A traditional Chinese Yijinjing mind-body training program improves balance and gait in stroke survivors: A randomized controlled trial.

To explore the possible mechanisms for improving lower extremity motor function in patients with early stroke through combining magnetic resonance diffusion tensor imaging (DTI) technology and functional electrical stimulation (FES) based on human walking patterns. From August 2012 to September 2013, a total of 48 eligible patients were stratified according to age, gender, disease course, Brunnstrom staging and types of stroke. And the Minimize software was used to divided them randomly into four-channel FES group (n = 18), dual-channel FES group (n = 15) and comfort stimulation group (n = 15). For all three groups, general medication and standard rehabilitation were provided. Based on normal walking pattern design of FES treatment, four-channel FES groups received the stimulations of quadriceps, hamstring, anterior tibialis and medial gastrocnemius. For the dual-channel FES group, the stimulations of tibialis anterior, peroneus longus and peroneus brevis muscles were applied. In comfort electrical stimulation group, the electrode positions were identical to the stimulation group, but there was no current output during stimulation. Before and after 3-week treatment, three groups received weekly rehabilitation evaluations of Fugl-Meyer assessment (FMA), posture assessment of stroke scale (PASS), Brunel balance assessment (BBA), Berg balance scale (BBS) and modified Barthel index (MBI). Before and after treatment, DTI examination was performed for some patients. Among three groups, general patient profiles and pre-treatment evaluations showed no significant difference. For intra-group comparisons versus pre-treatment, at week 1, 2 and 3, the scores of PASS, BBA, BBS, FMA and MBI had statistically significant differences (P < 0.05); At week 3 post-treatment, when four-channel and double-channel FES groups were compared versus pre-treatment, the scores of ipsilateral FA had statistically significant differences (P < 0.05). At week 1 post-treatment, MBI had statistically significant difference among 3 groups (P = 0.037). As compared with placebo, four-channel group had statistically significant difference [(52 ± 12) vs (38 ± 18), P < 0.05]; At week 2 post-treatment, the scores of PASS and MBI were (29 ± 3, 73 ± 13) in four-channel FES group versus (24 ± 8, 60 ± 17) in dual-channel FES group. And the scores of PASS, BBA, BBS, FMA and MBI were (9 ± 3, 8.3 ± 2.4, 37 ± 7, 22 ± 5, 73 ± 13) in four-channel FES group versus (21 ± 7, 6.2 ± 3.1, 24 ± 16, 15 ± 8, 47 ± 20) in comfort electrical stimulation group. When dual-channel FES and comfort stimulation groups were compared, MBI had significant statistical difference [(60 ± 17) vs (47 ± 20), P < 0.05]. At week 3 post-treatment, four-channel and dual-channel FES groups were compared, there was also statistical significance in FMA [(25 ± 5) vs (20 ± 7), P = 0.055]. The scores of PASS, BBS, FMA and MBI were (31 ± 3, 43 ± 8, 25 ± 5, 81 ± 13) in four-channel FES group versus (25 ± 8, 29 ± 17, 17 ± 9, 54 ± 25) in comfort stimulation group respectively. When dual-channel FES and comfort stimulation groups were compared, the scores of MBI were (71 ± 15) and (54 ± 25) respectively. And the difference was statistically significant (P < 0.05). At week 3 post-treatment, the scores of FA significantly increased [four-channel FES group (0.321 ± 0.172) vs comfort stimulation group (0.217 ± 0.135) (P = 0.020)]. When dual-channel FES group (0.333 ± 0.164) and comfort stimulation group (0.217 ± 0.135) (P = 0.049) were compared, the differences were statistically significant. DTI showed that four-channel FES group increased significantly, but contralateral fiber bundle was not obvious. And the improvements of dual-channel FES and comfort stimulation groups were insignificant. Compared with traditional dual-channel FES, functional electrical stimulation based on human walking patterns is more efficacious. And it helps to restore brain structure and function and promote motor function recovery in patients with early stroke.

