Dynamic changes in brain structure-function correspondence in typical and atypical upper limb motor recovery after stroke.

Background Digital health–driven rehabilitation systems incorporating Internet of Things (IoT) technologies have attracted increasing attention as a means to support upper limb motor recovery after stroke. However, detailed clinical descriptions of their implementation in routine inpatient rehabilitation remain limited. Case presentation We report the case of a right-handed man in his forties with right-sided upper limb motor impairment following putaminal hemorrhage. The patient underwent rehabilitation using a digital health–driven IoT-based upper limb rehabilitation system starting approximately one month after stroke onset during the convalescent rehabilitation phase. Intervention The intervention was conducted over a two-week period, consisting of 10 sessions (approximately 40 min per session) as part of routine inpatient rehabilitation. The system integrated a portable smart projector, a three-dimensional motion capture sensor, and a communication robot to deliver interactive, task-oriented training. Five activities of daily living–oriented tasks (wiping, unlocking, squeezing, cup transfer, and typing) were implemented, with task difficulty adjusted by the treating occupational therapist according to the patient's performance. Outcomes Upper limb motor function assessed by the Fugl–Meyer Assessment for the Upper Extremity improved from 63 to 66. Real-world arm use assessed by the Motor Activity Log showed an Amount of Use score of 5 both before and after the intervention, suggesting a ceiling effect, while the Quality of Movement score improved slightly from 4.8 to 5. The patient demonstrated high engagement and adherence throughout the intervention, and no adverse events were observed. Conclusion This case report demonstrates the clinical feasibility of integrating a digital health–driven IoT rehabilitation system into routine inpatient stroke rehabilitation. Although generalization is limited by the single-case design, the present case highlights the potential of IoT-based digital health technologies to support task-oriented training and patient engagement in upper limb rehabilitation.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the benefits and harms of contralaterally controlled functional electrical stimulation (CCFES) compared with neuromuscular electrical stimulation (NMES) for upper limb motor impairment in people after stroke.

Stroke is a leading cause of long-term upper limb disability, severely impacting patients' independence and quality of life. Robot-assisted therapy (RAT) has emerged as a promising, high-intensity rehabilitation alternative. However, conclusions from existing systematic reviews on its efficacy are inconsistent and often lack a holistic framework, limiting their use for guiding personalized clinical decisions. This study aims to systematically synthesize recent evidence on RAT for upper limb rehabilitation after stroke. Guided by the International Classification of Functioning, Disability and Health framework, it moves beyond singular outcomes to provide a multidimensional evaluation across body function, activity, and participation levels. The review aims to provide stratified guidance for clinical decision-making based on patient- and intervention-specific characteristics, thereby supporting evidence-based practice and informing future research. This study included systematic reviews and meta-analyses published from January 1, 2019, to December 26, 2025, comparing RAT with conventional therapy for upper limb rehabilitation after stroke. Overall, 6 databases, including PubMed, Web of Science, and Embase, were searched. Two reviewers (XZ and LZ) independently performed study selection, data extraction, and quality assessment using the AMSTAR 2 tool. The synthesis integrated outcome measures and subgroup analyses derived from the included studies. This umbrella review included 21 meta-analyses encompassing 535 randomized controlled trials and 27,598 patients across acute, subacute, and chronic stroke stages. According to AMSTAR 2, 17 reviews were high quality, 3 moderate, and 1 critically low. The synthesis demonstrated that RAT was superior in improving upper limb motor function, but no statistically significant advantages were observed in activities of daily living compared to conventional therapy. Subgroup analyses revealed that treatment effects were influenced by stroke stage, upper limb motor impairment level, and robot type. RAT is an effective intervention for improving upper limb motor function after stroke. However, its benefits are primarily observed at the level of body function, with limited evidence for long-term maintenance. The current evidence is constrained by significant outcome heterogeneity and methodological limitations inherent to umbrella reviews. Future research should validate these findings in broader clinical practice, focus on translating functional gains into sustained improvements in daily activities and participation, and include cost-effectiveness evaluations. PROSPERO CRD42024497183; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024497183.

