Constraint-induced Movement Therapy Research Articles

Effectiveness of constraint-induced movement therapy (CIMT)-Telerehabilitation compared to traditional CIMT on upper extremity dysfunction of adult chronic stroke patients-A systematic review and meta-analysis.

Constraint-induced movement therapy (CIMT), a therapy that encourages the use of the affected upper limb through intensive functional tasks, effectively promotes upper limb function in patients with chronic stroke. This study determined the effectiveness of CIMT using telerehabilitation compared with traditional CIMT in improving mild to moderate upper limb motor function in adult patients with chronic stroke. Eligible studies were identified by searching electronic databases and scanning the reference lists of articles. Review Manager 5.4 was used to determine the pooled mean effect size of the standardized mean difference and 95% confidence interval for the group comparison. Visual heterogeneity, I2 statistic, and chi-square test were used to measure the heterogeneity between the included studies. We evaluated the quality of evidence using GRADEpro GDT, software for creating evidence summaries and healthcare recommendations. Two randomized controlled trials were included in this review. A total of 109 participants (70 male, 39 female) were evaluated. The time since the stroke was ≥6months in one study and ≥1year in another study. Improvements in upper limb motor function while performing functional movements were measured using the Wolf Motor Function Test. The evidence for the effectiveness of CIMT using telerehabilitation compared with traditional CIMT in improving the upper extremity function in patients with chronic stroke is of moderate quality. This suggests no significant difference between the groups (mean difference [95% CI]: -0.04 [-0.42, 0.33]). CIMT using telerehabilitation is not superior to traditional CIMT in improving patients' upper extremity motor function with chronic stroke. CIMT using telerehabilitation may improve access to treatment, minimize SARS-CoV-2 risk, and reduce travel in patients with chronic stroke.

Recent Physiotherapy Advances in Stroke Patient for Upper Limb Training: A Literature Review

Various advanced techniques are used in rehabilitation to improve arm and hand function, which are essential for independent daily life. These techniques include Virtual Reality, Robotic devices, Constraint-Induced Movement Therapy to Mirror Therapy. Telerehabilitation, biofeedback, and wearable sensor methods primarily target neurological impairments such as paresis and spasticity by activating neural circuits or influencing peripheral effectors. However, CIMT, particularly in its modified expression, restrains the non-affected arm and simultaneously trains the affected limb, which is most effective in improving upper limb function. Mirror Therapy, which may also be applied to severely paralyzed limbs, offers several benefits. Nonetheless, newer technologies are costlier and more complicated while simultaneously limiting access, particularly to patients residing at a distance. In this regard, tele-rehabilitation appears to be a functional alternative that uses telecommunication networks, making therapy affordable and accessible.

Is more always better? Effectiveness of constraint-induced movement therapy in children with high-risk or unilateral cerebral palsy (0-6 years): Systematic review and meta-analysis.

While constraint-induced movement therapy is strongly recommended as an intervention for infants with unilateral cerebral palsy, the optimal dosage remains undefined. This systematic review aims to identify the most effective level of intensity of constraint-induced movement therapy to enhance manual function in infants at high risk of asymmetric brain lesions or unilateral cerebral palsy diagnosis. This systematic review with meta-analysis encompassed a comprehensive search across four electronic databases to identify articles that met the following criteria: randomised controlled trials, children aged 0-6 with at high risk or with unilateral cerebral palsy, and treatment involving constraint-induced movement therapy for upper limb function. Studies with similar outcomes were pooled by calculating the standardised mean difference score for each subgroup, and subgroups were stratified every 30 h of total intervention dosage (30-60, 61-90, >90 h). Risk of bias was assessed with Cochrane Collaboration's tool. Seventeen studies were included. Meta-analyses revealed significant differences among subgroups. The 30-60 h subgroup showed a weak effect for spontaneous use of the affected upper limb during bimanual performance, grasp function, and parents' perception of how often children use their affected upper limb. Additionally, this subgroup demonstrated a moderate effect for the parents' perception of how effectively children use their affected upper limb. Using a dosage ranging from 30 to 60 h when applying a constraint-induced movement therapy protocol holds promise as the most age-appropriate and cost-effectiveness approach for improving upper limb functional outcomes and parent's perception.

