Influence of Nutritional Interventions on Functional Outcomes in Stroke Rehabilitation: A Systematic Review.

Background: Stroke remains a leading cause of long-term disability, which affects motor function, balance, coordination, and daily activities. Virtual reality-based physiotherapy has emerged as an innovative approach, offering immersive, task-oriented rehabilitation environments. Objective: To review and synthesize recent evidence (2019-2025) on the effectiveness of VR-based physiotherapy in improving functional recovery among stroke patients. Methodology: This review employed a structured narrative synthesis guided by PRISMA to ensure transparent and systematic reporting of evidence on Virtual Reality–based physiotherapy in stroke rehabilitation. A comprehensive search of PubMed/MEDLINE, Scopus, Web of Science, PEDro, and the Cochrane Library identified studies published between January 2019 and June 2025. Free-text keywords and MeSH terms related to stroke, Virtual reality rehabilitation, physiotherapy, and functional recovery were combined using Boolean operators. Citations were managed and deduplicated in reference software, followed by title, abstract, and full-text screening per PRISMA criteria. Eligible studies included randomised controlled trials, controlled trials, and systematic reviews examining virtual reality interventions and functional outcomes such as motor recovery, balance, gait, and ADLs. Non-English papers, cognitive-only virtual reality studies, abstracts, and mixed populations without stroke-specific data were excluded. Data were extracted using a standardized template covering study design, virtual reality type, intervention dosage, and outcomes. Methodological quality was appraised (PEDro for trials), enabling a rigorous qualitative synthesis of contemporary evidence. Results: Evidence consistently demonstrates that virtual reality-based rehabilitation improves motor function, postural control, and functional independence compared with conventional therapy alone. Meta-analyses report superior gains in upper limb recovery, dexterity, and task performance when VR is used adjunctively. Improvements in balance, gait, and daily activities are also reported, alongside enhanced motivation, therapy adherence, and psychological well-being. Conclusion: Virtual reality-based physiotherapy is an effective adjunct to conventional stroke rehabilitation, enhancing recovery, engagement, and quality of life.

Effect of comorbidity on functional recovery in stroke patients

Objectively measured physical activity volume serves as a predictive factor for functional recovery in patients with stroke. Malnutrition, a frequent complication of stroke, may influence the relationship between physical activity and functional recovery. This study aimed to examine the association between physical activity volume and functional recovery in patients with stroke, stratified by their nutritional status. This multicenter prospective observational study included 209 patients with stroke admitted to two Japanese convalescent rehabilitation hospitals. Participants were categorized based on the geriatric nutritional risk index (GNRI) at admission [≥92, high GNRI group ( n = 133); <92, low GNRI group ( n = 76)]. Physical activity levels were measured as the duration of total physical activity (TPA), which is the sum of light-intensity physical activity and moderate-to-vigorous physical activity, using a triaxial accelerometer during the first 7 days after admission. Outcome measures are represented as the relative gain of the motor score on functional independence measure (M-FIM effectiveness) during the first month after admission. The multiple regression analysis, adjusting for age, sex, comorbidity, onset to admission intervals, motor paralysis, initial M-FIM, and cognitive FIM, showed that the duration of TPA in the first 7 days was significantly associated with the M-FIM effectiveness over the first month in both low GNRI [ B = 0.12, 95% confidential intervals (CI) = 0.01; 0.24, P = 0.049] and high GNRI group ( B = 0.11, 95% CI = 0.01; 0.21, P = 0.027). This study demonstrates a positive predictive association between early TPA level and functional recovery in stroke patients, irrespective of their nutritional status.