Stroke patients experience impaired sensory and motor functions, which impact their activities of daily living (ADL). The current study was designed to determine the best neurorehabilitation method to improve clinical outcomes, including the trunk-impairment scale (TIS), Berg balance scale (BBS), Fugl-Meyer assessment (FMA), and modified Barthel index (MBI), in stroke patients with impaired sensory function. Forty-four stroke survivors consistently underwent proprioceptive body vibration rehabilitation training (PBVT) or conventional physical therapy (CPT) for 30 min/session, 5 days a week for 8 weeks. Four clinical outcome variables-the FMA, TIS, BBS, and MBI-were examined pre- and post-intervention. We observed significant differences in the FMA, BBS, and MBI scores between the PBVT and CPT groups. PBVT and CPT showed significant improvements in FMA, BBS, TIS, and MBI scores. However, PVBT elicited more favorable results than CPT in patients with stroke and impaired sensory function. Collectively, this study provides the first clinical evidence of optimal neurorehabilitation in stroke patients with impaired sensory function.

Study DesignProspective Study.ObjectiveSpinal cord injury leads to severe limitations in autonomy including locomotor function. Intermittent theta burst stimulation (iTBS) has shown promising therapeutic effects on various neuropsychiatric disorders. We analyzed the efficacy of excitatory iTBS on motor and walking functions in patients with incomplete spinal cord injury (iSCI).MethodsThe prospectively selected iSCI patients were divided into the iTBS (n = 69) and sham-iTBS (n = 69) groups, and underwent iTBS and sham-iTBS treatment, respectively, followed by conventional physiotherapy. Clinical assessments were conducted on the muscle strength of quadriceps, gluteus maximus, hamstring, tibialis anterior and gastrocnemius muscle, lower extremity motor score (LEMS), walking speed (WS), stride length (SL), Berg balance scale (BBS), Holden walking ability scale (HWAS) score, the static eyes-open and eyes-closed center of gravity locus length, and the modified Barthel index (MBI) score.ResultsThere were no significant differences among all patients in baseline data. After 9-week treatment, all the patients had notably elevated muscle strength levels of quadriceps, gluteus maximus, hamstring, tibialis anterior and gastrocnemius, WS, SL, and HWAS, BBS, LEMS and MBI scores, as well as decreased static eyes-open and eyes-closed center of gravity locus length, with the changes more remarkable in the patients treated with iTBS. The total effective rate for patients treated with iTBS was 86.96%, which was apparently higher than that of patients treated with sham-iTBS.ConclusionExcitatory iTBS significantly improved lower limb strength and walking function in iSCI patients.

Objective To observe the effects of functional electrical stimulation (FES) based on a normal walking pattern on the lower extremity function of subjects early after cerebral infarction.Methods Twenty patients with cerebral infarction aged (59.7 ± 10.1) years (range 45-80) who were hospitalized and within 3 months (31.1 ± 19.3 days) after the onset were randomly assigned to an FES group (n =11) or a placebo stimulation group (n =9).All subjects in both groups received standard medical and rehabilitation treatment.In addition,the FES group received FES and the placebo group received sham-FES without current output.The daily stimulation and shamstimulation sessions lasted for 30 min,5 d/week for 3 weeks.All of the subjects in the two groups were assessed using the Fugl-Meyer assessment (FMA),postural assessment for stroke patients (PASS),the Berg balance scale (BBS),functional ambulation categories (FACs) and the modified Barthel index (MBI).Results After 3 weeks of treatment,FMA,PASS,BBS and MBI scores had all improved significantly compared with before treatment in both groups,but the FES group showed significantly better improvement.After treatment the average FAC results of both groups had improved,and there was no significant difference between the two groups.At the same time,the research revealed the expected significant correlations among the FMA,PASS,BBS and MBI results.Conclusion FES based on a normal walking pattern can improve lower extremity motor function early after cerebral infarction,improve balance,and improve ability in the activities of daily living. Key words: Functional electrical stimulation; Cerebral infarction; Lower extremities

