Limb Motor Function Research Articles

Effects of repetitive transcranial magnetic stimulation combined with repetitive peripheral magnetic stimulation on upper limb motor function after stroke: a systematic review and meta-analysis

ObjectiveTo evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) combined with repetitive peripheral magnetic stimulation (rPMS) on upper limb motor dysfunction after stroke.MethodsWe systematically searched databases up to May 2024, including PubMed, Embase, Cochrane Library, Web of Science, CNKI, VIP, Wanfang, and CBM. Randomized controlled trials (RCTs) examining the application of rTMS combined rPMS on upper limb motor dysfunction after stroke were included based on predefined inclusion criteria. We used Cochrane Risk of Bias 2 tool to assess bias risk of the included RCTs. Meta-analysis was conducted using RevMan 5.4 and Stata 17.0 software.ResultsA total of 9 RCTs involving 483 participants were included in this study. Compared with the control groups that used either conventional therapy or rTMS alone, the experimental group that used rTMS combined rPMS showed significant improvements in stroke patients' upper limb motor function [MD = 3.65, 95% CI (2.75, 4.54), P < 0.05], ability of daily living [MD = 4.50, 95% CI (3.50, 5.50), P < 0.05], and spasticity [MD = –0.34, 95% CI (−0.48, −0.20), P < 0.05]. Meanwhile, in terms of neurophysiological indicators, significant differences were found both for motor evoked potential latency [MD = −1.77, 95% CI (−3.19, −0.35), P < 0.05] and motor evoked potential amplitude [MD = 0.25, 95% CI (0.01, 0.49), P < 0.05].ConclusionThis study provides low-level evidence that the therapy of LF-rTMS or HF-rTMS combined with rPMS can improve the upper limb motor function and daily living ability of stroke patients. However, given that the low quality of the evidence for the evaluation results, further evidence from high-quality studies is needed to substantiate this conclusion.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024539195, PROSPERO Platform [CRD42024539195].

Lower Limb Motion Recognition Based on sEMG and CNN-TL Fusion Model.

To enhance the classification accuracy of lower limb movements, a fusion recognition model integrating a surface electromyography (sEMG)-based convolutional neural network, transformer encoder, and long short-term memory network (CNN-Transformer-LSTM, CNN-TL) was proposed in this study. By combining these advanced techniques, significant improvements in movement classification were achieved. Firstly, sEMG data were collected from 20 subjects as they performed four distinct gait movements: walking upstairs, walking downstairs, walking on a level surface, and squatting. Subsequently, the gathered sEMG data underwent preprocessing, with features extracted from both the time domain and frequency domain. These features were then used as inputs for the machine learning recognition model. Finally, based on the preprocessed sEMG data, the CNN-TL lower limb action recognition model was constructed. The performance of CNN-TL was then compared with that of the CNN, LSTM, and SVM models. The results demonstrated that the accuracy of the CNN-TL model in lower limb action recognition was 3.76%, 5.92%, and 14.92% higher than that of the CNN-LSTM, CNN, and SVM models, respectively, thereby proving its superior classification performance. An effective scheme for improving lower limb motor function in rehabilitation and assistance devices was thus provided.

Effect of Upper Robot-Assisted Training on Upper Limb Motor, Daily Life Activities, and Muscular Tone in Patients With Stroke: A Systematic Review and Meta-Analysis.

Upper limb rehabilitation robot is a relatively new technology, but its effectiveness remains debatable due to the inconsistent results of clinical trials. This article intends to assess how upper limb rehabilitation robots help the functional recovery of stroke patients. PubMed, Embase, Cochrane Library, and Web of Science databases were searched for eligible studies to explore the effect of upper limb rehabilitation robots on upper limb motor function, muscle tone, and daily living activities. Eighteen trials with 573 stroke patients met the inclusion criteria. The results showed that compared to conventional rehabilitation training, patients who received upper limb robotic therapy (RT) had significantly improved Fugl-Meyer Upper Extremity Motor Assessment (FMA-UE) scores (weighted mean differences [WMD]: 5.27, 95% confidence intervals [CI]: 3.36, 7.17), Action Research Arm Test (ARAT) scores (WMD: 4.07, 95% CI: -4.14, 12.28), Modified Barthel Index (MBI) scores (WMD: 9.55, 95% CI: 6.37, 12.73), and modified Ashworth Scale (MAS) scores (WMD: -0.28, 95% CI: -0.50, 0.06), with no significant heterogeneity. Upper limb robot-assisted training is superior to conventional training in terms of improving upper limb motor impairment, ability to perform daily living activities, and muscle tone recovery, which supports the application of robots in clinical practice.

