Objective
Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one’s physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia.
Methods
Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology.
Results
Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended.
Conclusion
This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.

Citations

• Using concept mapping to guide dysphagia service enhancements in Singapore: Recommendations from the speech-language pathology workforce
  Flora M.M Poon, Elizabeth C. Ward, Clare L. Burns
  International Journal of Speech-Language Pathology.2025; 27(1): 56.     CrossRef
• Cough Suppression Therapy in Patients With Chronic Refractory Cough and Oropharyngeal Dysphagia
  ShengYing A. Chen, Jessica F. Kim, Priya Krishna, Ethan Simmons, Brianna K. Crawley, Thomas Murry
  American Journal of Speech-Language Pathology.2025; : 1.     CrossRef
• Characterization of Beverage Viscosity Based on the International Dysphagia Diet Standardisation Initiative and Its Correspondence to the Japanese Dysphagia Diet 2021
  Mari Nakao-Kato, Aya Takahashi, Jin Magara
  Nutrients.2025; 17(6): 1051.     CrossRef
• Factors influencing oropharyngeal dysphagia in individuals with chronic neurological disorders presenting to the outpatient swallowing disorder clinic
  Güleser Güney Yılmaz, Müberra Tanrıverdi, Remzi Doğan, Orhan Özturan
  Multiple Sclerosis and Related Disorders.2025; 97: 106387.     CrossRef
• The Efficacy of Outpatient Swallowing Therapy: A Retrospective Longitudinal Cohort Study
  Tyler W. Crosby, Sonja Molfenter, Matina Balou, Uche C. Ezeh, Milan R. Amin
  Dysphagia.2025;[Epub]     CrossRef
• The Role of Dysphagia on Head and Neck Cancer Patients’ Quality of Life, Functional Disabilities and Psychological Distress: Outcomes of Cancer Rehabilitation from an Observational Single-Center Study
  Špela Matko, Christina Knauseder, David Riedl, Vincent Grote, Michael J. Fischer, Samuel Moritz Vorbach, Karin Pfaller-Frank, Wilhelm Frank, Thomas Licht
  Current Oncology.2025; 32(4): 220.     CrossRef
• The impact of physical therapy on dysphagia in neurological diseases: a review
  Kun Li, Cuiyuan Fu, Zhen Xie, Jiajia Zhang, Chenchen Zhang, Rui Li, Caifeng Gao, Jiahui Wang, Chuang Xue, Yuebing Zhang, Wei Deng
  Frontiers in Human Neuroscience.2024;[Epub]     CrossRef
• Clinical Characteristics and Evaluation of Dysphagia in Patients with Parkinson’s Disease
  Seo Jung Yun, Han Gil Seo
  Journal of the Korean Dysphagia Society.2024; 14(1): 10.     CrossRef
• Updated Clinical Practice Guidelines for the Diagnosis and Management of Long COVID
  Jun-Won Seo, Seong Eun Kim, Yoonjung Kim, Eun Jung Kim, Tark Kim, Taehwa Kim, So Hee Lee, Eunjung Lee, Jacob Lee, Yu Bin Seo, Young-Hoon Jeong, Young Hee Jung, Yu Jung Choi, Joon Young Song
  Infection & Chemotherapy.2024; 56(1): 122.     CrossRef
• Association between the C-reactive protein/albumin ratio and mortality in older Japanese patients with dysphagia
  Chunhong Guo, Pingping Zheng, Shiyang Chen, Lin Wei, Xiuzhen Fu, Youyuan Fu, Tianhong Hu, Shaohua Chen
  Frontiers in Nutrition.2024;[Epub]     CrossRef
• Compensatory strategies of dysphagia after anterior cervical spinal surgery: A case report
  Sung Joon Chung, Jun Ho Lee, Yunsoo Soh
  Medicine.2024; 103(29): e39016.     CrossRef
• The Right ICD Code, Right Now: A Call to Action for Pragmatic Language Disorders After Right Hemisphere Stroke
  Jamila Minga, Shanika Phillips Fullwood, Deborah Rose, Danai Kasambira Fannin
  American Journal of Speech-Language Pathology.2024; 33(6): 3121.     CrossRef
• Dysphagia Screening in Residential Long-Term Care Settings in the Republic of Ireland: A Cross-Sectional Survey
  Constantino Estupiñán Artiles, Claire Donnellan, Julie Regan, Mary Mooney
  Dysphagia.2024;[Epub]     CrossRef
• Dysphagia and Dysphonia After Head and Neck Cancer
  Aaron Parsons, Karuna Dewan
  Oral Diseases.2024;[Epub]     CrossRef
• The pathophysiology of dysphagia post‐lung transplant: A systematic review
  Sana Smaoui, Elly Cummins, Maryah Mena, Summer Scott, Rodrigo Tobar‐Fredes
  Laryngoscope Investigative Otolaryngology.2024;[Epub]     CrossRef
• Effect of segmental tongue function training on tongue pressure attributes in individuals with dysphagia after receiving radiotherapy for nasopharyngeal carcinoma
  Fei Zhao, Chen Yang, Si-Ming Sun, Yao-Wen Zhang, Hong-Mei Wen, Zu-Lin Dou, Xiao-Mei Wei, Chun-Qing Xie
  BMC Oral Health.2024;[Epub]     CrossRef
• Diagnosis and treatment of dysphagia
  Kyoung Hyo Choi
  Journal of the Korean Medical Association.2023; 66(10): 604.     CrossRef

Cerebral palsy (CP) is the most common motor disability in children, characterized by diverse clinical manifestations and often uncertain etiology, which has spurred increasing interest in genetic diagnostics. This review synthesizes findings from various studies to enhance understanding of CP’s genetic underpinnings. The discussion is structured around five key areas: monogenic causes and copy number variants directly linked to CP, differential genetic disorders including atypical CP and mimics, ambiguous genetic influences, co-occurrence with other neurodevelopmental disorders, and polygenic risk factors. Case studies illustrate the clinical application of these genetic insights, underscoring the complexity of diagnosing CP due to the phenotypic overlap with other conditions and the potential for misdiagnosis. The review highlights the significant role of advanced genetic testing in distinguishing CP from similar neurodevelopmental disorders and assessing cases with unclear clinical presentations. Furthermore, it addresses the ongoing challenges in establishing a consensus on genetic contributors to CP, the need for comprehensive patient phenotyping, and the integration of rigorous genetic and functional studies to validate findings. This comprehensive examination of CP genetics aims to pave the way for more precise diagnostics and personalized treatment plans, urging continued research to overcome the current limitations and refine diagnostic criteria within this field.

Artificial intelligence (AI) tools are increasingly able to learn from larger and more complex data, thus allowing clinicians and scientists to gain new insights from the information they collect about their patients every day. In rehabilitation medicine, AI can be used to find patterns in huge amounts of healthcare data. These patterns can then be leveraged at the individual level, to design personalized care strategies and interventions to optimize each patient’s outcomes. However, building effective AI tools requires many careful considerations about how we collect and handle data, how we train the models, and how we interpret results. In this perspective, we discuss some of the current opportunities and challenges for AI in rehabilitation. We first review recent trends in AI for the screening, diagnosis, treatment, and continuous monitoring of disease or injury, with a special focus on the different types of healthcare data used for these applications. We then examine potential barriers to designing and integrating AI into the clinical workflow, and we propose an end-to-end framework to address these barriers and guide the development of effective AI for rehabilitation. Finally, we present ideas for future work to pave the way for AI implementation in real-world rehabilitation practices.