Objective: The present study aimed to determine the discriminant power of the modified Trunk Impairment Scale (mTIS) in stroke survivors versus healthy adults.Design: Cross-sectional.Setting: Inpatient rehabilitation center.Participants: Fifty-five subjects with stroke and 29 healthy adults.Methods: Subjects were examined using the mTIS, Berg Balance Scale, and Timed Up and Go test for balance; 5-m Walk Test and Functional Ambulation Category for gait; Fugl-Meyer Assessment for motor function; Postural Assessment Scale for Stroke-Trunk Control and Trunk Control Test for trunk control; and Modified Barthel Index for activities of daily living performance.Results: The mTIS results differed significantly between stroke survivors and healthy adults (p < 0.001). In addition, mTIS scores were significantly correlated with the Berg Balance Scale (r = 0.82), Timed Up and Go test (r = –0.70), 5-m Walk Test (r = 0.73), Functional Ambulation Category (r = 0.54), Fugl-Meyer Assessment (r = 0.37–0.80), Postural Assessment Scale for Stroke-Trunk Control and Trunk Control Test (r = 0.55–0.63), and Modified Barthel Index score (r = 0.56) results (p < 0.05–0.01). The mTIS also showed 66% influence on the Berg Balance Scale, 49% on the Timed Up and Go test, 53% on the 5-m Walk Test, 28% on the Functional Ambulation Category, 12% on the Fugl-Meyer Assessment-upper extremity, 64% on the Fugl-Meyer Assessment-lower extremity, and 30% on the Modified Barthel Index. The cutoff value of the mTIS for the Modified Barthel Index classification was >10.5 points, while the area under the curve had a moderate accuracy of 73%.Conclusion: The mTIS can be used to examine the degree of trunk control or the level of trunk impairment, which is seen as a prerequisite for balance, gait, motor function, and activities of daily living performance in stroke survivors.Implications for RehabilitationThe modified Trunk Impairment Scale can be used as an assessment tool to classify the degree of trunk control or its level of impairment in stroke survivors.The modified Trunk Impairment Scale may have a favorable correlation with assessing physical functions such as balance, gait, motor function, and ADL in stroke survivors.

ObjectiveTo assess the efficacy and safety of our 4-week caregiver-mediated exercise (CME) in improving trunk control capacity, gait, and balance and in decreasing concerns about post-stroke falls when there is an increase in its efficacy.MethodsAcute or subacute stroke survivors were assigned to either the trial group (n=35) or the control group (n=37). Changes in Modified Barthel Index (MBI), Functional Ambulation Categories (FAC), Berg Balance Scale (BBS), and Trunk Impairment Scale (TIS) scores at 4 weeks from baseline served as primary outcome measures. Correlations of primary outcome measures with changes in Fall Efficacy Scale-International (FES-I) scores at 4 weeks from baseline in the trial group served as secondary outcome measures. Treatment-emergent adverse events (TEAEs) served as safety outcome measures.ResultsThere were significant differences in changes in MBI, FAC, BBS, TIS-T, TIS-D, TIS-C, and FES-I scores at 4 weeks from baseline between the two groups (all p<0.0001). There were no significant (p=0.0755) differences in changes in TIS-S scores at 4 weeks from baseline between the two groups. MBI, FAC, BBS, and TIS scores showed significantly inverse correlations with FES-I scores in patients receiving CME. There were no TEAEs in our series.ConclusionCME was effective and safe in improving the degree of independence, ambulation status, dynamic and static balance, trunk function, and concerns about post-stroke falls in stroke survivors.

