Telerehabilitation is emerging as a promising digital method for delivering rehabilitation to Parkinson’s Disease (PD) patients, especially in the early stages to promote brain resilience. This study explores how cognitive reserve (CR), the brain’s ability to withstand aging and disease, impacts the effectiveness of telerehabilitation. It specifically examines the influence of lifelong cognitive activities on the relationship between neural reserve and improved functional abilities following rehabilitation. In the study, 42 PD patients underwent a 4-month neuromotor telerehabilitation program. CR proxies were assessed using the Cognitive Reserve Index questionnaire (CRIq), brain changes via 3T-MRI, and functional response through changes in the 6-Minute Walk Distance (6MWD). Participants were divided into responders (n = 23) and non-responders (n = 19) based on their 6MWD improvement. A multiple regression model was run to test significant predictors of 6MWD after treatment in each group. The results revealed a significant correlation between 6MWD and CRIq scores, but only among responders. Notably, the CRIq Leisure-Time sub-index, along with baseline 6MWD, were predictors of post-treatment 6MWD. These findings highlight CR’s role in enhancing the benefits of telerehabilitation on PD patients’ neuromotor functions. Clinically, these results suggest that neurologists and clinicians should consider patients’ lifestyles and cognitive engagement as important factors in predicting and enhancing the outcomes of telerehabilitation. The study underscores the potential of CR as both a predictor and booster of telerehabilitation’s effects, advocating for a personalized approach to PD treatment that takes into account individual CR levels.

Background: Multiple Sclerosis (MS) is a neurodegenerative disorder causing lower and upper-limb (UL) impairments and significantly affecting independence. Current assistive technologies for UL rehabilitation in People with MS (PwMS) rely on actuated robotic systems, which present high costs and complexity. Passive gravity-compensated exoskeletons represent a promising alternative; however, their functional benefits remain underexplored. This study aimed to redesign and evaluate the orthotic effect of a passive gravity-compensated exoskeleton device in supporting upper-limb function in PwMS. Methods: This pilot cross-sectional study presents two phases: (I) redesigning an existing passive exoskeleton to improve usability and adaptability; (II) evaluating the orthotic effect and usability of the redesigned exoskeleton in a cohort of PwMS. Functional performance was assessed using the Action Research Arm Test (ARAT) and a modified Box and Block Test (mBBT) under Exoskeleton Supported and Exoskeleton Unsupported conditions. Kinematic parameters were extracted from three instrumented ARAT items, and usability was assessed with the System Usability Scale (SUS). Results: Phase I led to an iterative refinement of the exoskeleton, incorporating feedback from three PwMS and two therapists. In Phase II, thirteen PwMS (age: 59 [55–69] years; 10 males; EDSS: 7.5 [6.5-8.0] points) with different UL disabilities were recruited. Four participants with severe impairments increased the UL movement (orthotic effect) by 35.8% [29.0%–41.9%] and 24.1% [14.9%-33.3%] in the vertical and anteroposterior direction, with 8 [6.5–9.25] points improvements in the overall ARAT. Conversely, three individuals with mild UL disability needed 2.63 [2.17–3.45] seconds more to complete the instrumented ARAT items increasing the Jerk Index by 0.53[0.51–0.68]. The overall ARAT decreased by 7 [6–8] points and they transported 10[9–18] blocks less in the mBBT. The remaining participants with an FSS > 5.5 points, transported 9.5 [8-11.25] blocks more in the mBBT. The median SUS score was 70[62.5–70]. Conclusions: Collaboration between therapists and engineers was key in refining the exoskeleton during phase I. Phase II results supported its positive orthotic effect for PwMS, particularly for those with moderate to severe UL impairments and fatigue. However, for individuals with mild deficits, the device may alter movement dynamics, affecting execution quality. Future improvements should focus on reducing bulk for clinical use. Additionally, studies on larger populations are needed to validate these findings.