Citations

• Blending Bytes and Bench Presses: The Future of Online Exercise and Artificial Intelligence-Enhanced Rehabilitation
  Rowena Naidoo, Verusia Chetty
  Journal of Physical Activity and Health.2025; 22(1): 2.     CrossRef
• The potential role of artificial intelligence to promote the participation and inclusion in physical exercise and sports for people with disabilities: A narrative review
  João Paulo Pereira Rosa
  Journal of Bodywork and Movement Therapies.2025; 42: 127.     CrossRef
• Estimation of elbow flexion torque using equilibrium optimizer on feature selection of NMES MMG signals and hyperparameter tuning of random forest regression
  Raphael Uwamahoro, Kenneth Sundaraj, Farah Shahnaz Feroz
  Frontiers in Rehabilitation Sciences.2025;[Epub]     CrossRef
• From screens to scenes: A survey of embodied AI in healthcare
  Yihao Liu, Xu Cao, Tingting Chen, Yankai Jiang, Junjie You, Minghua Wu, Xiaosong Wang, Mengling Feng, Yaochu Jin, Jintai Chen
  Information Fusion.2025; 119: 103033.     CrossRef
• Artificial intelligence in stroke rehabilitation: From acute care to long-term recovery
  Spandana Rajendra Kopalli, Madhu Shukla, B. Jayaprakash, Mayank Kundlas, Ankur Srivastava, Jayant Jagtap, Monica Gulati, Sridevi Chigurupati, Eiman Ibrahim, Prasanna Shama Khandige, Dario Salguero Garcia, Sushruta Koppula, Amin Gasmi
  Neuroscience.2025; 572: 214.     CrossRef
• Deep Learning for Predicting Rehabilitation Success: Advancing Clinical and Patient-Reported Outcome Modeling
  Yasser Mahmoud, Kaleb Horvath, Yi Zhou
  Electronics.2025; 14(6): 1082.     CrossRef
• AI-Driven Telerehabilitation: Benefits and Challenges of a Transformative Healthcare Approach
  Rocco Salvatore Calabrò, Sepehr Mojdehdehbaher
  AI.2025; 6(3): 62.     CrossRef
• Harnessing Generative Artificial Intelligence for Exercise and Training Prescription: Applications and Implications in Sports and Physical Activity—A Systematic Literature Review
  Luca Puce, Nicola Luigi Bragazzi, Antonio Currà, Carlo Trompetto
  Applied Sciences.2025; 15(7): 3497.     CrossRef
• Functional and motoric outcome of AI-assisted stroke rehabilitation: A meta-analysis of randomized controlled trials
  Tivano Antoni, Benedictus Benedictus, Stefanus Erdana Putra
  Brain Disorders.2025; 18: 100224.     CrossRef
• Applying AI to Safely and Effectively Scale Care to Address Chronic MSK Conditions
  Anabela C. Areias, Dora Janela, Robert G. Moulder, Maria Molinos, Virgílio Bento, Carolina Moreira, Vijay Yanamadala, Fernando Dias Correia, Fabíola Costa
  Journal of Clinical Medicine.2024; 13(15): 4366.     CrossRef
• RETRACTED ARTICLE: Using AI to navigate complex neurosurgical procedures in rare gliomas
  Mayur Wanjari, Gaurav Mittal, Roshan Prasad
  Neurosurgical Review.2024;[Epub]     CrossRef
• Quantifying Asymmetric Gait Pattern Changes Using a Hidden Markov Model Similarity Measure (HMM-SM) on Inertial Sensor Signals
  Gabriel Ng, Aliaa Gouda, Jan Andrysek
  Sensors.2024; 24(19): 6431.     CrossRef
• Artificial Intelligence in Medical Education and Mentoring in Rehabilitation Medicine
  Julie K. Silver, Mustafa Reha Dodurgali, Nara Gavini
  American Journal of Physical Medicine & Rehabilitation.2024; 103(11): 1039.     CrossRef
• Artificial Intelligence and Its Revolutionary Role in Physical and Mental Rehabilitation: A Review of Recent Advancements
  Amir Rahmani Rasa, Alejandro L. Borja
  BioMed Research International.2024;[Epub]     CrossRef
• Enhanced gait tracking measures for individuals with stroke using leg-worn inertial sensors
  Francesco Lanotte, Shusuke Okita, Megan K. O’Brien, Arun Jayaraman
  Journal of NeuroEngineering and Rehabilitation.2024;[Epub]     CrossRef

This systematic review aims to determine the effectiveness of non-pharmacological interventions for the management of spasticity in people with multiple sclerosis (pwMS). A comprehensive literature search in health science databases (MEDLINE, Embase, CENTRAL, CINHAL) was performed to identify randomized controlled trials (RCTs) (up to April 2024). Manual searching in journals and screening of the reference lists of identified studies were conducted. Two authors independently selected the studies, assessed the methodological quality, and summarized the evidence. A meta-analysis was not feasible due to the methodological, clinical, and statistical diversity of the included studies. Overall, 32 RCTs (n=1,481 participants) investigated various types of non-pharmacological interventions including: physical activity, transcranial magnetic stimulation (intermittent theta burst stimulation [iTBS], repetitive transcranial magnetic stimulation [rTMS]), electromagnetic therapy, transcutaneous electrical nerve stimulation, vibration therapy, shock wave therapy, self-management educational programs, and acupuncture. All studies scored ‘low’ on the methodological quality assessment, implying a high risk of bias. The findings suggest ‘moderate to low certainty’ evidence for physical activity programs used in isolation or combination with other interventions (pharmacological or non-pharmacological), and for iTBS/rTMS with or without adjuvant exercise therapy in improving spasticity in adults with MS. There is ‘very low certainty’ evidence supporting the use of other modalities for treating spasticity in this population. Despite a wide range of non-pharmacological interventions used for the management of spasticity in pwMS, there is a lack of conclusive evidence for many. More robust trials with larger sample sizes and longer-term follow-ups are needed to build evidence for these interventions.

Objective
To determine the normative values of the Korean version of the Modified Barthel Index (K-MBI) score for typically developing children in Korea and assess its suitability for use in children.
Methods
Rehabilitation physicians and occupational therapists with children were invited through an online platform to participate in a survey assessing their children’s performance of activity of daily living (ADL) using the K-MBI. The questionnaire encompassed queries on sociodemographic information of children and the assessment criteria outlined in the K-MBI. The standardized K-MBI scores by age were estimated using the nonlinear least squares method.
Results
The analysis incorporated responses from a total of 206 individuals. K-MBI total scores showed a rapid increase over the first 8 years of life, with 99% of children achieving a score of 90 or higher by age 8. Mobility scores exhibited a swift increase during early childhood, surpassing 90% of the maximum score at 3 years of age and nearing 100% at 7 years of age. In contrast, self-care scores demonstrated a more gradual advancement, achieving approximately 100% of the maximum score by the age of 10 years.
Conclusion
Age-specific normative values for K-MBI scores of typically developing children were established, which can be used as a reference in clinical care. While the K-MBI captured the overall trajectory of children’s ADL development, it did not discern subtle differences across various developmental stages. There is a need for the development of more refined assessment tools tailored specifically to children.