Virtual reality (VR) therapy has gained attention as a promising intervention in stroke rehabilitation, particularly for its potential to enhance motor function and promote neuroplasticity. However, its specific effects on balance, mobility, and gait remain underexplored. This review aims to provide a comprehensive evaluation of the effectiveness of VR therapy on the recovery of lower limb function in stroke survivors. Randomized controlled trials comparing VR therapy with conventional therapy were eligible for inclusion. All studies were identified through databases, such as MEDLINE, Embase, PubMed, Cochrane Library, Web of Science, and PsycINFO (up to July 2024). The primary outcomes included balance, assessed using the Berg Balance Scale (BBS), and mobility, measured with the Timed Up and Go Test (TUG) and 10-Meter Walk Test (10-MWT). Secondary outcomes included gait parameters (stride length and step length), the Functional Reach Test (FRT), the Dynamic Gait Index (DGI), and the Falls Efficacy Scale-International (FES-I). RevMan version 5.4 (The Cochrane Collaboration) software was used for the meta-analysis. A total of 2145 studies were screened, and 24 randomized controlled trials that met the inclusion criteria were included, involving 768 participants. Meta-analysis results showed that VR therapy, compared to conventional therapy, significantly improved BBS (mean difference [MD] 3.29, 95% CI 0.52-6.06; P=.02), TUG (MD -1.67, 95% CI -2.89 to -0.46; P=.007), and step length (MD 3.59, 95% CI 0.50-6.69; P=.02). However, no significant difference was observed between the 2 groups in 10-MWT (MD -0.91, 95% CI -3.33 to 1.50; P=.46), stride length (MD 5.63, 95% CI -0.73 to 11.99; P=.08), FRT (MD 2.68, 95% CI -0.30 to 5.67; P=.08), DGI (MD 1.08, 95% CI -0.41 to 2.58; P=.16), and FES-I (MD 0.16, 95% CI -2.92 to 3.24; P=.92). In the subgroup analyses, significant improvements in balance and mobility were observed in patients receiving greater than or equal to 20 sessions, with BBS improved by 5.14 points (95% CI 0.43-9.85; P=.03) and TUG reduced by 1.98 seconds (95% CI -3.33 to -0.63; P=.004). In addition, patients who received VR therapy more than 6 months after stroke showed greater improvements in BBS (MD 1.64, 95% CI 0.14-3.14; P=.03), compared to those who received VR therapy between 7 days and 6 months after stroke. Long-term VR-based therapies are more effective in improving functional ability after stroke. VR therapy has demonstrated significant potential for enhancing lower limb recovery, especially when applied with frequencies of ≥20 sessions.

Background Complexity of interventions and lack of methodological clarity makes process evaluations (PEs) challenging. Assessment of PEs conducted for complex stroke rehabilitation and nonpharmacologic secondary stroke prevention interventions is lacking with only one study conducted for the latter. To address this gap, we conducted a scoping review. Methods Development and reporting of review follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews. Research questions were identified and search phrases developed according to keywords on 3 electronic databases: PubMed, Web of Science, and Cochrane Library. All titles and available abstracts were independently reviewed by 2 authors and disagreements settled by other authors. Inclusion criteria centered on complex secondary stroke nonpharmacologic prevention or a rehabilitation trial. Results Selected studies (n = 11) were derived from (n = 24) articles reporting on PE of main trial (n = 10). Studies are from 2015 onward with 9 studies for stroke rehabilitation and 1 from secondary stroke prevention, out of these 7 are randomized clinical trials. Medical Research Council’s framework was most widely used with common data collection method being interviews, surveys and log records. More than half of the studies are mobile health based which reveals future for stroke rehabilitation and stroke prevention interventions. We identified 3 themes on qualitative analysis of articles. Conclusion Paucity of relevant research studies indicates that more research should be carried out for PEs in stroke rehabilitation and prevention. Researchers in future may find guidance from this review where we support clarity on framework and its elements that helped to evaluate methodology.

