Conventional Rehabilitation Training Research Articles

Analyzing the Combination Effects of Repetitive Transcranial Magnetic Stimulation and Motor Control Training on Balance Function and Gait in Patients with Stroke-Induced Hemiplegia

Objective: To analyze the effects of repetitive transcranial magnetic stimulation combined with motor control training on the treatment of stroke-induced hemiplegia, specifically focusing on the impact on patients’ balance functionand gait. Methods: Fifty-two cases of hemiplegic stroke patients were randomly divided into two groups, 26 in the control group and 26 in the observation group, using computer-generated random grouping. All participants underwent conventional treatment and rehabilitation training. In addition to these, the control group received repetitive transcranialmagnetic pseudo-stimulation therapy + motor control training, while the observation group received repetitive transcranial magnetic stimulation therapy + motor control training. The balance function and gait parameters of both groups were compared before and after the interventions and assessed the satisfaction of the interventions in both groups. Results: Before the invention, there were no significant differences in balance function scores and each gait parameter between the two groups (P > 0.05). However, after the intervention, the observation group showed higher balance function scores compared to the control group (P < 0.05). The observation group also exhibited higher step speed and step frequency, longer step length, and a higher overall satisfaction level with the intervention compared to the control group (P < 0.05). Conclusion: The combination of repetitive transcranial magnetic stimulation and motor control training in the treatment of stroke-induced hemiplegia has demonstrated positive effects. It not only improves the patient’s balance function and gait but also contributes to overall physical rehabilitation.

Effects of a lower limb walking exoskeleton on quality of life and activities of daily living in patients with complete spinal cord injury: A randomized controlled trial.

In recent years, lower limb walking exoskeletons have been widely used in the study of spinal cord injury (SCI). To explore the effect of a lower limb walking exoskeleton on quality of life and functional independence in patients with motor complete SCI. This was a multi-center, single blind, randomized controlled trial. A total of 16 SCI patients were randomly assigned to either the exoskeleton-assisted walking (EAW) group (n= 8) or the conventional group (n= 8). Both groups received conventional rehabilitation training, including aerobic exercise and strength training. The EAW group additionally conducted the exoskeleton-assisted walking training using an AIDER powered robotic exoskeleton for 40-50 minutes, 5 times/week for 8weeks. World Health Organization quality of life-BREF (WHOQOL-BREF) and the Spinal Cord Independence Measure III (SCIM-III) were used for assessment before and after training. There was an increasing tendency of scores in the psychological health, physical health, and social relationships domain of WHOQOL-BREF in the EAW group after the intervention compared with the pre-intervention period, but there was no significant difference (P> 0.05). SCIM-III scores increased in both groups compared to pre-training, with only the conventional group showing a significant difference after 8weeks of training (P< 0.05). A lower limb walking exoskeleton may have potential benefits for quality of life and activities of daily living in patients with motor complete SCI.

The Rehabilitation Efficacy of the Novel Metronomic Breathing Technique for Gerontic Patients After Percutaneous Coronary Intervention for Acute Myocardial Infarction-A Pilot Study.

The respiratory rehabilitation technique is a crucial component of early cardiac recovery in geriatric patients with acute myocardial infarction (AMI). This study primarily investigated the effectiveness of a novel respiratory rehabilitation technique, metronomic breathing (MB), on geriatric patients after percutaneous coronary intervention for AMI and compliance with home-based rehabilitation compared to traditional respiratory rehabilitation. From June 2022 to March 2023, 75 acute myocardial infarction (AMI) patients admitted to the Shanghai Tenth People's Hospital Cardiovascular Department were consecutively enrolled. Ultimately, 46 patients completed the follow-up in this study-26 in the MB group and 20 in the control group-who underwent the novel MB technique and conventional abdominal breathing training. The primary endpoint of the study was left ventricular function measured by noninvasive hemodynamics three months after discharge. The secondary endpoints were compliance and quality of life after three months of home rehabilitation. After the intervention, several cardiac functional parameters (SV, SVI, CO, CI, LCW, and LCWI), myocardial contractility parameters (VI), and systemic vascular resistance parameters (SVR and SVRI) were significantly greater in the MB group than in the preintervention group (P < 0.05). Furthermore, post-treatment, the MB group exhibited greater SV, SVI, CO, CI, and VI; lower SVR, SVRI, and SBP; and a lower readmission rate three months later than did the control group. The SF-36 scores after three months of MB intervention, PE, BP, GH, VT, SF, RE, and MH, were all significantly greater than those before treatment (P < 0.05). Moreover, the MB group displayed greater compliance with home-based cardiac rehabilitation (P < 0.05). Compared to conventional respiratory rehabilitation training methods, short-term metronomic respiratory therapy is more effective for reducing systemic vascular resistance, enhancing left ventricular ejection function, enhancing quality of life, and increasing home-based rehabilitation compliance in geriatric patients following AMI with PCI.