The impact of disease-modifying therapy ranges from cure to no impact with a wide range of intermediates. In cases where the intermediate group reaches a plateau after the acquisition of some muscle strength, it is necessary to set a functional level appropriate for increased motor power and establish a long-term exercise plan to maintain it. As the disease status stabilizes and the life span increases, early nonsurgical interventions are required, such as using a standing frame to prevent joint contracture, applying a spinal brace at the early stage of scoliosis, and maintaining sitting postures that exaggerate lumbar lordosis. In cases where scoliosis and hip displacement occur and progress even after conservative managements are implemented, early referral to surgery should be considered. Oromotor activity and swallowing function are influenced not only by the effects of disease-modifying drugs, but also by post-birth experience and training. Therefore, although the feeding tube cannot be removed, it is necessary to make efforts to simulate the infant feeding development while maintaining partial oral feeding. Since the application period of non-invasive ventilators has increased, it has become more important to prevent long-term complications such as facial abrasion, skin allergy, orthodontic deformities, and maxillary flattening caused by the interface. Dual ventilator mode or interface can also be utilized.

Sarcopenic dysphagia is characterized by weakness of swallowing-related muscles associated with whole-body sarcopenia. As the number of patients with sarcopenia increases with the aging of the world, the number of patients with sarcopenic dysphagia is also increasing. The prevalence of sarcopenic dysphagia is high in the institutionalized older people and in patients hospitalized for pneumonia with dysphagia in acute care hospitals. Prevention, early detection and intervention of sarcopenic dysphagia with rehabilitation nutrition are essential. The diagnosis of sarcopenic dysphagia is based on skeletal and swallowing muscle strength and muscle mass. A reliable and validated diagnostic algorithm for sarcopenic dysphagia is used. Sarcopenic dysphagia is associated with malnutrition, which leads to mortality and Activities of Daily Living (ADL) decline. The rehabilitation nutrition approach improves swallowing function, nutrition status, and ADL. A combination of aggressive nutrition therapy to improve nutrition status, dysphagia rehabilitation, physical therapy, and other interventions can be effective for sarcopenic dysphagia. The rehabilitation nutrition care process is used to assess and problem solve the patient’s pathology, sarcopenia, and nutrition status. The simplified rehabilitation nutrition care process consists of a nutrition cycle and a rehabilitation cycle, each with five steps: assessment, diagnosis, goal setting, intervention, and monitoring. Nutrition professionals and teams implement the nutrition cycle. Rehabilitation professionals and teams implement the rehabilitation cycle. Both cycles should be done simultaneously. The nutrition diagnosis of undernutrition, overnutrition/obesity, sarcopenia, and goal setting of rehabilitation and body weight are implemented collaboratively.

Citations

• Dual burden of sarcopenia and impaired oral status on activities of daily living, cognition and swallowing outcomes in post-stroke patients
  Yoshihiro Yoshimura, Hidetaka Wakabayashi, Fumihiko Nagano, Ayaka Matsumoto, Sayuri Shimazu, Ai Shiraishi, Yoshifumi Kido, Takahiro Bise, Takenori Hamada, Kouki Yoneda
  Archives of Gerontology and Geriatrics.2025; 129: 105648.     CrossRef
• Progress in dysphagia management in older patients
  Gero Lueg, Maryam Pourhassan, Rainer Wirth
  Current Opinion in Clinical Nutrition & Metabolic Care.2025; 28(1): 14.     CrossRef
• The rehabilitation nutrition oral care process: Implementing the triad of rehabilitation, nutrition, and oral management
  Hidetaka Wakabayashi
  Journal of General and Family Medicine.2025; 26(2): 114.     CrossRef
• The Effect of Extremely Low-Frequency Magnetic Field on Stroke Patients: A Systematic Review
  Renata Marchewka, Tomasz Trzmiel, Katarzyna Hojan
  Brain Sciences.2024; 14(5): 430.     CrossRef
• Malnutrition and cachexia may affect death but not functional improvement in patients with sarcopenic dysphagia
  Mai Yamanaka, Hidetaka Wakabayashi, Shinta Nishioka, Ryo Momosaki
  European Geriatric Medicine.2024; 15(3): 777.     CrossRef
• Association between sarcopenia and urinary dysfunction in patients with dysphagia
  Shingo Kakehi, Hidetaka Wakabayashi, Eri Isono, Ryohei Takemura, Yuka Sato, Yukiko Otsuka, Takako Nagai, Shinta Nishioka, Ryo Momosaki
  Archives of Gerontology and Geriatrics.2024; 127: 105577.     CrossRef
• Treatment of Esophageal Achalasia With Sarcopenic Dysphagia by Rehabilitation and Nutritional Support: A Case Report
  Fumiko Furukawa, Kiyohito Kakita
  Cureus.2024;[Epub]     CrossRef
• Nutritional care in older adults: are we doing everything? An expert opinion review
  Elisabet Sanchez-Garcia, Alfonso J. Cruz-Jentoft, Paula Ravasco, Merja Suominen, Prof Kaisu Pitkälä
  Current Medical Research and Opinion.2024; 40(9): 1563.     CrossRef
• Age and sex differences in sarcopenic dysphagia: A secondary data analysis
  Hidetaka Wakabayashi, Shingo Kakehi, Ayano Nagano, Masako Kishima, Masataka Itoda, Shinta Nishioka, Ryo Momosaki
  Journal of General and Family Medicine.2024; 25(6): 343.     CrossRef
• Triad of rehabilitation, nutrition support, and oral management improves activities of daily living and muscle health in hospitalized patients after stroke
  Yoshihiro Yoshimura, Sayuri Shimazu, Ai Shiraishi, Hidetaka Wakabayashi, Fumihiko Nagano, Ayaka Matsumoto, Yoshifumi Kido, Takahiro Bise, Aomi Kuzuhara, Takenori Hamada, Kouki Yoneda
  Clinical Nutrition ESPEN.2024; 63: 837.     CrossRef
• The Prevalence and Prognosis of Cachexia in Patients with Non-Sarcopenic Dysphagia: A Retrospective Cohort Study
  Shingo Kakehi, Hidetaka Wakabayashi, Takako Nagai, Shinta Nishioka, Eri Isono, Yukiko Otsuka, Junki Ninomiya, Ryo Momosaki
  Nutrients.2024; 16(17): 2917.     CrossRef

Spinal cord injury (SCI) rehabilitation emphasizes locomotion. Robotic-assisted gait training (RAGT) is widely used in clinical settings because of its benefits; however, its efficacy remains controversial. We conducted a systematic review and meta-analysis to investigate the efficacy of RAGT in patients with SCI. We searched international and domestic databases for articles published until April 18, 2024. The meta-analysis employed a random effects model to determine the effect size as either mean difference (MD) or standardized MD (SMD). Evidence quality was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Twenty-three studies with a total of 690 participants were included in the final analysis. The overall pooled effect size for improvement in activities of daily living was 0.24, with SMD (95% confidence interval [95% CI], 0.04–0.43; GRADE: high) favoring RAGT over conventional rehabilitation. Muscular strength (MD, 0.23; 95% CI, 0.02–0.44; GRADE: high), walking index for SCI (MD, 0.31; 95% CI, 0.07–0.55; GRADE: moderate) and 6 min walk test distance (MD, 0.38; 95% CI, 0.14–0.63; GRADE: moderate) showed significant improvement in the robot group. Subgroup analysis revealed that subacute patients and intervention periods >2 months were more effective. This meta-analysis revealed that RAGT significantly improved activities of daily living, muscular strength, and walking abilities. Additional studies are needed to identify the optimal treatment protocol and specific patient groups for which the protocol is most effective.