Cost-Effectiveness of an Intensive Upper Limb Rehabilitation Therapy for Children With Unilateral Cerebral Palsy: An Economic Evaluation of a Randomized Controlled Trial

Background: Unilateral cerebral palsy is a major cause of childhood disability and a substantial economic burden. Intensive group-based therapy, consisting of hybrid constraint-induced movement and bimanual therapies, has been shown to be effective in improving specific quality-of-life domains in children with this disability. Our objective in this study was to assess if this intervention was cost-effective compared with standard care. Methods: An open-label, parallel, randomized controlled trial with an embedded economic evaluation of the intervention was conducted. A total of 47 children were randomized to either the intervention group (n = 27) or the standard care (n = 20) group. The effectiveness of the intervention was assessed using the Cerebral Palsy Quality of Life (Child) questionnaire across several domains. Nonparametric bootstrapping was used to quantify uncertainty intervals (UIs) for incremental cost-effectiveness ratios. Results: The incremental cost-effectiveness ratios for the intervention were $273 (95% UI: $107 to $945) for Pain and Impact of Disability, $1071 (95% UI: -$5718 to $4606) for Family Health and $1732 (95% UI: -$6448 to $8775) for Access to Services. For the 4 remaining domains, the intervention was dominated by standard care. At a willingness-to-pay threshold of $1000, only for the Pain and Impact of Disability domain was the intervention likely to have a probability of being cost-effective exceeding 0.75. Conclusions: Other than the Pain and Impact of Disability domain, there was insufficient evidence demonstrating the intervention to be cost-effective over a 13-week time horizon.

Cost-Effectiveness of an Intensive Upper Limb Rehabilitation Therapy for Children With Unilateral Cerebral Palsy: An Economic Evaluation of a Randomized Controlled Trial

Background: Unilateral cerebral palsy is a major cause of childhood disability and a substantial economic burden. Intensive group-based therapy, consisting of hybrid constraint-induced movement and bimanual therapies, has been shown to be effective in improving specific quality-of-life domains in children with this disability. Our objective in this study was to assess if this intervention was cost-effective compared with standard care. Methods: An open-label, parallel, randomized controlled trial with an embedded economic evaluation of the intervention was conducted. A total of 47 children were randomized to either the intervention group (n = 27) or the standard care (n = 20) group. The effectiveness of the intervention was assessed using the Cerebral Palsy Quality of Life (Child) questionnaire across several domains. Nonparametric bootstrapping was used to quantify uncertainty intervals (UIs) for incremental cost-effectiveness ratios. Results: The incremental cost-effectiveness ratios for the intervention were $273 (95% UI: $107 to $945) for Pain and Impact of Disability, $1071 (95% UI: -$5718 to $4606) for Family Health and $1732 (95% UI: -$6448 to $8775) for Access to Services. For the 4 remaining domains, the intervention was dominated by standard care. At a willingness-to-pay threshold of $1000, only for the Pain and Impact of Disability domain was the intervention likely to have a probability of being cost-effective exceeding 0.75. Conclusions: Other than the Pain and Impact of Disability domain, there was insufficient evidence demonstrating the intervention to be cost-effective over a 13-week time horizon.

Preliminary Results of a Pilot Clinical Trial Using a Reimbursable Form of Constraint-induced Movement Therapy: The Keys Treatment protocol

Preliminary Results of a Pilot Clinical Trial Using a Reimbursable Form of Constraint-induced Movement Therapy: The Keys Treatment protocol

Design and Performance Analysis of a Mecanum-Built Perturbation-Based Balance Training Device.

This study proposes a mecanum-built perturbation-based balance training device aimed at improving motor adaptive skills for fall prevention in individuals with neurological disorders or the elderly. Incorporating multidirectional fall simulations in line with modified constraint-induced movement therapy, the device's efficacy was evaluated by measuring the distance traveled and peak acceleration under different static loads (20, 30, and 40 kg) and input accelerations (1, 2, and 3 m/s2). A pilot study with 10 subjects was conducted to assess device performance, utilizing repeated measures analysis of variance and Bonferroni's post hoc analysis. Results indicated a load-dependent reduction in distance traveled, with an average mean difference of 0.74-1.23 cm between the 20 and 40 kg loads for trials of 9 and 18 cm, respectively. Despite varying loads, the device consistently achieved near-anticipated peak accelerations, suggesting its capability to induce effective perturbations. The study also observed a significant lateral movement preference, suggesting adjustments to pulse width modulation and time period may optimize lateral movement performance.

