Spinal cord injury changes far more than movement—it can affect identity, relationships, cognition, sleep, pain, and emotional well-being. In this episode of NeuroSimplified, we explore a clinical review examining mental and behavioral health after spinal cord injury. Although depression, anxiety, PTSD, and suicide risk are elevated, the research also offers an important reminder: most people adapt well and can build meaningful, fulfilling lives after injury.

We discuss how rehabilitation professionals can distinguish normal emotional adjustment from clinical distress, preserve hope without creating false expectations, recognize disability-related bias, and address often-overlooked concerns such as sexuality, caregiver relationships, substance use, and chronic pain. We also examine why rehabilitation psychologists should be integrated into the interdisciplinary team—and how every clinician can help create more psychologically informed, disability-affirming rehabilitation.

Source:

Schultz KR, Mona LR, Cameron RP. Mental health and spinal cord injury: clinical considerations for rehabilitation providers. Curr Phys Med Rehabil Rep. 2022;10:131-139. doi:10.1007/s40141-022-00349-4

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In this episode of Neuro Simplified, we review a 2025 clinical review examining rehabilitation across the course of ALS. The authors emphasize that the goal of rehabilitation is not to reverse the disease, but to help preserve function, independence, participation, and quality of life for as long as possible.

We discuss what the evidence says about exercise in ALS, including why moderate, individualized strengthening and aerobic exercise may be appropriate, while high-resistance exercise, eccentric strengthening, and overexertion should generally be avoided. We also explore how physical therapy and occupational therapy can address mobility, transfers, positioning, energy conservation, assistive devices, and adapting daily activities as the disease progresses.

The review also highlights areas that sometimes receive less attention in rehabilitation—including respiratory muscle weakness and cough assistance, dysphagia and nutrition, augmentative and alternative communication, pain and spasticity management, cognitive and behavioral changes, caregiver support, and early palliative care.

Source:Gratzer A, Gdynia N, Sasse N, et al. Rehabilitation in amyotrophic lateral sclerosis: recommendations for clinical practice and further research. J Clin Med. 2025;14(23):8590. doi:10.3390/jcm14238590.

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Foot drop after stroke can significantly affect gait, balance, and fall risk, but electrical stimulation is increasingly used alongside conventional rehabilitation to improve ankle control and lower-extremity function. In this episode of Neuro Simplified, we review a 2025 systematic review and network meta-analysis of 37 randomized controlled trials involving 2,309 patients with post-stroke foot drop.

The study compared several forms of electrical stimulation, including FES, NMES, TENS, EMG biofeedback, tDCS, and electroacupuncture. Overall, electrical stimulation combined with conventional rehabilitation improved ankle dorsiflexion range of motion and lower-extremity Fugl-Meyer scores, with electroacupuncture ranking highest in the network analysis. However, the certainty of evidence ranged from intermediate to very low, with notable heterogeneity, possible publication bias, and limited long-term follow-up. We break down what these findings mean for clinicians and how much weight we should actually place on the rankings.

Source:

He W, Yaning L, Shaohong Y. Effect of electrical stimulation in the treatment on patients with foot drop after stroke: a systematic review and network meta-analysis. J Stroke Cerebrovasc Dis. 2025;34:108279. doi:10.1016/j.jstrokecerebrovasdis.2025.108279

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Foot drop is a common problem after stroke that can reduce walking speed, disrupt gait mechanics, and increase fall risk. In this episode of Neuro Simplified, we look at a systematic review and meta-analysis protocol designed to evaluate whether acupuncture can improve post-stroke foot drop, including gait speed, plantarflexor spasticity, dorsiflexor strength, lower-extremity motor function, and independence with daily activities.

Importantly, this paper is a study protocol, not a completed systematic review, so it does not provide final evidence that acupuncture is effective. Instead, it outlines how randomized controlled trials would be analyzed to determine its efficacy and safety. We discuss the proposed role of acupuncture alongside more established rehabilitation approaches such as physical therapy, ankle-foot orthoses, and functional electrical stimulation—and what clinicians should keep in mind when interpreting emerging evidence.