Citations

• Effects of Unpredictable Perturbation Training on a Split-Belt Treadmill on Physical Performance in Older Adults: A Randomized Controlled Trial
  Kap-Soo Han, Myoung-Hwan Ko
  Geriatrics.2025; 10(1): 23.     CrossRef
• Advances and New Therapies in Traumatic Spinal Cord Injury
  Antonio Montoto-Marqués, Jesús Benito-Penalva, María Elena Ferreiro-Velasco, Mark Andrew Wright, Sebastian Salvador-De la Barrera, Hatice Kumru, Nelson Gaitán-Pérez, Agustin Hernández-Navarro, Antonio Rodríguez-Sotillo, Fernando Martins Braga, Angela Pale
  Journal of Clinical Medicine.2025; 14(7): 2203.     CrossRef
• Factors influencing on functional independence outcomes after hospitalization and rehabilitation in children with spinal cord injury
  Hong-Bo Zhao, Xiang-Jiang Rong, Qi Zhang, Ting-Ting Ma, He Yan, Tian-Tian Zhou, Yan-Qing Zhang
  BMC Pediatrics.2025;[Epub]     CrossRef

Objective
To systematically review the effects of protein supplementation in older adults with sarcopenia.
Methods
A systematic literature search was conducted in PubMed, Cochrane Library, and Embase databases until May 2023. The inclusion criteria were as follows: (1) randomized controlled trials with a quantitative study design; (2) studies with a study group of older adults with sarcopenia; (3) studies comparing muscle mass, muscle strength, and performance of older adults with sarcopenia after protein supplementation; and (4) studies published up to May 2023.
Results
Six retrospective comparative studies, including 715 patients, met the inclusion criteria. The nutritional supplementation group exhibited significant improvement in appendicular skeletal muscle mass (standardized mean difference [SMD]=0.41; 95% confidence interval [CI], 0.24–0.58; p<0.001; I²=1%), while handgrip strength (SMD=0.37; 95% CI, -0.32–1.07; p=0.29; I²=94%) and Short Physical Performance Battery (SPPB) (SMD=0.35; 95% CI, -0.47–1.18; p=0.40; I²=94%) showed a tendency for improvement.
Conclusion
Nutritional supplementation with protein increased appendicular muscle mass in older adults with sarcopenia and improved handgrip strength and SPPB scores.

Citations

• Age-related and cancer-related sarcopenia: is there a difference?
  Federico Bozzetti
  Current Opinion in Clinical Nutrition & Metabolic Care.2024; 27(5): 410.     CrossRef
• Protein‐enriched soup and weekly exercise improve muscle health: A randomized trial in mid‐to‐old age with inadequate protein intake
  Li‐Ning Peng, Ming‐Hsien Lin, Sung‐Hua Tseng, Ko‐Han Yen, Huei‐Fang Lee, Fei‐Yuan Hsiao, Liang‐Kung Chen
  Journal of Cachexia, Sarcopenia and Muscle.2024; 15(4): 1348.     CrossRef
• SuperAgers and centenarians, dynamics of healthy ageing with cognitive resilience
  Md Ariful Islam, Ujala Sehar, Omme Fatema Sultana, Upasana Mukherjee, Malcolm Brownell, Sudhir Kshirsagar, P. Hemachandra Reddy
  Mechanisms of Ageing and Development.2024; 219: 111936.     CrossRef
• Consumption of protein supplements/protein-fortified foods among young adults in Jeju
  Hyoju Lee, Youjeong Jang, Sumin Kim, Kyungho Ha
  Journal of Nutrition and Health.2024; 57(2): 261.     CrossRef
• Impact of increased protein intake in older adults: a 12-week double-blind randomised controlled trial
  Janine Wirth, Annalisa Segat, Katy Horner, Domenico Crognale, Thomas Smith, Maurice O’Sullivan, Lorraine Brennan
  Age and Ageing.2024; 53(Supplement): ii13.     CrossRef
• Nutrition resilience for healthy ageing
  Claire T McEvoy, Colin D McClure
  Age and Ageing.2024; 53(Supplement): ii1.     CrossRef
• Study of whey protein on muscle mass and functional rehabilitation in postoperative total knee arthroplasty patients
  Mengshi Li, Qiongfang Shi, Xinle Che, Xingyan Du, Dongming Wang, Yufeng Song
  Journal of Back and Musculoskeletal Rehabilitation.2024; 37(5): 1381.     CrossRef
• Functional status of the cardiovascular system in elderly patients with sarcopenia
  Iu. Samoilova, M. Matveeva, D. Podchinenova, Ya. Yakimova, L. Shuliko, V. Avkhimenko, D. Kudlay, E. Samoylov, E. Khoroshunova, A. Ragimov
  Vrach.2024; : 48.     CrossRef

Objective
To prove 5-time sit-to-stand (5-STS) and 30-second sit-to-stand (30sSTS) tests in assessing cardiorespiratory fitness in chronic heart failure (HF) patients with systolic dysfunction. Alternative tests, such as 5-STS and 30sSTS, may be used to assess cardiorespiratory fitness in patients with HF but have not been thoroughly evaluated. Thus, this study aimed to prove 5-STS and 30sSTS tests in assessing cardiorespiratory fitness in chronic HF patients with systolic dysfunction.
Methods
A cross-sectional study was done, evaluating chronic HF patients with systolic dysfunction that have received optimal guideline directed medical treatment for at least 3 months. All patients underwent the same intervention on the same day, starting with an initial 5-STS test, followed by a 30sSTS, and a 6-minute walk test (6MWT).
Results
A total of 34 patients were enrolled in this study. The median left ventricular ejection fraction was 44% (interquartile range=34%–48%). Mean values of 5-STS, 30sSTS, and 6MWT were 13.90±4.72, 13.29±3.38, and 463.65±87.04, respectively. 5-STS showed moderate correlation with 6MWT (r=-0.436, p=0.01). However, the 30sSTS revealed strong correlation with 6MWT (r=0.629, p<0.001).
Conclusion
The 30sSTS test had strong correlation with 6MWT. It could be used to illustrate cardiorespiratory fitness in chronic HF patients with systolic dysfunction.

Objective
To assess postural stability, specifically center of body sway during single-leg standing balance, among individuals with and without forward head posture (FHP) during smartphone use.
Methods
The research recruited 53 healthy smartphone users, aged 18–25, and categorized them into FHP group comprising 26 subjects and the normal (control) group with 27 subjects. Participants were assigned the task of maintaining balance while engaged in smartphone typing during single-leg standing. The experiment involved four specific conditions according to neck posture and stable of surface. The study meticulously quantified body center of pressure (COP) sway amplitudes using the Nintendo Wii Balance Board.
Results
The research revealed that individuals with FHP exhibited significantly greater body sway compared to the control group when using smartphones. Notably, distinct variations were observed in path length sway, anteroposterior (AP), and mediolateral (ML) sway amplitude, particularly evident when maintaining flexed neck positions on a soft surface while engaged with smartphones.
Conclusion
These findings strongly suggest that individuals with FHP encounter deteriorated postural stability during smartphone use, particularly in challenging head positions.