Virtual reality (VR) is a new promising computer-assisted technology to promote motor recovery in stroke patients. VR-induced neuroplasticity supporting locomotor recovery is not known. We investigated the effects of VR intervention on cortical reorganization and associated locomotor recovery in stroke patients. Ten chronic stroke patients were assigned randomly to either the control group or the VR group. VR was designed to provide interactive real-life practice environments in which practice parameters can be individualized to optimize motor relearning. Laterality index (LI) in the regions of interests (ROIs) and locomotor recovery were measured before and after VR using functional MRI (fMRI) and standardized locomotor tests, respectively. The t test and nonparametric test were performed to compare the mean differences at P<0.05. There was a significant difference in the interval change in the LI score for the primary sensorimotor cortex (SMC) between the groups (P<0.05), indicating that VR practice produced a greater increase in LI for the control group. However, the interval changes in the other ROIs were not significantly different (P>0.05). Motor function was significantly improved after VR (P<0.05). Our novel findings suggest that VR could induce cortical reorganization from aberrant ipsilateral to contralateral SMC activation. This enhanced cortical reorganization might play an important role in recovery of locomotor function in patients with chronic stroke. This is the first fMRI study in the literature that provides evidence for neuroplasticity and associated locomotor recovery after VR.

Psychological factors such as low self-esteem, depressive and anxiety symptoms have been found to hinder stroke survivors’ social participation and adversely affect their quality of life. While there have been previous reviews that studied on interventions on social participation after stroke, there is a lack of studies that utilize psychological interventions for participation among stroke survivors. This review aims to provide a comprehensive overview of psychological interventions designed to improve post-stroke participation and assess their effectiveness. Three databases (MEDLINE, Scopus, and Web of Science) were used to identify relevant articles using search terms strategies that are related to stroke, participation and psychological health. Eligible articles are studies using randomized controlled trial or pre- and post-interventions design that measured participation and psychological outcomes. Eleven studies met the inclusion criteria, with varied sample sizes, intervention types, and measurement tools. The findings revealed that while psychological interventions can improve participation, inconsistencies in measurement and a lack of focus on participation as a primary outcome limit the strength of the conclusions, with some studies did not show long-term improvements. Positive effects on participation were observed in interventions involving home visits with multidisciplinary care, cognitive behavioural therapy (CBT) augmented with occupational therapy, self-management through virtual services, and group music therapy alongside occupational therapy. These findings highlight the need for further research focusing on psychological interventions with participation as primary outcomes in stroke rehabilitation.

Introduction Culture has been defined as: “a tradition of knowledge and practice that is shared, albeit imperfectly, across the members of a society and across its generations” [Zou et al 2009]. It shapes people's experiences and their emotional reactions [Gard et al 2005], including their understandings of what it means to be healthy, the meanings of symptoms, attitudes towards disability and treatment, and coping strategies [Dean et al 2006; Gallaher et al 2001]. The study suggested here may offer new insights by exploring how culture shapes the experience of stroke care through the perceptions of Physical therapists working in the state of Qatar. Qatar is one of the wealthiest countries in the world. The culture reveals the modernising influences associated with oil exploration and technological advances whilst preserving collective traditions. The state provides extensive financial support for its own citizens including generous pensions and access to health care. However, in common with other Gulf st...

Stroke is a significant cause of death and disability in the world. It creates problems for families and nationaleconomies alike due to its disruptive nature. Rehabilitation is a way to treat disabilities in stroke survivors, apopulation that is steadily growing into a larger percentage of the population. However, stroke rehabilitation is notstandardized as there is no clear evidence-based guideline that can be applied to every person, leading to differencesin care. Other problems with rehabilitation include limitations with a therapist’s ability to work continuously andconsistently over longer periods of time. Robotics can help with solving both types of problems through their abilityto record data and work without requiring rest. There has already been development of rehabilitation robots since the1990s and more advanced robot platforms have begun to emerge in the literature. This article reviews the literatureon stroke rehabilitation and how robotics can positively affect a patient’s outcome in stroke rehabilitation. It alsoreviews several rehabilitation robots classified as either exoskeletons or end-effectors.