Ginsenoside Rg1 Regulates the Activation of Astrocytes Through lncRNA-Malat1/miR-124-3p/Lamc1 Axis Driving PI3K/AKT Signaling Pathway, Promoting the Repair of Spinal Cord Injury.

To investigate the regulation of ginsenoside Rg1 on the PI3K/AKT pathway through the lncRNA-Malat1/miR-124-3p/ Laminin gamma1 (Lamc1) axis, activating astrocytes (As) to promote the repair of spinal cord injury (SCI). Bioinformatics analysis was used to predict miRNA targeting Lamc1 and lncRNA targeting miR-124-3p, which were then validated through a dual-luciferase assay. Following transfection, the relationships between Malat1, miR-124-3p, and Lamc1 expression levels were assessed by qRT-PCR and Western blot (WB). Immunofluorescence staining and immunohistochemistry were utilized to measure Lamc1 expression, while changes in cavity area were observed through hematoxylin-eosin (HE) staining. Basso-Beattie-Bresnahan (BBB) scale and footprint analysis were used to evaluate functional recovery. WB was performed to assess the expression of PI3K/AKT pathway-related protein. Rg1 was found to upregulate Malat1 expression, which in turn modulated the Malat1/miR-124-3p/Lamc1 axis. Furthermore, Rg1 activated the PI3K/Akt signaling pathway, significantly reducing the SCI cavity area and improving hind limb motor function. However, knockout of Malat1 hindered these effects, and inhibition of miR-124-3p reversed the silencing effects of Malat1. Rg1 can induce Malat1 expression to activate the Lamc1/PI3K/AKT signaling pathway by sponging with miR-124-3p, thereby regulating As activity to repair SCI.

Restorative Treatments for Cervical Spinal Cord Injury, a Narrative Review.

A narrative review. To summarize relevant data from representative studies investigating upper limb restorative therapies for cervical spinal cord injury. Cervical spinal cord injury (SCI) is a debilitating condition resulting in tetraplegia, lifelong disability, and reduced quality of life. Given the dependence of all activities on hand function, patients with tetraplegia rank regaining hand function as one of their highest priorities. Recovery from cervical SCI is heterogeneous and often incomplete; currently, various novel therapies are under investigation to improve neurological function and eventually better quality of life in patients with tetraplegia. In this article, a narrative literature review was performed to identify treatment options targeting the restoration of function in patients with cervical SCI. Studies were included from available literature based on the availability of clinical data and whether they are applicable to restoration of arm and hand function in patients with cervical SCI. We describe relevant studies including indications and outcomes with a focus on arm and hand function. Different treatment modalities described include nerve transfers, tendon transfers, spinal cord stimulation, functional electrical stimulation, non-invasive brain stimulation, brain-machine interfaces and neuroprosthetics, stem cell therapy, and immunotherapy. As the authors' institution leads one of the largest clinical trials on nerve transfers for cervical SCI, we also describe how patients undergoing nerve transfers are managed and followed at our center. While complete recovery from cervical spinal cord injury may not be possible, novel therapies aimed at the restoration of upper limb motor function have made significant progress toward the realization of complete recovery.

Clinical study on the effects of cluster needling at scalp points with needle retaining combined with the training of the upper-limb intelligent rehabilitation robot on shoulder function in stroke patients during convalescence