Stroke remains the leading cause of long-term disability worldwide. Approximately 60% of individuals with chronic ischemic stroke experience persistent upper limb impairment that limits daily activities. The Repair Study aims to evaluate the safety and efficacy of vagus nerve stimulation (VNS) paired with rehabilitation in patients with chronic ischemic stroke in developing countries, including those with severe upper limb dysfunction, thereby generating evidence to support broader global application. It is a multicenter, triple-blinded, randomized controlled trial conducted across 13 centers in China. Up to 99 participants with upper limb motor impairment, 9 months to 10 years post-stroke, will be enrolled. All participants will undergo VNS implantation (Model G115R/G115, PINS Medical, Beijing, China) and be randomized 2:1 by a central randomization system to active stimulation (0.8 mA) or sham stimulation (0 mA) paired with standardized upper limb rehabilitation. The blinded phase includes 6 weeks of clinical therapy (three sessions/week, 90-120 min/session, ≥300 stimulation-movement repetitions) followed by 6 weeks of home-based therapy (30 min/day). Post-unblinding, the active VNS group continues home-based therapy, while the sham group receives 6 weeks of clinic-based therapy. The primary outcome is the between-group difference in Fugl-Meyer Assessment for Upper Extremity scores at the end of 6 weeks of clinical therapy. Secondary outcomes include additional motor, functional, and quality-of-life measures. Safety will be assessed through adverse event monitoring. The Repair Study is a multicenter randomized controlled trial targeting chronic ischemic stroke populations in developing countries. It supplements the existing clinical evidence by enrolling patients with more servere motor dysfunction and being conducted in a developing country. ClinicalTrials.gov: NCT06722677.

Virtual reality (VR) has been demonstrated as an effective intervention for promoting motor recovery post-stroke. A self-directed game-based VR training can reduce manpower, but its safety and efficacy still need to be evaluated. To evaluate the efficacy of a self-directed game-based VR program on upper-limb motor recovery in mild-to-moderate ischemic stroke patients. Randomized controlled trial. Inpatient rehabilitation center. A total of 84 mild-to-moderate ischemic stroke patients with unilateral upper limb motor impairment were randomly allocated to the VR group (N.=42) and the control group (N.=42). All participants underwent a standardized inpatient rehabilitation program. The VR group received an additional 20 minutes of user-centric VR training, while the control group engaged in an additional 20 minutes of conventional upper-limb training as a control training. The treatment plan was implemented for 6 days per week over a 4-week period. Blinded assessments at baseline (T0), post-intervention (T1) and 6-week follow-up (T2) revealed significant group-time interactions favoring the VR group in the Fugl-Meyer Assessment-Upper Extremity (FMA-UE, P=0.001), elbow extension strength (MMT, P=0.038) and Barthel Index (BI, P=0.002), although no significant differences were observed in MMT scores for shoulder flexion/extension and elbow flexion (P=0.407/P=0.573, P=0.407). Notably, significantly more patients in the VR group achieved the FMA-UE MCID (≥9 points) than controls (44.7% vs. 2.6%, P<0.001), with moderate stroke patients deriving the greatest benefit. Post-intervention usability metrics demonstrated high system acceptability (SUS: 75.07±7.20), minimal simulator sickness (SSQ=3.74 [0.00, 3.74]) and positive exercise motivation (BREQ-2 RAI: 15.79±3.80). The findings indicate that integrating self-directed VR games into conventional rehabilitation enhances upper-limb functional recovery and independence in mild-to-moderate ischemic stroke patients, with sustained effects at 6 weeks. This facilitated clinically meaningful improvements, particularly in patients with moderate baseline impairment. Although safe and engaging, the program may require targeted approaches for specific joint movements. Further studies should explore long-term outcomes and optimal implementation protocols. Self-directed game-based VR games with conventional therapy enhance upper-limb functional recovery and independence in mild-to-moderate stroke patients, offering a scalable solution for inpatient rehabilitation.

Dining robots significantly enhance the quality of life for individuals with upper limb motor impairments by enabling autonomous feeding. This paper systematically reviewed the technological evolution and representative products in this field, with a focused analysis of key technologies including kinematic modeling, trajectory planning, and intelligent control. Future development trends were also discussed, highlighting the need for innovative structural designs, optimized human-robot interaction, and deeper multi-source sensory fusion to advance the field toward more precise and human-like robotic feeding systems.

