pain (MD ≈ −0.35; 95% CI $[-1.06, 0.36]$; $p=0.34$) or in WOMAC pain (MD ≈ −0.46; 95% CI $[-8.50, 7.58]$; $p=0.89$). In contrast, hydrotherapy produced a moderate, statistically significant improvement in lower-limb muscle strength (Hedges’ $g=0.46$; 95% CI $[0.23, 0.69]$), particularly in knee extensor and hip abductor strength. Heterogeneity was low for VAS pain and muscle strength but substantial for WOMAC pain ($I^2\approx 71\%$), and no evidence of publication bias was identified. Conclusions: Hydrotherapy did not reduce postoperative pain more than land-based exercise or usual care; pain relief was comparable between approaches, whereas hydrotherapy yielded greater gains in muscle strength. Heterogeneity in treatment parameters and the limited number of high-quality trials preclude definitive conclusions; future research should standardize hydrotherapy protocols and investigate long-term outcomes. Full article

Background/Objectives: Repetitive transcranial magnetic stimulation (rTMS) has been increasingly investigated as an adjunctive intervention in neurorehabilitation, particularly for motor recovery after stroke. However, conventional rTMS protocols remain limited by variability in target localization, inter-individual anatomical differences, lesion-related network reorganization, and limited reproducibility across treatment sessions. Neuronavigated repetitive transcranial magnetic stimulation (nrTMS) integrates structural neuroimaging with real-time coil tracking, enabling more precise and reproducible stimulation of patient-specific cortical targets. This approach may be especially relevant in patients with focal brain lesions, postoperative anatomical distortion, or functionally reorganized networks. Methods: This narrative review summarizes the biological rationale, current clinical evidence, practical workflow, and limitations of nrTMS in neurorehabilitation, with particular attention to the distinction between conventional rTMS and neuronavigated protocols. Results: The strongest evidence for rTMS-based rehabilitation remains in post-stroke motor recovery, although most studies have used non-navigated protocols. In contrast, postoperative neuro-oncological rehabilitation represents a clinically relevant but still investigational context for nrTMS, as preoperative functional mapping, postoperative deficits, and early rehabilitation can be integrated within a patient-specific therapeutic pathway. Early studies suggest feasibility when stimulation is combined with structured physiotherapy; however, the available evidence is based on small and heterogeneous cohorts, and clinically meaningful superiority over conventional rTMS or standard rehabilitation has not yet been established. Data in traumatic brain injury, multiple sclerosis, ataxias, and neurodegenerative disorders are still preliminary and heterogeneous. Conclusions: Neuronavigation should not be interpreted as an independent therapeutic breakthrough, but rather as a precision-enhancing component of rTMS-based rehabilitation. Its main potential value lies in improving targeting accuracy, session-to-session reproducibility, and integration with individualized neuroimaging and rehabilitation goals. Accordingly, nrTMS should currently be considered a precision-enhancing and hypothesis-generating framework rather than an established rehabilitation standard. Full article

Background: Drop finger may occur in patients with C7 and/or C8 cervical radiculopathy caused by cervical spondylosis. Although surgical decompression of the affected nerve roots is performed in patients with drop finger refractory to conservative treatment, postoperative recovery of drop finger is often unsatisfactory. Furthermore, no effective rehabilitation strategy for improving drop finger has yet been established. Methods: Here, we report a patient with drop finger who underwent a novel postoperative rehabilitation program. A 64-year-old man presented with drop finger of the left hand caused by left C7 and C8 radiculopathy and underwent cervical foraminotomy. For postoperative rehabilitation, we applied the single-joint Hybrid Assistive Limb (HAL), a wearable robotic suit. The patient underwent a total of 21 sessions of metacarpophalangeal HAL training, which assisted voluntary flexion and extension movements of the metacarpophalangeal joints, and 6 sessions of wrist abduction HAL training, which assisted ulnar-direction wrist abduction movements. Results: As a result, improvement in the left-sided drop finger was achieved. In this case, the use of HAL enabled voluntary motor training within the normal range of motion of the fingers and wrist even during the early postoperative phase, when sufficient neurological recovery had not yet been achieved. Conclusions: This successful motor experience may have facilitated the reacquisition of normal movement patterns, thereby contributing to improvement in drop finger. Full article