The L-test is a performance-based measure to assess balance and mobility. Currently, the primary outcome from this test is the time required to finish it. In this study we present the instrumented L-test (iL-test), an L-test wherein mobility is evaluated by means of a wearable inertial sensor worn at the lower back. We analyzed data from 113 people across seven cohorts: healthy adults, chronic obstructive pulmonary disease, multiple sclerosis, congestive heart failure, Parkinson’s disease, proximal femoral fracture, and transfemoral amputation. The iL-test automatic segmentation was validated using stereophotogrammetry. Univariate and multivariate analyses were performed on 164 kinematic features derived from inertial signals to identify distinct patterns across different cohorts. The iL-test accurately recognized and segmented activities during the L-test for all cohorts (technical validity). A random forest classifier revealed that proximal femoral fracture and transfemoral amputation induced significantly different mobility patterns compared to healthy people with AUC values of 0.89 and 0.99, respectively. Strong correlations were found between kinematic features and clinical scores in multiple sclerosis, congestive heart failure, proximal femoral fracture, and transfemoral amputation, with consistent patterns of decreased movement ranges and smoothness with increasing disease severity. Furthermore, features derived from 90° and 180° turns were found to be important contributors to differentiation amongst cohorts, underscoring the need to evaluate different turn degrees and directions. This study emphasizes the iL-test potential to deliver automated mobility assessment across a wide range of clinical conditions, indicating a prospective avenue for improved mobility assessment and, eventually, more informed healthcare interventions.

Importance: Task-specific balance deficits are common in people with neurological disorders (PwND), significantly affecting their Activities of Daily Living (ADLs). However, the relationship between balance deficits and ADLs measured by patient-reported outcomes is poorly understood, thus limiting the selection of specific static and dynamic tasks to be used to train for a given activity. Objective: The aim of the study was to provide a clinical framework linking ADLs, balance tasks, and balance resources (Horak, 2009) to support clinicians’ decision-making when planning task-oriented balance rehabilitation for PwND. Design: This was an observational study with a cross-sectional design. Setting: This study examined clinical contexts involving PwND. Participants: This study involved people with Parkinson disease, stroke, or multiple sclerosis. Exposure: The study used the Activities-Specific Balance Confidence Scale (ABC) for patient-reported outcomes to assess perceived balance during ADLs, and the Berg Balance Scale (BBS) and Dynamic Gait Index (DGI) to evaluate static and dynamic balance. Main Outcomes and Measures: Kendall tau correlations (τ) were used to identify meaningful associations between ABC and BBS-DGI items, matching ADLs with specific balance tasks. Results: The study sample comprised 299 people with Parkinson disease (n = 94), stroke (n = 94), and multiple sclerosis (n = 111) with a median (IQR) age of 63 (52.0–71.5) years, all exhibiting moderate to severe balance impairments. Moderate correlations (τ ≥ 0.39) were found between dynamic and semi-dynamic challenging outdoor ADLs with static and dynamic tasks involving sensory orientation and the use of vestibular and proprioceptive systems. Moreover, stability limits-verticality, anticipatory postural adjustments, and stability in gait are the primary balance resources to consider when designing ad hoc rehabilitation interventions. Conclusions: This study establishes associations between specific ADLs and balance tasks, offering a clinical framework to identify relevant balance resources for rehabilitation. It provides clinicians with a structured approach for planning task-oriented, needs-based balance rehabilitation for PwND, focusing on the training of specific balance resources to enhance ADLs. Relevance: This study provides a clinical framework to help clinicians in planning task-oriented and needs-based balance rehabilitation for PwND, suggesting which balance resources should be trained to improve specific ADLs.

Fatigue and balance disorders are common in people with multiple sclerosis (PwMS), but the neural mechanisms linking them during postural control remain unclear. This cross-sectional study aims to examine associations between fatigue, balance impairment, and task-evoked cortical hemodynamics/connectivity. Sixteen PwMS (relapsing-remitting MS; EDSS < 3.5) and 19 healthy controls (HC) were enrolled. Based on the Modified Fatigue Impact Scale (MFIS), PwMS were classified as fatigued (f_PwMS, MFIS ≥ 38; n = 10) or non-fatigued (nf_PwMS, n = 6). Participants performed five 30 s trials of static stance on foam with eyes closed. fNIRS recorded frontal, temporal, and occipital cortical activity, while stabilometry measured center-of-pressure sway. In PwMS, MFIS showed a trend toward association with sway (r = 0.49; p = 0.06). Sway was higher in f_PwMS than nf_PwMS and HC but not significantly different (ANOVA p = 0.341). Compared with HC, PwMS showed increased bilateral prefrontal and reduced occipital HR. Stratified analyses showed greater HR in f_PwMS versus HC and nf_PwMS in bilateral BA10 and in temporo-parietal regions, with a right-hemisphere predominance. Global coherence did not differ across groups, but exploratory BA10 analysis showed higher prefrontal coherence in f_PwMS than nf_PwMS (p = 0.02). Fatigued PwMS exhibit amplified, right prefrontal and temporo-parietal activation and focal prefrontal hyper-connectivity, consistent with compensatory top–down control to maintain balance.