Stroke is a leading cause of long-term disability worldwide highlighting the need for effective rehabilitation strategies to improve functional recovery. Dynamic Scalp Acupuncture (DSA), which combines scalp acupuncture with concurrent task-oriented training, has emerged as a potentially beneficial intervention for stroke rehabilitation. However, evidence regarding DSA has not been systematically synthesized as a distinct task-integrated rehabilitation approach. This protocol outlines a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of DSA in stroke rehabilitation. This study will be conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. A comprehensive literature search will be performed in international databases, including PubMed, Embase, the Cochrane Central Register of Controlled Trials, and the Cumulative Index to Nursing and Allied Health Literature; Chinese databases, including the China National Knowledge Infrastructure and Wanfang; and Korean databases, including the Research Information Sharing Service, Korean Studies Information Service System, and Korea Medical database. Eligible studies will be RCTs evaluating DSA either as a standalone intervention or as an adjunct to conventional rehabilitation in adults with stroke. The primary outcome will be motor function. Secondary outcomes will include activities of daily living and adverse events, while exploratory outcomes will include neurological impairment, balance, spasticity, health-related quality of life, and depression. Two reviewers will independently conduct study selection, data extraction, and risk-of-bias assessment using the Cochrane Risk of Bias 2 tool. Where appropriate, meta-analyses will be performed using a random-effects model, and the certainty of evidence will be assessed using the Grading of Recommendations. Assessment, Development, and Evaluation approach. This systematic review is expected to provide up-to-date evidence on the efficacy and safety of DSA for stroke rehabilitation. The findings may inform clinical practice and policy, and help guide future research.

Improving overground walking in people with chronic, incomplete spinal cord injury (iSCI) is especially important for older adults, who now represent more than 40% of the SCI population. Age and injury appear to interact to limit neuroplasticity in spared pathways, constraining gains from gait training. Brief episodes of low oxygen breathing (therapeutic acute intermittent hypoxia [tAIH]) may function as a plasticity-promoting primer to enhance the effects of transcutaneous spinal stimulation-augmented gait training (WALKtSTIM), particularly in older individuals. This multicenter, age-stratified, placebo-controlled clinical trial will examine dose- and age-dependent effects of tAIH+WALKtSTIM on walking recovery in 60 adults with chronic (>1 year) iSCI. After an eight-session WALK prewash phase, participants are randomized within age strata (18-49 and 50-80 years) to tAIH+WALKtSTIM or Placebo+WALKtSTIM. The active intervention delivers daily tAIH or Placebo immediately before a 45-min WALKtSTIM session, 4 days per week for 4 weeks. Primary outcomes are walking speed (10-Meter Walk Test), endurance (6-Minute Walk Test), and balance (Timed Up-and-Go), assessed at baseline, during intervention weeks, and 1, 4, and 8 weeks post intervention. Safety and mechanistic measures include lower extremity strength, spasticity, pain, cardiopulmonary function, cognition, autonomic events, and serum testosterone. Findings will determine whether tAIH priming augments WALKtSTIM relative to Placebo, whether extending pretreatment from 2 to 4 weeks (in pooled analyses with BO2ST-I) yields larger or more durable walking gains, and whether age and hormone levels modify responsiveness. These results will inform age-appropriate tAIH dosing strategies and support the development of personalized neuromodulatory rehabilitation for an aging SCI population.

Hereditary spastic paraplegias (HSPs) comprise a heterogeneous group of heritable neurodegenerative disorders resulting from mutations in a wide variety of genes. HSP locomotor symptoms include lower limb weakness and spasticity that arise from progressive degeneration of corticospinal axons projecting from the motor cortex to the distal spinal cord. Ensuing gait defects typically lead to wheelchair dependence. Degeneration of other tracts can also occur, expanding the constellation of symptoms to potentially include urinary, fecal, and speech problems, as well as intellectual disability. SPG4-HSP, the most common variant, is caused by mutations in the SPAST gene, which encodes spastin, a microtubule-severing protein with membrane-related properties. Significant progress has been made in developing preclinical models for SPG4-HSP and in elucidating its mechanistic etiology. On this basis, progress is being made on developing a flexible therapeutic regimen for patients at all stages of disease progression. © 2026 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Central paralyses are not limited to a simple motor deficit; they are associated with spasticity and-over time-contractures, as well as major disturbances in motor patterns. Significant clinical variability complicates both their assessment and the formulation of a therapeutic strategy. For these reasons, indications for tendon transfers in this patient population are more limited than in cases of peripheral paralysis; such procedures are generally incorporated into a complex surgical program that variously combines tendon lengthening, selective denervation, and joint stabilization. Faced with clinical presentations involving widely differing objectives-ranging from functional restoration to mere comfort-it is difficult at first glance to devise a standardized surgical program. In this article, we therefore propose an evaluation method using a score (INOM) based on functional prognostic factors and parameters requiring surgical correction to improve grasp. Three key areas guide this program: a prognostic factor, proximal motor control of the shoulder and elbow, and the correction of abnormal postures alongside the restoration of active extension of the elbow, wrist, and fingers. The INOM score highlights treatment priorities, enabling the formulation of a surgical strategy. Spasticity often obscures the motor assessment of these patients; anesthetic blocks and botulinum toxin injections are essential tools for this analysis. They make it possible to distinguish between spasticity and contracture, as well as to unmask certain antagonist muscles. In this population, a tendon transfer will be just as effective through the function it restores as through the elimination of its detrimental effect on the development of a deformity. We thus report, for each joint segment, the indications for tendon transfers and their relative roles among the techniques with which they must be combined.