Background/Objectives: Restricted tongue mobility may require lingual frenotomy; postoperative scarring can cause secondary restriction, making rehabilitation relevant. We evaluated tongue mobility and pressure after frenotomy with adjunctive myofascial rehabilitation, and their association with adherence. Methods: This retrospective observational longitudinal study analyzed anonymized records of 64 patients aged 5–46 years treated between 2021 and 2024. All underwent frenotomy followed by a structured Myofascial Release Technique (MRT) protocol. Tongue mobility (Tongue Elevation at Maximal Mouth Opening, TEMMO) and tongue pressure (Iowa Oral Performance Instrument, IOPI) were assessed at baseline and at up to four follow-up visits (≈15 months). Adherence was classified retrospectively as high (≥3 home MRT sessions/week) or low. Results: Among V4 completers (n = 30), mean IOPI increased from 35.4 to 49.0 kPa and mean TEMMO improved from 3.1 to 1.4; 66.7% achieved TEMMO grade 1. Higher adherence was associated with better final tongue pressure (52.7 vs. 43.5 kPa; mean difference, 9.2 kPa; 95% CI, 0.8–17.6; p = 0.032). No postoperative complications were documented. Conclusions: Lingual frenotomy with adjunctive MRT-based rehabilitation was associated with favorable tongue-function changes and better adherence with better long-term outcomes among completers. Prospective controlled studies are needed to clarify the contributions of surgery, rehabilitation, and adherence. Full article

With the increasing number of stroke patients, there is a growing demand for lower-limb rehabilitation exoskeletons. While current mechanisms are preferred for their light weight and dexterous design in limited environments, the alignment of the structures and motion are still not matched perfectly to human movements. This study develops a novel structure and configuration optimization method for knee part rehabilitation with special passive self-alignment modules. The driving segment is mechanically coupled to the patients’ lower limb. All components are designed with high rigidity and fully constrained to ensure smooth and continuous motion. Then, the kinematics are systematically derived to establish the foundation for the control system. Next, the application of the particle swarm optimization algorithm determines the optimal parameters for each revolute joint during the bending motion, and reduces the non-ideal S-shaped motion deformation curve caused by the offset of the joint rotation center and the load at the end effector successfully. The final results demonstrate that the optimized SRE achieves 97.5% motion accuracy under large-angle knee movement. This work presents simulation-only validation, and clinical testing remains future work. The proposed mechanism provides a promising solution for post-stroke rehabilitation, and is also applicable to geriatric lower-limb weakness and orthopedic postoperative recovery. Full article

