This Week in Physical Medicine & Rehabilitation — Sep 17, 2026

Welcome to This Week in Physical Medicine and Rehabilitation. This week we're covering 10 notable papers spanning stroke recovery and fall prevention, spinal cord injury physiology and conditioning, and the growing use of technology-assisted rehabilitation for pain, function and disorders of consciousness. Let's dive in.

We start with stroke, where the most immediately usable paper of the week is also the simplest. In Archives of Physical Medicine and Rehabilitation, Inoue and colleagues report a retrospective pre-post study across 1,437 patients in a post-acute inpatient rehabilitation hospital, comparing usual care with a standardized fall-prevention education session delivered at the very moment a patient first achieved independent walking [1]. The content was deliberately unglamorous: independence in walking does not mean absolute safety, here are the boundaries of safe activity, and here is when to ask for help. Of the whole cohort, 217 patients fell at least once after becoming independent ambulators. Patients who received the standardized education took significantly longer to have their first fall, and their adjusted hazard of a first fall was cut by roughly forty percent, with the overall fall rate down about a third. This is observational, with all the confounding that a before-and-after design carries, but the intervention costs nothing but a few structured minutes of staff time, and it targets exactly the window every inpatient rehabilitation clinician recognises — the days right after the walking restriction comes off, when confidence outruns capacity.

Two trials this week tackled stroke gait itself, both in the American Journal of Physical Medicine and Rehabilitation, and both should be read as small and preliminary. Fang and colleagues randomised 40 patients in the subacute phase, one to six months after stroke, to augmented reality gait training alone or to sequential electroacupuncture delivered before that same augmented reality training, four weeks in total [2]. The primary outcome, gait speed, favoured the combined protocol, with additional gains in stride length, gait symmetry, lower limb motor function, balance and a co-contraction index of neuromuscular control. Step width, cadence and joint kinematics did not differ, and no adverse events occurred. The authors' proposed mechanism — that electroacupuncture opens a transient neuromodulatory window that primes motor relearning — is speculation at this sample size, and they say so. Alongside that, Bildik and colleagues ran a sham-controlled, participant- and assessor-blinded trial of high-intensity laser therapy in 24 patients with plantar flexor spasticity, three sessions a week for three weeks on top of six weeks of conventional rehabilitation [3]. Here the honest summary is that the primary outcome was not clearly met. There was a group-by-time interaction favouring laser on the ten-metre walk test, but the direct between-group comparison of gait speed was not significant, and the gait benefit emerged only in a post-hoc covariate-adjusted analysis, at a magnitude of a few hundredths of a metre per second. What was robust was pain: spasticity-related pain fell substantially and durably with laser at both three and six weeks. Measured spasticity itself and muscle thickness did not change, and range of motion and quality of life improved equally in both arms. So the fair reading is an adjunct that may help spasticity-related pain, with a gait signal too fragile to act on.

Turning to spinal cord injury, Spinal Cord published a case-control laboratory series from Sturgess and colleagues examining transcutaneous spinal stimulation during an orthostatic challenge in eleven people with cervical injury and ten without [4]. Without stimulation, tilting upright raised systolic pressure in the non-injured group and dropped it in the injured group, a difference of roughly twenty millimetres of mercury. With stimulation applied over the lower thoracic segments, the injured group's pressure response upright looked much more like the uninjured group's, and in the subgroup who actually had orthostatic hypotension, lower thoracic stimulation blunted the orthostatic drop by around twenty-six millimetres of mercury. The caution is the mirror image of the benefit: when the same stimulation was applied lying horizontal, systolic pressure rose by roughly twenty-five millimetres of mercury regardless of position. That is a pressor effect you do not want to deliver unintentionally in a population already prone to autonomic dysreflexia, so position matters if this moves toward clinical use.

Staying with spinal cord injury, The Journal of Spinal Cord Medicine reports a randomised trial from Rodríguez-Barragán and colleagues comparing kayak ergometer training with conventional trunk training in 36 people who completed the study, all three to twelve months post-injury, five sessions weekly for six weeks [5]. Everyone improved on every outcome. The kayak group showed nominally better functional independence and estimated peak oxygen uptake, but neither survived correction for multiple comparisons, so the correct conclusion is a trend, not a demonstrated advantage. What it does support is that a cardiovascularly demanding, trunk-loaded modality is feasible and well tolerated in the subacute phase — reasonable as a patient-preference alternative, not as an evidence-based upgrade.

