Juan Pablo Appelgren González

Objective . Low back pain (LBP) is a significant public health issue. Despite current medical imaging and neurophysiological tests, up to 90% of patients lack a clear cause, leading to a diagnosis of chronic primary LBP (CPLP). Non-invasive functional near-infrared spectroscopy (fNIRS) was employed to detect spinal cord dysfunctions by recording perispinal neurovascular response (NVR). Approach . In a prospective study of 71 CPLP patients and 65 healthy age-matched volunteers, pain maps, visual analog scale (VAS), body mass index (BMI), posterior tibial nerve conduction velocity (NCV), and lumbar and cervical NVRs triggered by non-noxious electrical stimulation of this nerve were assessed. Main results . CPLP patients exhibited a 53.29% reduction in NVR amplitude at the cervical level compared to the controls, with no significant difference at the lumbar level. CPLP patients compared to controls show a rise time of 6.64% and 5.14% larger in cervical and lumbar recordings, respectively, but a duration of 10.11% and 5.32% shorter, respectively. Posterior tibial NCV was within normal clinical range in both groups. In CPLP patients, VAS scores were negatively correlated with NVR rise time, amplitude, and duration at the lumbar site, as well as with rise time and duration at the cervical site ( p < 0.05). Additionally, BMI showed a negative correlation with all NVR parameters at both recording sites in CPLP patients, but not in controls ( p < 0.05). Significance . This is the first report of perispinal NVR dysfunction in patients with CPLP. Its results suggest a loss of inhibitory regulation in the lumbar spinal cord in CPLP patients and demonstrate the potential of fNIRS to detect and quantify spinal cord neurovascular dysfunctions. For the first time, perispinal NVR dysfunction is reported in CPLP patients, suggesting an altered descending modulation system at the lumbar spinal cord.

Background: Functional disability is a growing concern in aging populations with chronic health conditions, yet few studies have compared disability profiles across diagnostic categories using standardized tools. Objectives: This study aimed to characterize the functional profiles of adults with neurological, musculoskeletal, and chronic pain conditions using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) and to examine differences by age and sex. Methods: A total of 419 participants (median age = 73 years; 73% female) completed the 36-item WHODAS 2.0. Diagnoses were classified into three groups: neurological (n = 134), musculoskeletal (n = 230), and pain-related (n = 55). Domain-level scores were analyzed using non-parametric tests and Spearman correlations. Results: revealed that neurological conditions were associated with the highest disability levels, particularly in cognition, interpersonal relations, and participation. Musculoskeletal conditions showed greater impairments in mobility and self-care, while pain-related conditions demonstrated variable disability, especially in participation. Women reported higher disability scores in the neurologic group, with significant differences observed in the cognition domain among neurological cases (p = 0.048). Age was positively correlated with disability in self-care and mobility, especially in musculoskeletal conditions. Conclusions: These findings highlight the utility of WHODAS 2.0 in identifying domain-specific limitations across clinical populations. They support the need for individualized, diagnosis- and gender-sensitive rehabilitation strategies, and suggest that WHODAS 2.0 can inform targeted care planning and resource allocation in rehabilitation settings. Future research should incorporate longitudinal designs and explore contextual factors influencing functional outcomes.

One emerging method in home stroke rehabilitation is digital technology. However, existing approaches typically target one domain (e.g., upper limb). Moreover, existing interventions do not cater to older adults with stroke (OAwS), especially those with high motor impairment, who require adjunct therapeutic agents to independently perform challenging exercises. We examined the feasibility of Smartphone-based Exercise Training after Stroke (SETS) with Functional Electrical Stimulation (FES). A total of 12 participants (67 ± 5 years) with stroke (onset > 6 months) exhibiting moderate-to-high motor impairment (Chedoke McMaster Leg ≤ 4/7) underwent 6 weeks of multicomponent (gait, functional strength, dynamic balance) training integrated with FES to paretic lower limb muscles. Primary measures included safety and adherence. Secondary measures included motivation, acceptability and attitude, usability, and clinical measures of gait and balance function like the 10-Meter Walk Test and Mini-BESTest. Participants reported no adverse events and moderate-to-high adherence (84.17 ± 11.24%) and improvement (up to 40%) in motivation, acceptability, and attitude and system usability. Participants also showed pre-post improvements in all measures of gait and balance function (p < 0.05). Integrating SETS and FES is feasible and yields short-term gains in gait and balance function among OAwS. Future studies could validate our findings by examining its efficacy with control groups to identify the differential effects of SETS and FES.