Background/Objectives: To evaluate the clinical feasibility and short-term radiographic outcomes of adapting a prosthesis-based guide system originally developed for single-implant placement for multi-implant placement in the edentulous maxilla, and to compare implant-level marginal bone change from prosthetic loading to one year between full-rough (IBT/IBNT/IBR) and hybrid-surface (MSC-IBT/MSC-IBNT) implants in a split-mouth design. Patient-reported outcomes were assessed with the OHIP-14 questionnaire. Methods: Fifteen patients with an edentulous maxilla received four or five maxillary implants placed flaplessly using a 3D-printed prosthesis-based guide incorporating polyether-ether-ketone (PEEK) rails and interchangeable angulation-correction sleeves (0°, 12°, 24°). Implants had either a fully roughened or a hybrid (rough apical and middle third with a machined coronal collar) surface. Side allocation was non-randomized: the hybrid side was assigned by alternating sequence and three patients received only full-rough implants for prosthetic reasons. All patients followed a delayed loading protocol and received a screw-retained zirconia fixed bridge. Standardized periapical radiographs were obtained at definitive prosthetic loading (baseline) and at the 12-month follow-up. Implant-level marginal bone loss was calculated as the mean of mesial and distal measurements per implant. All radiographic measurements were performed by two independent examiners (M.T. and T.M.); intra-rater reliability (M.T., remeasurement of 10 radiographs) and inter-rater reliability (M.T. versus T.M., full dataset) were quantified by intraclass correlation coefficient (ICC; two-way mixed effects, absolute-agreement, single-measurement). The primary split-mouth surface comparison was performed at the patient level by averaging implant-level change scores within each surface for each patient and comparing the paired patient-level means with a Wilcoxon signed-rank test. No a priori sample-size calculation was performed; the study was designed as a feasibility pilot. Results: Sixty-one implants were placed in 15 patients (seven male, eight female; mean age 62.5 ± 8.9 years; three current smokers). Four implants in three patients required removal and replacement during the observation period (three early failures, one late failure; per-implant early-failure rate of 3/61, 4.9%); one patient (P7) withdrew from clinical follow-up. Paired baseline and 12-month radiographs were available for 53 implants from 14 patients. Median implant-level marginal bone level increased from 0.38 mm (IQR 0.20–0.54) at baseline to 0.78 mm (IQR 0.47–1.32) at 12 months (paired Wilcoxon signed-rank, p < 0.001); two implants exceeded 4 mm of bone change at 12 months. In the patient-level paired surface comparison (n = 8 patients contributing at least one full-rough and one hybrid implant with paired data), full-rough implants showed less 12-month marginal bone change than hybrid implants in every paired patient (median paired difference full-rough hybrid of −0.49 mm; Hodges–Lehmann pseudo-median of 0.55 mm; paired Wilcoxon p = 0.012). OHIP-14 scores at one year (n = 14) showed a pronounced floor effect, with most patients scoring zero across most domains. Both intra-rater (M.T.) and inter-rater (M.T. versus T.M.) reliability showed good agreement (ICC = 0.85). Conclusions: A prosthesis-based guide system originally validated for single-implant placement can be feasibly adapted for flapless multi-implant rehabilitation of the edentulous maxilla, with early clinical and radiographic outcomes broadly consistent with comparable published series. Contrary to the design rationale that a machined coronal collar would limit early crestal remodeling, full-rough implants showed less 12-month within-patient bone change than hybrid implants in the eight paired patients; this finding is preliminary and hypothesis generating given the small, unbalanced paired sample and the contrast with larger published series. The approach is best characterized as a reduced infrastructure alternative to proprietary guided-surgery platforms, remains operator dependent, and requires confirmation in formally powered, balanced split-mouth trials with concealed allocation, placement anchored bone level measurement, postoperative CBCT for deviation quantification, and longer follow-up. Full article

Background: The rehabilitation of patients who have undergone extensive maxillectomy for neoplastic lesions is a significant clinical challenge. The resulting anatomical and functional defects severely impact quality of life, and traditional removable prostheses often lack stability. Zygomatic implants offer a viable solution by providing stable anchorage in the zygomatic bone, bypassing the need for bone reconstruction. Methods: This case report details the rehabilitation of a 62-year-old female patient with a history of recurrent oral squamous cell carcinoma. A fully digital workflow, including CBCT and CAD/CAM technology, was used for meticulous surgical and prosthetic planning. The surgical procedure involved a guided maxillectomy, a free forearm flap reconstruction, and the simultaneous placement of two zygomatic implants and one conventional implant. The procedure was done with EZGOMA guided surgery, which, starting from the EZPLAN software design of zygomatic and traditional implants, allowed us to determine the implant’s position in the three-dimensional axes and also the position of the internal hexagon. This allowed us to design the implant beneath the diagnostic wax-up in the three axes, and also to calculate the degrees of inclination of the multi-unit abutment. Results: All implants achieved primary stability with a torque exceeding 45 Ncm. The patient received an immediate provisional prosthesis, which allowed for the rapid restoration of phonetic and esthetic function. The post-operative course was uneventful, with no complications. Follow-up imaging confirmed the successful integration of the implants and the absence of any prosthetic or surgical issues at 24-month successful follow-up. Conclusions: This case suggests that implant-supported rehabilitation with zygomatic implants can be a highly effective treatment for patients with severe maxillary defects following cancer surgery. By using an integrated surgical and prosthetic strategy, along with advanced digital technology, we can achieve fast, safe, and predictable results. This approach successfully restores both function and esthetics, even in challenging anatomical situations. The auxilium of guided plates is a helpful aid for both implant placement and managing bone resection during cancer surgery. Full article