Effect of Constraint-Induced Movement Therapy (CIMT) on Upper Extremity Function in Stroke Patients

Background: Stroke is a leading cause of disability worldwide, with upper extremity impairments presenting significant rehabilitation challenges. Constraint-Induced Movement Therapy (CIMT) has emerged as a potential intervention for enhancing upper limb functionality, but its efficacy compared to traditional therapy methods requires further exploration. Objective: The study aimed to evaluate the effectiveness of CIMT versus traditional therapy in improving upper extremity function among stroke survivors. Methods: In this quasi-experimental study, 58 stroke patients from Aziz Fatima and Allied Hospital in Faisalabad were recruited and allocated to either the CIMT group (n=29) or the traditional therapy group (n=29). Eligible participants were those aged 30-50 years with ischemic or infarctive stroke and impaired use of their hemiparetic arm. The CIMT group received standard treatment plus CIMT, while the traditional group received only standard treatment, including manual therapy and TENS, for 8 weeks. Pre- and post-treatment assessments utilized the Upper Extremity Motor Activity Log (UEMAL) scales. Data analysis was conducted using SPSS version 25, employing independent t-tests. Results: The CIMT group showed a significant improvement in the UEMAL Amount Scale (pre-treatment: 1.64 ± 0.51, post-treatment: 3.04 ± 0.75; p=0.000) and the UEMAL How Well Scale (pre-treatment: 2.28 ± 0.57, post-treatment: 3.81 ± 0.55; p=0.000). The traditional therapy group also demonstrated gains but to a lesser extent (UEMAL Amount Scale pre-treatment: 1.08 ± 0.24, post-treatment: 1.69 ± 0.33; UEMAL How Well Scale pre-treatment: 1.47 ± 0.30, post-treatment: 2.11 ± 0.40; p=0.000 for both). Conclusion: CIMT provided significant functional improvements in upper extremity motor activity compared to traditional therapy, suggesting that CIMT may be a more effective approach for post-stroke rehabilitation of the upper limb.

Lower limb rehabilitation using modified constraint-induced movement therapy and motor relearning program on balance and gait in sub-acute hemiplegic stroke: a comparative study

Background A stroke is described by the World Health Organization as “a clinical syndrome with rapidly developing symptoms that consist of a focal (or global, in a situation of coma) disruption of cerebral function that lasts more than 24 hours or leads to mortality without a known cause other than a vascular origin”. Stroke is the most prevalent cause of impairment and mortality on a global scale. Modified constraint-induced movement therapy (mCIMT) is an approach to therapy for motor disabilities that involves constraining the movements of the nonparetic limb, diligent practice and behaviour modification to extend the time the paretic limb is utilized for daily tasks. The motor relearning program (MRP) method involves many aspects of motor learning theory and is helpful in providing instructions for retraining practical skills (including walking, standing and sitting in balance and transferring abilities). So, the objective of this study is to assess the impact of the MRP and mCIMT on balance and gait in sub-acute hemiplegic stroke patients. Methods In this study, each group will consist of 17 people in total. The randomization procedure will be conducted using a computer-generated random number system. For sample distribution, we will use the sequentially numbered opaque sealed envelope technique. Outcome measures will be as follows: Berg balance scale, Dynamic gait index, Trunk impairment scale, Functional reach test, 10 Meter walk test and Fall efficacy test. Each patient will be evaluated prior to and during treatment at baseline and six weeks later. Conclusions There is sufficient evidence to derive the conclusion that the functional mobility and balance of stroke victims can be improved with physiotherapy. Therefore, this study will try to seek the comparison of mCIMT (group A) and MRP (group B) in sub-acute stroke subjects and compare the two regimes to determine which one will be superior. Registration CTRI (CTRI/2023/05/052674; 16/05/2023).

