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/Objectives: Upper limb rehabilitation in chronic stroke is often suboptimal, and somatosensory integration is frequently neglected. The aim of this study was to investigate the feasibility and potential effects of an integrated sensorimotor therapy. Methods: Individuals with chronic stroke and persistent sensorimotor and functional upper limb deficits were included. For four weeks, participants received standard care (control), followed by 48 h of integrated sensorimotor upper limb therapy (ROBUST) over four weeks in addition to their standard care (intervention). ROBUST combined robotic, therapist-led, and home exercises. Feasibility was assessed through adherence, motivation, experiences, and adverse events. Potential effects of the intervention were evaluated via a multimodal assessment approach at baseline (T1), post-control (T2), and post-intervention (T3), with the Action Research Arm Test (ARAT) as the primary outcome. Results: Ten participants were included in this study, of whom nine completed the protocol. Therapy session adherence was 100%, and home program adherence 67%. Motivation remained stable over the intervention period, participants were positive, and no adverse events occurred. Six participants (67%) improved more than the minimal clinically important difference for ARAT, with further relevant improvements in clinical, kinematic, and patient-reported outcomes observed. Conclusions: The novel integrated sensorimotor upper limb therapy (ROBUST) is feasible and shows promising potential for people after stroke in the chronic stage. A randomised controlled trial is warranted. Trial registration: (identifier: NCT06870682).

This prospective study examined the psychometric properties of the Speed Precision ObsTacle courSe (SPOTS), a six-item, triangle-shaped obstacle course to assess walking adaptability in individuals with a central neurological disorder (CND). Inter- and intra-rater reliability, validity and sensitivity of the SPOTS were evaluated in adults with CND undergoing inpatient rehabilitation. The SPOTS was performed on 2 consecutive days, and 1 month later, alongside clinical assessments on the first and last day. Completion time was recorded, and three raters performed clinician-rated assessments for motor and cognitive function based on video recordings. Reliability of the clinician-rated SPOTS score was assessed with Intraclass Correlation Coefficients (ICC), Bland-Altman, and weighted Kappa analysis; validity with Spearman rank correlation coefficients and sensitivity to change with the minimal detectable change (MDC). Thirty-five independent walkers (FAC ≥3) with CND were recruited. The SPOTS showed excellent inter-rater (ICC: 0.90-0.93) and intra-rater reliability (ICC: 0.91-0.96). Adequate to excellent correlations (r = 0.36-0.66) were found with other common balance and gait assessments. An MDC value of 4.63 points (6.4% of SPOTS) was found. The SPOTS is a new, promising, reliable, valid and sensitive tool for assessing advanced walking adaptability in patients with CND.