To explore the effects of cluster needling at scalp points with needle retaining combined with the training of the upper-limb intelligent rehabilitation robot on shoulder function in stroke patients during convalescence. Ninety stroke patients during convalescence were collected and randomized into scalp point group, robot training group and combined intervention group, with 30 cases each. In the scalp point group, the cluster needling was delivered at scalp points with the needles retained. In the robot training group, the patients were trained with the upper-limb intelligent rehabilitation robot. In the combined intervention group, the patients received both the cluster needling and the training of the upper-limb intelligent rehabilitation robot. In each group, the treatment was given once daily, 5 treatments a week with 2 days rest, for consecutive 4 weeks. Separately, before and after treatment, the score of Fugl-Meyer assessment upper extremity scale (FMA-UE) and the score of activity of daily living (ADL) were evaluated. Using the in-built assessment system of the upper-limb intelligent rehabilitation robot, the range of motion (ROM) of forward flexion, horizontal abduction and horizontal adduction of the affected shoulder joint were evaluated. With surface electromyogram (sEMG), the sEMG value of the deltoid muscle and the pectoralis major on the affected side were detected. Compared with the values before treatment, ADL score and FMA-UA score increased in patients of the three groups (P<0.05), and ROM of forward flexion, horizontal abduction and horizontal adduction of the affected shoulder joint was larger (P<0.05), the sEMG value of the fasciculi pectoralis major anterior of patients in the combined intervention group was reduced (P<0.05), and the sEMG of anterior deltoid tract was elevated in the three groups (P<0.05). When compared with the scalp point group and the robot group, in the combined intervention group, after treatment, ADL score and FMA-UA score were higher (P<0.05), ROM of forward flexion, horizontal abduction and horizontal adduction of the affected shoulder joint elevated (P<0.05) and sEMG value of the fasciculi pectoralis major anterior reduced (P<0.05), while which of the anterior deltoid tract was elevated (P<0.05). The cluster needling at scalp points with needle retaining, combined with the training of the upper-limb intelligent rehabilitation robot, improves the upper limb motor function and the range of motion of the shoulder joint in stroke patients during convalescence.

Efficacy and safety of very early rehabilitation for acute ischemic stroke: a systematic review and meta-analysis.

Early rehabilitation after acute ischemic stroke (AIS) contributes to functional recovery. However, the optimal time for starting rehabilitation remains a topic of ongoing investigation. This article aims to shed light on the safety and efficacy of very early rehabilitation (VER) initiated within 48 h of stroke onset. A systematic search in PubMed, Embase, Cochrane Library, and Web of Science databases was conducted from inception to January 20, 2024. Relevant literature on VER in patients with AIS was reviewed and the data related to favorable and adverse clinical outcomes were collected for meta-analysis. Subgroup analysis was conducted at different time points, namely at discharge and at three and 12 months. Statistical analyses were performed with the help of the Meta Package in STATA Version 15.0. A total of 14 randomized controlled trial (RCT) studies and 3,039 participants were included in the analysis. VER demonstrated a significant association with mortality [risk ratio (RR) = 1.27, 95% confidence interval (CI) (1.00, 1.61)], ability of daily living [weighted mean difference (WMD) = 6.90, 95% CI (0.22, 13.57)], and limb motor function [WMD = 5.02, 95% CI (1.63, 8.40)]. However, no significant difference was observed between the VER group and the control group in adverse events [RR = 0.89, 95% CI (0.79, 1.01)], severity of stroke [WMD = 0.52, 95% CI (-0.04, 1.08)], degree of disability [RR = 1.06, 95% CI (0.93, 1.20)], or recovery of walking [RR = 0.98, 95% CI (0.94, 1.03)] after stroke. Subgroup analysis revealed that VER reduced the risk of adverse events in the late stage (at three and 12 months) [RR = 0.86, 95% CI (0.74, 0.99)] and degree of disability at 12 months [RR = 1.28, 95% CI (1.03, 1.60)], and improved daily living ability at 3 months [WMD = 4.26, 95% CI (0.17, 8.35)], while increasing severity of stroke during hospitalization [WMD = 0.81, 95% CI (0.01, 1.61)]. VER improves activities of daily living (ADLs) and lowers the incidence of long-term complications in stroke survivors. However, premature or overly intense rehabilitation may increase mortality in patients with AIS during the acute phase. PROSPERO registration number: CRD42024508180. This systematic review was registered with PROSPERO (https://www.crd.york.ac.uk/PROSPERO/). PROSPERO registration number: CRD42024508180.

