After stroke, is walking training with cueing of cadence superior to walking training alone in improving walking speed, stride length, cadence and symmetry? Systematic review with meta-analysis of randomised or controlled trials. Adults who have had a stroke. Walking training with cueing of cadence. Four walking outcomes were of interest: walking speed, stride length, cadence and symmetry. This review included seven trials involving 211 participants. Because one trial caused substantial statistical heterogeneity, meta-analyses were conducted with and without this trial. Walking training with cueing of cadence improved walking speed by 0.23 m/s (95% CI 0.18 to 0.27, I(2)=0%), stride length by 0.21 m (95% CI 0.14 to 0.28, I(2)=18%), cadence by 19 steps/minute (95% CI 14 to 23, I(2)=40%), and symmetry by 15% (95% CI 3 to 26, random effects) more than walking training alone. This review provides evidence that walking training with cueing of cadence improves walking speed and stride length more than walking training alone. It may also produce benefits in terms of cadence and symmetry of walking. The evidence appears strong enough to recommend the addition of 30 minutes of cueing of cadence to walking training, four times a week for 4 weeks, in order to improve walking in moderately disabled individuals with stroke. PROSPERO (CRD42013005873).

The aim of this study was to review the literature about the effects of Activity-based therapy (ABT) interventions on mobility, functional independence and quality of life for people with a spinal cord injury (SCI). A systematic review with meta-analysis of randomised and non-randomised trials was performed, including adults with a non-progressive SCI at any level. The intervention of interest was ABT defined as any intervention that sought to improve muscle activation or sensory function below the level of injury in the spinal cord and does not rely on compensatory mechanisms for improving function. The comparison was either no intervention or conventional physical interventions targeted to regions above the level of injury. The outcome measures were Quality of life questionnaires; mobility and functional independence scales. Nineteen trials were included in this systematic review. Three compared ABT to no intervention and 16 to conventional physical rehabilitation. The methodological quality of the trials was assessed using the PEDro scale as moderate. Six studies investigated the effects of ABT interventions for the upper limbs, 11 investigated gait-related interventions and two applied multimodal interventions. When compared to no intervention, the meta-analysis found that ABT was not more effective for improving independence or lower limb mobility, and a large positive effect on upper limb function. When compared to conventional physical interventions, there was no significant effect of ABT on lower limb mobility, independence or quality of life, however it had positive effects on upper limbs. In conclusion, there is evidence that ABT can improve independence and functional ability when applied to the upper limbs in people with SCI. However, they are not superior to conventional physical interventions when applied to the lower limbs.

Study design: A systematic review. Objectives: The aim of this systematic review was to establish whether combined aerobic training and muscle strength training is effective in improving aerobic fitness, muscle strength, function and/or quality of life (QoL) in people with spinal cord injury (SCI). Settings: Faculty of Health Sciences. University of Sydney, NSW, Australia. Methods: A search was conducted for randomized controlled trials (RCTs), controlled trials, uncontrolled clinical trials, case series and cross-over studies involving exercise interventions that included a combination of aerobic and strength components, either in circuit-mode or in sequence for people with SCI. Methodological quality was independently rated using the PEDro scale and key findings were extracted from trials by two reviewers. Results: The search identified 7981 abstracts, from which nine trials met the inclusion criteria. From the nine selected trials, seven reported aerobic outcomes, two of which showed a statistically significant within-group difference in aerobic fitness. Five studies reported muscle strength outcomes, four of them showed a statistically significant within-group mean difference on at least one outcome measure. Two studies looked at QoL, one of them found a statistically significant between-group difference on one outcome measure. Conclusion: Our systematic review showed that literature on SCI population is scarce, of low quality and findings of existing studies are inconsistent. Thus, further RCTs with larger number of participants are needed to make a definite conclusion about the influence of combined aerobic and muscle strength training on aerobic fitness, muscle strength and QoL in people with SCI.