Improvement of gait and balance function in chronic post-stroke patients induced by Lower Extremity – Constraint Induced Movement Therapy: a randomized controlled clinical trial

ABSTRACT Objective To evaluate the effects of Lower Extremity – Constraint Induced Movement Therapy on gait function and balance in chronic hemiparetic patients. Methods Randomized, controlled, single-blinded study. We recruited chronic post stroke patients and allocated them to Lower Extremity – Constraint Induced Movement Tharapy (LE-CIMT) or Control Group. The LE-CIMT group received this protocol 2.5 hour/day for 15 followed days, including: 1) intensive supervised training, 2) use of shaping as a strategy for motor training, and 3) application of a transfer package. The control group received conventional physiotherapy for 2.5 hours/day for 15 followed days. Outcomes were assessed at baseline, after the interventions, and after 6 months, through 6-minute walk test and Mini-Balance Evaluation Systems Test; 10-meter walk test, Timed Up and Go, 3-D gait analysis, and Lower Extremity – Motor Activity Log. Results LE-CIMT was superior on the Assistance and confidence subscale of Lower Extremity – Motor Activity Log, Mini-BESTest and 6-minute walk test. The effect size for all outcomes was small when comparing both groups. LE-CIMT showed clinically significant differences in daily activities, balance, and gait capacity, with no clinically significant difference for spatiotemporal parameters. Conclusion The LE-CIMT protocol had positive outcomes on balance, performance, and confidence perception.

Constraint-induced movement therapy through telerehabilitation for upper extremity function in stroke

BackgroundStroke is considered to be a leading cause of impairment. After experiencing strokes, patients are frequently left with impaired motor function, making it difficult to carry out daily tasks. The most extensively researched method for treating stroke patients in recent decades is CIMT (constraint-induced movement therapy), which was developed to treat upper limb deficits following stroke. CIMT entails limiting the use of the unaffected limb, altering behavior to increase the use of the affected limb, and finally, mass-training of the affected limb. ObjectiveThe current study aimed to determine the effectiveness of CIMT through TR for upper extremity function in stroke patients. Materials and methodsThirty post-stroke participants were selected on the basis of inclusion and exclusion criteria, and allocated into group A and group B. Group A was treated with CIMT in the physiotherapy department and group B was treated with CIMT through TR. Outcome measures were the Fugl-Meyer Assessment scale for upper extremities (FMA-UE), the Wolf Motor Function Test (WMFT), and the Motor Activity Log (MAL). ResultsBoth groups showed significant improvements in FMA-UE, WMFT and MAL-A0U, MAL-Q0M scores. However, there were no significant differences between groups A and B in FMA-UE, WMFT, MAL-AOU, and MAL-QOM scores in the inter-group analysis. ConclusionCIMT via TR was equally effective than CIMT in physiotherapy department for upper extremity function in stroke. Further studies should be conducted to identify the long-term effectiveness of this approach.

Current knowledge and practice of post-stroke unilateral spatial neglect rehabilitation: a national survey of Nigerian physiotherapists

BackgroundUnilateral spatial neglect (USN) is a leading cause of disability and handicap in stroke survivors affecting functional recovery. Therapists’ knowledge and practice in post-stroke unilateral spatial neglect are key to the success of rehabilitation.AimThis study aimed to evaluate physiotherapists’ knowledge of USN and the current practice of USN management.MethodA cross-sectional study was undertaken among Nigerian physiotherapists (N = 240). An online structured questionnaire that assessed respondents’ knowledge, current practice, barriers, and enablers to post-stroke USN rehabilitation was administered.ResultsThe total knowledge score was 12.6 ± 4.75 on a scale of 25. Few physiotherapists (7.92%) demonstrated good knowledge of USN. Postgraduate certification (p = 0.001), clinical practice setting (p = 0.008), and working full time in neurorehabilitation (p = 0.033) were significantly associated with the therapist’s knowledge of USN. There was a nonsignificant positive correlation between the duration of practice in the neurorehabilitation setting (r = 0.02; p = 0.854) and USN knowledge. A nonsignificant minimal negative correlation between practice as a physiotherapist (r = − 0.02; p = 0.772) and USN knowledge was also noted. The age of physiotherapists showed no linear relationship with the therapist’s knowledge of USN (r = − 0.00; p = 0.992). Constraint-induced movement therapy (86.47%) was the most commonly used USN treatment, while Albert’s test (49.37%) was the most utilized screening tool for USN.ConclusionsVery few physiotherapists had good knowledge of USN. Participants’ knowledge increased as they attained higher education levels relating to neurological physiotherapy. These findings emphasize the need for specialist rehabilitation training for physiotherapy practice.