Background and PurposeUpper limb motor impairment after stroke is a leading cause of long-term disability. This single-center pilot randomized controlled trial (RCT) evaluated the safety, feasibility, and preliminary efficacy of intermittent theta-burst stimulation (iTBS) combined with task-oriented training (TOT) for upper limb rehabilitation. iTBS, a non-invasive brain stimulation technique, may enhance recovery when paired with task-oriented training (TOT), particularly in the subacute phase of heightened neuroplasticity.MethodsTwenty-nine patients with subacute stroke were randomized into three groups: (1) iTBS + TOT (n = 10), (2) sham iTBS + TOT (n = 9), and (3) traditional physiotherapy (n = 10). All underwent a 4-week intervention. Primary outcomes were safety and feasibility. Secondary outcomes included motor impairment (Fugl-Meyer Assessment for Upper Extremity, FMA-UE), functional independence (Modified Barthel Index, MBI), and neurological deficit (National Institutes of Health Stroke Scale, NIHSS), assessed at baseline, week 2, and week 4.ResultsTwenty-nine participants completed the trial without any adverse events, and one participant from Group 2 discontinued early due to discharge. At week 4, the iTBS + TOT group showed greater improvements in FMA-UE (22.9 points vs. 3.6 and 10.2; p = 0.013; p = 0.013), NIHSS (3.0 vs 6.6; p = 0.009), and MBI (90.7 vs 51.4; p < 0.001) compared with controls, indicating potential functional benefits.ConclusionsThis exploratory pilot RCT suggests that combining iTBS with TOT is safe and feasible, with preliminary evidence supporting its potential to improve upper limb recovery in subacute stroke. However, these findings should be interpreted with caution and validated in larger, adequately powered trials.

BackgroundStroke often results in upper limb motor impairment and activity limitation, however terminology to describe severity levels vary. This hinders data pooling from clinical trials to inform practice. There are no reviews that have synthesized severity levels of stroke-related upper limb motor impairment or activity limitation.ObjectiveTo systematically review published literature on descriptors of severity levels for post-stroke upper limb motor impairment and activity limitation.MethodsFollowing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched eight major databases. Inclusion criteria: primary research studies, adults post-stroke, severity of upper limb motor impairment and/or activity limitation described. We classified included papers by assessing descriptor precision: 'green' (studies including descriptors that used recommended outcome measures, cut-offs or central tendency and dispersion), 'red' (descriptors only), and 'amber' (remaining studies). Of the 'green' studies, we identified the most commonly reported descriptors and measures, and computed cut-off scores using non-parametric statistics.ResultsFrom 17,273 records, 750 studies were included. The most commonly used severity descriptors were 'mild, and/or moderate, and/or severe,' used in 580 (77%) of studies. For the Fugl-Meyer Assessment (Upper Extremity) (57 studies, 8% of the total number of studies included), 'severe' ranged from 0 to 25, 'moderate' from 26 to 50, and 'mild' from 51 to 66. Limited data from the remaining studies prevented further analysis.ConclusionsOur review highlights a lack of standardization of the operationalization of 'severity' of post-stroke upper limb motor impairment and activity limitation. It provides a foundation for developing a standardized clinical language to describe severity levels to improve research and clinical practice.

ABSTRACT Background Stroke is a major cause of disability globally, with particularly severe effects in low-resource countries like Ghana. Survivors often experience upper limb motor impairments that limit independence, while access to advanced rehabilitation technologies remains limited. This highlights the need for affordable and effective solutions to support recovery. Objectives This study develops a low-cost mechanical hand exoskeleton to assist rehabilitation using pneumatic and biomechanical design principles suitable for resource-limited environments. Methods Pneumatic soft actuators made from 3D-printed TPU 95A bellows and PLA scaffolds were designed to generate finger flexion through controlled pressurization. A pneumatic box equipped with dual vacuum pumps, solenoid valves, silicone tubing, and an Arduino-based controller regulated airflow. Integrated flex sensors enabled real-time motion replication for bilateral training. Iterative prototyping and testing were performed to optimize performance and usability, and the final prototype was evaluated for functionality in hand rehabilitation tasks. Results The exoskeleton successfully assisted digit flexion and extension by mimicking movements of the healthy hand. It achieved a bend angle of 66.0° at 30 kPa in approximately 5 seconds, producing a flexion force of 3.82 N and a hyperextension force of 1.342 N at a 16.0° hyperextension angle. The glove weighed 207 g, and the pneumatic control box weighed 794 g. Conclusions This low-cost pneumatic exoskeleton offers a practical and accessible rehabilitation tool with strong potential to improve hand recovery outcomes for stroke patients in Ghana and similar settings.