This study aimed to investigate the efficacy of traditional Chinese medicine (TCM) syndrome differentiation nursing in the rehabilitation of language function in stroke patients. This study compares the effects of TCM syndrome differentiation nursing and conventional rehabilitation nursing by assessing changes in language function using the Boston Diagnostic Aphasia Examination (BDAE) scores and clinical efficacy evaluation. This study is a retrospective study in which we reviewed cases of poststroke rehabilitation from 2020 to 2023. A total of 100 stroke patients were enrolled and divided into 2 groups: the TCM syndrome differentiation nursing group (n = 50) and the conventional rehabilitation nursing group (n = 50). TCM syndrome differentiation nursing was tailored based on individual patients' TCM diagnoses (e.g., Qi deficiency, blood stasis, or phlegm-dampness) and involved a combination of targeted nursing care, acupuncture, and herbal remedies. The conventional rehabilitation nursing group received standard poststroke rehabilitation therapies, including speech therapy and physical exercises. Both groups were assessed using BDAE scores and clinical efficacy evaluations at baseline and after 12 weeks of intervention. The TCM syndrome differentiation nursing group showed significantly greater improvements in BDAE scores compared with the conventional rehabilitation group (mean increase: 15.2 vs 8.6, P < .05). In addition, 72% of patients in the TCM group were classified as having "marked improvement" in clinical efficacy, compared with 48% in the conventional rehabilitation group (P < .05). The TCM group also reported fewer complications such as fatigue and stress compared with the conventional rehabilitation group (P < .05). TCM syndrome differentiation nursing significantly enhances language function recovery in stroke patients and serves as a valuable supplement to conventional rehabilitation methods. This study provides novel evidence supporting the integration of TCM-based interventions in stroke rehabilitation, offering a complementary approach to existing therapeutic strategies. Further research is needed to explore the long-term effects and underlying mechanisms of TCM syndrome differentiation nursing.

The bimodal balance-recovery model predicts that corticospinal tract (CST) integrity in the affected hemisphere influences the partterns of brain recovery after stroke. Repetitive transcranial magnetic stimulation (rTMS) has been used to promote functional recovery of stroke patients by modulating motor cortical excitability and inducing reorganization of neural networks. This study aimed to explore how to optimize the efficiency of repetitive transcranial magnetic stimulation to promote upper limb functional recovery after stroke according to bimodal balance-recovery model. 60 patients who met the inclusion criteria were enrolled to high CST integrity group (n = 30) or low CST integrity group (n = 30), and further assigned randomly to receive high-frequency rTMS (HF-rTMS), low-frequency rTMS (LF-rTMS) or sham rTMS in addition to routine rehabilitation, with 10 patients in each group. Outcome measures included Fugl-Meyer scale for upper extremity (FMA-UE), Wolf Motor Function (WMFT) scale and Modified Barthel Index (MBI) scale which were evaluated at baseline and after 21 days of treatment. For patients with high CST integrity, the LF group achieved higher FMA-UE, WMFT and MBI scores improvements after treatment when compared to the HF group and sham group. For patients with low CST integrity, after 21 days treatment, only the HF group showed significant improvements in FMA-UE and WMFT scores. For MBI assessment, the HF group revealed significantly better improvements than the LF group and sham group. For stroke patients with high CST integrity, low-frequency rTMS is superior to high-frequency rTMS in promoting upper limb motor function recovery. However, only high-frequency rTMS can improve upper limb motor function of stroke patients with low CST integrity.

Functional recovery of stroke patients with postacute care: a retrospective study in a northern medical center.

BackgroundRecovery post stroke is well documented in the field of stroke rehabilitation. The structure and process of rehabilitation are different between developed and developing countries. The aim of the present study was to compare the motor and functional recovery of stroke patients in Germany versus stroke patients receiving rehabilitation in South Africa.MethodsThis study used secondary data analysis of patient protocols collected in two independent studies conducted in Germany and South Africa respectively. A total of 73 patients from the two separate studies were matched for age at stroke onset, gender, and initial motor functioning. Motor and functional recovery were assessed at baseline, two and six months post stroke using the Rivermead Motor Assessment Scale and the Barthel Index (BI) respectively. Significant differences in motor and functional recovery were found, using the Wilcoxon rank sum test on admission to the centre, and at two and six months after stroke. A generalized linear mixed-methods model (GLIMMIX) was used to compare the recovery patterns between the participants from the two settings over time.ResultsThe results of the GLIMMIX revealed a significant difference in favour of the German participants for gross motor (RMA-GF) and upper limb (RMA-A) recovery, while no significant difference was found for lower limb (RMA-LT) and functional (BI) recovery patterns between the participants of the two settings. No significant differences existed in RMA-A and BI-scores on admission to the CHC/SRU. At two and six months after stroke, both the RMA-A and BI-scores were significantly lower in the South African than the German sample.ConclusionThe results of this study provide empirical evidence for differential recovery patterns for patients in developed and developing countries. A detailed exploration of the factors to which this difference in recovery patterns can be attributed was beyond the scope of the present study, and is recommended for future research.