Source:

Gao Y, Gang X, Yuan Y, Yin K, Gong X. Efficacy and safety of acupuncture in the treatment of foot drop in post-stroke: a protocol for systematic review and meta-analysis. Medicine (Baltimore). 2022;101(40). doi:10.1097/MD.0000000000030994

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Functional Neurological Disorder (FND) is increasingly recognized as a real and treatable neurological condition, yet patients continue to experience stigma, dismissal, delayed diagnosis, and inconsistent access to care. In this episode of Neuro Simplified, we review a large systematic review examining stigma in FND, including how beliefs about malingering, voluntary control, poor clinician education, and fragmented care can affect patients, families, and healthcare professionals.

We also explore a practical shift in how clinicians can approach FND—from relying on stress-based explanations to using positive diagnostic signs, transparent education, validation, and multidisciplinary rehabilitation. We discuss the roles of physical therapy, psychology, neurology, and other rehabilitation disciplines, with an emphasis on restoring function, building patient trust, and creating consistent treatment expectations.

Source:

• McLoughlin C, McWhirter L, Pisegna K, et al. Stigma in functional neurological disorder (FND)—a systematic review. Clin Psychol Rev. 2024;112:102460. doi:10.1016/j.cpr.2024.102460
• Keatley E, Molton I. A shift in approach: assessment and treatment of adults with functional neurological disorder. J Health Serv Psychol. 2022;48:79-87. doi:10.1007/s42843-022-00061-w

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In this episode of Neuro Simplified, we break down Neuro-Behçet’s disease, a rare but serious neurologic complication of Behçet’s disease that can affect the brainstem, spinal cord, cerebral cortex, and neurovascular system. The sources highlight that NBD can present with motor weakness, cognitive changes, ataxia, dysphagia, headaches, and MRI findings that may mimic other neurologic diseases like MS.

We also discuss why rehab matters. One long-term case report showed that even in recurrent and steroid-refractory NBD, comprehensive rehabilitation including physical, occupational, cognitive, and dysphagia therapy helped improve walking, balance, cognition, swallowing, and ADL function over time.

Sources:

Peine B, Figueroa C, Robinette N. Neuro-Behcet’s syndrome: case report and literature review. Radiol Case Rep. 2022;17(8):3064-3070. doi:10.1016/j.radcr.2022.05.070.

Zhan H, Cheng L, Li Y. Neuro-Behçet’s disease: an update of clinical diagnosis, biomarkers, and immunopathogenesis. Clin Exp Immunol. 2025;219(1):uxae123. doi:10.1093/cei/uxae123.

Park JW, Joo MC, Lee KM, Kim MS. Effect of long-term comprehensive rehabilitation on functional recovery in recurrent and refractory Neuro-Behcet’s disease: a case report with 4-year follow-up. Brain Neurorehabil. 2018;11(2):e15. doi:10.12786/bn.2018.11.e15.

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In this episode of Neuro Simplified, we review a pilot study on people with multiple sclerosis that combined noninvasive tongue stimulation using the Portable Neuromodulation Stimulator, or PoNS, with intensive physical therapy and working-memory training. The study looked at whether this approach could improve balance, gait, working memory, and whether those changes could be seen on fMRI.

Fourteen participants with MS were split into active and sham stimulation groups. Both groups completed a 14-week program that included intensive physical therapy, working-memory training, balance testing, gait testing, neuropsychological assessment, and fMRI before and after treatment.

The active PoNS group showed significant improvement on the Sensory Organization Test, while fMRI showed changes in the left primary motor cortex. Both groups improved on working-memory tasks, but only the active group showed increased dorsolateral prefrontal cortex activity.

The big clinical takeaway: this was a small pilot study, so we cannot overstate the findings. But the results suggest that pairing intensive rehab with neuromodulation may enhance balance, working memory, and brain activation patterns in people with MS. It also gives clinicians a useful reminder that neuroplasticity is not just a concept. With the right combination of repetition, intensity, task-specific training, and sensory input, we may be able to measure changes in the brain.

Source: Leonard G, Lapierre Y, Chen JK, Wardini R, Crane J, Ptito A. Noninvasive tongue stimulation combined with intensive cognitive and physical rehabilitation induces neuroplastic changes in patients with multiple sclerosis: a multimodal neuroimaging study. Mult Scler J Exp Transl Clin. 2017;3(1):1-9. doi:10.1177/2055217317690561.

