Motor rehabilitation aims to help people after stroke to gain optimal motor functioning, independence and quality of life. This European Stroke Organisation (ESO) guideline provides updated, evidence-based support for clinical practice in six agreed critical areas: dose for upper limb and gait therapy, high-intensity gait training, effect of therapy transfer package, group versus individual therapy and sit-to-stand training. The guideline was developed according to ESO standard operating procedures and Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Expert consensus statements are provided where a GRADE recommendation cannot be made due to insufficient evidence. For therapy dose, very low quality evidence supports a weak recommendation to provide an additional minimal dose of 20 h of repetitive upper limb practice to improve arm capacity. For gait, expert consensus suggests that an additional minimal dose of 20 h of walking practice could be beneficial for walking capacity. For high-intensity gait training, moderate quality evidence supports a strong recommendation for high-intensity gait training to improve walking endurance in people with chronic stroke and stable cardiovascular status, while low quality evidence supports a weak recommendation for improving walking speed. An expert consensus suggests using a transfer package when providing upper limb task-specific training to enhance transfer to daily life. For group therapy, a weak recommendation based on very low quality evidence suggests that task-specific group-based therapy is non-inferior to individual therapy for improving balance, gait speed and walking endurance. A weak recommendation based on moderate quality evidence suggests additional sit-to-stand training to improve balance.

Background: Continuity of care (COC) is essential for high-quality patient care in the perinatal period. Insights in the effects of COC models on patient outcomes are important to direct perinatal healthcare organization. To our knowledge, no previous review has listed the effects of COC on the physical and mental health of mother and child in the postnatal period. Methods: A search was conducted in four databases (PubMed, Web of Knowledge, CENTRAL and CINAHL), from 2000 to 2018. Studies were included if: participants were healthy mothers or newborns with a gestational age between 37–42 weeks; they covered the perinatal period and aimed to measure breastfeeding or any outcome related to the maternal/newborn physical or mental health. At least one of the three COC types (management, informational and relationship) was identified in the intervention. The methodological quality was assessed. Results: Ten articles were included. COC is mostly present in the identified care models. The effects of COC on the outcomes of mother and child in the postnatal period seem mostly to be positive, although not always significant. The relation between COC and the outcomes can be influenced by confounding factors, like the socio-economic status of the included population. Interventions with COC during pregnancy appear to be more effective for all the studied outcome factors. Conclusion: COC as management, relational and informational continuity starting antenatal has the most impact on the postnatal outcomes of mother and child.

Background: Rehabilitation is important in the first months after a stroke for recovery of functional ability, but it is also challenging, since distinct recovery trajectories are seen. Therefore, studying the early changes in muscle characteristics over time (e.g. muscle strength, muscle mass and muscle volume), which are known to be associated with functional abilities, may deepen our understanding of underlying recovery mechanisms of stroke survivors.Objective: This systematic review aims to describe the longitudinal changes in skeletal muscles, including muscle strength, muscle mass and muscle volume, during the first 3 months post-stroke.Methods: Electronic searches were conducted in Medline, Scopus and CENTRAL. Longitudinal cohort studies or controlled interventional trials that report data about patients in the first 3 months after stroke were identified. Skeletal muscle characteristics should be measured at least twice within 3 months post-stroke by objective, quantitative assessment methods (e.g. dynamometry, ultrasound, computed tomography). Effect sizes were calculated as Hedges’ g using standardized mean differences.Results: A total of 38 studies (1,097 subjects) were found eligible. Results revealed an mean increase on the paretic side for upper and lower limb muscle strength (small to moderate effect sizes), whereas muscle thickness decreased (moderate to large effect sizes). Similar, but smaller, effects were found on the non-paretic side. There were insufficient data available to draw conclusions about lean muscle mass and muscle cross-sectional area. No studies aimed at investigating distinct trajectories of the muscle changes.Conclusion: Muscle strength and thickness changes during the first 3 months after stroke in both the paretic and non-paretic side. Future studies should aim to understand “how” the stroke-induced muscle strength changes are achieved. Exploring existing data from longitudinal studies, by using cluster analyses, such as pattern recognition, could add to the current knowledge-base. LAY ABSTRACTAfter a stroke, it is important to restore functional ability as much as possible. Studying changes in the muscles (e.g. muscle strength, muscle thickness, muscle volume) during the first months post-stroke can help to elucidate individual variations and the underlying repair mechanisms. A systematic search of the literature was performed for studies of objective quantifiable measurements of muscles at least 2 times during the first 3 months after stroke. A total of 38 studies (with in total 1,097 patients) met these criteria. Overall, an improvement in strength was measured on the paretic side for both the upper and lower limbs, but muscle thickness decreased. Similar, but smaller, effects were found on the non-paretic side. For other muscle parameters insufficient data were found to draw conclusions. Because understanding the underlying mechanism of muscle changes post-stroke can improve rehabilitation programmes, further studies should focus on why these muscle strength changes occur.