An Able-Bodied Study for Potential Usage of a Knee Scooter as a Constraint-Induced Movement Therapy (CIMT) Gait Training Device.

Post-stroke gait is characterized by slow and asymmetrical hemiparetic gait. This is attributed to the paretic lower limb which has limited plantar propulsion. The most effective method to restore paretic limb function is constraint-induced movement therapy (CIMT), which promotes the usage of the paretic limb by restricting the movement of the unafflicted limb. However, due to the necessity of both lower limbs to perform gait, CIMT methods could not be directly applied for gait rehabilitation. In this study, we explore the feasibility of utilizing a knee scooter as a means to facilitate CIMT gait training. We hypothesize that if lower limb kinematics and muscle activation patterns during gait with a knee scooter match that of natural gait, the knee scooter could be utilized for CIMT gait training. We measured the lower-limb joint angles, plantar force, EMG patterns, stride length, and step times of 13 healthy subjects during gait with a knee scooter and natural gait. The results suggest that the gait patterns while using the knee scooter closely resemble those of natural gait.

Non-pharmacological interventions on quality of life in stroke survivors: A systematic review and meta-analysis.

Non-pharmacological interventions have been used in the rehabilitation of stroke survivors, but their effects on stroke survivors' quality of life (QoL) are unknown. This review aimed to summarize the existing evidence regarding non-pharmacological interventions for QoL in stroke survivors and to evaluate the effectiveness of different types of interventions. We systematically searched databases including PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Chinese BioMedical Literature Database, China Science and Technology Journal Database, and Wanfang data from the earliest available records to March 2023. Randomized controlled trials which explored the effects of non-pharmacological interventions on QoL in stroke patients were included. The meta-analysis was conducted to evaluate the effectiveness of different interventions on QoL. The Review Manager 5.3 was used to conduct the meta-analysis and the revised Cochrane risk-of-bias tool was used to assess the methodological quality of trials. A total of 93,245 records were identified, and 34 articles were reviewed and summarized, of which 20 articles were included in the meta-analysis. The summary of the findings of the included studies revealed fitness training, constraint-induced movement therapy (CIMT), physical exercise, music therapy (MT), and art-based interventions may have positive effects on QoL. The fitness training improved total QoL, especially in physical domains including physical functioning (mean difference [MD] = 10.90; 95% CI [7.20, 14.59]), role physical (MD = 10.63; 95% CI [6.71, 14.55]), and global health (MD = 8.76; 95% CI [5.14, 12.38]). The CIMT had a slight effect on general QoL (standardized mean difference [SMD] = 0.48, 95% CI [0.16, 0.80]), whereas significantly improved strength (MD = 8.84; 95% CI [1.31, 16.38]), activities of daily living/instrumental activities of daily living (ADL/IADL; MD = 10.42; 95% CI [2.98, 17.87]), and mobility (MD = 8.02; 95% CI [1.21, 14.83]). MT had a positive effect on the mental health domain (SMD = 0.54; 95% CI [0.14, 0.94]). Our findings suggest that fitness training and CIMThave a significant effect on improving physical QoL, while MThas a positive effect on improving psychological QoL. Future studies may use comprehensive and multicomponent interventions to simultaneously improve the patients' physical, psychological, and social QoL.