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Which speech therapy approach works best for post-stroke aphasia? This episode reviews a 2026 network meta-analysis of 17 randomized controlled trials involving 931 participants. The researchers compared constraint-induced aphasia therapy, multimodality aphasia therapy, melodic intonation therapy, computerized therapy, high-intensity treatment, and other approaches.

Multimodality aphasia therapy and constraint-induced aphasia therapy showed the strongest evidence for improving quality of life, including among people with chronic aphasia. However, no single treatment was clearly superior for isolated language skills such as naming, fluency, comprehension, or repetition. Treatment should still be individualized according to aphasia type, severity, recovery stage, and the patient’s communication goals.

Source: Yang FA, Huang CC, Lu CH, Wu PJ, Escorpizo R, Chen HC. Speech therapy for poststroke aphasia: a network meta-analysis of randomized controlled trials. PeerJ. 2026;14:e21118. doi:10.7717/peerj.21118.

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Spinal cord injury research is filled with promising treatments, but which options are actually helping patients today?

In this episode of Neuro Simplified, we break down current and emerging approaches to spinal cord injury rehabilitation, including functional electrical stimulation, robotic-assisted training, high-intensity locomotor training, spinal cord stimulation, stem cells, and tissue engineering.

We look at where the evidence is strongest, what remains experimental, and why rehabilitation still plays such an important role in improving function, health, and independence after spinal cord injury.

Source:

Yari D, Saberi A, Salmasi Z, et al. Recent advances in the treatment of spinal cord injury. Arch Bone Jt Surg. 2024;12(5):380-399. doi:10.22038/ABJS.2023.73944.3424.

Lee KE, Jeoung B. An analysis of the effectiveness of rehabilitation protocols for patients with spinal cord injury: a systematic review. J Public Health (Berl). 2025;33:1461-1470. doi:10.1007/s10389-023-02115-9

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Why do bladder problems occur after a stroke or spinal cord injury, and what can be done about them?

In this episode of Neuro Simplified, we review neurogenic bladder and neurogenic voiding dysfunction following stroke and spinal cord injury. These neurological injuries can disrupt voluntary bladder control, leading to urinary urgency, incontinence, incomplete emptying, urinary retention, and recurrent urinary tract infections. Without proper treatment and monitoring, complications may include bladder damage, kidney stones, infections, and impaired kidney function.

We discuss how the location of the neurological injury affects bladder function. Injuries higher in the spinal cord are more commonly associated with an overactive bladder and poor coordination between the bladder and urinary sphincter, while lower spinal cord or sacral injuries may cause an underactive bladder and urinary retention. After stroke, loss of cortical bladder control frequently contributes to urinary urgency and incontinence.

This episode also covers:

• Common signs of neurogenic bladder after stroke and spinal cord injury
• Overactive versus underactive bladder dysfunction
• Urinary incontinence, retention, and incomplete bladder emptying
• Urodynamic testing, bladder ultrasound, and uroflowmetry
• Bladder retraining and pelvic floor exercises
• Intermittent catheterization and medication options
• Botulinum toxin injections and neuromodulation
• Preventing urinary tract infections and kidney complications
• The role of rehabilitation, occupational therapy, nursing, neurology, and urology

Treatment may include scheduled voiding, fluid-management strategies, pelvic floor rehabilitation, medications, clean intermittent catheterization, botulinum toxin, neuromodulation, or surgery in more complex cases. Ongoing renal and urodynamic monitoring is important because management should protect both bladder function and long-term kidney health.

This episode is intended for physical therapists, occupational therapists, nurses, rehabilitation professionals, stroke survivors, people with spinal cord injury, and caregivers looking for a clearer understanding of bladder dysfunction after neurological injury.

Source:

Sevilla Torres E, Soto-Junco EJ, Baizan Orias SD, et al. Neurogenic voiding dysfunction in spinal cord injury and stroke: urodynamic evaluation, functional classification, and therapeutic strategies. Cureus. 2025;17(8):e89348. doi:10.7759/cureus.89348.

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