Introduction: Activity-based therapy (ABT) aims to activate the neuromuscular system below the level of the spinal cord lesion and promote recovery of motor tasks through spinal reorganisation, motor learning and changes to muscles and sensory system. We investigated the effects of a multimodal ABT program on mobility, independence and sitting balance in individuals with spinal cord injury (SCI). Methods: Retrospective clinical data from 91 adults who independently enrolled in four community-based ABT centres in Australia were analysed. The multimodal ABT program was delivered for 3 to 12 months, one to four times per week. Assessments were undertaken every 3 months and included the Modified Rivermead Mobility Index (MRMI), Spinal Cord Independence Measure (SCIM) and seated reach distance (SRD). A linear mixed model analysis was used to determine time-based and other predictors of change. Results: There was a significant improvement after 12 months for all outcome measures, with a mean change score of 4 points in the SCIM (95% confidence interval [CI]: 2.7-5.3, d = 0.19), 2 points in the MRMI (95% CI: 1-2.3, d = 0.19) and 0.2 in the SRD (95% CI: 0.1-2.2, d = 0.52). Greater improvements occurred in the first 3 months of intervention. There were no interaction effects between time and the neurological level of injury, American Spinal Injury Association Impairment Scale classification, or duration post-injury for most outcomes. Conclusions: A community-based ABT exercise program for people with SCI can lead to small improvements in mobility, independence and balance in sitting, with greater improvements occurring early during intervention.

Introduction: Unilateral neglect is a debilitating condition that can occur after stroke and can affect a variety of domains and modalities, including proprioception. Proprioception is a sensorimotor process essential to motor function and is thus important to consider in unilateral neglect. To date, there has not been a comprehensive review of studies examining the various aspects of proprioceptive impairment in unilateral neglect after stroke. This review aimed to determine if people with unilateral neglect have more severe proprioceptive impairments than those without unilateral neglect after stroke. Methods: The MEDLINE, Embase, Scopus, CINAHL and Web of Science databases were searched from inception to September 2019 using an a priori search strategy. Two independent reviewers screened abstracts and full texts, and extracted data from the included full texts. A third reviewer resolved disagreements at each step. Risk of bias was assessed using the AXIS Quality Assessment tool. Results: A total of 191 abstracts were identified, with 56 eligible for full-text screening. A total of 18 studies were included in the review and provided evidence that people with unilateral neglect have more severe proprioceptive impairment than people without unilateral neglect. This impairment is present in multiple subtypes of unilateral neglect and aspects of proprioception. Most studies had a moderate risk of bias. Conclusion: People with unilateral neglect after stroke are more likely to have impaired processing of multiple types of proprioceptive information than those without unilateral neglect. However, the available evidence is limited by the large heterogeneity of assessment tools used to identify unilateral neglect and proprioception. Unilateral neglect and proprioception were rarely assessed comprehensively. PROSPERO Registration: CRD42018086070.

Kinesio taping (KT) is an approach that has been used in the rehabilitation of patients with chronic stroke. The aim of this review is to evaluate the effectiveness of KT alone or combined with other interventions for patients with chronic stroke. The search was performed on CENTRAL, EMBASE, PEDro, and five other databases and two trial registries up to July 2022. We included randomized controlled trials that evaluated the effectiveness of KT compared to control interventions. The primary outcomes were upper limb function and gait. We assessed the risk of bias in the included studies using the PEDro scale. The certainty of the evidence was assessed using the GRADE approach. We included 14 RCTs undertaken in six different countries. PEDro score ranged from 4 to 9 points. There is very-low certainty evidence that KT has no effect on gait, balance, and postural control. We found very-low certainty evidence of a slightly benefit when used in addition to other therapies for gait, balance and postural control, and pain intensity. Our study findings show KT does not have enough robust evidence for improving upper limb function, gait, balance and postural control, and pain intensity in chronic stroke patients.Implications for rehabilitationKinesio taping (KT) is a method that has gained popularity among some health professionals to treat patients poststroke.There is very-low certainty evidence that KT alone has no effect on gait, balance and postural control compared to no treatment.There is very-low certainty evidence that KT plus other therapies may be slightly beneficial for gait, balance and postural control, and pain intensity intervention.Only one study reported there were no adverse events such as skin reactions or local ulceration for patients poststroke.