To examine the dose-response relationship between time spent in gait training and gait independence in individuals with nonambulatory subacute hemiparetic stroke in a rehabilitation ward. Retrospective cohort study. A rehabilitation ward in Japan. Nonambulatory individuals with subacute hemiparetic stroke who were admitted and discharged from the ward between January 2018 and December 2021 (N=326). Gait training using orthoses, canes, robotic technology, and/or manual assistance by the therapist as needed. Functional Independence Measure walk score. In total, 326 individuals (mean age [SD], 70.4 [14.7] years; men, 205) were included in the study. The cumulative rates of achieving gait independence (Functional Independence Measure walk score ≥6), estimated by the Kaplan-Meier method with total gait training time during hospitalization as the time scale, were 50.6% (95% confidence interval [CI], 45.3-56.2), 61.7% (95% CI, 56.4-66.9), 65.0% (95% CI, 59.9-70.2), and 65.9% (95% CI, 60.5-70.8), at 2000, 4000, 6000, and 8000 minutes, respectively. When participants were categorized according to the severity of lower limb motor impairment assessed by the Stroke Impairment Assessment Set motor function in lower extremity total score at admission, the cumulative rates of gait independence were significantly different among the 4 groups, with complete paralysis being the lowest, followed by severe, moderate, and mild paralysis (P<.001). Stratifying by gait training time per day, the higher the gait training time per day, the higher the cumulative rate of achieving gait independence in complete and severe cases, and the lower rate in mild cases (P<.001). A dose-response relationship with a plateau relationship was found between gait training time and achieving gait independence for nonambulatory individuals with subacute hemiparetic stroke. The relationships differ by the degree of severity of lower limb motor impairment and by training intensity.

Background: Upper limb motor impairment affects approximately 70–80% of stroke survivors and constitutes a primary determinant of functional independence and quality of life. Task-oriented motor training (TOT) engages neuroplastic recovery through repetitive, goal-directed functional practice, yet evidence from low- and middle-income country (LMIC) rehabilitation settings remains limited. Objective: To evaluate the efficacy of structured task-oriented motor training on upper limb motor recovery, arm function, motor performance efficiency, and functional independence compared to conventional physiotherapy in subacute post-stroke patients. Methods: A single-blind, parallel-group randomized controlled trial was conducted at a tertiary care neurorehabilitation centre in Khyber Pakhtunkhwa, Pakistan. One hundred and two subacute stroke patients (2–6 months post-ictus) were allocated by computer-generated randomization to TOT (n = 51) or conventional physiotherapy (n = 51), each receiving 45–60 minutes of supervised therapy five sessions per week for six weeks. Primary outcome was the Fugl-Meyer Assessment–Upper Extremity (FMA-UE); secondary outcomes included the Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), and Barthel Index. Intention-to-treat analysis with multiple imputation was applied; Bonferroni correction controlled for multiple comparisons. Results: Ninety-five participants completed post-intervention assessment (TOT: n = 48; control: n = 47). The TOT group demonstrated significantly greater improvements across all outcomes: FMA-UE (MD = +3.9, 95% CI: 2.5–5.3; d = 0.58), ARAT (MD = +4.4, 95% CI: 2.7–6.1; d = 0.52), WMFT (MD = −2.1 s, 95% CI: −3.2 to −1.0; d = 0.46), and Barthel Index (MD = +5.4, 95% CI: 3.2–7.6; d = 0.49); all p &lt; 0.0125 after Bonferroni correction. TOT group improvements exceeded established minimal clinically important difference thresholds for all outcomes. Conclusion: Structured task-oriented motor training yields clinically meaningful, statistically robust improvements in upper limb motor recovery and functional independence following stroke, and represents an effective, low-resource-compatible rehabilitation strategy for LMIC clinical settings.