Stroke is one of the most widespread reasons for acquired adult disability. Recent experimental studies have reported the beneficial influence of Wii Fit-based feedback on improving overall balance and gait for stroke survivors. We conducted a systematic review of the literature using the following keywords to retrieve the data: feedback, biofeedback, stroke, visual, auditory, tactile, virtual reality, videogame rehabilitation, Nintendo Wii stroke, videogame stroke, exergame stroke, Nintendo Wii rehabilitation, balance, and gait. A review and meta-analysis of RCTs regarding Wii Fit-based rehabilitation accompanied by conventional therapy effects on Berg Balance Scale (BBS), Timed Up and Go (TUG), functional reach test, and gait (speed) in stroke survivors was conducted. To determine the impacts of Wii Fit-based feedback combined with traditional therapy on balance and gait in stroke survivors. 22 studies were included. The meta-analysis results revealed statistically significant improvements in functional ambulation measured using TUG (p < 0.0001), balance measured using BBS (p = 0.0001), and functional reach test (p = 0.01), but not in gait speed (p = 0.32) following Wii Fit-based feedback. Regarding the types of feedback, significant differences were found in BBS scores when mixed visual and auditory feedback was used. Wii Fit-based feedback has desired effects on improving balance in stroke patients, making it a suitable adjunct to physical therapy.

Objectives: To compare the clinical characteristics and outcomes between elderly and young patients with traumatic brain injury (TBI) in a subacute rehabilitation unit. Subjects and Methods: Ninety-two TBI patients who had been admitted to a rehabilitation unit from January 2010 to July 2017 were included for analysis and categorized into elderly and young TBI patient groups. A retrospective analysis was performed to compare the clinical characteristics and functional outcomes of the 2 groups at admission and discharge. The main measures included the Glasgow Coma Scale (GCS), Mini-Mental State Examination (MMSE), Berg Balance Scale (BBS), Modified Barthel Index (MBI), and Glasgow Outcome Scale (GOS). Results: The most common cause of injury was fall, and subdural hematoma was more common in the elderly group. Although initial GCS scores were similar between both groups, BBS and MBI scores at admission were significantly lower in elderly patients. At discharge, the MMSE, BBS, and MBI scores were significantly better in the young TBI group. However, the amount of functional improvement (Δ) in MMSE, BBS, and MBI scores during admission and the home discharge rate were similar in both groups (P &gt; .05). Conclusion: Although the initial injury severity was similar in both groups, the functional outcome of cognition, balance, and activities of daily living at discharge was better in the young TBI group. However, the amount of functional improvement was similar after rehabilitation, regardless of age.

To observe the clinical effect of "brain-gut coherence" method of acupuncture on cerebral ischemic stroke (CIS) and explore its action mechanism. A total of 82 patients with CIS were randomly divided into an observation group (41 cases, 3 cases dropped out, 2 cases discontinued) and a control group (41 cases, 4 cases dropped out, 2 cases excluded). The conventional basic treatment was administered in the two groups. Additionally, in the observation group, "brain-gut coherence" method of acupuncture was delivered. The stimulating points