Background: Rehabilitation is a critical process for enhancing functionality, independence, and quality of life in individuals with disabilities. Grounded in the biopsychosocial model, it addresses physical, emotional, and social dimensions through personalized, evidence-based interventions. By integrating standardized assessments and continuous evaluation, rehabilitation has the potential to promote recovery and support active participation in society. Objectives: This study evaluated the impact of a long-term, multidisciplinary, home-based rehabilitation program on quality of life, balance, and functional autonomy in adults with neuromusculoskeletal disabilities. Methods: A total of 559 participants received individualized interventions from a team of physical therapists, occupational therapists, psychologists, and other health professionals. Functional independence, balance, depressive symptoms, and quality of life were assessed using the Barthel Index, Berg Balance Scale, Beck Depression Inventory, and SF-36 questionnaire, respectively. Results: A longitudinal analysis comparing pre- and post-intervention outcomes revealed statistically significant improvements (p < 0.001) across all metrics. The Barthel Index median increased from 85 to 90 points, indicating greater functional independence, while the Berg Balance Scale improved from 39 to 47 points, reflecting reduced fall risk. Depressive symptoms decreased, with Beck Depression Inventory scores dropping from 12 to 9, and both physical and mental health components of the SF-36 showed marked enhancements. Conclusions: These findings demonstrate the program’s effectiveness in addressing both physical and emotional needs, emphasizing the value of extended, personalized, home-based care in improving health, autonomy, and overall quality of life for individuals with disabilities. This study underscores the potential of multidisciplinary approaches to support long-term rehabilitation in diverse populations.

Introducción: En pacientes con Accidente Cerebro Vascular (ACV), recuperar la marcha es uno de los principales objetivos de rehabilitación. La estimulación eléctrica funcional (EEF) es una modalidad utilizada para este propósito. Objetivo: Cuantificar la efectividad de la EEF en comparación con otras terapias de rehabilitación para mejorar la marcha en pacientes mayores de 14 años con ACV. Material o Pacientes y Métodos: Revisión sistemática y metaanálisis de ensayos clínicos aleatorizados (ECA). Se seleccionaron artículos en inglés o español. Los resultados primarios analizados fueron velocidad de marcha, longitud del paso, cadencia, capacidad aeróbica, balance y espastici- dad. El riesgo de sesgo se evaluó con RoB-2. Resultados: Se seleccionaron 57 artículos, que incluyeron en total a 1.163 pacientes que recibieron EEF. De estos, se metaanalizaron 30 artículos. La EEF mostró una mejora significativa en el Test de velocidad de marcha en 10 metros para ACV agudo y subagudo, en la longitud del paso en ACV crónico y en la Escala de Equilibrio de Berg, independientemente del tiempo de evolución. La Escala de Espasticidad de Ashworth modificada logró diferencia estadística independiente del tiempo de evolución del ACV. Conclusión: La EEF es más efectiva que otras terapias de rehabilitación para mejorar la velocidad de marcha en ACV agudo y suba­gudo, la longitud del paso en ACV crónico y el balance, independientemente del tiempo de evolución del ACV. Sin embargo, la variabilidad en edades, tiempos de evolución, tipos y severidad de ACV, así como los distintos tipos y tiempos de intervención, sugieren cautela en la interpretación de los resultados.