The global aging population faces significant health challenges, including an increasing vulnerability to disability due to natural aging processes. Wearable lower limb exoskeletons (LLEs) have emerged as a promising solution to enhance physical function in older individuals. This systematic review synthesizes the use of LLEs in alignment with the WHO’s healthy aging vision, examining their impact on intrinsic capacities and functional abilities. We conducted a comprehensive literature search in six databases, yielding 36 relevant articles covering older adults (65+) with various health conditions, including sarcopenia, stroke, Parkinson’s Disease, osteoarthritis, and more. The interventions, spanning one to forty sessions, utilized a range of LLE technologies such as Ekso^®, HAL^®, Stride Management Assist^®, Honda Walking Assist^®, Lokomat^®, Walkbot^®, Healbot^®, Keeogo Rehab^®, EX1^®, overground wearable exoskeletons, Eksoband^®, powered ankle–foot orthoses, HAL^® lumbar type, Human Body Posturizer^®, Gait Enhancing and Motivation System^®, soft robotic suits, and active pelvis orthoses. The findings revealed substantial positive outcomes across diverse health conditions. LLE training led to improvements in key performance indicators, such as the 10 Meter Walk Test, Five Times Sit-to-Stand test, Timed Up and Go test, and more. Additionally, enhancements were observed in gait quality, joint mobility, muscle strength, and balance. These improvements were accompanied by reductions in sedentary behavior, pain perception, muscle exertion, and metabolic cost while walking. While longer intervention durations can aid in the rehabilitation of intrinsic capacities, even the instantaneous augmentation of functional abilities can be observed in a single session. In summary, this review demonstrates consistent and significant enhancements in critical parameters across a broad spectrum of health conditions following LLE interventions in older adults. These findings underscore the potential of LLE in promoting healthy aging and enhancing the well-being of older adults.

Objective: Show the benefit of kinematically compatible joint structures in exoskeletons for improving their performance in reducing metabolic consumption. Methods: Subjects were fitted with a hip exoskeleton, with misalignment compensation for all degrees of freedom and were instructed to perform recurring sit-to-stand motions for 5 min. This was executed three times: Unequipped (i.e., not wearing the exoskeleton), assisted, and unassisted. During each trial, oxygen consumption and muscle activity were monitored. Results: An increased oxygen consumption was observed between the unequipped and the unassisted trial. During the assisted trial, oxygen consumption was reduced to levels seen in the unequipped state. Muscle activity increased for rectus femoris and tibialis anterior and decreased for biceps femoris and gluteus maximus. Conclusion: Oxygen consumption only increases in accordance with the added mass. No added penalty was seen related to increased inertia or hindrance of natural motion patterns. This indicates that the mechanism operates as intended. The increased muscle activity can be explained by the nature of the actuation system, which is not optimized for sit-to-stand tasks. A more targeted actuation system can easily reduce muscle activity, and therefore, induce a reduced oxygen consumption, below unequipped levels. Significance: Because the benefits induced by using these systems are independent of user capabilities or deficiencies, it is applicable in a wide range of exoskeleton applications. The design presented here, allows for the realization of compact and light devices, that have a minimal impact on the metabolic cost of their user. This allows to maximally exploit the metabolically beneficial effects of a well-designed actuation system.