Background/Objectives: Structural retear after rotator cuff repair does not always correspond to poor clinical outcomes. Functional factors may help explain this discrepancy and may have rehabilitation relevance in patients with postoperative retear. This study aimed to evaluate the association of preoperative external-to-internal rotation strength ratio for postoperative pain and functional outcomes in patients with retear after arthroscopic rotator cuff repair. Methods: This retrospective cohort study included 72 patients who underwent arthroscopic rotator cuff repair at a tertiary referral center between January 2015 and December 2019 and whose magnetic resonance imaging performed 5–6 months after surgery revealed postoperative retear. Patients were classified according to the preoperative external-to-internal rotation strength ratio into a normal group (NG; ratio, 60–80%; n = 34) and an abnormal group (AG; n = 38). Postoperative outcomes were assessed at 1 year and 2 years using functional and pain visual analog scale (FVAS and PVAS), the American Shoulder and Elbow Surgeons (ASES) score, and Constant score. Two-way repeated measures analysis of variance (ANOVA) was used to assess group and time effects and group × time interaction. Results: No significant between-group differences were observed at baseline for PVAS and FVAS scores, ASES score, or Constant score. During follow-up, NG showed significantly lower PVAS values at 1 year (p = 0.007) and 2 years (p = 0.009), significantly higher FVAS scores at 1 year (p = 0.002) and 2 years (p = 0.007), significantly higher Constant scores at 1 year (p = 0.019) and 2 years (p = 0.020), and significantly higher ASES scores at 2 years than the AG (p = 0.041). Repeated-measures ANOVA demonstrated significant time effects for all outcome measures (all p < 0.001) and significant group effects for PVAS (p = 0.007) and FVAS scores (p = 0.002) and ASES (p = 0.016) and Constant scores (p = 0.012). No significant group × time interaction was observed for any outcome measure. Conclusions: A normal preoperative external-to-internal rotation strength ratio was associated with better pain and functional outcomes in patients with structurally confirmed postoperative retear after arthroscopic rotator cuff repair. These findings suggest that preoperative rotator cuff strength balance may provide clinically useful information for postoperative functional stratification. Full article

Incentive spirometry is widely used in respiratory rehabilitation to enhance lung expansion and prevent postoperative pulmonary complications. However, conventional devices, including volume-oriented and flow-oriented incentive spirometers, rely on subjective visual interpretation, which may limit measurement accuracy and clinical utility. A digital incentive spirometer (DIS) has been developed to provide objective, real-time measurements of inspiratory volume. This study aimed to evaluate the agreement and reliability between the DIS and a volume-oriented incentive spirometer (VIS) across different age groups. A cross-sectional study was conducted in 150 participants aged 7–80 years, stratified into five age groups with equal sex distribution. Inspiratory volume was measured simultaneously using both devices. Agreement was assessed using Bland–Altman analysis, and reliability was evaluated using intraclass correlation coefficients (ICC). The DIS demonstrated good overall reliability (ICC = 0.868, 95% CI: 0.821–0.903). The mean difference was 48.69 mL, indicating slight overestimation by the DIS. However, the limits of agreement were wide (−469.24 to 566.63 mL), suggesting limited interchangeability. Reliability varied across age groups, with the highest ICC in older adults and the lowest in adolescents. The DIS showed good reliability but limited agreement with the VIS. Full article