Effectiveness of Modified Constraint Induced Movement Therapy in Improving Functional Activities of Hand in Sub Acute Stroke Subjects

BACKGROUND: In stroke, upper limb hemi paresis is a commonly seen impairment and challenging for activities of daily living that have a significant impact on one's quality of life. The majority of studies used both occupational therapy and physiotherapy to improve hand functions in subjects who had chronic strokes. Stroke patients often under-utilizes their paretic limb despite sufficient residual motor function. We hypothesize that acquired non-use can be overcome by reinforcement-based training strategies. The goal of this study is to analyze the efficacy of modified constraint induced movement therapy (m CIMT), to improve functional activities of hand in sub acute Stroke subjects. AIM: The Objective of this study was to analyze the effectiveness of Modified constraint induced movement therapy in improving hand functions in Sub acute stroke subjects. Methodology: This study was an Experimental study and the type of sampling was convenient sampling. The sample size was 30 subjects with unilateral hemiplegia with duration of more than 3 months and the study was conducted in outpatient PT Department. Results: The results were obtained using FMA and MAL on the basis of Pre and Post treatment data and comparing the Control and experimental groups. The statistical analysis showed significant difference between the experimental group and the control group. This shows that subjects in the experimental group who received Modified Constraint induced movement therapy have shown significant improvement than control Group who received only Conventional Physiotherapy. Conclusion: Modified constraint induced movement therapy can be added in stroke rehabilitation for improvement of activities of daily living and functional independence of stroke patients. Keywords: Hemi paresis, CIMT, m CIMT

Pairing taVNS and CIMT is feasible and may improve upper extremity function in infants.

In this study we combined non-invasive transcutaneous auricular vagal nerve stimulation (taVNS) with 40 h of constraint induced movement therapy (CIMT) in infants. All infants completed the full intervention with no adverse events. Therapists were able to maintain high treatment fidelity and reported high ratings for ease of use and child tolerance. Preliminary results show promising gains on motor outcomes: Mean QUEST increase 19.17 (minimal clinically important difference, MCID 4.89); Mean GMFM increase 13.33 (MCID 1%-3%). Infants also exceeded expectations on Goal Attainment Scores (+1). Early data is promising that taVNS paired with intensive motor CIMT is feasible, reliable, and safe in young infants with hemiplegia, and may help harness activity-dependent plasticity to enhance functional movement.

Priming constraint-induced movement therapy with intermittent theta burst stimulation to enhance upper extremity recovery in patients with stroke: protocol for a randomized controlled study.

The treatments based on motor control and motor learning principles have gained popularity in the last 20 years, as well as non-invasive brain stimulations that enhance neuroplastic changes after stroke. However, the effect of intermittent theta burst stimulation (iTBS) in addition to evidence-based, intensive neurorehabilitation approaches such as modified constraint-induced movement therapy (mCIMT) is yet to be investigated. We aim to establish a protocol for a randomized controlled study investigating the efficiency of mCIMT primed with iTBS after stroke. In this randomized controlled, single-blind study, patients with stroke (N = 17) will be divided into 3 groups: (a) mCIMT + real iTBS, (b) mCIMT + sham iTBS, and (c) mCIMT alone. 600-pulse iTBS will be delivered to the primary motor cortex on the ipsilesional hemisphere, and then, patients will receive mCIMT for 1h/session, 3 sessions/week for 5weeks. Upper extremity recovery will be assessed with Fugl-Meyer Test-Upper Extremity and Wolf Motor Function Test. Electrophysiological assessments, such as Motor-Evoked Potentials, Resting Motor Threshold, Short-Intracortical Inhibition, and Intracortical Facilitation, will also be included. In this study, a protocol of an ongoing intervention study investigating the effectiveness of iTBS on ipsilesional M1 prior to the mCIMT in patients with stroke is proposed. This will be the first study to research priming mCIMT with iTBS and it may have the potential to reveal the true effect of the iTBS when it is added to the high-quality neurorehabilitation approaches. Trial registration number: NCT05308667.

To Study the Effect of Jigsaw Puzzle versus Modified Constraint Induced Movement Therapy on Fine Motor Abilities of Upper Extremities in Individuals with Subacute Stroke - An Experimental Study

To Study the Effect of Jigsaw Puzzle versus Modified Constraint Induced Movement Therapy on Fine Motor Abilities of Upper Extremities in Individuals with Subacute Stroke - An Experimental Study

Constraint-Induced Movement Therapy Promotes Myelin Remodeling and Motor Function by Mediating Sox2/Fyn Signals in Rats with Hemiplegic Cerebral Palsy.