Effect of Traditional Chinese Emotional Nursing Combined with Lung Rehabilitation Training and Oral Nutrition Preparation on Improving the Nutritional Status and Lung Function in Elderly Patients with Chronic Obstructive Pulmonary Disease

This study aimed to investigate the effect of traditional Chinese emotional nursing combined with lung rehabilitation training and oral nutrition preparation on improving the nutritional status and lung function of elderly patients with chronic obstructive pulmonary disease. The control group received conventional Western medicine and lung rehabilitation training, while the observation group received traditional Chinese emotional nursing combined with oral nutrition preparation. After nursing, the self-rating depression scale and self-rating anxiety scale scores in the observwere lower than those in the control group (P &lt; 0.05), whereas forced vital capacity, forced expiratory volume in 1 s, and 6-min walk distance were higher (P &lt; 0.05). Serum albumin, prealbumin, transferrin, immunoglobulin A, immunoglobulin G, and immunoglobulin M levels were higher than those in the control group (P &lt; 0.05). After nursing, the scores for physical, material, social, and psychological functions in the observation group were higher than those in the control group (P &lt; 0.05). In conclusion, traditional Chinese emotional nursing combined with lung rehabilitation training and oral nutrition preparation can relieve negative emotions, promote pulmonary function and nutritional status, and improve the quality of life of elderly patients with chronic obstructive pulmonary disease.

EEG microstates analysis after TMS in patients with subacute stroke during the resting state.

To investigate whether intermittent theta burst stimulation over the cerebellum induces changes in resting-state electroencephalography microstates in patients with subacute stroke and its correlation with cognitive and emotional function. Twenty-four stroke patients and 17 healthy controls were included in this study. Patients and healthy controls were assessed at baseline, including resting-state electroencephalography and neuropsychological scales. Fifteen patients received lateral cerebellar intermittent theta burst stimulation as well as routine rehabilitation training (intermittent theta burst stimulation-RRT group), whereas 9 patients received only conventional rehabilitation training (routine rehabilitation training group). After 2wk, baseline data were recorded again in both groups. Stroke patients exhibited reduced parameters in microstate D and increased parameters in microstate C compared with healthy controls. However, after the administration of intermittent theta burst stimulation over the lateral cerebellum, significant alterations were observed in the majority of metrics for both microstates D and C. Lateral cerebellar intermittent theta burst stimulation combined with conventional rehabilitation has a stronger tendency to improve emotional and cognitive function in patients with subacute stroke than conventional rehabilitation. The improvement of mood and cognitive function was significantly associated with microstates C and D. We identified electroencephalography microstate spatiotemporal dynamics associated with clinical improvement following a course of intermittent theta burst stimulation therapy.

Evaluating the effectiveness of video-game based swallowing function training in patients with dysphagia: study protocol for a randomized controlled trial

