The Box and Block Test (BBT) is an essential and widely used test in rehabilitation for the assessment of gross unilateral manual dexterity. Although it is a valid, simple, and ecological instrument, it does not provide a quantitative measure of the upper limb trajectories during the test. The study introduces a new motion-capture-based method (using ecological Inertial Measurement Units - IMUs) to evaluate upper body kinematics while performing a targeted version of BBT (tBBT). This observational study compares data from 35 healthy subjects, 35 subjects with Parkinson's disease, and 35 post-stroke individuals to evaluate upper limb kinematics during tBBT quantitatively. Seven IMUs were placed on the trunk, head, and upper limb of each subject. The joint angles and kinematic scores were calculated and analyzed. Motor task execution time and kinematic scores were statistically correlated with clinical assessment measures. Kruskal-Wallis between groups test and Dunn-Bonferroni post-hoc were used. The statistics revealed significant differences (p<0.05) among the three groups. The analyzed joint angles highlight various compensatory strategies in neurological subjects, such as using the trunk to complete a motor task instead of the shoulder and using the wrist instead of the elbow, along with differences in movement fluidity (DimensionLess-Jerk, p<0.05). A positive correlation was found between kinematics and the Fugl-Meyer Assessment-Upper Limb (r=0.7344; p<0.01), and a negative correlation between kinematics and the Unified Parkinson's Disease Rating Scale (r=-0.5286; p<0.01). The quantitative assessments of joint kinematics correlated to clinical assessments could guarantee a new method of assessment of the upper limb in subjects with motor deficits. This would allow to capture new insight into the characteristics of the subject's disability, with implications for the choice of a personalized rehabilitation treatment focused on the motor recovery of the upper limb.

Background: One of the main goals of rehabilitation after stroke is the restoration of motor function. Understanding movement patterns and compensatory strategies is essential to optimize therapy. This study analyzes upper limb kinematics during the Box and Block Test (BBT) to identify and quantify typical post-stroke compensation strategies. Methods: Thirty-one sub-acute stroke participants and thirty-one healthy controls were included. Kinematic data were collected using a 7-IMU system. Joint angles were analyzed with MATLAB R2023a, and 3D trajectories were reconstructed from calibrated quaternions and anthropometric data. Group differences were assessed with the Mann–Whitney test. Compensation strategies were quantified in percentage terms relative to healthy subjects. Results: Significant intergroup differences were observed in mean joint angles and ranges of motion. On the paretic side, participants overused the wrist and shoulder to compensate for reduced elbow and trunk activity. Similar overuse was also observed on the unaffected side. Quantification showed that 83.9% and 80.6% compensate, respectively, with wrist and trunk and 67.7% with the shoulder. Conclusions: Using IMUs during the BBT, this study identified specific compensation strategies that may hinder recovery. It also contributed to developing a quantification scale, supporting more personalized rehabilitation and improved quality of life.

Parkinson’s disease (PD) is the second most common neurodegenerative disease in the world and involves impairment of both motor and cognitive functions, significantly affecting the quality of walking and consequently the quality of life of people affected by this disease. This study analyzed the relationship between gait alterations and cognitive deterioration, using validated clinical tests and an innovative indicator, the φ -bonacci gait number, which quantifies gait harmonicity, symmetry, and consistency. Kinematic data collected during the 6-Minute Walk test on 19 people with PD (pwPD) and 15 healthy adults were analyzed. The results highlighted a significant negative correlation between gait harmonicity and cognitive performance ( φ -bonacci gait number—Time Up and Go Dual Task; r = 0.797, p < 0.05). Finally, mediation analysis showed that global cognitive function (MoCA) indirectly influences gait harmonicity through TUG-DT. The results suggest that gait in pwPD is strongly modulated by executive-attentional functions, supporting its cognitive modulation rather than a purely automatic nature. This study allowed to explore the complex relationship between cognitive functions and the motor system, deepening how these interactions influence and refine motor behavior. Therefore, rehabilitation programs combining motor exercises and cognitive training could be more effective in improving gait quality, reducing the risk of falls, and improving person’s quality of life.