BackgroundStroke is a leading cause of long-term disability, often resulting in cognitive and upper limb motor impairments that significantly impact activities of daily living. While conventional rehabilitation approaches have shown effectiveness, challenges such as high cost, limited accessibility, and poor adherence hinder their widespread implementation. Calligraphy training has emerged as a promising rehabilitation strategy, offering a multimodal intervention that integrates motor and cognitive processes. However, the underlying neural mechanisms and the combined effects of calligraphy training on cognitive and motor recovery remain underexplored. This study aims to investigate the effects of calligraphy training on cognitive function and upper limb motor recovery in stroke patients.MethodsA single-center, open-label, three-arm design, randomized controlled trial will be conducted at Shanghai Yangzhi Rehabilitation Hospital. A total of 93 subacute stroke patients will be randomly assigned in a 1:1:1 ratio to one of three groups: the calligraphy training group, the reading control group, or the conventional rehabilitation control group. The intervention group will receive a four-week calligraphy training program alongside routine rehabilitation, while the control group will undergo standard rehabilitation alone. Assessments will be conducted at baseline (T0) and post-intervention (T1). The primary outcome measure is cortical activation changes as assessed by functional near-infrared spectroscopy (fNIRS), with oxygenated hemoglobin (ΔHbO) levels serving as an indicator of brain activity. Secondary outcomes include cognitive function, upper limb motor function, hand dexterity, activities of daily living, grip strength, muscle strength, and muscle tone. Statistical analyses will be conducted using analysis of covariance (ANCOVA) to compare pre and post-intervention outcomes, adjusting for baseline values.DiscussionThis study provides empirical evidence regarding the efficacy of calligraphy training in improving cognitive function and upper limb motor skills in stroke patients. By utilizing fNIRS to monitor dynamic neural changes, this research will deepen our understanding of the neurophysiological mechanisms behind calligraphy-based rehabilitation. The findings may inform the development of cost-effective, accessible, and culturally relevant rehabilitation strategies, thereby bridging the gap between clinical and home-based recovery.Trial registrationchictr.org.cn ChiCTR2500095411. Registered on January 7, 2025.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13063-025-09279-7.

BackgroundImpaired arm position sense is a common somatosensory impairment after stroke, which significantly impacts the performance of functional activities using the upper limb. However, few clinical interventions target loss of position sense after stroke. Our aim was to use interlimb force-coupling to augment position sense of the stroke-affected arm during a bilateral reaching task and investigate the impact of training with this feedback manipulation on measures of arm position matching ability and both bilateral and unilateral motor control.MethodsTwenty-four participants with a history of stroke were randomized (N = 12/group) to perform mirrored bimanual aiming movements with either interlimb force-coupling (Augmented PF) or uncoupled symmetrical reaches with only visual feedback about movement position. Participants completed 11 sessions (295 bimanual reaches/session) using a Kinarm End-Point robot. Performance on measures of arm position sense (Arm Position Matching, APM), motor impairment (Fugl-Meyer Upper Limb, FM), motor function (Wolf Motor Function Test, WMFT), unilateral reach accuracy and speed (Visually Guided Reaching, VGR), and bilateral reach symmetry were collected before and after training to characterize changes in upper limb somatosensory and motor control performance.ResultsAPM Task Scores improved for both groups. This improvement was specifically observed through reduced APM variability, but not accuracy. FM scores also improved for both groups. The group that did not practice with force-coupling between limbs improved on measures of bilateral movement symmetry on a mirrored reaching task and had faster VGR movement times in post-test.ConclusionSymmetrical reach training with or without augmented PF led to reduced motor impairment and benefited upper limb position matching ability by reducing APM variability. Augmenting position sense during reaching did not provide additional benefits for position matching accuracy. Advantages for unilateral movement speed and bilateral reach symmetry measures in the group that practiced without interlimb coupling may reflect specificity of practice effects due to similarity between test and training conditions for this group.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12984-025-01764-z.