BackgroundDysphagia can lead to serious complications such as aspiration and aspiration pneumonia, timely and effective rehabilitation training can improve the swallowing function of patients. However, the conventional rehabilitation training methods used in clinical settings have shortcomings such as poor adherence of patients. We present the study design of a randomized controlled trial that evaluated whether video-game based swallowing rehabilitation training can effectively improve swallowing in patients with dysphagia and whether it has additional benefits compared with conventional training methods to improve swallowing function and training compliance among patients with dysphagia.MethodsA randomized controlled trial with 4 weeks of intervention and 4 weeks of follow-up will be conducted in a rehabilitation center in Beijing, China. We will enroll 78 patients aged 18–80 years with dysphagia. Participants will be randomly assigned to the experimental group (video-game based swallowing function training) and the control group (conventional swallowing function training). All participants will receive 30 min of training per day, 5 times per week, for a total of 4 weeks. The primary outcome is swallowing function. Secondary outcomes include patients' quality of life, training compliance, and training satisfaction. Outcomes are assessed at baseline (pre-treatment), 4 weeks of treatment (post-treatment), and 8 weeks (follow-up), and the assessor is not aware of the participants’ grouping.DiscussionThe protocol describes a new rehabilitation training method for dysphagia, which involves participant eligibility recruitment, recruitment strategies, and data analysis plan. The results of the study will inform the rehabilitation training and clinical care management of swallowing function in patients with dysphagia.Trial registrationClinicalTrials.gov, NCT05978700. Registered on 28 July 2023.

Nordic hamstring exercises in functional knee rehabilitation after anterior cruciate ligament reconstruction: a prospective, randomised, controlled study

To study the effect of using Nordic hamstring exercise method on muscle strength and knee joint stability of patients after ACL reconstruction. 60 patients admitted to our hospital for ACL reconstruction were randomly divided into a test group (n = 30, applying Nordic hamstring exercise) and a control group (n = 30, applying conventional rehabilitation training methods), and the difference in the circumference of the thighs of the patients in the two groups was analysed after training, and the peak torque (PT), total torque (PT), and flexion and extension strength were measured by using the Biodex system3 Multi-joint Isokinetic Testing System at knee joints with an angular velocity of 60°/s and 120°/s. The peak torque (PT), total work (TW), and average peak torque (AVG PT) were measured by extension and flexion strength at angular velocity, and the Lysholm Knee Score was used to assess the knee function of 60 patients. There was no difference in the difference in thigh circumference between the two groups before surgery (P > 0.05); the difference in thigh circumference between the patients in the test group at 12 and 24 weeks after surgery was (− 0.35 ± 0.22) cm and (0.12 ± 0.03) cm, respectively, which were higher than those in the control group, (− 0.51 ± 0.15) cm and (− 0.41 ± 0.34) cm (P < 0.05). At the 12th and 24th postoperative weeks, the popliteal muscle strength of both groups was improved compared with that before surgery; among them, by comparing the popliteal peak moments with different angular velocities, the ratio of popliteal peak moment on the affected side/peak moment on the healthy side of the popliteal muscle of the experimental group was significantly higher than that of the control group, and the difference was significant (P < 0.05), but there was still a gap compared with that of the healthy side. The Lachmen test and the anterior drawer test were negative in the test and control groups at the 24th postoperative week of review, and the anterior tibial shift was < 5 mm in the KT-1000 test, and the difference in the anterior shift was < 3 mm compared with the healthy side, and there was no significant difference between the two groups. By Nordic hamstring exercise can make patients after knee ACL reconstruction reduce patient pain, accelerate the recovery of knee function, improve the swelling of the lower limb, reach the level of flexor strength of the healthy side within 24 weeks, and can increase the stability of the knee joint.

Effects of soft robotic exoskeleton for gait training on clinical and biomechanical gait outcomes in patients with sub-acute stroke: a randomized controlled pilot study.

Ankle function impairment is a critical factor impairing normal walking in survivors of stroke. The soft robotic exoskeleton (SRE) is a novel, portable, lightweight assistive device with promising therapeutic potential for gait recovery during post-stroke rehabilitation. However, whether long-term SRE-assisted walking training influences walking function and gait quality in patients following subacute stroke is unknown. Therefore, the primary objective of this study was to assess the therapeutic effects of SRE-assisted walking training on clinical and biomechanical gait outcomes in the rehabilitation of patients with subacute stroke. A group patients who had experienced subacute stroke received conventional rehabilitation (CR) training combined with 10-session SRE-assisted overground walking training (30 min per session, 5 sessions/week, 2 weeks) (SRE group, n = 15) compared with the control group that received CR training only (CR group, n = 15). Clinical assessments and biomechanical gait quality measures were performed pre-and post-10-session intervention, with the 10-Minute Walk Test (10MWT) and 6-Minute Walk Test (6MWT) used to define the primary clinical outcome measures and the Functional Ambulation Category, Fugl-Meyer Assessment for Lower Extremity (FMA-LE) subscale, and Berg Balance Scale defined the secondary outcome measures. The gait quality outcome measures included spatiotemporal and symmetrical parameters during walking. After the 10-session intervention, the SRE and CR groups exhibited significant within-group improvements in all clinical outcome measures (p < 0.05). Between-comparison using covariance analyses demonstrated that the SRE group showed greater improvement in walking speed during the 10MWT (p < 0.01), distance walked during the 6MWT (p < 0.05), and FMA-LE scores (p < 0.05). Gait analyses showed that the SRE group exhibited significantly improved spatiotemporal symmetry (p < 0.001) after 10-session training, with no significant changes observed in the CR group. Compared with CR training, SRE-assisted walking training led to greater improvements in walking speed, endurance, and motor recovery. Our findings provide preliminary evidence that SRE may be considered for inclusion in intensive gait training clinical rehabilitation programs to further improve walking function in patients who have experienced stroke.