included the parietal and temporal anterior oblique line on the affected side, Zhongwan (CV 12), Guanyuan (CV 4), and bilateral Tianshu (ST 25), Zusanli (ST 36), Shangjuxu (ST 37) and Xiajuxu (ST 39). In the control group, the routine acupuncture was operated at Baihui (GV 20), Yintang (GV 24+), bilateral Fengchi (GB 20) and Zusanli (ST 36), and Hegu (LI 4), Jianyu (LI 15), Quchi (LI 11), Waiguan (TE 5), Futu (ST 32), Sanyinjiao (SP 6) and Taichong (LR 3) on the affected side. Acupuncture stimulation lasted 30 min each time, once daily, and for 5 days a week. The intervention for 4 weeks was required. The scores of Fugl-Meyer assessment scale (FMA), Berg balance scale (BBS) and the modified Barthel index (MBI), as well as the score of gastrointestinal symptoms were compared before and after treatment in the two groups. The neutrophil count (NUE) and the content of the serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) were detected before and after treatment in the two groups. Using 16S rRNA gene sequencing, the structure and relative abundance of intestinal microflora was detected before and after treatment; and with the enzyme linked immunosorbent assay (ELISA) adopted, the levels of intestinal fatty acid-binding protein (iFABP), D-lactate (D-LA), lipopolysaccharide (LPS), lipopolysaccharide binding protein (LBP), tumor necrosis factor-α(TNF-α), interleukin (IL)-1β and IL-6 in the serum were detected before and after treatment in the two groups. After treatment, the scores of FMA, BBS and MBI were increased (P<0.05), and the scores of gastrointestinal symptoms were decreased (P<0.05) compared with those before treatment in the two groups. Compared with the control group, the scores of FMA, BBS and MBI were higher (P<0.05) and the score of gastrointestinal symptoms was lower (P<0.05) in the observation group after treatment. NEU and the content of serum NT-proBNP were reduced in the two groups (P<0.05), and the content of serum NT-proBNP in the observation group was lower than that of the control group (P<0.05) after treatment. Chao1, Ace, Sobs and Shannon indexes were increased after treatment compared with those before treatment in the two groups (P<0.05); and these indexes in the observation group were higher when compared with the control group (P<0.05). After treatment, the relative abundance of Bacteroidaceae, Enterobacteriaceae, Oscillospiraceae, Streptococcaceae and Sutterellaceae was reduced in comparison with that before treatment in the two groups (P<0.05); and the relative abundance of these microflora was lower in the observation group when compared with the control group (P<0.05). After treatment, the relative abundance of Lachnospiraceae, Ruminococcaceae, Bifidobacteriaceae and Coriobacteriaceae was increased in comparison with that before treatment in the two groups (P<0.05); and the relative abundance of these microflora was elevated in the observation group when compared with the control group (P<0.05). After treatment, the levels of iFABP, D-LA, LPS, LBP, TNF-α, IL-1β and IL-6 were reduced when compared with those before treatment in the two groups (P<0.05), and these levels of the observation group were lower than those of the control group (P<0.05). "Brain-gut coherence" method of acupuncture can improve the motor function and gastrointestinal function of the patients with cerebral ischemic stroke, which may be related to modulating the structure of intestinal microflora, alleviating inflammatory reactions and accelerating the intestinal barrier repair.