Abstract Stroke often leads to upper limb motor impairments, underscoring the need for precise assessment to guide personalized rehabilitation. Conventional clinical scales are limited by subjectivity and the absence of detailed kinematic analysis. To address this, we propose a novel assessment framework that integrates gamified virtual reality tasks with inertial measurement unit (IMU)–based kinematic analysis, enabling fine‐grained and autonomous evaluation of upper limb movements in stroke patients. Specifically, we introduce a region‐based motion normalcy index (rMNI) to quantify motor deficits across five spatial regions, offering a more nuanced characterization of movement impairments. Regression models, including elastic net, ridge, and least absolute shrinkage and selection operator regression, were trained on regional rMNI features to predict Fugl–Meyer assessment upper extremity (FMA‐UE) scores. Experiments with 12 stroke patients and 8 healthy controls demonstrated strong correlations between rMNI and both FMA‐UE total and subscale scores (| r | &gt; 0.70), highlighting the ability of rMNI to spatially resolve motor dysfunction and identify impaired limbs. The best‐performing regression model achieved an R 2 of 0.90 and a Pearson's correlation coefficient of 0.95, indicating excellent predictive validity. These results suggest that the proposed framework is a promising tool for personalized rehabilitation, providing both fine‐grained spatial assessment and patient‐specific insights.

Background Stroke remains a leading cause of acquired physical disability globally, with upper limb motor impairment significantly affecting independence and quality of life. Currently, objective neurophysiological biomarkers are not routinely incorporated into stroke care. This study aimed to investigate the predictive value of MEPs for upper limb outcomes in acute ischemic stroke. Patients and Methods This prospective cohort study included 133 adults experiencing their first acute ischemic stroke. Within 10 days of onset, participants underwent Motor-evoked potential (MEP) testing via transcranial magnetic stimulation (TMS) and were categorized as MEP+ (with preserved responses) or MEP– (with absent responses). Outcome measures included the Fugl-Meyer Assessment (FMA), Barthel Index, and modified Rankin Scale (mRS), assessed at baseline and 90 days. Logistic regression models adjusted for age and baseline stroke severity were used to determine the independent predictive value of MEP status. Results Among 133 patients (mean age 63.6 ± 12.2 years; 57.9% male), those with preserved MEPs (57.1%) demonstrated significantly better motor and functional outcomes at 90 days. MEP+ patients had higher FMA scores (61.0 ± 9.5 vs. 33.5 ± 25.5), Barthel Index scores (80.3 ± 25.0 vs. 57.7 ± 30.0), and greater odds of achieving minimal disability (mRS ≤ 1: 52.6% vs. 17.5%; all p < 0.001). Proportional recovery was also significantly higher in the MEP+ group for both the FMA and the Barthel Index (both p < 0.001). Conclusions Early MEP assessment is a valuable prognostic tool for upper-limb stroke recovery, supporting its routine incorporation into clinical practice.

BackgroundWhile 1 Hz repetitive transcranial magnetic stimulation (rTMS) targeting contralesional primary motor cortex (M1) shows promise for stroke recovery, individual response variability remains a critical challenge. Emerging evidence suggests that interhemispheric activation patterns may mediate rTMS efficacy. We investigated whether pretreatment spatial features of contralesional activation, measured by functional near-infrared spectroscopy (fNIRS), could predict response to 1 Hz rTMS.MethodsIn this nested unmatched case-control study, 60 patients with upper limb motor impairment received 1 Hz rTMS over contralesional M1 hand area plus conventional rehabilitation for 4 weeks. Responders were defined by a ≥5-point improvement on the Upper Extremity Fugl-Meyer (UEFM) assessment. Cortical activation during affected wrist extension was recorded using fNIRS, and the Euclidean distance from the peak activation channel to the M1 hand area (“activation distance”) was computed. An additional non-rTMS cohort (n=30) receiving only conventional rehabilitation was included to evaluate specificity.ResultsIn the rTMS cohort, responders (n=32) exhibited significantly shorter pretreatment activation distances than non-responders (n=28) (25.80±8.82 mm vs. 34.07±7.81 mm; p<0.001). Activation distance independently predicted treatment response after adjusting for baseline UEFM, time since stroke and age (adjusted OR=0.40 per 10 mm increase; 95% CI: 0.17–0.83; p=0.014). A cutoff of ≤25 mm optimally discriminated responders (response rate 86% vs. 34% for >25 mm). No association was found in the non-rTMS cohort, confirming specificity to rTMS response.ConclusionPretreatment contralesional activation proximity to M1—assessed via fNIRS—predicts response to inhibitory rTMS, supporting its use as a biomarker for personalized neuromodulation therapy in stroke rehabilitation.