Different doses of intermittent theta burst stimulation for upper limb motor dysfunction after stroke: a study protocol for a randomized controlled trial.

Upper limb motor recovery is one of the important goals of stroke rehabilitation. Intermittent theta burst stimulation (iTBS), a new type of repetitive transcranial magnetic stimulation (rTMS), is considered a potential therapy. However, there is still no consensus on the efficacy of iTBS for upper limb motor dysfunction after stroke. Stimulus dose may be an important factor affecting the efficacy of iTBS. Therefore, we aim to investigate and compare the effects and neural mechanisms of three doses of iTBS on upper limb motor recovery in stroke patients, and our hypothesis is that the higher the dose of iTBS, the greater the improvement in upper limb motor function. This prospective, randomized, controlled trial will recruit 56 stroke patients with upper limb motor dysfunction. All participants will be randomized in a 1:1:1:1 ratio to receive 21 sessions of 600 pulses active iTBS, 1,200 pulses active iTBS, 1,800 pulses active iTBS, or 1,800 pulses sham iTBS in addition to conventional rehabilitation training. The primary outcome is the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) score from baseline to end of intervention, and the secondary outcomes are the Wolf Motor Function Test (WMFT), Grip Strength (GS), Modified Barthel Index (MBI), and Stroke Impact Scale (SIS). The FMA-UE, MBI, and SIS are assessed pre-treatment, post-treatment, and at the 3-weeks follow-up. The WMFT, GS, and resting-state functional magnetic resonance imaging (rs-fMRI) data will be obtained pre- and post-treatment. The iTBS intervention in this study protocol is expected to be a potential method to promote upper limb motor recovery after stroke, and the results may provide supportive evidence for the optimal dose of iTBS intervention.

The effects of computer-aided cognitive rehabilitation combined with virtual reality technology on event-related potential P300 and cognitive function of patients with cognitive impairment after stroke.

The aim of this study was to explore the effects of computer-aided cognitive rehabilitation (CACR) combined with virtual reality (VR) technology on event-related potential P300 and cognitive function in patients with cognitive impairment after stroke. Clinical data from 94 patients with post-stroke cognitive impairment, admitted to our hospital from January 2020 to March 2023, were retrospectively analyzed. Of them, 45 patients received routine rehabilitation training (Control group), and 49 patients received CACR combined with VR technology (Observation group). Cognitive rehabilitation status, event-related potential P300 examination status, biochemical indices levels, and daily living activity scores of the two groups were evaluated and compared. After treatment, cognitive function significantly improved in the Observation group compared to the Control group. The amplitude of P300 in the Observation group was significantly higher, and the latency was significantly lower compared to the Control group. The levels of brain-derived neurotrophic factor (BDNF) in the Observation group were significantly higher (p<0.05), while the levels of cystatin C (Cys-C) and neuron-specific enolase (NSE) were significantly lower than those in the Control group (p<0.05 each). Patients in the Observation group demonstrated a significantly higher ability to perform daily living activities compared to the Control group (p<0.05). Compared with conventional rehabilitation training, the combination of CACR and VR technology in the treatment of stroke-induced cognitive impairment is more effective in improving patients' cognitive function, regulating BDNF, Cys-C, and NSE levels, and enhancing patients' ability to perform daily living activities.