Fixed-dose Botulinum neurotoxin type A regimens ignore patient-specific variables, such as body weight, despite allometric principles governing the distribution of biologic drugs. This computational study developed a weight-adjusted dosing framework for onabotulinumtoxinA (ONA) across nine therapeutic and aesthetic indications. Mechanistic pharmacokinetic/pharmacodynamic models incorporating allometric scaling were integrated with machine learning and Bayesian hierarchical analysis to simulate ONA distribution, efficacy, and toxicity in synthetic patient cohorts (N = 10,000). Body weight was the dominant determinant of ONA bioavailability and therapeutic outcome for systemic indications (chronic migraine, cervical dystonia, adult spasticity, overactive bladder), with weight-scaling exponents of 0.55-0.72 and predicted dose requirements showing 30-70% variance from fixed regimens. Weight-adjusted dosing improved the simulated duration of efficacy by up to 50% and reduced adverse event rates by 20-60% in systemic indications, while low-weight populations exhibited a heightened risk of toxicity under fixed dosing. For aesthetic indications and hyperhidrosis, weight-scaling exponents approached zero (0.02-0.18); muscle thickness and skin elasticity superseded weight as determinants of dosing. Machine learning models achieved high predictive accuracy (mean absolute error <10 units; toxicity AUC >0.85). All predictions apply exclusively to ONA and are not interchangeable with other botulinum toxin formulations. All predictions are derived from in silico simulations and have not been validated in prospective clinical trials. These findings require confirmation in controlled human studies before clinical adoption.

Peroneal spastic flatfoot (PSFF) involves peroneal spasm and subtalar restriction, yet optimal conservative care is undefined. This pilot retrospective study explored the preliminary outcomes of botulinum toxin type A (BoNT-A) injection combined with rehabilitation in 19 PSFF patients (10 with structural abnormalities [SA], 9 without [NSA]). Pain (VAS), spasticity (MAS), and function (AOFAS-AH) were assessed at baseline, 1, 3, and 6 months. Significant improvements were observed across all metrics (P < 0.05). The median VAS decreased from 4 to 0, median AOFAS-AH improved from 67 to 100, and median MAS reduced from grade 4 to grade 0 at 6 months relative to baseline. In subgroup comparisons, NSA patients achieved superior outcomes, with significantly higher AOFAS-AH and lower MAS at 3 and 6 months (P < 0.05) and 100% satisfaction versus 40% in SA patients (P < 0.05). One patient experienced transient calf swelling. These exploratory findings suggest BoNT-A combined with rehabilitation may warrant further investigation as a potential conservative option for PSFF, particularly among patients without structural abnormalities. Due to the small sample size and lack of control group, these results should be interpreted as exploratory rather than confirmatory. LEVEL OF EVIDENCE: Level IV, retrospective case series.

With the objective of describing the characteristics and comparing the need with the previous utilization of rehabilitation services in children with cerebral palsy at a referral hospital in Peru, a descriptive study was conducted through the review of medical records of 86 patients treated during 2024. It was found that 41.8% did not attend any educational institution and 44.2% did not have a disability certificate; among those who had one, the mean time to obtain it was 4.9 years. Less than half had a pelvic radiograph, despite hip dislocation being a frequent comorbidity. Although the majority required rehabilitation therapies, their coverage was limited, especially in occupational therapy and speech/swallowing therapy. Likewise, more than half of those who required botulinum toxin had not received it. These findings demonstrate significant discrepancies between the need and previous utilization of rehabilitation services in this population.

Children with spastic cerebral palsy (CP) often exhibit significant changes in their skeletal muscles due to altered neural control and atypical mechanical loading. While muscle morphology, in particular muscle size, has been extensively studied, other important properties, such as passive stiffness and muscle composition, remain poorly characterised. Previous studies have typically examined these features in isolation, leaving the interactions among morphology, composition and passive stiffness largely unexplored. This protocol addresses these gaps by providing a comprehensive, multimodal assessment of gastrocnemius muscle properties within a single cohort, which will be systematically compared with control data from typically developing (TD) children.