Multimodal human computer interaction of wheelchairs supporting lower limb active rehabilitation

Currently, an important challenge in stroke rehabilitation is how to effectively restore motor functions of lower limbs. This paper presents multimodal human computer interaction (HCI) of wheelchairs supporting lower limb active rehabilitation. First, multimodal HCI incorporating motor imagery electroencephalography (EEG), electromyography (EMG) and speech is designed. Second, prototype supporting wheelchair active rehabilitation method is illustrated in details. Third, the preliminary brain-computer interfaces (BCI) and speech recognition task experiments are carried out respectively, and the results are obtained. Finally, discussion is conducted and conclusion is drawn. This study has important practical significance in auxiliary movements and neurorehabilitation for stroke patients.

A Wearable Solution of Muscle Atrophy Assessment: Oriented Toward Upper Limb Rehabilitation

In the process of the upper limb rehabilitation, the rehabilitation effect is often evaluated from the perspective of the motor function of limbs. However, the state of muscle atrophy is also a noteworthy indicator reflecting the rehabilitation effect. We proposed a wearable solution for the monitoring and grade assessing of local muscle atrophy based on wearable bioimpedance (BioZ) sensors. This work elaborates on the theoretical basis, procedure, and key influencing factors of the proposed solution, and the feasibility and effectiveness have been verified through in vitro and in vivo experiments. A total of 25 phantoms in different CSA (cross-sectional area) and FMR (fat-to-muscle ratio) values were designed to simulate different stages of muscular atrophy, and a linear correlation was observed between BioZ, CSA, and FMR, with an R-squared value of 0.898. The relative impedance difference of 38 patients with unilateral muscle atrophy was 5.231% larger than that of 30 healthy control samples on average (p&lt; 0.05). These results demonstrate the correlation between muscle atrophy and BioZ. As the proof-of-concept for graded assessment, the results analyzed by support vector machines (SVMs) show that the accuracy of three-level classification can reach 94.1% using the five-fold cross-validation.

The effect of family posture control combined with GAME therapy on motor function in children with severe cerebral palsy.

This paper has a purpose to explore the effects of home posture control combined with goal-activity-exercise-environment therapy on motor function in children with severe cerebral palsy (CP). Data of 80 children with severe CP treated from January 2022 to December 2023 were collected. They were divided into experimental group (EG) and control group according to different treatment methods, with 40 people in each group. The controlled group (CG) obtained routine treating means, including occupational therapy, electromyographic biofeedback therapy, and other treatment items. The EG received a combination of home posture control and goal-activity-exercise-environment therapy on the basis of conventional treatment. Meanwhile, parents received professional training to manage their children's posture and received reinforcement training through goal-activity-exercise-environment therapy. The Gross motor function measure-88, Peabody developmental motor scale-fine motor, pediatric balance scale, Fugl-Meyer assessment and other scales were used to evaluate the motor function, balance ability, daily living activity ability, and developmental level of patients. After 3 months of treatment, the Gross motor function measure-88 scores of these 2 groups were 70.96 ± 18.29 and 57.42 ± 21.41, respectively. The Peabody developmental motor scale-fine motor scores were 76.48 ± 14.42 and 59.77 ± 14.89, respectively. The balance ability index, upper limb motor function index, daily living activity ability, and developmental level of the EG were significantly higher than the CG's, and the P-values were all <.05. The combination of home posture control and GAME therapy can significantly improve the motor function and daily living activities of children with severe CP. This helps to maintain the normal growth and development of the child, and has certain clinical value.

USO DA TERAPIA ESPELHO EM MEMBRO SUPERIOR EM PACIENTES COM SEQUELAS APÓS ACIDENTE VASCULAR ENCEFÁLICO: UMA REVISÃO INTEGRATIVA

Introduction: Stroke has become a public health problem worldwide, being the second leading cause of functional limitation, which results in motor dysfunctions in the upper limbs, affecting the notion of space and body senses. These alterations are related to touch, temperature, pain and proprioception, extensor/flexor spasms, increased tendon reflexes, spastic co-contraction, dystonia, fatigability or spasticity. Mirror therapy has been considered a very effective form of treatment for motor dysfunctions. Thus, the present study aims to evaluate the use of mirror therapy in the functional recovery of the upper limbs in patients with sequelae after stroke, in addition to its impact on the quality of life of the participants. Methodology: This study is an integrative literature review with searches in the following databases: PubMed, Medline, Cochrane and Pedro, with articles published between 2019 and 2024. Results and discussion: Thirteen studies were selected, which presented mirror therapy associated with other therapeutic approaches, demonstrating their results in relation to motor functionality, manual dexterity, motor control and grasping. Final Considerations: Based on the findings, it was possible to observe that mirror therapy can contribute significantly to the rehabilitation of upper limb motor function and quality of life of patients after stroke.