Individualized Vibrotactile Neurofeedback Training in Patients with Chronic Bilateral Vestibulopathy.

Patients with bilateral vestibulopathy (BVP) suffer from postural imbalance during daily life conditions, which in turn leads to a high frequency of falls. Unfortunately, vestibular rehabilitation has only modest and somewhat inconsistent effects in this patient group. Approximately 50% of BVP patients show an improved postural control after conventional vestibular rehabilitation training. New and more promising approaches are required. The individualized vibrotactile neurofeedback training (IVNT) in stance and gait conditions has already been described as highly effective in patients with various vestibular disorders. The purpose of the present multicenter study was to determine the efficacy of the IVNT in improving balance, reducing self-perceived disability, and improving gait in patients with confirmed BVP. In total, 22 patients performed the IVNT with the Vertiguard® system for 10 daily sessions. The dizziness handicap inventory (DHI), the stance stability score of the sensory organization test (SOT) and the score for everyday life mobility in stance and gait tasks (SBDT) were obtained immediately before and after the rehabilitation training period, as well as 3 and 12 months later. All measures improved significantly after the IVNT. Between 77.3% and 94.4% of patients showed an individual benefit (depending on outcome measure). The effect was not significantly reduced within the follow-up period of 12 months. The results demonstrate a high efficacy of the IVNT for vestibular rehabilitation in BVP patients.

Motor Activated Auricular Vagus Nerve Stimulation as a Potential Neuromodulation Approach for Post-Stroke Motor Rehabilitation: A Pilot Study

Background Implanted vagus nerve stimulation (VNS), when synchronized with post-stroke motor rehabilitation improves conventional motor rehabilitation training. A non-invasive VNS method known as transcutaneous auricular vagus nerves stimulation (taVNS) has emerged, which may mimic the effects of implanted VNS. Objective To determine whether taVNS paired with motor rehabilitation improves post-stroke motor function, and whether synchronization with movement and amount of stimulation is critical to outcomes. Methods We developed a closed-loop taVNS system for motor rehabilitation called motor activated auricular vagus nerve stimulation (MAAVNS) and conducted a randomized, double-blind, pilot trial investigating the use of MAAVNS to improve upper limb function in 20 stroke survivors. Participants attended 12 rehabilitation sessions over 4-weeks, and were assigned to a group that received either MAAVNS or active unpaired taVNS concurrently with task-specific training. Motor assessments were conducted at baseline, and weekly during rehabilitation training. Stimulation pulses were counted for both groups. Results A total of 16 individuals completed the trial, and both MAAVNS (n = 9) and unpaired taVNS (n = 7) demonstrated improved Fugl-Meyer Assessment upper extremity scores (Mean ± SEM, MAAVNS: 5.00 ± 1.02, unpaired taVNS: 3.14 ± 0.63). MAAVNS demonstrated greater effect size (Cohen’s d = 0.63) compared to unpaired taVNS (Cohen’s d = 0.30). Furthermore, MAAVNS participants received significantly fewer stimulation pulses (Mean ± SEM, MAAVNS: 36 070 ± 3205) than the fixed 45 000 pulses unpaired taVNS participants received (P < .05). Conclusion This trial suggests stimulation timing likely matters, and that pairing taVNS with movements may be superior to an unpaired approach. Additionally, MAAVNS effect size is comparable to that of the implanted VNS approach.

Deep muscle stimulator in the treatment of post-stroke spasticity: A protocol for systematic review and meta-analysis.