Background/Objectives: Previous studies have measured a limited number of biomechanical parameters during medical rehabilitation of an anterior cruciate ligament (ACL) rupture. This study aimed to quantitatively assess changes in gait biomechanics, knee function, and lower-extremity muscle activity during after ACL reconstruction. Methods: The study included 32 patients after arthroscopic ACL reconstruction. The patients were divided into three groups based on postoperative time points: 0.5 year (12 men), 1 year (7), and over 1 year (9). Gait analysis at both self-selected and fast speeds was performed using an inertial system. Statistical analysis was performed using rank models and full-factorial orthogonal designs. Results: After 0.5 year, the timing of the gait cycle at self-selected speed was within the control group’s range and showed no significant asymmetry. With increasing speed, a decrease in knee joint range of motion was observed in the 0.5 year and 1-year groups, without achieving a full physiological increase in range of motion at long-term follow-up. Multivariate analysis revealed the greatest biomechanical imbalance during fast walking at one year and a phase-dependent effect of time after surgery, speed, and limb status on kinematics and EMG, particularly in the quadriceps. Conclusions: Basic temporal gait parameters during self-selected walking were within the control range by 0.5 year, but load-dependent knee kinematic and EMG abnormalities persisted. The knee joint’s response to increased loads remained impaired for at least one year. The persistence of phase-specific compensatory changes in kinematics and muscle activity at later stages can be assessed using exercise testing. Full article

Background: Glioblastoma (used to be called glioblastoma multiforme—GBM) is the most common and aggressive brain tumor, having the lowest overall survival rate. Initial focal neurological deficits are primarily attributable to surrounding edema; however, as tumor invasion progresses, these deficits become more pronounced and permanent. The standard treatment for newly diagnosed glioblastoma is represented by cytoreductive neurosurgery followed by the Stupp Protocol. Postoperative recovery of the patient with glioblastoma is a long-term process that should include, for overall more acceptable outcomes, neurorehabilitation. This review aims to bring together evidence from neuro-oncology, neurosurgery, and neurorehabilitation in order to better understand the factors associated with recovery, functional status, and quality of life (QoL) after glioblastoma surgery. Our work also aimed to update the related knowledge base and to attempt to optimize the related protocols in patients with operated cerebral glioblastoma. Methods: For these purposes, we conducted a systematic literature review to assess the current state of research referring to the above-mentioned topic. We have used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA—widely recognized internationally) methodology. We used, in this respect, specific keyword combinations/“syntaxes” for searching literature in the domain, in four international databases. Results: Following PRISMA screening, 14 studies met the predefined eligibility criteria. Additional manual reference screening and complementary searches identified further relevant publications, resulting in a total of 22 included articles. Together, the reviewed work addressed a diverse range of topics relevant to postoperative glioblastoma management, including the potential role of multidisciplinary rehabilitation, cognitive interventions, neuromodulation approaches, and functional assessment strategies in improving postoperative outcomes and QoL in glioblastoma patients, while emphasizing that this interdisciplinary domain warrants more extended approaches. Discussion and Conclusions: Despite the relatively limited and largely exploratory available information, neurorehabilitation may contribute to improved functional outcomes and QoL in patients with glioblastoma. Full article

Background: Chronic corticosteroids are commonly prescribed for autoimmune and inflammatory disorders, yet their impact on perioperative outcomes following elective total hip arthroplasty (THA) remains incompletely defined. This study evaluated the association between chronic corticosteroid use and postoperative complications and hospital outcomes after elective primary THA. Methods: We performed a retrospective cohort study using the National Inpatient Sample (2016–2021). Adult patients undergoing elective primary THA were identified using ICD-10-PCS codes. Chronic corticosteroid use was defined by ICD-10-CM code Z79.52. The primary outcome was any postoperative complication, including venous thromboembolism (VTE), major bleeding, acute kidney injury, myocardial infarction, stroke, or sepsis. Secondary outcomes included prolonged length of stay, high hospital charges, discharge to rehabilitation, and in-hospital mortality. Multivariable weighted logistic regression and 1:1 propensity score matching (PSM) was applied. Results: The weighted cohort represented approximately 600,000 hospitalizations, of which 0.91% involved chronic steroid use. Steroid users had a higher burden of comorbidities. After adjustment, chronic corticosteroid use was independently associated with increased odds of any postoperative complication (OR 1.32), major bleeding (OR 1.46), prolonged hospitalization (OR 1.26), discharge to rehabilitation (OR 1.06), and in-hospital mortality (OR 2.53). In the matched cohort (1079 pairs), steroid use remained significantly associated with overall complications (OR 1.84) and acute kidney injury (OR 2.10). Conclusions: Although uncommon, chronic corticosteroid use is associated with a clinically meaningful increase in perioperative morbidity after elective THA. These findings highlight chronic corticosteroid use as a marker of increased perioperative risk that warrants greater clinical recognition, and they provide hypothesis-generating evidence to inform future studies of perioperative management in this population. Full article