Anatomic Study and Clinical Application of C7 Nerve Transfer Surgery via the Anterior Vertebral Approach for Central Upper Limb Spastic Paralysis

Objective: To explore the anatomic characteristics of C7 nerve localization, course, and length during cross-transfer surgery of the C7 nerve through the anterior vertebral approach and investigate the feasibility, safety, and clinical efficacy of C7 nerve transfer surgery through the anterior vertebral approach for the treatment of central upper limb spastic paralysis. Methods: Four fresh-frozen adult head and neck samples were selected. C7 nerve transfer surgery was simulated through the anterior vertebral approach. The vertical distance between the C7 nerve and the medial edge of the clavicle, the length of the C7 nerve, and the shortest distance of C7 nerve transfer required through the anterior vertebral approach were measured. This was a retrospective analysis of the clinical data of 2 patients with central upper limb spastic paralysis after C7 nerve transfer surgery at Northern Jiangsu People’s Hospital affiliated with Yangzhou University. The patients were all female, aged 50 to 51 years, with upper limb paralysis on the affected side. The muscle strength was grade 0 or grade 1, and the muscle tension was relatively high. Both patients underwent C7 nerve transfer surgery through the anterior vertebral approach. Upper limb sensation and motor function were observed. Results: Bilateral C7 nerves can be fully exposed and located through the anterior vertebral approach. The C7 nerve runs between the anterior and middle scalene muscles, with a vertical distance of 1.7 to 2.5 (2.1±0.3) cm from the inner edge of the clavicle. The length of the C7 nerve is 5.6 to 6.8 (6.4±0.5) cm, and the shortest distance of C7 nerve transfer through the anterior vertebral approach is 4.8 to 5.7 (5.3±0.4 cm). Two patients with central upper limb paralysis successfully underwent C7 nerve transfer surgery using the anterior vertebral approach. Two patients had normal motor function in the healthy upper limb after surgery but experienced pain and numbness in the healthy upper limb. Both patients recovered within 1 month. Two patients experienced significant relief of spasticity symptoms in the affected upper limb. One patient was followed up for 15 months, and, at the last follow-up, sensation in the affected upper limb was normal, with proximal muscle strength at level 3 and distal muscle strength at level 2. Another patient was followed up for 11 months, and at the last follow-up, sensation in the affected upper limb was normal, with proximal muscle strength at level 1+ and distal muscle strength at level 1. Conclusion: For central upper limb spastic paralysis, C7 nerve transfer surgery through the anterior vertebral approach is safe and feasible and is a good treatment option. Related anatomic research can effectively guide clinical surgery and assist in locating the C7 nerve, and incising the musculus longus colli can shorten the distance of C7 nerve transfer.

Effect of nursing care based on goal-oriented mind mapping model on the prognosis of patients with severe brain injury.

The objective of this study was to observe the effect of nursing care based on goal-oriented mind-mapping on the prognosis of patients with severe brain injury. Clinical data of 116 patients with severe brain injury admitted to Qinghe County Central Hospital between March 2021 and August 2023 were retrospectively analyzed. Based on the nursing mode the patients received, they were divided into an Observation group (n = 58, patients received nursing based on the goal-oriented mind mapping mode) and a Control group (n = 58, patients received routine care). Data on length of hospital stay, complications, functional recovery, cerebral oxygen metabolism, and quality of life scores of the 2 groups were collected and analyzed. The length of hospital stay of the Observation group was shorter than that of the Control group (P < .05). The total incidence of complications in the Observation group was lower than that in the Control group (P < .05). After intervention, neurological function, cerebral oxygen metabolism indicators, and quality of life of the 2 groups improved significantly compared with those before the intervention; furthermore, the neurological function and cerebral oxygen metabolism indexes of the Observation group were better than those of the Control group (P < .05). The nursing care based on goal-oriented mind-mapping model for patients with severe brain injury can effectively shorten the length of hospital stay, reduce the occurrence of prognostic complications, and improve the recovery of neurological and limb motor functions, and ultimately achieve the goal of improving the quality of life.