Spasticity is one of the most common complications and sequelae of stroke, with the main clinical manifestations being increased muscle tension, pain, stiffness, and other disorders. It not only increases the length of hospitalization and medical costs but also affects the quality of daily life and the stress of returning to society, increasing the burden on patients and their families. At present, 2 driver types of deep muscle stimulator (DMS) have been used in the clinical treatment of post-stroke spasticity (PSS) with good clinical results, but there is no evidence of clinical efficacy and safety. Therefore, this study aims to integrate direct and indirect comparative clinical evidence through a systematic review and network meta-analysis (NMA). According to the data, different driver types for DMS with the same body of evidence will be collected, analyzed, and sequenced in a quantitative and comprehensive manner and then screened for the optimal driver type of DMS device for PSS treatment. The study also aims to provide reference value and an evidence-based theoretical basis for the clinical optimization of DMS equipment selection. A comprehensive retrieval of China National Knowledge Infrastructure, Chinese scientific journal database, China biological feature database, Wanfang Chinese databases and the Cochrane Library, PubMed, Web of Science, and Embase foreign databases will be conducted. Randomized controlled trials of these 2 driver types of DMS devices combined with conventional rehabilitation training of PSS will be searched and published. The retrieval time is from the establishment of the database to December 20, 2022. The 2 first authors will screen references that meet the inclusion criteria, independently extract data according to predesigned rules, and assess the quality of the included studies and the risk of bias according to the Cochrane 5.1 Handbook criteria. R programming and Aggregate Data Drug Information System software will be used to perform a combined NMA of the data and to evaluate the probability of ranking for all interventions. The NMA and probability ranking will determine the best driver type of DMS device for PSS. This study will offer a comprehensive evidence-based approach to DMS therapy and assist doctors, PSS patients, and decision-makers in selecting a more efficient, secure, and cost-effective treatment option.

Effects of motor imagery based brain-computer interface on upper limb function and attention in stroke patients with hemiplegia: a randomized controlled trial

BackgroundSeeking positive and comprehensive rehabilitation methods after stroke is an urgent problem to be solved, which is very important to improve the dysfunction of stroke. The aim of this study was to investigate the effects of motor imagery-based brain-computer interface training (MI-BCI) on upper limb function and attention in stroke patients with hemiplegia.MethodsSixty stroke patients with impairment of upper extremity function and decreased attention were randomly assigned to the control group (CR group) or the experimental group (BCI group) in a 1:1 ratio. Patients in the CR group received conventional rehabilitation. Patients in the BCI group received 20 min of MI-BCI training five times a week for 3 weeks (15 sessions) in addition to conventional rehabilitation. The primary outcome measures were the changes in Fugl-Meyer Motor Function Assessment of Upper Extremities (FMA-UE) and Attention Network Test (ANT) from baseline to 3 weeks.ResultsAbout 93% of the patients completed the allocated training. Compared with the CR group, among those in the BCI group, FMA-UE was increased by 8.0 points (95%CI, 5.0 to 10.0; P < 0.001). Alert network response time (32.4ms; 95%CI, 58.4 to 85.6; P < 0.001), orienting network response (5.6ms; 95%CI, 29.8 to 55.8; P = 0.010), and corrects number (8.0; 95%CI, 17.0 to 28.0; P < 0.001) also increased in the BCI group compared with the CR group. Additionally, the executive control network response time (− 105.9ms; 95%CI, − 68.3 to − 23.6; P = 0.002), the total average response time (− 244.8ms; 95%CI, − 155.8 to − 66.2; P = 0.002), and total time (− 122.0ms; 95%CI, − 80.0 to − 35.0; P = 0.001) were reduced in the BCI group compared with the CR group.ConclusionMI-BCI combined with conventional rehabilitation training could better enhance upper limb motor function and attention in stroke patients. This training method may be feasible and suitable for individuals with stroke.Trial registration: This study was registered in the Chinese Clinical Trial Registry with Portal Number ChiCTR2100050430(27/08/2021).

Effect of electroacupuncture combined with rehabilitation training on hypertension: A systematic review and meta-analysis.

To evaluate the clinical effects of electroacupuncture combined with rehabilitation training (EART) versus conventional rehabilitation training (CRT) on hypertension. Multiple databases like PubMed, Embase, Web of Science and Wanfang database, China National Knowledge Internet database, and Chinese Biological Medical database were used to search for the relevant studies and full-text articles involved in evaluating EART versus CRT with hypertension. Review Manager 5.4 was used to estimate the effects of the results among included articles. Forest plots, sensitivity analysis, and funnel plots were also conducted on the included articles. In this meta-analysis study, there were 9 relevant studies were eventually satisfied the included criteria. There were significant differences between EART group and CRT group in systolic blood pressure after treatment (MD -16.62, 95%CI=-21.84 to -11.39;P<0.00001), diastolic blood pressure after treatment (MD=-16.03, 95% CI=-21.55 to -10.50;P<0.00001), and effective rate (MD=1.22, 95% CI=1.13 to 1.32;P<0.00001). Sensitivity analysis and funnel chart demonstrated that the study was robust and limited publication bias was observed. Our data showed that EART was clinically more significant than CRT in hypertension. Further studies need to be performed using large relevance references to verify the effectiveness of EART in the treatment of hypertension.