Objective To investigate the effects of lower limb training combined with hyperbaric oxygen on motor function in a paretic lower limb and on the ability in the activities of daily living （ADL） of hemiplegic stroke survivors. Methods A total of 297 hemiplegic stroke patients received routine interventions and then were randomly divided into 3 groups. The hyperbaric oxygen group accepted hyperbaric oxygen, the training group accepted lower limb training, and the treatment group accepted both hyperbaric oxygen and lower limb training. Evalnations were carried out pretreatment and 30 d post treatment to assess the function of the paretic lower limb and ADL ability with the Fugl-Meyer assessment （ FMA）, a modified Barthel index （MBI） , Berg＇s balance scale （BBS） and the timed up and go test （TUGT）. Results FMA, MBI, BBS and TUGT scores in all 3 groups improved significantly compared with pretreatment. On the 30th day post treatment, the scores in the treatment group were significantly better than in the other two groups. Conclusions Lower limb training combined with hyperbaric oxygen can significantly improve motor function in the paretic lower limbs of stroke patients and their ADL performance. Key words: Hemiplegia; Lower limb training; Hyperbaric oxygen; Lower limb function; Activities of daily living

To compare the effect difference among the staged acupuncture combined with conventional rehabilitation, traditional acupuncture combined with conventional rehabilitation, and conventional rehabilitation in the patients with ischemic stroke hemiplegia. A total of 145 patients with ischemic stroke hemiplegia were randomly assigned into an observation group (49 cases), a control group A (49 cases) and a control group B (47 cases). All the patients were received aspirin tablets 100 mg orally, once a day. The staged acupuncture according to Brunnstrom's theory combined with conventional rehabilitation were used in the observation group, at the acupoints in the yangming meridian during the flaccid paralysis phase, at the acupoints in the antagonistic muscle and the tendon of spastic dominant muscle during the spasm stage, and at the acupoints in the yangming meridian and Taixi (KI 3), Guanyuan (CV 4) and Qihai (CV 6) during the sequela stage. Conventional traditional acupuncture at the acupoints in the yangming meridian combined with conventional rehabilitation were applied in the control group A. Simple conventional rehabilitation was used in the control group B. Patients in the observation group and the control group A were received acupuncture and rehabilitation once a day from Monday to Friday, 2 weeks as 1 course; patients in the control group B were received the same rehabilitation as the observation group. The indexes were observed before treatment and at the end of the 2nd, 4th, 6th and 8th weeks of treatment, including National Institutes of Health Stroke Scale (NIHSS), short form Fugl-Meyer motor function assessment (FMA) scale, Fugl-Meyer balance (FM-B) scale, comprehensive spasm scale (CSS) and modified Barthel index (MBI). Compared with those before treatment, except the MBI score in the control group B after 2 weeks' treatment, the NIHSS, FMA, FM-B and MBI scores were improved in all three groups at the end of the 2nd, 4th, 6th and 8th weeks of treatment (P<0.01, P<0.05). At the end of the 2nd week of treatment, the NIHSS and CSS scores were lower (P<0.05, P<0.01), the FMA, FM-B and MBI scores were higher (all P<0.05) in the observation group and the control group A than those in the control group B. After 4, 6 and 8 weeks' treatment, the FMA, FM-B and MBI scores were higher (P<0.05, P<0.01), the NIHSS and CSS scores were lower (all P<0.01) in the observation group than those of control group A and control group B; the FMA, FM-B and MBI scores in the control group A were higher than those in the control group B (P<0.05, P<0.01); the NIHSS and CSS scores in the control group A were lower than those in the control group B (P<0.05, P<0.01). Staged acupuncture combined with conventional rehabilitation are consistent with the rehabilitation rule of patients with hemiplegia. They can improve motor function and the ability of daily life. They achieve better effect than traditional acupuncture combined with rehabilitation.

To investigate the effect of blood flow restriction training (BFRT) on lower limb motor function recovery in stroke patients with hemiplegia. In this parallel-group, assessor-blinded, randomized controlled trial, 80 patients with first-ever stroke (ischemic or hemorrhagic) were enrolled. Participants were randomly allocated to receive either routine rehabilitation (RR group, n = 40) or routine rehabilitation plus BFRT (RR + BFRT group, n = 40) for 8 weeks (5 days/week). Assessments performed before and after the intervention included the Fugl-Meyer Assessment of the Lower Extremity (FMA-LE), Berg Balance Scale (BBS), Modified Barthel Index (MBI), 6-Minute Walk Test (6MWT), and Manual Muscle Testing (MMT) for key lower limb muscles. Baseline characteristics and all outcome measures were comparable between the two groups (all P > 0.05). After the intervention, both groups showed significant within-group improvements in FMA-LE, BBS, MBI, 6MWT, and MMT scores (all P < 0.05). The RR + BFRT group demonstrated significantly greater improvement than the RR group in FMA-LE, BBS, MBI, 6MWT, and MMT scores for the iliopsoas, quadriceps, and hamstrings (all P < 0.05). No between-group difference was found for tibialis anterior muscle strength (P > 0.05). Adjunctive BFRT can effectively enhance lower limb motor function, balance, walking capacity, and muscle strength in stroke patients with hemiplegia, leading to greater functional independence. BFRT appears to be a beneficial adjunct to routine stroke rehabilitation.