Effect of intermittent theta burst stimulation on upper limb function in stroke patients: a systematic review and meta-analysis.

Stroke is a serious health issue that affects individuals, families, and society. Particularly, the upper limb dysfunction caused by stroke significantly reduces the quality of life for patients and may lead to psychological issues. Current treatment modalities are not fully effective in helping patients regain upper limb motor function to optimal levels. Therefore, there is an urgent need to explore new rehabilitation methods to address this issue. The purpose of this meta-analysis and systematic review is to explore the effects of intermittent theta burst stimulation (iTBS) on upper limb function in stroke patients. We searched PubMed, Cochrane Library, Embase, Web of Science, PEDro and China National Knowledge Internet as of April 8, 2024. Retrieved a total of 100 articles. Standardized mean differences (SMDs) and 95% confidence intervals (CI) were calculated. The study included a total of 9 trials and involved 224 patients. The results demonstrate that compared to the control group, iTBS therapy significantly improved Fugl-Meyer assessment-upper extremity (FMA-UE) scores (SMD = 0.88; 95% CI = 0.11-1.66; P = 0.03, I 2 = 84%), Action Research Arm Test (ARAT) scores (SMD = 0.83; 95% CI = 0.16-1.50; P = 0.02, I 2 = 57%), and Barthel Index (BI) scores (SMD = 0.93; 95% CI = 0.53-1.32; P < 0.0001, I 2 = 0%) in stroke patients. The comprehensive evidence suggests that iTBS has superior effects in improving upper limb function and activities of daily living in stroke patients.

Modeling Upper Limb Rehabilitation-Induced Recovery after Stroke: The Role of Attention as a Clinical Confounder.

People who have survived stroke may have motor and cognitive impairments. High dose of motor rehabilitation was found to provide clinically relevant improvement to upper limb (UL) motor function. Besides, mounting evidence suggests that clinical, neural, and neurophysiological features are associated with spontaneous recovery. However, the association between these features and rehabilitation-induced, rather than spontaneous, recovery has never been fully investigated.The objective was to explore the association between rehabilitation dose and UL motor outcome after stroke, as well as to identify which variables can be considered potential candidate predictors of motor recovery. People who survived stroke were assessed before and after a period of rehabilitation using motor, cognitive, neuroanatomical, and neurophysiological measures. We investigated the association between dose of rehabilitation and UL response (ie, Fugl-Meyer Assessment for upper extremity [FMA-UE]), using ordinary least squares regression as the primary analysis. To obtain unbiased estimates, adjusting covariates were selected using a directed acyclic graph. Baseline FMA-UE was the only factor associated with motor recovery (b = 0.99; 95% CI = 0.83 to 1.15 points). Attention emerged as a confounder of the association between rehabilitation and final FMA-UE (b = 5.5; 95% CI = -0.8 to 11.9 points), influencing both rehabilitation and UL response. Preserved attention in people who have survived stroke might lead to greater UL motor recovery, albeit estimates have high levels of variability. Moreover, the increase in the dose of rehabilitation can lead to 5.5 points improvement on the FMA-UE, a nonsignificant but potentially meaningful finding. The approach described here discloses a new framework for investigating the effect of rehabilitation treatment as a potential driver of recovery. Attentional resources could play a key role in UL motor recovery. There is a potential association between amount of UL recovery and dose of rehabilitation delivered, needing further exploration. Preserved attention and rehabilitation dose are candidate predictors of UL motor recovery.

Safety and efficacy of viltolarsen in ambulatory and nonambulatory males with Duchenne muscular dystrophy.

Duchenne muscular dystrophy (DMD) is an X-linked recessive disease characterized by mutations in the dystrophin gene, causing motor and pulmonary function decline. Viltolarsen is indicated for patients with dystrophin gene mutations amenable to exon 53 skipping. Here, we report safety, motor function, and the first pulmonary function results from the open-label, phase II Galactic53 trial of viltolarsen (NCT04956289). Male participants aged ≥ 8years with DMD received 80mg/kg intravenous viltolarsen once weekly for 48weeks. Results from participants receiving viltolarsen were compared with an external control cohort group-matched for multiple variables. All treatment-emergent adverse events were mild or moderate, 4 were considered treatment-related, and no participants discontinued. Participants receiving viltolarsen experienced clinically meaningful benefits in pulmonary function with higher percent predicted forced vital capacity and higher peak cough flow at Week 49 compared with the control cohort for both ambulatory and nonambulatory participants. Viltolarsen also stabilized upper limb motor function over the Treatment Period. These results support viltolarsen as an important part of the treatment armamentarium for both ambulatory as well as nonambulatory patients with DMD.

