Treating Knee Locking After A Stroke

FND Is Real: Why the Legs Can Move, But Walking Still Breaks Down

Functional gait disorder is one of the most challenging and misunderstood presentations in neuro rehab. It can mimic structural neurologic disease, coexist with neurologic injury, and present with highly variable movement patterns including slow gait, astasia-abasia, knee buckling, dragging gait, dystonic gait, tremulous gait, truncal imbalance, and “walking on ice.” The review by Issak and colleagues emphasizes that functional gait disorder is multidimensional, often involving both motor symptoms and non-motor symptoms such as pain, fatigue, dizziness, fear of falling, anxiety, and depression. We also discuss an 8-week outpatient multidisciplinary FND program that included physiotherapy, CBT, self-management, group physiotherapy, and psychoeducation. Patients who completed the program showed improvements in anxiety, depression, functional impairment, walking speed, Timed Up and Go, and balance measures, although the study was retrospective and did not include a control group. The big takeaway: FND is not fake. Functional walking problems are real nervous-system problems, and rehab may help when it targets both movement and the factors that keep symptoms stuck. Source: Issak S, Kanaan R, Nielsen G, Fini NA, Williams G. Functional gait disorders: clinical presentations, phenotypes and implications for treatment. Brain Inj. 2023;37(5):437-445. doi:10.1080/02699052.2023.2165158 Guy L, Caceres GA, Jackson T, et al. Routine outcomes and evaluation of an 8-week outpatient multidisciplinary rehabilitative therapy program for functional neurological disorder. J Neurol. 2024;271(4):1873-1884. doi:10.1007/s00415-023-12111-4 Powered by: Google Notebook LM

NMES: Electrical Stimulation After Stroke

In this episode of Neuro Simplified, we talk about one of the most frustrating problems after stroke: the arm that does not move the way the brain wants it to. After stroke, weakness is not always just a muscle problem. The signal from the brain to the arm can become disrupted, delayed, or poorly coordinated. That is where electrical stimulation and neuromodulation-based rehab become interesting. Instead of simply asking the patient to move harder, these approaches try to pair intention with activation, helping the nervous system reconnect effort, sensation, and movement. We break down why the arm can be so difficult to recover after stroke, why repetition alone may not be enough, and how stimulation-based treatments may help “wake up” the pathway between the brain, spinal cord, peripheral nerves, and muscles. The big takeaway: stroke arm rehab is not just about strengthening. It is about timing, feedback, attention, repetition, and giving the nervous system a clearer signal to practice with. Source: Kristensen MGH, Busk H, Wienecke T. Neuromuscular electrical stimulation improves activities of daily living post stroke: a systematic review and meta-analysis. Arch Rehabil Res Clin Transl. 2022;4:100167. doi:10.1016/j.arrct.2021.100167 Powered by Google Notebook LM

Is Virtual Reality Appropriate for Stroke Rehab?

Virtual reality rehabilitation is gaining attention in stroke recovery, but one question matters more than the technology itself: what do stroke survivors actually think about it? In this episode of Neuro Simplified, we break down a 2025 systematic review and qualitative meta-synthesis on stroke survivors’ experiences with virtual reality rehabilitation. The review included 14 studies and 133 participants, exploring the benefits, barriers, motivators, and expectations patients reported after using VR-based rehab. Patients described improvements in movement, attention, confidence, mood, and daily function, but they also identified real challenges, including pain, fatigue, fear, technical problems, home setup barriers, and the need for better personalization. The big takeaway: VR is not magic, and it is not a replacement for skilled therapy. But when it is engaging, safe, task-specific, and matched to the patient’s abilities, it may help stroke survivors practice more, stay motivated, and reconnect with meaningful daily activities. Source: Ding K, Ma Y, Zhang L, Gu Y, Pan H, Gu Z-E, Zhang H. Patient-centered insights into virtual reality rehabilitation for stroke: a systematic review and qualitative meta-synthesis. Journal of NeuroEngineering and Rehabilitation. 2025;22:124. doi:10.1186/s12984-025-01641-9. Powered by: Google Notebook LM