Background: Stroke survivors often face challenges in recovery and reintegration after acute care. Home‐based rehabilitation, incorporating advanced technologies like Functional Electrical Stimulation (FES), shows promise for improving long‐term outcomes by providing more accessible, high‐intensity, and task‐oriented rehabilitation outside traditional clinical settings. Method: This study assessed efficacy and usability of a 10‐week home‐based rehabilitation protocol for 52 individuals with chronic stroke. The intervention featured a cloud‐based platform, a mobile application, and functional electrical stimulation devices. Participants were categorized into groups for tailored exercise training and received both synchronous and asynchronous sessions. Efficacy was measured through standardized motor function tests, while usability was evaluated based on adherence, patient satisfaction, and the frequency of technical support requests. Results: High adherence (74.03%) and a satisfaction of 73% were observed. On average, patients performed on average 414 min of unsupervised exercise per week. Significant improvement, including a median decrease of 6.08 s (22%) in Timed Up and Go (TUG) [ z (24) = 4.17, p < 0.001], a median decrease of 4.04 s (17%) in Five Times Sit to Stand (5STS) [ z (28) = 3.96, p < 0.001], Motor Assessment Scale (MAS) showed a mean increase of 3.2 ± 2.8 points, paired t ‐test [ t (20) = −5.01 p < 0.001] and an increase of 0.095 m/s (28%) in 10‐Meter Walk Test (10MWT) [ z (24) = 3.71, p < 0.001]. Clinical relevance was observed in all outcome measures compared with the reported Minimum Detectable Change. Conclusion: This evaluation of a home‐based physiotherapy protocol indicates that integrating FES devices with virtual platforms and mobile applications can sustain high adherence while improving functional outcomes in chronic stroke rehabilitation. The prescription of high‐intensity training, significant improvements in balance, gait, and overall functionality were observed, highlighting the viability of this approach for home‐based programs.

This study evaluated the impact of a long-term, multidisciplinary, home-based rehabilitation program on quality of life, balance, and functional autonomy in adults with neuromusculoskeletal disabilities. A total of 559 participants received individualized interventions from a team of physical therapists, occupational therapists, psychologists, and other health professionals. Functional independence, balance, depressive symptoms, and quality of life were assessed using the Barthel Index, Berg Balance Scale, Beck Depression Inventory, and SF-36 questionnaire, respectively. A longitudinal analysis comparing pre- and post-intervention outcomes revealed statistically significant improvements (p < 0.001) across all metrics. The Barthel Index median increased from 85 to 90 points, indicating greater functional independence, while the Berg Balance Scale improved from 39 to 47 points, reflecting reduced fall risk. Depressive symptoms decreased, with Beck Depression Inventory scores dropping from 12 to 9, and both physical and mental health components of the SF-36 showed marked enhancements. These findings demonstrate the program's effectiveness in addressing both physical and emotional needs, emphasizing the value of extended, personalized, home-based care in improving health, autonomy, and overall quality of life for individuals with disabilities. This study underscores the potential of multidisciplinary approaches to support long-term rehabilitation in diverse populations.

Recently, functional Near-Infrared Spectroscopy (fNIRS) was applied to obtain, non-invasively, the human peri‑spinal Neuro-Vascular Response (NVR) under a non-noxious electrical stimulation of a peripheral nerve. This method allowed the measurements of changes in the concentration of oxyhemoglobin (O₂Hb) and deoxyhemoglobin (HHb) from the peri‑spinal vascular network. However, there is a lack of clarity about the potential differences in perispinal NVR recorded by the different fNIRS technologies currently available. In this work, the two main noninvasive fNIRS technologies were compared, i.e., LED and LASER-based. The recording of the human peri‑spinal NVR induced by non-noxious electrical stimulation of a peripheral nerve was recorded simultaneously at C₇ and T₁₀ vertebral levels. The amplitude, rise time, and full width at half maximum duration of the perispinal NVRs were characterized in healthy volunteers and compared between both systems. The main difference was that the LED-based system shows about one order of magnitude higher values of amplitude than the LASER-based system. No statistical differences were found for rise time and for duration parameters (at thoracic level). The comparison of point-to-point wave patterns did not show significant differences between both systems. In conclusion, the peri‑spinal NRV response obtained by different fNIRS technologies was reproducible, and only the amplitude showed differences, probably due to the power of the system which should be considered when assessing the human peri‑spinal vascular network.