New Assessment Method for Upper Limb Function in Patients with Cervical Spondylotic Myelopathy: The 10 Coins Test.

Retrospective cohort study. Although there are several methods available to assess upper limb function in patients with cervical spondylotic myelopathy, few methods can evaluate the degree of upper limb functional impairment in activities of daily living. We devised and evaluated the utility of a new assessment method called the 10 Coins Test, which is based on daily movements. The study included 39 patients who underwent spinal surgery for cervical spondylotic myelopathy and who were followed up for 1 year postoperatively. The mean age was 65.2±11.5 years, with 31 (79.5%) male and 8 (20.5%) female patients. The 10 Coins Test is a simple examination that measures the time it takes to pick up and move 10 coins forward. Patient satisfaction with surgery was evaluated on a 5-point scale. We compared the 10 Coins Test results, patient satisfaction, and Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) results before and after surgery. The mean time to perform the 10 Coins Test was 27.4 seconds for the dominant hand and 24.5 seconds for the non-dominant hand preoperatively. In control group, the average time was 14.6 seconds for the dominant hand and 15.0 seconds for the non-dominant hand. The cut-off value was 16.2 seconds. There was a significant difference in the 10 Coins Test time and satisfaction for both hands at 1 week postoperatively compared with preoperatively. The JOACMEQ upper limb motor function showed a significant improvement 3 months postoperatively compared with preoperatively. The 10 Coins Test result was correlated with satisfaction and the JOACMEQ upper limb motor function. The 10 Coins Test allows for the quantitative evaluation of complex movements. It is convenient and highly useful for assessing upper limb function in patients with cervical spondylotic myelopathy.

Depressive Symptoms in Multiple Sclerosis: Links to Body Composition, Physical Activity, and Functional Ability.

BACKGROUND In patients with multiple sclerosis, depression and its associated symptoms are factors that reduce the health-related quality of life can affect the course of the disease and the patient's compliance with therapeutic recommendations, or may even increase the risk of suicide. This study aimed to determine the relationship between body composition, motor function of limbs, physical activity, and the occurrence of depressive symptoms in patients with multiple sclerosis. MATERIAL AND METHODS The study group included 110 patients - 84 women (76.4%) and 26 men (23.6%) - with multiple sclerosis and with or without depression. Disability status was assessed using the EDSS scale. Depressive symptoms were recognized based on the Beck Depression Inventory-II, while motor function was determined with the 9-Hole Peg Test and Timed 25-Foot Walk test. Accelerometers were used to evaluate physical activity of patients. Statistical analysis of collected data was performed using logistic regression. RESULTS Depressive symptoms (BDI-II score ≥14) were observed in 24.55% of the participants. MS patients with and without depression symptoms differed significantly in terms of fat mass, T25-FW, and 9-HPT-dominant hand. Multivariate regression analyses demonstrated that increased adiposity (OR=1.09; 95% CI=1.02-1.16; P=.008; and decreased motor ability of the upper limb, both dominant (OR=1.07; 95% CI=1.01-1.15; P=.043) and non-dominant one (OR=1.10 95% CI 1.01-1.18; P=.025) were associated with a higher risk of depression. The differences in physical activity and T25-FW between groups were statistically insignificant. CONCLUSIONS The severity of depression symptoms was related to higher body mass and decreased functional ability of the upper limbs in patients with MS. Thus, a detailed evaluation of the patient's upper-limb function should constitute an integral part of motor function assessment of patients with MS.