Laughing Gas and Spinal Cord Injury

In this episode of Neuro Simplified, we’re talking about nitrous oxide, commonly known as laughing gas, and why recreational use can become a serious neurologic problem. Nitrous oxide can interfere with vitamin B12 metabolism and create a functional B12 deficiency, even when the serum B12 number looks normal or even elevated. That matters because B12 is essential for myelin health. When that pathway is disrupted, patients can develop subacute combined degeneration of the spinal cord, a condition that commonly affects the dorsal columns and can lead to numbness, loss of vibration sense, impaired proprioception, sensory ataxia, weakness, gait instability, and sometimes cognitive changes. One case report described an 18-year-old male with six months of nitrous oxide use who developed progressive limb numbness, unsteady walking, weakness, sensory loss, impaired vibration and position sense, positive Romberg sign, peripheral nerve injury, and acute cognitive impairment. His homocysteine was elevated, and MRI showed cervical spinal cord T2 hyperintensity with posterior column involvement and the classic “inverted V sign.” The big clinical message: do not stop at “B12 is normal.” Nitrous oxide can inactivate B12 at the functional level, so the neurologic exam, homocysteine, methylmalonic acid when available, exposure history, and spinal MRI may tell the real story. Other reports also reinforce that serum B12 may not always reflect true cellular B12 status, and that MRI findings such as dorsal column hyperintensity and the inverted V sign can be key clues. Source: AMA Citations Wu H, Huang H, Xu L, Ji N, Zhou X, Xie K. Case report: Subacute combined degeneration of the spinal cord due to nitrous oxide abuse. Front Neurol. 2023;14:1099077. doi:10.3389/fneur.2023.1099077 Al-Jizani AS, Pathak S, Palit P, Achufusi N. Subacute combined degeneration of the spinal cord caused by an impairment in the functional vitamin B12 metabolic pathway. Cureus. 2024;16(11):e73617. doi:10.7759/cureus.73617 Van Berkel B, Vandevenne J, Vangheluwe R, Van Cauter S. Subacute combined degeneration of the cervical and dorsal spinal cord in a 40-year-old male patient: A case report. Radiol Case Rep. 2021;16(1):13-17. doi:10.1016/j.radcr.2020.10.033 Powered by Google Notebook LM

AFib and Stroke: The Heart-Brain Connection We Can’t Ignore

In this episode of Neuro Simplified, we look at three recent papers on atrial fibrillation and stroke and why this connection matters for prevention, acute care, and rehabilitation. AFib is more than an irregular heartbeat. It is one of the major cardiac contributors to stroke risk, and AFib-related strokes are often associated with worse outcomes. These papers discuss how stroke risk is not always fully explained by traditional scoring systems, why heart structure and comorbidities may matter, and why better detection and long-term management are critical. We also highlight a practical rehab angle: people living with AFib may benefit from more comprehensive care that includes education, physical exercise, symptom management, psychosocial support, and risk factor control. For clinicians, this is a reminder that stroke recovery does not start and stop with the brain. The heart, vascular system, lifestyle factors, and long-term prevention plan all matter. Source: Alonso A, Akin I, Hochadel M, et al. Atrial fibrillation in patients with very high risk for stroke and adverse events: insights from the observational ARENA study. J Clin Med. 2024;13(22):6645. doi:10.3390/jcm13226645. Elsheikh S, Hill A, Irving G, Lip GYH, Abdul-Rahim AH. Atrial fibrillation and stroke: state-of-the-art and future directions. Curr Probl Cardiol. 2024;49:102181. doi:10.1016/j.cpcardiol.2023.102181. Elnegaard CM, Pedersen MK, Zwisler ADO, et al. Atrial fibrillation and primary care prevention and rehabilitation: a feasibility study. Pilot Feasibility Stud. 2025;11:150. doi:10.1186/s40814-025-01724-3. Powered by: Google Notebook LM