Non-traumatic spinal cord injuries (NTSCI) represent an increasing public health concern, particularly in aging populations, yet there is limited literature on rehabilitation outcomes and key predictors of home discharge in this population. This study evaluates the impact of demographic and clinical characteristics on rehabilitation outcomes and home discharge rates in individuals with NTSCI. Prospective observational cohort study. Thirty-one specialized SCI centers in 13 Italian regions. Individuals with NTSCI. Demographic and clinical characteristics of 394 rehabilitation were recorded at admission (T1) and discharge (T2). The American Spinal Injury Association (ASIA) Scale and Spinal Cord Independence Measure (SCIM) were used to assess motor function and functional independence. Binary logistic regression was employed to develop a predictive model for home discharge, incorporating categorical and continuous variables. Two common metrics for this purpose are the Akaike Information Criterion (AIC) and the Bayesian Information Criterion (BIC). Predictive factors for home discharge were analyzed using logistic regression and ROC curves. 80% of participants were discharged home. Key predictors of home discharge included higher SCIM scores, younger age, and being married. The SCIM score at discharge was a stronger predictor of home discharge than at admission. Length of stay (LOS) was also a significant factor, with longer stays associated with better functional outcomes, particularly in individuals with severe impairments. SCIM scores at discharge, age, and marital status emerged as key predictors of home discharge, highlighting the importance of personalized rehabilitation strategies and structured discharge planning. Tailoring rehabilitation programs to maximize SCIM score improvements may enhance home discharge rates and long-term patient outcomes. This study emphasizes the importance of continuous functional assessment using SCIM during rehabilitation, allowing clinicians to optimize treatment plans and improve home discharge likelihood. Additionally, considering demographic factors such as age and marital status in discharge planning may facilitate better reintegration into home environments. Longer rehabilitation stays for individuals with more severe injuries (ASIA A/B) can significantly enhance outcomes. By incorporating these predictors into everyday practice, rehabilitation clinics can better optimize patient care, increase home discharge rates, and improve overall quality of life post-rehabilitation.

BACKGROUND: Stroke recovery is highly heterogeneous, and predictive neurophysiological markers of motor outcome are still needed. Although transcranial magnetic stimulation-derived motor evoked potentials (MEPs) are widely used to assess corticospinal integrity, their trial-to-trial variability remains poorly explored and has largely been interpreted as noise rather than a source of clinically relevant information. METHODS: In this prospective longitudinal observational study, we investigated MEP peak-to-peak amplitude and amplitude variability in 77 patients with subacute stroke assessed at baseline (T0, early subacute phase) and after a 2-month high-intensity daily rehabilitation program (T1), alongside 10 age- and sex-matched healthy controls. MEPs were recorded from both hemispheres at rest. Clinical outcomes were evaluated using the Fugl-Meyer Upper Extremity scale and a Motor Recovery Index. RESULTS: Seventy-seven patients with subacute stroke (mean age, 68.5±12.7 years; 41.6% women) and 10 age- and sex-matched healthy controls (mean age, 73.9±4.3 years; 40.0% women) were included. At T0, MEP amplitude was lower in the affected than in the unaffected hemisphere (0.16±0.02 versus 0.38±0.01 mV; P =5.42×10 ⁻¹⁰ ), as was MEP variance (0.013±0.002 versus 0.038±0.003 mV ² ; P =8.43×10 ^{− 12} ). Regarding T1, MEP amplitude increased over time in the affected hemisphere (0.21±0.02 mV; P =0.01), whereas MEP variance remained unchanged ( P =0.55). Importantly, baseline MEP amplitude was strongly associated with motor status at follow-up (Fugl-Meyer Upper Extremity scale at T1; P =9.52×10 ^{− 9} ), but not with the degree of recovery. In contrast, baseline MEP variability was significantly associated with both motor outcome (Fugl-Meyer Upper Extremity scale at T1; P =2.76×10 ^{− 7} ) and the Motor Recovery Index ( P =0.009), indicating a specific link with recovery potential. CONCLUSIONS: These findings reveal a dissociation between MEP amplitude and variability, suggesting that they capture complementary aspects of corticospinal function. Although amplitude reflects the current functional state of motor pathways, variability appears to index network flexibility and adaptive capacity. MEP variability may, therefore, represent a novel neurophysiological biomarker for predicting motor recovery and guiding personalized rehabilitation strategies after stroke.