Ighmbp2 mutations and disease pathology: Defining differences that differentiate SMARD1 and CMT2S

Mutations in the Immunoglobulin mu DNA binding protein 2 (IGHMBP2) gene result in two distinct diseases, SMA with Respiratory Distress Type I (SMARD1) and Charcot Marie Tooth Type 2S (CMT2S). To understand the phenotypic and molecular differences between SMARD1 and CMT2S, and the role of IGHMBP2 in disease development, we generated mouse models based on six IGHMBP2 patient mutations. Previously, we reported the development and characterization of Ighmbp2D564N/D564N mice and in this manuscript, we examine two mutations: D565N (D564N in mice) and H924Y (H922Y in mice) in the Ighmbp2H922Y/H922Y and Ighmbp2D564N/H922Y contexts. We found significant differences between these mouse models, providing critical insight into the role of IGHMBP2 in the pathogenesis of SMARD1 and CMT2S. Importantly, these studies also demonstrate how disease pathogenesis is significantly altered in the context of Ighmbp2 D564N and H922Y homozygous recessive and compound heterozygous mutations. Notably, there were short-lived and long-lived lifespan cohorts within Ighmbp2D564N/H922Y mice with early (P12/P16) respiratory pathology serving as a key predictor of lifespan. Despite differences in lifespan, motor function deficits initiated early and progressively worsened in all Ighmbp2D564N/H922Y mice. There was decreased limb skeletal muscle fiber area and increased neuromuscular junction (NMJ) denervation in Ighmbp2D564N/H922Y mice. Consistent with CMT2S, Ighmbp2H922Y/H922Y mice did not have altered lifespans nor respiratory pathology. Interestingly, Ighmbp2H922Y/H922Y limb muscle fibers demonstrated an increase in muscle fiber area followed by a reduction while changes in NMJ innervation were minimal even at P180. This is the first study that demonstrates differences associated with IGHMBP2 function within respiration with those within limb motor function. Significant to our understanding of IGHMBP2 function, we demonstrate that there is a direct correlation between disease pathogenesis associated with these IGHMBP2 patient mutations and IGHMBP2 biochemical activity. Importantly, these studies reveal the dynamic differences that are presented when either a single mutant protein is present (IGHMBP2-D564N or IGHMBP2-H922Y) or two mutant proteins are present (IGHMBP2-D564N and IGHMBP2-H922Y) within cells.

Effects of wearable device training on upper limb motor function in patients with stroke: a systematic review and meta-analysis.

To evaluate the effect of wearable device training on improving upper limb motor function in patients who experienced strokes. The PubMed, Embase, Cochrane Library, Web of Science, MEDLINE, SCOPUS, China National Knowledge Infrastructure, WanFang, and VIP databases were searched for randomized controlled trials (RCTs) that assessed the effectiveness of wearable device training in improving upper limb motor function in patients with stroke. Two investigators independently screened studies by their titles and abstracts and cross-checked, downloaded, and evaluated the results. Disagreements were resolved by a third highly experienced researcher. Risk of bias was evaluated using the Cochrane risk-of-bias tool. This meta-analysis was registered in PROSPERO (registration No. CRD42023421633). This study comprised 508 patients from 14 RCTs. The experimental group assessed various wearable devices, including 3D-printed dynamic orthoses, inertial measurement unit (IMU) sensors, electrical stimulation devices, and virtual reality (VR) devices for virtual interactive training. The control group received traditional rehabilitation therapies, including physical and conventional rehabilitation. The experimental group scored better on the Fugl-Meyer Assessment (FMA-UE) scale (standardized mean difference [SMD] 0.26, 95% confidence interval [CI] 0.07, 0.45) and Box and Block Test (BBT) (SMD 0.43, 95% CI 0.17, 0.69) versus controls. No significant intergroup differences were observed in the Action Research Arm Test (SMD 0.20, 95% CI -0.15, 0.55), motor activity log (mean difference [MD] 0.32, 95% CI -0.54, 0.33), and modified Ashworth scale (MD -0.08, 95% CI -0.81, 0.64). The probability rankings of wearable devices that improved FMA-UE scores in patients with stroke were: orthotic devices, with the highest probability ranking of 0.45, followed by sensor devices at 0.23, electrical stimulation devices at 0.21, and VR devices at 0.11. Wearable device training was found to significantly improve upper limb motor function in patients with stroke, particularly for large-range movements. Improvements in FMA-UE and BBT scores reflected reduced impairment and enhanced manual dexterity, respectively. However, the training had no significant effect on hand movement frequency, fine motor skills, or spasticity. Among the different wearable devices tested, orthoses produced the most effective results.