Citations

• Validity of a qualitative visual method for diagnosing forward head posture
  Shohei Shibasaki, Tomonori Kishino, Yoriko Sei, Keiichiro Harashima, Konomi Sakata, Hiroaki Ohnishi, Takashi Watanabe
  Musculoskeletal Science and Practice.2025; 76: 103282.     CrossRef
• Assessment of balance in overweight and obese young adults: utilizing centre of pressure displacement variables in the single leg sit-to-stand test
  Noppharath Sangkarit, Weerasak Tapanya, Patchareeya Amput, Chananya Muangchuen, Piyaporn Seeta, Worrasak Paleeta
  International Journal of Adolescence and Youth.2025;[Epub]     CrossRef
• Evaluating fall risk in community-dwelling older adults through balance assessment with the Nintendo Wii Balance Board
  Weerasak Tapanya, Noppharath Sangkarit, Puttipong Poncumhak, Saisunee Konsanit
  Human Movement.2025; 26(1): 161.     CrossRef

Objective
To compare the progression of muscle fibrosis of various site and its relation between cardiac deterioration in Duchenne muscular dystrophy (DMD). In this study aimed to examine the associations between echocardiogram-based cardiac function indices and fibrosis of the abdominal and lower extremity muscles in patients with DMD to facilitate early detection of cardiac dysfunction and identify its predictors.
Methods
Twenty-one patients with DMD patients were enrolled in the study. The association between cardiac dysfunction and fibrosis of the abdominal and lower extremity muscles was determined by analyzing the echocardiography and elastography. Non-parametric Spearman rank correlation coefficients were used to examine the pairwise relationships between cardiac function and muscle elasticity.
Results
All patients were male and non-ambulant. Their mean age was 18.45±4.28 years. The strain ratios of the abdominal muscle and quadriceps muscles were significantly higher than those of the medial gastrocnemius. The strain ratio of the rectus abdominis muscle has a significant negative correlation with left ventricular ejection fraction. Cardiac function and valvular insufficiency were not significantly correlated with muscle strain ratio. According to the result of our study, the only skeletal muscle which showed significant correlation with cardiac dysfunction was degree abdominal muscle fibrosis.
Conclusion
The degree of fibrosis of respiratory muscles was also significantly associated with cardiac dysfunction; therefore, it can be used as a predictor of cardiac dysfunction in patients with DMD in clinical practice.

Objective
To establish and evaluate the validity of the recently developed Korean version of the Oxford Cognitive Screen (K-OCS), this study verified its reliability, validity, and diagnostic accuracy.
Methods
Between November 2021 and December 2023, we recruited 72 patients with stroke from our hospital who agreed to participate in the study. The patients were repeatedly tested using K-OCS by the same or different assessors to estimate inter- and intra-rater reliability. To demonstrate the validity and usability of K-OCS, the test results of screening tools currently used in clinical practice, including the Korean-Mini Mental State Examination and the Korean version of the Montreal Cognitive Assessment, were used in comparison analyses.
Results
The subtests of K-OCS demonstrated excellent inter-rater reliability (intra-class correlation coefficient [ICC]=0.914–0.998) and test–retest reliability (ICC=0.913–0.994). We found moderate-to-strong correlations for convergent validity for the subsets (r=0.378– 0.979, p<0.01), and low-to-moderate discriminant validity correlations. The optimal cut-offs estimated for the subtests of the K-OCS showed a good-to-high range of specificity (94.8%– 100%). The positive predictive value was 58.2%–100% and negative predictive value was 65.6%–98.4%. Sensitivity was estimated at 25.6%–86.9%.
Conclusion
The results of this study indicate that K-OCS is a reliable and valid tool for screening cognitive impairment in patients post-stroke.

Objective
To comprehensively assess the relationship between nerve conduction study (NCS), sympathetic skin response (SSR), and demographic factors in patients with diabetic neuropathy, exploring potential risk factors and mechanisms.
Methods
A retrospective study (N=184) included patients diagnosed with type 2 diabetes mellitus undergoing NCS and SSR. Demographic, clinical, and laboratory data were analyzed. Patients were categorized by diabetic peripheral neuropathy (DPN) and SSR stages for comparative analysis.
Results
HbA1c levels correlated with DPN progression. SSR stages exhibited age-related differences. Height correlated with DPN but not SSR stages. Body mass index showed no significant differences.
Conclusion
While DPN progression correlated with glycemic control and duration of diabetes, SSR was influenced by age. Unexpectedly, cholesterol levels remained within the normal range, challenging established concepts. Understanding these relationships is crucial for interpreting test results and developing targeted interventions for diabetic neuropathy.

Objective
To determine the factors influencing the life satisfaction of people with physical disabilities during the COVID-19 pandemic, considering demographics, disability-related characteristics, health behaviors, and psychosocial characteristics.
Methods
We used cross-sectional data from 301 respondents of the 2021/2022 survey of the Korean Health Cohort Study for People with Physical Disabilities. Descriptive statistics were used to analyze the research subjects’ characteristics, and chi-square tests and multiple logistic regression were used to identify the determinants of life satisfaction.
Results
Among socio demographic variables, occupation had a strong association with life satisfaction. Significant health behavior variables included daily regular meals, weight control effort, and chronic pain. All psychosocial characteristics (perceived stress, depression, suicidal ideation, cognitive function assessment, subjective health status, family satisfaction, income satisfaction) were strongly associated with life satisfaction. Results of the analysis of factors affecting life satisfaction showed that unemployment, lack of regular exercise, elevated stress, suicidal thoughts, and dissatisfaction with family contributed to increased life dissatisfaction.
Conclusion
Economic support through job creation that considers the specific characteristics of people with disabilities, and social access through community integration services that encourage participation in social activities, should be prioritized.

Objective
To determine the effectiveness of adding inspiratory muscle training (IMT) alongside a pulmonary rehabilitation protocol in terms of inspiratory muscle strength, lung function, and exercise capacity in burned adults.
Methods
A randomized, double-blinded, sham-controlled study. Fifty-two adult patients with burn injuries, more than 20 years old and at least 20% total body surface area, were assigned randomly either to the experimental or the conventional group. The participants in the experimental group were given IMT plus a pulmonary rehabilitation program; the conventional group received only a pulmonary rehabilitation program. The interventions were performed for 8 weeks. At the beginning and after 8 weeks of training, the respiratory muscles’ strength, lung function and exercise capacity were all examined.
Results
After 2 months of training, the experimental group demonstrated statistically significant improvements than conventional group in maximum inspiratory pressure, maximum expiratory pressure, 6-minute walk test, forced vital capacity, and forced expiratory volume in 1 second (p<0.05).
Conclusion
An 8-week IMT program coupled with pulmonary rehabilitation increases respiratory muscle strength, pulmonary functions, and functional capacity in burn patients. IMT is a beneficial and efficient therapy that can be easily implemented for burn patients.

Objective
To identify the prevalence and factors associated with T-score discordance between the spine and hip, as well as between the paretic and non-paretic hips in hemiplegic stroke patients, this study investigated bone mineral density (BMD) patterns. Bone loss predominantly affects the paretic hip after a stroke, and typical clinical assessments using dual-energy X-ray absorptiometry (DXA) that scan the lumbar spine (LS) and a single hip may overlook an osteoporosis diagnosis. This oversight could potentially lead to suboptimal treatment for stroke patients.
Methods
This study was a multicenter retrospective analysis of 540 patients admitted for stroke rehabilitation between October 2014 and February 2022, who underwent DXA of LS and bilateral hips.
Results
The prevalence rates of concordance, low LS discordance, and low hip discordance between the LS and hips were 48.2%, 12.2%, and 39.6%, respectively. The discordance rate between bilateral hips was 17.0%. The paretic side had significantly lower total hip T-scores than the non-paretic side (p<0.001). Notably low paretic hip discordance was more prevalent during the chronic phase. DXA scans of the LS and both hips revealed a 0.7%–0.9% higher major discordance compared to LS and single hip DXA scans. The multivariate analysis revealed a significant correlation between a low paretic hip discordance and cognitive impairment (adjusted odds ratio 0.071, 95% confidence interval 0.931–1.003, p<0.05).
Conclusion
Since stroke survivors are at high risk for hip fractures, comprehensive BMD assessments, which include LS and bilateral hips, should be considered for post-stroke osteoporosis care to enhance diagnostic accuracy and timely treatment.