BackgroundImpaired balance and gait in stroke survivors are associated with decreased functional independence. This study aimed to evaluate the effectiveness of unilateral lower-limb exoskeleton robot-assisted overground gait training compared with conventional treatment and to explore the relationship between neuroplastic changes and motor function recovery in subacute stroke patients.MethodsIn this randomized, single-blind clinical trial, 40 patients with subacute stroke were recruited and randomly assigned to either a robot-assisted training (RT) group or a conventional training (CT) group. All outcome measures were assessed at the enrollment baseline (T0), 2nd week (T1) and 4th week (T2) of the treatment. The primary outcome was the between-group difference in the change in the Berg balance scale (BBS) score from baseline to T2. The secondary measures included longitudinal changes in the Fugl-Meyer assessment of the lower limb (FMA-LE), modified Barthel index (mBI), functional ambulation category (FAC), and locomotion assessment with gait analysis. In addition, the cortical activation pattern related to robot-assisted training was measured before and after intervention via functional near-infrared spectroscopy.ResultsA total of 30 patients with complete data were included in this study. Clinical outcomes improved after 4 weeks of training in both groups, with significantly better BBS (F = 6.341, p = 0.018, partial η2 = 0.185), FMA-LE (F = 5.979, p = 0.021, partial η2 = 0.176), FAC (F = 7.692, p = 0.010, partial η2 = 0.216), and mBI scores (F = 7.255, p = 0.042, partial η2 = 0.140) in the RT group than in the CT group. Both groups showed significant improvement in gait speed and stride cadence on the locomotion assessment. Only the RT group presented a significantly increased stride length (F = 4.913, p = 0.015, partial η2 = 0.267), support phase (F = 5.335, p = 0.011, partial η2 = 0.283), and toe-off angle (F = 3.829, p = 0.035, partial η2 = 0.228) on the affected side after the intervention. The RT group also showed increased neural activity response over the ipsilesional motor area and bilateral prefrontal cortex during robot-assisted weight-shift and gait training following 4 weeks of treatment.ConclusionsOverground gait training with a unilateral exoskeleton robot showed improvements in balance and gait functions, resulting in better gait patterns and increased gait stability for stroke patients. The increased cortical response related to the ipsilesional motor areas and their related functional network is crucial in the rehabilitation of lower limb gait in post-stroke patients.

Previous studies note the significant effects of Cognitive Training on older adults, but achieving consensus on optimal dosage is challenging due to intervention protocol heterogeneity. Short-term training seems preferable for clinical use due to potential dropout among older adults during long-term intervention. This feasibility study aimed to explore preliminary changes in cognitive and functional outcomes following a 4-week home-based cognitive and physical training program. This prospective single-arm intervention study enrolled older adults aged ≥ 65 years who were capable of independently performing activities of daily living. Adults with a Mini-Mental Status Examination (MMSE) score of < 24 points, a history of any brain injury, or difficulty in continuing the intervention were excluded. The training program comprised 1-2-hour cognitive tasks and 1-hour physical exercise for 5 days per week for 4 consecutive weeks. The MMSE, Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Berg Balance Scale (BBS), and modified Barthel Index (MBI) scores were assessed before and after the intervention. Functional outcomes were analyzed according to compliance level. Twenty-five participants were enrolled and completed the trial. After the intervention, preliminary changes were observed in MMSE, RBANS-attention, BBS, and MBI scores (P < 0.05). The RBANS total score (primary outcome) did not significantly change. However, exploratory analyses showed a significant within-group change in the RBANS attention domain. The high-compliance group showed greater increments in RBANS short memory and delayed memory indices and BBS scores than the low-compliance group (P < 0.05). These findings suggest preliminary feasibility signals rather than evidence of efficacy, and controlled trials are needed to confirm these observations. The trial registration number of this study is NCT06648343 (retrospectively registered: Oct 16, 2024).

Objective. To investigate the effectiveness of four-channel FES based on a normal gait pattern on improving functional ability in subjects early after ischemic stroke. Methods. Forty-five subjects were randomly assigned into a four-channel FES group (n = 16), a placebo group (n = 15), or a dual-channel group (n = 14). Stimulation lasted for 30 min in each session with 1 session/day, 5 days a week for 3 weeks. All subjects were assessed at baseline, at 3 weeks of treatment, and at 3 months after the treatment had finished. The assessments included Fugl-Meyer Assessment (FMA), the Postural Assessment Scale for Stroke Patients (PASS), Berg Balance Scale (BBS), Functional Ambulation Category (FAC), and the Modified Barthel Index (MBI). Results. All 3 groups demonstrated significant improvements in all outcome measurements from pre- to posttreatment and further gains at followup. The score of FMA and MBI improved significantly in the four-channel group at the end of the 3 weeks of training. And the scores of PASS, BBS, MBI, and FAC in the four-channel group were significantly higher than those of the placebo group. Conclusions. This study indicated that four-channel FES can improve motor function, balance, walking ability, and performance of activities of daily living in subjects with early ischemic stroke.