Abstract The Timed Up and Go (TUG) test is a standardized clinical tool used to assess the dynamic balance of older adults for fall prevention. It is typically assessed using a stopwatch recording the total duration to complete the test. Recently, studies have focused on the relevance of the subtasks of the TUG: sit-to-stand, 3-meter forward-walk, turn, back-walk, stand-to-sit. Studies using wearable devices or depth cameras have introduced new metrics for assessing fall risk in clinical settings. These metrics have been shown to be associated with lower limb strength, motor impairments, and executive function. We aimed to utilize an affordable video camera and computer vision (CV) to detect the durations of TUG components and validate it through comparison with manual coding. The sample included 17 older adults (70.6 + 7.3 years, 70.6% female), who completed four trials of the TUG. The trials were recorded on a GoPro Hero 12 video camera, placed 110 inches away from the turning point with a frontal view of the participant. The videos were segmented into subtasks by trained research assistants and analyzed using AlphaPose and MotionBERT for 2D and 3D human pose estimation, respectively. Subtasks were extracted using the head and shoulder coordinates from the CV output. Spearman correlations were utilized to compare the annotated and CV-extracted durations of the subtasks, revealing comparable durations (ρ = 0.479, p &amp;lt; 0.001). These preliminary results indicate the potential of CV in primary care settings as an affordable method of expanding clinical evaluation of dynamic balance in older adults by medical professionals.

Effects of segmental muscle vibration on flexor and extensor groups of the upper limb in enhancing functional recovery after stroke: A randomized trial.

BackgroundUpper limb motor impairment after stroke is a major cause of limitations in daily activities and reduced quality of life. Although traditional rehabilitation is effective, it is often insufficiently intensive and lacks focus on fine motor activation. Portable soft exoskeletons offer a promising approach to intensify recovery. This trial aimed to evaluate the effectiveness of the ReHand robotic system in subacute stroke rehabilitation.MethodsThis Randomized Controlled Trial (RCT) included 120 patients in the subacute period of stroke. Participants were stratified by age and motor deficit severity and randomized into the intervention group (robotic therapy + standard therapy) or control group (standard therapy only). The intervention was delivered 5 times per week over 8 weeks. The primary outcome was change in Fugl-Meyer Assessment for Upper Extremity (FMA-UE); secondary outcomes included Barthel Index (BI), Functional Independence Measure (FIM), National Institutes of Health Stroke Scale (NIHSS), modified Wolf Motor Function Test (mWMFT), Frenchay Arm Test (FAT), Disabilities of the Arm, Shoulder and Hand (DASH), and Hospital Anxiety and Depression Scale (HADS). Statistical analysis was performed in Python (v3.11). Normality was assessed with the Shapiro–Wilk test; the Mann–Whitney test was used for intergroup comparisons; Pearson’s χ2 test with Yates’ correction was used for categorical variables. Effect size was calculated using Cliff’s delta; rank-ANCOVA was performed via the Quade method. Significance was set at p < 0.05.ResultsThe intervention group demonstrated significantly greater improvements in upper limb motor impairment compared to the control group, as reflected by larger gains in FMA-UE scores. Clinically meaningful improvements (≥5.25 points) were observed in 91.7% of patients in the intervention group versus 43.3% in the control group. All secondary outcomes also showed significant improvements in the intervention group (p < 0.001). No adverse events were reported in either group.ConclusionWhen combined with standard therapy, the ReHand robotic system may enhance upper limb recovery after stroke and appears to be a safe and feasible adjunct to multidisciplinary rehabilitation programs.Clinical trial registrationClinicalTrials.gov, identifier (NCT06937346).