Citations

• Association between bone mineral density and stroke: a meta-analysis
  Peng Zhao, Huaxia Sun
  Frontiers in Neurology.2025;[Epub]     CrossRef

Objective
Tremors are caused by contractions of reciprocally innervated muscles. The role of ultrasound in diagnosing tremors has not yet been investigated, although it appears to be promising because it can visualize muscle movements. In the present study, we report four cases of tremor (Holmes’ tremor, extremity tremor associated with palatal myoclonus, dystonic tremor, and tremor associated with dystonia), which were evaluated using ultrasound and treated with botulinum toxin injections.
Methods
The muscles of patients with tremors were examined using B- or M-mode ultrasound while they were in the supine position. Tremor was determined by involuntary muscular contraction (B-mode) or fasciculation (M-mode) from recorded sonography clips. Thereafter, tremors were measured as frequency and amplitude of specific muscles. Ultrasound-guided botulinum toxin type A injection was administered, and follow-up ultrasonography was used to assess tremors.
Results
Tremors, which manifest as a specific set of muscle contractions, were measured using ultrasonography and treated with botulinum toxin injection. Follow-up ultrasonography revealed improved tremors as seen with decreased frequency and amplitude of specific muscle after the intervention, which included medication and botulinum toxin injections.
Conclusion
Ultrasonography is an effective assessment tool for tremors, allowing further information regarding tremor characteristics with high sensitivity, playing a role in detecting specific muscles that are affected by tremors, and guiding an exact intervention with botulinum toxin.

Objective
To evaluate the association between outcomes, including affected extremity functions and activities of daily living (ADL), and fractional anisotropy (FA) derived from automated tractography incorporating age among patients after stroke.
Methods
This study enrolled stroke patients, and diffusion-tensor imaging was conducted during the second week. Standardized automated tractography was utilized to compute FA values in the corticospinal tract (CST), the inferior fronto-occipital fasciculus (IFOF), and the superior longitudinal fasciculus (SLF). Outcome evaluations were performed at discharge from our affiliated rehabilitation facility. Extremity functions were assessed using the total scores of the motor component of the Stroke Impairment Assessment Set (SIAS-motor). Independence levels in ADL were appraised through the motor and cognition components of the Functional Independence Measure (FIM). For each outcome measure, multivariate regression analysis incorporated the FA values of the CST, the IFOF, and the SLF, along with age.
Results
Forty-two patients were enrolled in the final analytical database. Among the four explanatory variables, the CST emerged as the most influential factor for SIAS-motor scores. Conversely, age proved to be the primary determinant for both the motor and cognition components of FIM, surpassing the impact of FA metrics, including the CST and the IFOF.
Conclusion
The key influencing factors exhibited significant variations based on the targeted outcome assessments. Clinicians should be aware of these differences when utilizing neuroimaging techniques to predict stroke outcomes.

Objective
To culturally adapt the original English Scale for the Assessment and Rating of Ataxia to Thai (SARA-TH) and to evaluate the reliability and validity of the SARA-TH in assessing ataxia in acute ischemic stroke or transient ischemic attack (TIA) patients, as assessed by three healthcare professionals.
Methods
The SARA underwent translation and cross-cultural adaptation to Thai according to established guidelines. Reliability (e.g., internal consistency, intrarater reliability, interrater reliability) and validity (e.g., content validity, convergent validity) were assessed in a sample of 50 participants with ataxia after acute ischemic stroke or TIA. Spearman correlation analysis was used to examine the relationships between the SARA-TH and the Barthel Index (BI-TH), the National Institutes of Health Stroke Scale (NIHSS-TH), and the International Cooperative Ataxia Rating Scale (ICARS) to assess convergent validity. Interrater and intrarater reliability among experienced and novice neurologists, physiotherapists, and occupational therapists were assessed using weighted kappa.
Results
The SARA-TH demonstrated good comprehension and exhibited no significant floor or ceiling effects. It showed excellent internal consistency (Cronbach’s α≥0.776). Significant correlations were found between the SARA-TH score and the BI-TH score (rs=-0.743 to -0.665), NIHSS- TH score (rs=0.404–0.513), and ICARS score (rs=0.859–0.917). The intrarater reliability for each rater ranged from 0.724 to 1.000 (p<0.01), and the interrater reliability varied from 0.281 to 0.927 (p<0.01).
Conclusion
The SARA-TH has excellent internal consistency, validity, and intrarater reliability, as well as acceptable interrater reliability among health professionals with varying levels of experience. It is recommended for assessing ataxia severity in individuals following acute ischemic stroke or TIA.

Objective
To implement early rehabilitation interventions by physical therapists is recommended. However, the effectiveness of early rehabilitation for severe coronavirus disease 2019 (COVID-19) patients in the prevention of post-intensive care syndrome (PICS) is unclear. We analyzed a multicenter prospective observational study (Post-Intensive Care outcomeS in patients with COronaVIrus Disease 2019) to examine the association between early rehabilitation interventions and PICS physical impairment.
Methods
An analysis was performed on COVID-19 patients who were admitted to intensive care units (ICUs) between March 2020 and March 2021, and required mechanical ventilation. The primary outcome was the incidence of PICS physical impairment (Barthel Index≤90) after one year. Multivariate logistic regression analysis was used to estimate the association between early rehabilitation interventions and PICS physical impairment by adjusting ICU mobility scale (IMS) during seven-day following ICU admission, and clinically relevant risk factors.
Results
The analysis included 259 patients, 54 of whom developed PICS physical impairment one year later. In 81 patients, physical therapists intervened within seven days of ICU admission. There was no significant difference in mean IMS by day seven of admission between the early and non-early rehabilitation patients (0.70 and 0.61, respectively). Multivariate logistic regression analysis showed that early rehabilitation interventions were significantly associated with a low incidence of PICS physical impairment (odds ratio, 0.294; 95% confidence interval, 0.123–0.706; p=0.006).
Conclusion
Early rehabilitation interventions by physical therapists were an independent factor associated with the decreased development of PICS physical impairment at one year, even though early rehabilitation had no significant effect on IMS.

Objective
To evaluate muscle strength and cardiorespiratory parameters, this study uses simple tests in older adults, including those who have and have not recovered from mild coronavirus disease 2019 (COVID-19).
Methods
Eighty older adults (age≥60 years old) were divided into two groups: those without previous COVID-19 (control group, n=40) and those with recovery from mild COVID-19 (recovered group, n=40). Muscle strength was assessed using a handgrip strength test and the sit-to-stand test (STS10). Cardiorespiratory parameters were evaluated with a 1-minute sitto- stand (1-min STS) test and a 6-minute walk test (6MWT).
Results
Both groups had normal values for body mass index, blood pressure, heart rate, and pulse oxygen saturation. The recovered group showed significant differences in handgrip strength test (24.73±6.99 vs. 22.03±4.36, p=0.041) and duration for the STS10 (25.15±6.11 vs. 33.40±7.56, p<0.001) when compared to the control group. Furthermore, the recovered group had significantly decreased repetitions of a 1-min STS (31.38±4.89 vs. 21.25±3.64, p<0.001) and increased the rate of perceived exertion (RPE) (7.43±1.20 vs. 8.95±1.01, p=0.01) and leg fatigue (1.49±1.13 vs. 3.00±1.04, p=0.03) after performing a 1-min STS when compared with the control group. Moreover, the recovered group had also significantly decreased distances for the 6MWT (421.68±8.28 vs. 384.35±6.17, p<0.001) and increased the post-test RPE (7.63±1.37 vs. 12.05±1.63, p<0.001) and the post-test leg fatigue (1.71±0.88 vs. 5.28±0.91, p<0.001) compared with the control group.
Conclusion
Older adults with recovery from mild COVID-19 reported reduced muscle strength and exercise tolerance when compared with older adults without COVID-19.