Hypoxic-ischemic brain injury in infants often leads to hemiplegic motor dysfunction. The mechanism of their motor dysfunction has been attributed to deficiencies of the transcription factor SRY (sex-determining region) box 2 (Sox2) or the non-receptor-type tyrosine kinase Fyn (involved in neuronal signal transduction), which causes a defect in myelin formation. Constraint-induced movement therapy (CIMT) following cerebral hypoxia-ischemia may stimulate myelin growth by regulating Sox2/Fyn, Ras homolog protein family A (RhoA), and Rho-associated kinase 2 (ROCK2) expression levels. This study investigated how Sox2/Fyn regulates myelin remodeling following CIMT to improve motor function in rats with hemiplegic cerebral palsy (HCP). To investigate the mechanism of Sox2 involvement in myelin growth and neural function in rats with HCP, Lentivirus-Sox2 adeno-associated virus and negative control-Lenti-Sox2 adeno-associated virus were injected into the lateral ventricle. The rats were divided into a control group and an HCP group with different interventions (CIMT, Lenti-Sox2 [LS], or negative control-Lenti-Sox2 [NS] treatment), yielding the HCP, HCP plus CIMT (HCP + CIMT), HCP + LS, HCP + LS + CIMT, HCP + NS, and HCP + NS + CIMT groups. Front-limb suspension and RotaRod tests, Golgi-Cox staining, transmission electron microscopy, immunofluorescence staining, Western blotting, and quantitative polymerase chain reaction experiments were used to analyze motor function, dendrite/axon area, myelin ultrastructure, and the levels of expression of oligodendrocytes and Sox2/Fyn/RhoA/ROCK2 in the motor cortex. The rats in the HCP + LS + CIMT group had better values for motor function, dendrite/axon area, myelin ultrastructure, oligodendrocytes, and Sox2/Fyn/RhoA/ROCK2 expression in the motor cortex than rats in the HCP and HCP + NS groups. The improvement of motor function and myelin remodeling, the expression of oligodendrocytes, and the expression of Sox2/Fyn/RhoA/ROCK2 in the HCP + LS group were similar to those in the HCP + CIMT group. CIMT might overcome RhoA/ROCK2 signaling by upregulating the transcription of Sox2 to Fyn in the brain to induce maturation and differentiation of oligodendrocytes, thereby promoting myelin remodeling and improving motor function in rats with HCP.Impact. The pathway mediated by Sox2/Fyn could be a promising therapeutic target for HCP.

Post-stroke rehabilitation in the peri-pandemic COVID-19 era.

The coronavirus disease 2019 (COVID-19), which arosein late 2019, caused extensive destruction, impacting a substantial proportion of the worldwide population and leading to millions of deaths. Although COVID-19 is mainly linked to respiratory and pulmonary complications, it has the potential to affect neurologic structures as well. Neurological involvement may manifest as minimal and reversible; however, a notable proportion of cases have exhibited pronounced neurological consequences, such as strokes. Endothelial inflammation, hypercoagulation, renin-angiotensin-aldosterone system alterations, and cardiogenic embolism are the pathophysiological mechanismsof stroke under COVID-19 circumstances. Physical activity and exercise have improved several aspects of post-stroke recovery, including cardiovascular health, walking capacity, and upper limb strength. They are commonly used to assist stroke survivors in overcomingtheir motor restrictions. Furthermore, stroke rehabilitation can incorporate a range of specific techniques, including body-weight-supported treadmill applications, constraint-induced movement therapy, robotic rehabilitation interventions, transcranial direct current stimulation, transcranial magnetic stimulation, and prism adaptation training. Under pandemic conditions, there were several barriers to neurological rehabilitation. The most significant of these were individual's fear of infection, which caused them to postpone their rehabilitation applicationsand rehabilitation areas being converted into COVID-19 units. The primary emphasis had turned to COVID-19 treatment. Several valuable data and views were gained in reorganizing rehabilitation during the pandemic, contributing to establishing future views in this regard.