Cerebral activity manipulation of low-frequency repetitive transcranial magnetic stimulation in post-stroke patients with cognitive impairment.

The aim of this study was to evaluate the therapeutic effect of low-frequency repetitive transcranial magnetic stimulation (rTMS) on post-stroke cognitive impairment (PSCI). Thirty-six PSCI patients were randomly divided into treatment and control groups of equal size. Both groups were pre-treated with conventional cognitive rehabilitation training. Subsequently, the treatment group was exposed to 1 Hz low-frequency repetitive transcranial magnetic stimulations for 8 weeks, with 5 days per week. Meanwhile, the control group was treated with placebo stimulations. Patients were evaluated via the LOTCA scale assessments and changes in P300 latencies and amplitudes before and after 8 weeks of treatment. Before treatment, there were no significant differences between the two groups in LOTCA scores, P300 latencies, and amplitudes (P > 0.05). After treatment, LOTCA scores for both groups improved (P < 0.05), and those of the treatment group were higher than those of the control (P < 0.05). For both groups, P300 latencies were not only shortened but also had greater amplitudes (P < 0.05), and those for the treatment group were significantly shorter and larger than those of the control (P < 0.05). As a therapy, rTMS improved cognitive function in PSCI patients, possibly via regulation of neural electrical activity of the cerebral cortex.

Effect of transcutaneous auricular vagus nerve stimulation on post-stroke dysphagia.

It has been proved that electrical vagus nerve stimulation can promote the recovery of motor function after stroke. There were no trials on the use of transcutaneous auricular electrical vagus nerve stimulation (ta-VNS) in patients with dysphagia after acute stroke. Our aim was to confirm whether ta-VNS can promote the recovery of swallowing function in these acute stroke patients with dysphagia. We conducted a sham-controlled, double-blinded, parallel pilot study in 40 acute stroke patients randomly assigned to receive ta-VNS or sham ta-VNS combined with conventional rehabilitation training. The intensity of ta-VNS treatment was adjusted according to the patient's tolerance, 30min each time, twice a day, five times a week, with a total course of 3weeks. In the sham group, the parameters were the same except energy output. Swallowing function was assessed with Modified Mann assessment of swallowing ability (MASA), functional communication measure swallowing test (FCM), and the Rosenbek leakage/aspiration scale (RAS) according to swallowing video fluoroscopic (SVF) before the intervention (baseline, T0), immediately after the intervention (T1) and 4weeks after the intervention (T2). After treatment, ta-VNS group statistically and clinically had larger change of MASA, FCM, and RAS scores compared with control group (P < 0.05) and this improvement continued at least 4weeks after the end of treatment. There were no serious adverse events occurred during the whole intervention. The transcutaneous auricular electrical vagus nerve stimulation is effective as a novel and noninvasive treatment strategy for patients with dysphagia after acute stroke. No: kelunshen No. 63 in 2020.

Decompression and fusion combined with rehabilitation training for the foot drop secondary to lumbar degenerative disease: Case report and literature review

Foot drop (FD) secondary to lumbar degenerative disease is a relatively uncommon finding in spinal practice. Although only a part of patients with FD can obtain satisfactory recovery of their muscle strength after operation, most of the articles still advocate surgical intervention at early stage. Despite the double roots compression is one of the accepted causes for FD, we describe an extremely rare case of a middle-age man presenting with a severe foot drop (tibialis anterior ​= ​0/5) resulted from three roots compression (L4-S1), who had undergone pedicle screws fixation (L3-S1), transforaminal lumbar interbody fusion (TLIF) at L4/5, laminotomy and discectomy at L5/S1 with laminotomy at L3/4 as well as conventional rehabilitation training postoperatively, which included strength training of the active and antagonistic muscles in the week lower extremity. Twelve months after surgery, the patient recovered from his deficit (tibialis anterior improved from 0/5 to 4/5). Therefore, we discuss the possible pathological mechanism and surgical option for the foot drop due to the lumbar degenerative disease as well as the potential risk factors portending prognosis postoperatively.

