Physical Medicine

Power plus HIIT treadmill improves fast gait in bilateral spastic CP

This multisite RCT randomized 10- to 17-year-olds with bilateral spastic CP to 24 sessions of power plus interval treadmill training (PT3) or strength plus steady-state treadmill (STT). PT3 produced greater gains in fast gait speed at 2 months than STT (adjusted mean difference 0.030 m/s; 95% CI 0.002-0.059). Lower-extremity muscle power improved more immediately after PT3, supporting a specific benefit of power-focused training. Self-selected gait speed was unchanged between groups, implying impact mainly on higher-demand walking conditions. Stride rate intensity increased immediately after PT3 but was not sustained, suggesting a need for maintenance or booster sessions. 1

International Fugl-Meyer manual aims to harmonize stroke motor scoring

An expert panel created a consensus Fugl-Meyer Assessment manual to standardize motor assessment after stroke across centers and trials. Fourteen experienced users from 13 research centers on three continents iteratively refined the manual, achieving at least 79% agreement for all sections. The group recommends assessors have strong neurorehabilitation foundations and receive structured, supervised patient-based training before independent scoring. A parallel literature review confirmed strong validity and reliability of the original FMA but limited data on minimal clinically important differences. Using this manual should improve consistency, data pooling, and interpretability when the FMA is a primary motor outcome. 2

Maximum weighted CST overlap best explains post-stroke motor outcomes

This ENIGMA Stroke Recovery study compared four corticospinal tract lesion-load metrics across three templates in 221 ischemic stroke patients. Maximum weighted cross-sectional overlap (Max-WLL) with an age-appropriate CST template best explained motor and functional outcomes. Max-WLL accounted for 58.9% of variance in Fugl-Meyer Upper Extremity and 60% in Barthel Index scores in the derivation cohort. In an independent 125-patient cohort, Max-WLL again explained substantial Fugl-Meyer Upper Extremity variance (47.6%). These findings support using age-appropriate Max-WLL metrics as imaging biomarkers to study recovery and stratify patients in stroke trials. 3

Nationwide intradialytic exercise rollout is feasible, safe, and improves function

This nationwide implementation study examined intradialytic exercise delivered as routine practice across 20 hemodialysis units. Of 1270 eligible patients, 811 started exercise and completed about 86 minutes of aerobic training weekly with 75% adherence. Exercise participants had fewer dialysis cramps and no increase in other adverse events versus those who declined. Functional performance improved on most physical tests, and lean tissue mass and body cell mass increased compared with nonparticipants. High attrition and only moderate adoption indicate a need for additional implementation strategies to sustain engagement. 4