Objective
To investigate longitudinal changes in plantar pressure examinations and plain radiographs and to assess the correlations between these two modalities in pediatric patients with flexible flatfoot (FFF).
Methods
Pediatric patients diagnosed with FFF were analyzed in this retrospective cohort study. Medical records were reviewed to collect data on plain radiographs and plantar pressure examinations. Changes in radiographic angles and plantar pressure parameters were analyzed over a follow-up period exceeding 1 year. Statistical analyses included paired t-test, Wilcoxon signed rank test, and Spearman’s correlation analysis.
Results
A total of 52 subjects was included in the plantar pressure analysis, with a mean age of 9.9 years at the first visit and a median follow-up duration of 52 months. The lateral tarso-first metatarsal angle decreased by 1.3° (p<0.001) and calcaneal inclination angle increased by 2.5° (p<0.001) in these patients. The percentage value of midfoot width (WMF) divided by forefoot width (WFF) decreased by an average of 9.8% p (p<0.001), and the maximal pressure on the medial midfoot (MMF) decreased by 1.6 N/cm2 (p<0.001). However, no correlations were found between plantar pressure and radiographic changes.
Conclusion
During follow-up of patients with FFF, the maximal pressure on the MMF and the ratio of WMF to WFF decreased in successive plantar pressure examinations. Changes observed in plantar pressure and plain radiographs were not consistent, indicating that these two testing modalities can complement each other.

Objective
To determine the efficacy of concentric vs. eccentric exercise in improving shoulder function, pain, and tendon characteristics for patients with rheumatoid arthritis and rotator cuff tendinopathy.
Methods
Forty patients with rheumatoid arthritis and rotator cuff tendinopathy were divided into either concentric or eccentric exercise groups, with 20 patients in each group. Patients received 12 sessions at a pace of 3 sessions per week. Shoulder Pain and Disability Index (SPADI), the visual analogue scale (VAS), supraspinatus and subscapularis thickness, echo pixels, and the Disease Activity Score-28-erythrocyte sedimentation rate (DAS-28-ESR) were assessed at baseline and post-treatment.
Results
There was a significant difference between the concentric and eccentric groups regarding SPADI and VAS scores in favor of the eccentric group. However, there was no significant difference between the two groups regarding tendon thickness, echo pixels, or DAS-28-ESR.
Conclusion
Eccentric exercises were more effective than concentric exercises in improving shoulder function and pain intensity. However, neither of the two types of exercises was superior in improving tendon characteristics or disease activity.

Citations

• Response: Eccentric Versus Concentric Exercises in Patients With Rheumatoid Arthritis and Rotator Cuff Tendinopathy: A Randomized Comparative Study (Ann Rehabil Med 2023;47:26-35)
  Mina Magdy Wahba, Mona Selim, Mohammed Moustafa Hegazy, Rasmia Elgohary, Mohammed Shawki Abdelsalam
  Annals of Rehabilitation Medicine.2024; 48(1): 3.     CrossRef
• Letter to the Editor: Eccentric Versus Concentric Exercises in Patients With Rheumatoid Arthritis and Rotator Cuff Tendinopathy: A Randomized Comparative Study
  Vanshika Agarwal, Jeyanthi. S, Adarsh Sharma
  Annals of Rehabilitation Medicine.2024; 48(1): 1.     CrossRef

Citations

• Exploring Nintendo Wii Balance Board as a tool to assess lower limb muscle strength for fall risk screening in elderly women
  Weerasak Tapanya, Noppharath Sangkarit, Patchareeya Amput
  Translational Medicine of Aging.2025; 9: 1.     CrossRef

Post-stroke spastic movement disorder (PS-SMD) develops in up to 40% of stroke survivors after a first ever stroke within the first year. Chronic PS-SMD is often associated with severe disabilities and complications, emphasizing the importance of its early recognition and early adequate management. Extensive research has aimed to accurately predict and sensitively detect a PS-SMD. Symptomatic therapies include conventional rehabilitation and local intramuscular injections of botulinum toxin A (BoNT-A). The latter is widely used, but primarily in the chronic phase of stroke. However, recent studies have shown the safety and efficacy of BoNT-A therapy even in the acute phase and early sub-acute phase after stroke, i.e., within three months post-stroke, leading to an improved long-term outcome in stroke rehabilitation. Local BoNT-A injections evolve as the primary approach in focal, multifocal, and segmental chronic or acute/subacute PS-SMD. Patients at high risk for or manifest PS-SMD should be identified by an early spasticity risk assessment. By doing so, PS-SMD can be integral part of the patient-centered goal-setting process of a multiprofessional spasticity-experienced team. The benefit of an early PS-SMD treatment by BoNT-A should predominate putative degenerative muscle changes due to long-term BoNT-A therapy by far. This, as early treatment effectively avoids complications typically associated with a PS-SMD, i.e., contractures, pain, skin lesions. The management of PS-SMD requires a comprehensive and multidisciplinary approach. Early assessment, patient-centered goal setting, early intervention, and early use of BoNT-A therapy prevents from PS-SMD complications and may improve rehabilitation outcome after stroke.

Citations

• How many stroke survivors develop problematic spasticity requiring pharmacological therapy? An international (Europe and USA) observational study protocol
  Richard D Zorowitz, Laura Serrano Barrenechea, Simon Butet, Sergiu Groppa, David Hernández Herrero, Rama Prasad, Susan Sandars, Seema Meloni, Simon Page, Pascal Maisonobe, Alessandro Picelli
  BMJ Open.2025; 15(1): e087404.     CrossRef
• The Role of Botulinum Toxin Type-A in Spasticity: Research Trends from a Bibliometric Analysis
  Salvatore Facciorusso, Stefania Spina, Alessandro Picelli, Alessio Baricich, Gerard E. Francisco, Franco Molteni, Jörg Wissel, Andrea Santamato
  Toxins.2024; 16(4): 184.     CrossRef
• Botulinum Toxin in Treatments for Abnormal Movements
  María Gabriela González Chico, Xaviera Elizabeth Medina Godoy, Miliana Esperanza Estupiñan Bazurto, María José López Becerra
  Más Vita.2024; 6(2): 82.     CrossRef
• Botulinum Toxin Type A (BoNT-A) Use for Post-Stroke Spasticity: A Multicenter Study Using Natural Language Processing and Machine Learning
  María Jesús Antón, Montserrat Molina, José Gabriel Pérez, Santiago Pina, Noemí Tapiador, Beatriz De La Calle, Mónica Martínez, Paula Ortega, María Belén Ruspaggiari, Consuelo Tudela, Marta Conejo, Pedro Leno, Marta López, Carmen Marhuenda, Carlos Arias-Ca
  Toxins.2024; 16(8): 340.     CrossRef
• Risk factors for post-stroke spasticity: a retrospective study
  Chuanxi Zhu, Lingxu Li, Long Qiu, Guangcheng Ji
  Frontiers in Neurology.2024;[Epub]     CrossRef
• Early is Better, Then, How Early and How to Apply: Practical Approach of Botulinum Toxin Injection
  Joon-Ho Shin
  Annals of Rehabilitation Medicine.2023; 47(6): 439.     CrossRef