The musculoskeletal and pain papers this week are a useful lesson in the gap between statistical significance and clinical meaning. In Archives of Physical Medicine and Rehabilitation, Canlı and colleagues randomised 60 people with partial rotator cuff tears to six weeks of progressive conventional physiotherapy, with or without added virtual reality task-oriented training built around activities of daily living [6]. Upper extremity function on the DASH favoured the virtual reality group by about four points — statistically significant, but, as the authors themselves state plainly, below the published minimal clinically important difference. Resting, activity and night pain, shoulder pain and disability, kinesiophobia and pain catastrophising all improved more in the virtual reality group, while anxiety and depression scores and grip and pinch strength did not differ. The plausible signal here is on fear of movement and catastrophising rather than on raw function.

A sobering counterpoint comes from the American Journal of Physical Medicine and Rehabilitation, where Sherwood and colleagues prospectively audited 102 consecutive patients receiving 60-day temporary percutaneous peripheral nerve stimulation for chronic pain, following them out to 14 months [7]. At two weeks, just under half of patients reported at least fifty percent pain relief. By two months that had fallen to a third of patients, by five months to about one in six, by eight months to roughly one in ten, and by eleven months to about one in twenty-five. At fourteen months, no one met the fifty percent threshold. This is a single-centre, heterogeneous, real-world cohort without a control arm, but it is exactly the kind of unvarnished longitudinal follow-up that the durability claims around this technology have lacked, and it should reshape how we counsel patients about what happens after explant.

Also in Archives of Physical Medicine and Rehabilitation, Ceballos-Sánchez and colleagues used accelerometer data from 968 adults with knee osteoarthritis in the Osteoarthritis Initiative to build age-related percentile curves for physical activity [8]. Median weekly moderate-to-vigorous activity was about 14 minutes — an order of magnitude below guideline targets. Activity declined with age; men accumulated more moderate-to-vigorous activity and women more total activity; those with significant pain and higher body mass index were least active, especially at the lower percentiles. Income showed no significant association. The authors are explicit that sitting at a high percentile within this cohort does not mean meeting guidelines, which is the interpretive trap to avoid when using these curves with a patient.

Two papers round out the week on the technology and consciousness front. In Disability and Rehabilitation, Zhang and colleagues pooled 18 studies and 884 participants on multimodal sensory therapy for disorders of consciousness after acquired brain injury [9]. The effect on consciousness scores was large, and the odds of emergence from coma were several-fold higher with stimulation. But risk-of-bias concerns were flagged in most included studies, heterogeneity was substantial, and an effect size that large in this population should prompt caution rather than confidence. And in PM&R, Vu and colleagues offer a narrative review of therapeutic surface electromyography, arguing that real-time biofeedback on muscle activation — both to recruit weak muscles and to suppress unwanted co-contraction — remains underused relative to its evidence base, largely for practical and workflow reasons rather than scientific ones [10].

If you only have time for one paper this week, make it the fall-prevention education study in Archives of Physical Medicine and Rehabilitation [1]. It is the only intervention in this batch that is essentially free, deliverable tomorrow, and aimed at the single most consequential adverse event on an inpatient stroke unit.

Here are the key takeaways from this week in Physical Medicine and Rehabilitation. First, the moment a stroke patient achieves independent walking is a discrete, teachable risk window, and a structured conversation at that moment was associated with meaningfully fewer falls. Second, for stroke gait, the augmented reality plus electroacupuncture protocol met its primary endpoint in a small trial, while high-intensity laser did not convincingly improve walking speed but did reduce spasticity-related pain. Third, transcutaneous spinal stimulation can meaningfully blunt orthostatic hypotension after cervical injury, but it raises blood pressure when applied supine, so position is a safety consideration. Fourth, counsel patients honestly that benefit from 60-day temporary peripheral nerve stimulation faded steadily and was essentially absent by fourteen months in a real-world cohort. And fifth, adults with knee osteoarthritis accumulate strikingly little moderate-to-vigorous activity, and being average within that population is nowhere near being adequately active.

That's your roundup for This Week in Physical Medicine and Rehabilitation. The full transcript and references are available on the episode page in your AudioScholar library. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.

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This is an automated summary generated by artificial intelligence, which can make mistakes. Always review the original source materials.