Background: Cognitive impairments and depression are common after stroke. Noninvasive treatments like transcranial direct current stimulation (tDCS) and mindfulness-based interventions have shown potential for improving these outcomes, though their effects on stroke survivors remain unclear. This study is aimed at evaluating the efficacy of mindfulness and tDCS in enhancing cognitive function and alleviating depression in stroke survivors. Methods: This randomized controlled trial, conducted from July 2021 to July 2022, included 30 stroke survivors divided into three groups: mindfulness (n = 5), tDCS (n = 14), and control (n = 11). Cognitive function was measured using Addenbrooke's Cognitive Examination-III (ACE-III), and depression was assessed using the Beck Depression Inventory-II (BDI-II) before and after interventions. The tDCS group received 10 sessions of anodal stimulation, and the mindfulness group underwent eight weekly sessions of mindfulness-based stress reduction. Data were analyzed using paired t-tests for within-group comparisons and ANOVA for between-group differences. Results: The tDCS group showed significant improvement in cognitive function, with ACE-III scores increasing by 9.14 ± 8.24 points (p = 0.02). Fluency and orientation scores also improved significantly in this group (p < 0.001 and p = 0.01, respectively). No significant cognitive changes were observed in the mindfulness group. Depression scores (BDI-II) did not change significantly in any group. Conclusions: tDCS significantly improved cognitive performance, particularly in fluency and orientation, while mindfulness showed no significant cognitive or depression-related effects. Future studies should explore the long-term impact of these interventions in stroke rehabilitation. Trial Registration: ClinicalTrials.gov identifier: IRCT20090716002195N3.

Central Post-Stroke Pain (CPSP) is a debilitating condition with a significant prevalence in stroke survivors. Set apart by its refractory to treatment neuropathic pain, it appears to arise from lesions in the spino-thalamo-cortical pathways, particularly in the thalamus. Despite advances in neuroimaging techniques, the pathophysiology of CPSP remains poorly understood, with limited diagnostic criteria and therapeutic approaches. This systematic review aims to identify neuroimaging markers associated with CPSP, establish correlations between brain lesions and CPSP development, and explore the utility of neuroimaging techniques for diagnosis and prognosis. Secondary objectives involve establishing a link between CPSP and secondary brain area lesions and what type of pain patients with CPSP are more likely to experience. A systematic review was conducted following PRISMA guidelines. Relevant articles were sourced from PubMed, Embase, and Web of Science, using a predefined search strategy targeting CPSP and neuroimaging studies (MRI, PET, SPECT). Studies involving adult CPSP patients with post-stroke neuroimaging were included. Data from 14 studies was analyzed, focusing on lesion locations, neuroimaging findings, and functional connectivity. Risk of bias was assessed using the QUADAS-2 tool. Key findings highlighted the association of CPSP with lesions in the ventral posterolateral and the ventral medial nuclei of the thalamus, spinothalamic pathway, and cortical areas like the insula and operculum. Functional connectivity studies highlighted the role of disrupted neural networks in pain perception. Limitations in the reviewed studies included small sample sizes, selection bias, and heterogeneity in study designs. Neuroimaging findings confirm the significance of thalamic and spinothalamic pathway lesions in CPSP pathophysiology. Despite these insights, gaps in research underline the need for larger, multicenter trials to identify reliable biomarkers for diagnosis and therapeutic targets. Advanced neuroimaging combined with machine learning could be the key to understanding and managing CPSP.