Introduction: Chronic conditions such as stroke, Parkinson’s disease, spinal cord injury, multiple sclerosis, vestibular disorders, chronic pain, arthritis, diabetes, chronic obstructive pulmonary disease (COPD), and heart disease are leading causes of disability among middle-aged and older adults. While evidence-based treatment can optimize clinical outcomes, few people with chronic conditions engage in the recommended levels of exercise for clinical improvement and successful management of their condition. Rehabilitation technologies that can augment therapeutic care—i.e., exoskeletons, virtual/augmented reality, and remote monitoring—offer the opportunity to bring evidence-based rehabilitation into homes. Successful integration of rehabilitation techniques at home could help recovery and access and foster long term self-management. However, widespread uptake of technology in rehabilitation is still limited, leaving many technologies developed but not adopted. Methods: In this narrative review, clinical need, efficacy, and obstacles and suggestions for implementation are discussed. The use of three technologies is reviewed in the management of the most prevalent chronic diseases that utilize rehabilitation services, including common neurological, musculoskeletal, metabolic, pulmonary, and cardiac conditions. The technologies are (i) exoskeletons, (ii) virtual and augmented reality, and (iii) remote monitoring. Results: Effectiveness evidence backing the use of technology in rehabilitation is growing but remains limited by high heterogeneity, lack of long-term outcomes, and lack of adoption outcomes. Conclusion: While rehabilitation technologies bring opportunities to bridge the gap between clinics and homes, there are many challenges with adoption. Hybrid effectiveness and implementation trials are a possible path to successful technology development and adoption.

BACKGROUND: Spastic equinovarus foot (SEF) is a common dysfunctional foot posture after stroke that impairs balance and mobility. Selective tibial neurotomy (STN) is a simple but underutilized surgical option that can effectively address critical aspects of SEF and thereby provide enduring quality of life gains. There are few studies that examine both functional outcomes and patient satisfaction with this treatment option. OBJECTIVE: To elucidate the patient goals that motivated their decision to undergo the procedure and compare subjective and objective changes in balance and functional mobility as a consequence of surgery. METHODS: Thirteen patients with problematic SEF who had previously failed conservative measures were treated with STN. Preoperative and postoperative (on average 6 months) assessments evaluated gait quality and functional mobility. In addition, a custom survey was conducted to investigate patient perspectives on STN intervention. RESULTS: The survey showed that participants who opted for STN were dissatisfied with their previous spasticity management. The most common preoperative expectation for STN treatment was to improve walking, followed by improving balance, brace comfort, pain, and tone. Postoperatively, participants rated the improvement in their expectations and were, on average, 71 on a 100-point scale, indicating high satisfaction. The gait quality, assessed with the Gait Intervention and Assessment Tool, improved significantly between preoperative and postoperative assessment (M = −4.1, P = .01) with a higher average difference in stance of −3.3 than in swing −0.5. Improvement in both gait endurance (M = 36 m, P = .01) and self-selected gait speed (M = .12 m/s, P = .03) was statistically significant. Finally, static balance (M = 5.0, P = .03) and dynamic balance (M = 3.5, P = .02) were also significantly improved. CONCLUSION: STN improved gait quality and functional mobility and was associated with high satisfaction in patients with SEF.

Importance: Physical activity can improve clinical outcomes among people with neurological conditions; however, people with these conditions rarely engage in recommended levels of activity. Remote monitoring (RM) with the incorporation of behavior change strategies is purported to be an effective approach to promote increased physical activity in the home setting, however, its effectiveness in promoting activity for people with neurological conditions is unclear. Objectives: The objectives of this review were to examine the effectiveness of behaviorally informed RM interventions on physical activity in the home and community and to identify usage and impact of specific behavior change techniques (BCTs) implemented with RM interventions. Data Sources: PubMed, PsycINFO, and CINAHL were searched in March 2024. Study Selection: This study included a selection of randomized controlled trials on behaviorally informed RM interventions that use wearable sensors or digital applications to target physical activity for patients with neurological diseases. Data Extraction and Synthesis: Data extraction was performed by 2 independent reviewers and data synthesis was performed with random effects meta-analysis. BCT were classified using Michie’s behavior change technique taxonomy. Promising BCTs were identified by examining the proportion of statistically significant studies for each technique. Risk of bias was assessed with the risk of bias 2 tool. Main Outcomes and Measures: The main outcomes and measures included physical activity measured by self-report and accelerometers. Results: Fourteen studies were included with some concerns of bias, encompassing individuals with multiple sclerosis, stroke, Parkinson disease, and spinal cord injury. Behaviorally informed RM interventions resulted in statistically significant improvements in self-reported physical activity (SMD = 0.27, 95% CI = 0.06 to 49), but not accelerometry outcomes (SMD = 0.52, 95% CI = −0.07 to 1.11). Promising BCTs included self-monitoring, problem solving, goal setting, graded tasks, social support, and adding objects to the environment. Conclusions and Relevance: RM shows initial promise to increase physical activity of people living with neurological conditions when paired with behavior change consultation.

Background/Objectives: People living with neurological conditions are inactive despite widespread literature showing physical activity (PA) is beneficial for this population. To impact long term changes in PA behavior, physical therapists treating individuals with neurological conditions need to provide effective PA promotion in combination with behavior change techniques (BCTs). The purpose of this study is to (1) characterize the use of BCTs during neurorehabilitation, and (2) to gain an understanding of considerations related to PA promotion. Methods: Observations of outpatient physical therapy encounters with subsequent semi-structured interviews were conducted. Observations were transcribed with detailed field notes and analyzed with descriptive analysis and deductive coding. Interviews were analyzed with thematic analysis. Results: Observations indicated that PA promotion in neurorehabilitation practice emphasizes home exercise programs, with less focus on aerobic activity. The most common BCTs used were instruction on how to perform the behavior, behavioral practice and rehearsal, and social support. Primary themes that impacted physical therapist use of BCTS for PA promotion included knowledge, decision processes, perceived role, beliefs, environmental context, and social influences. Conclusions: PA promotion from physical therapists in neurorehabilitation is not targeting activity guidelines and there is uncertainty about using behavior change strategies and PA guidelines for PA promotion.