Clinical observation of taking acupuncture at the acupoints based on "four seas theory" for post-stroke cognitive impairment 基于“四海理论”组穴针刺治疗脑卒中后认知障碍的临床观察

ObjectiveTo observe the clinical effect on post-stroke cognitive impairment (PSCI) treated by acupuncture at the acupoints composed in accordance with the "four seas theory". MethodsA total of 70 patients with PSCI were randomly divided into a treatment group (n = 35) and a control group (n = 35). In the control group, conventional basic treatment and rehabilitation training were adopted, while in the treatment group, on the base of the treatment as the control group, acupuncture was applied at the acupoints composed in accordance with "four seas theory", lasting 8 weeks. The scores of mini-mental state examination (MMSE) and the instantaneous memory, the scores of Montreal cognitive assessment (MoCA) and the delayed memory, the score of kidney essence insufficiency in syndrome differentiation scale of vascular dementia (SDSVD), event-related potentials (ERP) P300 and clinical therapeutic effect were compared in the patients between two groups before and after treatment separately. ResultsAfter treatment, MMSE score and the score of instantaneous memory were higher than the results before treatment in either group respectively (all P < 0.05), in which, MMSE score in the treatment group was higher than that in the control group (P < 0.05). After treatment, MoCA score and the score of delay recall were higher than the results before treatment in either group (all P < 0.05), in which, MoCA score in the treatment group was higher than that of the control group (P < 0.05). After treatment, the score of SDSVD was lower than that before treatment in either group (both P < 0.05), in which SDSVD score in the treatment group were lower than the control group (P < 0.05). There were no statistical changes in P300 latency and wave amplitude in the patients of the control group after treatment (both P > 0.05). However, in the treatment group, P300 latency was reduced and the wave amplitude was increased after treatment (both P < 0.05). The total effective rate was 88.57% in the treatment group, higher than 71.43% in the control group (P < 0.05). ConclusionAcupuncture at the acupoints composed on the base of the "four seas theory” effectively improves the cognitive function and traditional Chinese medicine syndrome scores in PSCI patients. This therapy is of great value in clinic in the future.

Interactive Digital Game for Improving Visual-Perceptual Defects in Children With a Developmental Disability: Randomized Controlled Trial.

BackgroundVisual–perceptual defects in children can negatively affect their ability to perform activities of daily living. Conventional rehabilitation training for correcting visual–perceptual defects has limited training patterns and limited interactivity, which makes motivation difficult to sustain.ObjectiveWe aimed to develop and evaluate an interactive digital game system for correcting visual–perceptual defects and evaluate its effectiveness.MethodsParticipants were children aged 5 to 10 years with a diagnosis of visual–perceptual defect associated with a developmental disability. The children were randomized into a digital game group who received the traditional course of rehabilitation combined with an interactive digital game intervention (n=12) and a standard rehabilitation group (n=11) who only received the traditional course of rehabilitation. Each group underwent rehabilitation once a week for 4 weeks. Overall improvement in Test of Visual Perceptual Skills 3rd edition (TVPS-3) score and overall improvement in performance in the interactive digital game were evaluated. Parents and therapists were asked to complete a satisfaction questionnaire.ResultsAfter 4 weeks, the TVPS-3 score had significantly increased (P=.002) in the digital game group (pre: mean 41.67, SD 13.88; post: 61.50, SD 21.64). In the standard rehabilitation group, the TVPS-3 score also increased, but the increase was not statistically significant (P=.58). Additionally, TVPS-3 score increases were significantly larger for the digital game group compared with those for the standard rehabilitation group (P=.005). Moreover, both parents and therapists were highly satisfied with the system. All 5 themes of satisfaction had mean scores higher than 4 in a 5-point scale questionnaire (mean 4.30, SD 0.56).ConclusionsThe system has potential applications for improving visual–perceptual function in children undergoing medical rehabilitation for developmental disability.Trial RegistrationClinicalTrials.gov NCT05016492; http://clinicaltrials.gov/ct2/show/NCT05016492