Objective
To evaluate the relationship between respiratory muscle strength, diaphragm thickness (DT), and indices of sarcopenia.
Methods
This study included 45 healthy elderly volunteers (21 male and 24 female) aged 65 years or older. Sarcopenia indices, including hand grip strength (HGS) and body mass index-adjusted appendicular skeletal muscle (ASM/BMI), were measured using a hand grip dynamometer and bioimpedance analysis, respectively. Calf circumference (CC) and gait speed were also measured. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were obtained using a spirometer, as a measure of respiratory muscle strength. DT was evaluated through ultrasonography. The association between indices of sarcopenia, respiratory muscle strength, and DT was evaluated using Spearman’s rank correlation test, and univariate and multiple regression analysis.
Results
ASM/BMI (r=0.609, p<0.01), CC (r=0.499, p<0.01), HGS (r=0.759, p<0.01), and gait speed (r=0.319, p<0.05) were significantly correlated with DT. In the univariate linear regression analysis, MIP was significantly associated with age (p=0.003), DT (p<0.001), HGS (p=0.002), CC (p=0.013), and gait speed (p=0.026). MEP was significantly associated with sex (p=0.001), BMI (p=0.033), ASM/BMI (p=0.003), DT (p<0.001), HGS (p<0.001), CC (p=0.001) and gait speed (p=0.004). In the multiple linear regression analysis, age (p=0.001), DT (p<0.001), and ASM/BMI (p=0.008) showed significant association with MIP. DT (p<0.001) and gait speed (p=0.050) were associated with MEP.
Conclusion
Our findings suggest that respiratory muscle strength is associated with DT and indices of sarcopenia. Further prospective studies with larger sample sizes are needed to confirm these findings.

Citations

• The Role of Diaphragmatic Ultrasound in Identifying Sarcopenia in COPD Patients: A Cross-Sectional Study
  Nur Aleyna Yetkin, Sibel Akın, Derya Kocaslan, Burcu Baran, Bilal Rabahoglu, Fatma Sema Oymak, Nuri Tutar, İnci Gulmez
  International Journal of Chronic Obstructive Pulmonary Disease.2025; Volume 20: 1.     CrossRef
• Relationship Between Diaphragm Function and Sarcopenia Assessed by Ultrasound: A Cross-Sectional Study
  Takahiro Shinohara, Toru Yamada, Shuji Ouchi, Suguru Mabuchi, Ryoichi Hanazawa, Kazuharu Nakagawa, Kanako Yoshimi, Tatsuya Mayama, Ayane Horike, Kenji Toyoshima, Yoshiaki Tamura, Atsushi Araki, Haruka Tohara, Akihiro Hirakawa, Takuma Kimura, Takeshi Ishid
  Diagnostics.2025; 15(1): 90.     CrossRef
• Descriptive Epidemiology and Prognostic Significance of Diaphragm Thickness in the General Population: The Nagahama Study
  Yasuharu Tabara, Takeshi Matsumoto, Kimihiko Murase, Takahisa Kawaguchi, Kazuya Setoh, Tomoko Wakamura, Toyohiro Hirai, Kazuo Chin, Fumihiko Matsuda
  Journal of Cachexia, Sarcopenia and Muscle.2025;[Epub]     CrossRef
• Diaphragm thickness and ICU admission risk in elderly COVID-19 patients: a CT-based analysis
  Mercan Tastemur, Cagla Ozdemir, Esin Olcucuoğlu, Gunes Arik, Ihsan Ates, Kamile Silay
  BMC Pulmonary Medicine.2025;[Epub]     CrossRef
• Definition, diagnosis, and treatment of respiratory sarcopenia
  Shinjiro Miyazaki, Akira Tamaki, Hidetaka Wakabayashi, Hidenori Arai
  Current Opinion in Clinical Nutrition & Metabolic Care.2024; 27(3): 210.     CrossRef
• Diaphragm Ultrasound in Different Clinical Scenarios: A Review with a Focus on Older Patients
  Carmine Siniscalchi, Antonio Nouvenne, Nicoletta Cerundolo, Tiziana Meschi, Andrea Ticinesi
  Geriatrics.2024; 9(3): 70.     CrossRef
• Appropriate body position and site for diaphragm ultrasound: Comparison with inspiratory mouth pressure
  Kazunori Okada, Akiko Kamiya, Yusuke Yanagi, Masahiro Nakabachi, Yasuhiro Hayashi, Michito Murayama, Sanae Kaga
  WFUMB Ultrasound Open.2024; 2(2): 100052.     CrossRef
• Evaluation of the Functional Reserve and Exercise Tolerance in Patients with CHF in Clinical Trials (Consent Document of the Editorial board of the Journal of Cardiology, the Board of the Society of Specialists in Heart Failure (SSHF) and Working Group “N
  Yu. L. Begrambekova, G. P. Arutynov, M. G. Glezer, N. A. Karanadze, E. A. Kolesnikova, T. A. Lelyavina, A. S. Lishuta, Ya. A. Orlova, Yu. N. Belenkov
  Kardiologiia.2024; 64(7): 4.     CrossRef
• Validating respiratory sarcopenia diagnostic criteria by mortality based on a position paper by four professional organizations: Insights from the Otassha study
  Takeshi Kera, Hisashi Kawai, Manami Ejiri, Keigo Imamura, Hirohiko Hirano, Yoshinori Fujiwara, Kazushige Ihara, Shuichi Obuchi
  Geriatrics & Gerontology International.2024; 24(9): 948.     CrossRef
• Evaluating Respiratory Muscle Strength in Sarcopenia Screening among Older Men in South Korea: A Retrospective Analysis
  Tae Sung Park, Sa-Eun Park, Ki-Hun Kim, Sang Hun Kim, Myung Hun Jang, Myung-Jun Shin, Yun Kyung Jeon
  The World Journal of Men's Health.2024; 42(4): 890.     CrossRef
• Tongue pressure, respiratory muscle and limb strength and functional exercise capacity in oesophageal cancer
  Takuya Fukushima, Makoto Yamasaki, Nobuyuki Yamamoto, Yasuaki Arima, Takashi Harino, Soshi Hori, Yuki Hashimoto, Masaya Kotsuka, Kentaro Inoue, Kimitaka Hase, Jiro Nakano
  BMJ Supportive & Palliative Care.2024; 14(4): 434.     CrossRef

Objective
To assess whether performing exercises during hemodialysis reduces the risk of developing intradialytic hypotension and enhances exercise capacity in patients with chronic kidney disease.
Methods
This study included patients aged ≥18 years undergoing hemodialysis. Participants performed exercises using a portable lower extremity ergometer during hemodialysis sessions for 3 weeks. Data regarding walking distance, knee strength, quality of life, fat-free mass, arterial pressure, blood pressure, heart rate, frequency of intradialytic hypotension, fatigue, and duration of hemodialysis were collected and analyzed.
Results
Significant improvements in walking distance and knee strength were observed following the implementation of exercise training during hemodialysis. Although there was no significant reduction in the frequency of intradialytic hypotension, a decreasing trend was noted. Other parameters such as quality of life and fatigue did not show significant changes.
Conclusion
Using a portable ergometer during hemodialysis improved exercise capacity and knee strength in patients with chronic kidney disease. There was a trend toward reduced intradialytic hypotension, suggesting potential cardiovascular benefits. Further research with larger sample sizes is needed to confirm these findings.

Citations

• Can exercise reduce fatigue in people living with kidney disease?
  Thomas J. Wilkinson, Lisa Ancliffe, Jamie H. Macdonald
  Current Opinion in Clinical Nutrition & Metabolic Care.2025; 28(3): 200.     CrossRef