Background: Neuromodulation is a rapidly developing field with growing interest in its application in neuro-oncology, particularly since the publication of the EF-14 trial which demonstrated a survival benefit conferred by tumour treating fields (TTF) in patients with glioblastoma. In addition, the emerging field of cancer neuroscience has postulated the role of neural–tumour communication in tumour aetiology, which is theoretically targetable by neuromodulation strategies. This scoping review therefore aims to comprehensively evaluate current or future applications of neuromodulation in managing patients with brain tumours, encompassing preclinical and clinical studies. Methods: The MEDLINE database was queried for all relevant articles from inception to 1 December 2024. A synthesis of findings was performed, broadly categorised to preclinical and clinical research. Findings: The database search returned 3296 results, from which 187 full-text articles were further assessed. A total of 79 studies met the inclusion and exclusion criteria and were included. The results from preclinical studies (n = 18) were stratified according to modality which included electrical therapy, electroporation, electromagnetic field (EMF) and deep brain stimulation (DBS). Similarly, clinical studies (n = 61) were classified to preoperative modalities such as transcranial magnetic stimulation (TMS) and transcranial direct stimulation (tDCS), and postoperative modalities such as TMS, TTF, EMF and spinal cord stimulation (SCS). Interpretation: The application of neuromodulation as adjunctive therapy in the context of neuro-oncology is an emerging field, with encouraging results in various modalities across a wide range of applications from surgical planning and functional rehabilitation, to its therapeutic potential. Further research is urgently needed to harness the potential of neuromodulation in improving patient outcomes. Full article

Background: Mechanical complications remain a concern after vertebral body replacement (VBR), especially during rehabilitation. Yet exercise prescription is often guided by body posture or single loading measures. This study characterized mechanical demands during rehabilitation exercises after VBR and examined the effects of posture and postoperative time. Methods: Telemetric in vivo load data from instrumented VBRs in the OrthoLoad database were analyzed. A total of 119 trials across 21 exercises, performed in supine, prone, seated, and standing positions, were collected from five patients over 0.1–63 postoperative months. Mechanical demand was quantified across six biomechanical domains and integrated into a composite SafetyIndex. Posture- and time-related effects were assessed using linear mixed-effects models. Worst-case demand was defined as the 95th percentile of SafetyIndex values. Results: SafetyIndex showed a right-skewed distribution (median 8.5, IQR 3.7–14.1), with marked inter-exercise variability. Composite SafetyIndex did not differ between postures (all p > 0.13). However, posture-dependent effects emerged at the domain level: peak shear ratio was greater in prone than in sitting, standing, and supine positions (all p < 0.05); peak force was greater in standing than prone (p = 0.007 and p = 0.013 in unadjusted and adjusted models); and peak resultant moment was smaller in supine than prone (p = 0.036 and p = 0.046). Postoperative time was positively associated with peak force (β = +0.40 %BW/month, p = 0.042), peak resultant moment (β = +0.025 Nm/month, p < 0.001), and SafetyIndex (β = +0.25/month, p = 0.011), but not peak shear ratio (p = 0.879). Worst-case SafetyIndex_P95 values ranged from 0.6 to 85.0, with stable ranking across percentile thresholds (Spearman’s ρ = 0.995–0.997). Conclusions: Mechanical demand after VBR is task-specific and domain-dependent and cannot be inferred from posture alone. Axial and bending-related components increased over postoperative time, whereas shear-related loading remained task-dependent. Full article