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

Effects of four days of lower limb motor skill learning and concurrent tDCS on cortical directed connectivity.

Background Converting the transient spasticity-reducing effect of botulinum toxin A (BTX-A) into durable neuroplastic adaptations through mirror therapy (MT) represents a promising yet understudied approach. Although MT facilitates motor recovery, evidence on its long-term synergistic use with BTX-A in chronic stroke remains limited. Aim To investigate the synergistic effects of MT combined with BTX-A on upper limb spasticity and motor recovery in chronic ischemic stroke. Design Randomized, single-blind, sham-controlled clinical trial. Methods and Population Thirty patients with unilateral chronic ischemic stroke and upper limb spasticity were randomized into two groups following BTX-A injection. The experimental group received MT plus standard rehabilitation, while the control group underwent sham therapy using a transparent panel. Interventions began 2 weeks postinjection and were applied three times weekly for approximately 60 sessions over six months. Outcomes were assessed using Brunnstrom recovery stages, modified Ashworth scale (MAS), and Fugl–Meyer assessment for upper extremity (FMA-UE). Results Both groups showed significant within-group improvements in motor and spasticity scores ( p < 0.001). Greater improvements were observed in the MT group for Brunnstrom hand ( p = 0.021), Brunnstrom upper extremity ( p = 0.029), MAS upper extremity ( p = 0.012), and FMA-UE ( p = 0.002). Muscle strength differences were not significant. Conclusion MT combined with BTX-A improves motor recovery and reduces spasticity more than BTX-A alone in chronic stroke, supporting cortical reorganization and neuromuscular relaxation as a cost-effective rehabilitation strategy.

Shoulder-hand syndrome (SHS) is a common upper limb complication following stroke. It is associated with poor functional recovery of the upper limb and reduced mobility. Both kinesiology tape (KT) and manual lymphatic drainage (MLD) are considered effective interventions for treating pain and swelling associated with SHS. However, there is currently no research examining the limitations and safety profile of combining K-tape with MLD for SHS management. This study aims to investigate the efficacy of KT combined with MLD in patients with post-stroke shoulder-hand syndrome. This study will be a prospective, single-center, randomized, factorial, controlled clinical trial. This exploratory randomized controlled trial aimed to investigate the efficacy of MLD combined with KT for post-stroke SHS. This study used a blinded design. Ninety-six patients with post-stroke SHS are randomly divided into four groups: (n = 24 per group): Experimental Group 1: Conventional Rehabilitation (CR) + KT, Experimental Group 2: Conventional Rehabilitation (CR) + MLD, Experimental Group 3 (EG3): KT + MLD, Control Group: CR alone. All participants will receive CR as the baseline intervention. All subjects are first‑ever stroke patients diagnosed with unilateral limb paralysis by CT and/or MRI and meet the diagnostic criteria for SHS. The informed consent process is carried out by a trained researcher not involved in the patients' clinical care in a private room. Therapists participating in this study must hold a rehabilitation therapist qualification. Unified training will be provided to the treating therapists on MLD, KT, and conventional rehabilitation techniques. This study is conducted at the Army Specialized Medical Center. The Army Specialized Medical Center is a tertiary Grade A hospital located in Southwest China. In China's hierarchical medical system, tertiary Grade A hospitals represent the highest level in the hospital classification system. Outcome measures will be assessed at four time points: baseline (T0), 4weeks after initiating the intervention (T1), 3months post-treatment (T2), 6-month follow-up (T3). The primary endpoints will be as follows: pain intensity measured by the Visual Analogue Scale (VAS) at T1, volume difference between the affected and unaffected upper limbs at T1. Secondary endpoints will include the following: upper limb motor function assessed by the Fugl-Meyer assessment for upper extremity (FMA-UE), activities of daily living evaluated using the modified Barthel index (MBI), joint range of motion (ROM) measurements, quality of life measured by the Stroke-specific quality of life scale (SS-QOL). Safety is assessed by monitoring vital signs (blood pressure and heart rate) before and after treatment, examining skin integrity at the tape application site for any adverse reactions (e.g., redness, rash), and recording any patient-reported increases in pain or other unexpected discomfort potentially related to the intervention. The efficacy of personalized rehabilitation therapy prescription interventions will be assessed through changes in primary and secondary outcome measures at the 4-week intervention point and during the 12-week follow-up period. To analyze whether MLD combined with KT for post-stroke shoulder-hand syndrome is superior to conventional rehabilitation in terms of pain, swelling, and motor function. Clinical Trial Registry-China ChiCTR2300074140.https://www.chictr.org.cn/. First submitted on 31 July 2023.

BackgroundBrain-computer interface-driven functional electrical stimulation (BCI-FES) is a promising approach for post-stroke upper limb rehabilitation. However, considerable variability exists in stimulation parameters and task designs across studies, and evidence remains insufficient to support definitive protocol recommendations.MethodsWe searched PubMed, Embase, Web of Science, and the Cochrane Library for randomized controlled trials (RCTs) up to September 2025. Eligible studies applied BCI-FES and reported the Fugl-Meyer Assessment for the upper extremity (FMA-UE). Risk of bias was assessed with the PEDro scale, and evidence certainty graded with GRADE. Random-effects meta-analyses were performed.ResultsTwelve RCTs (n = 619) showed BCI-FES improved FMA-UE scores versus controls (MD = 5.82, 95% CI 3.04-8.59, p < 0.00001; I2 = 39%), with larger benefits in subacute stroke (MD = 8.45). Dynamic-threshold paradigms and motor imagery were associated with higher effect sizes. Higher stimulation frequency (>50 Hz), narrow-pulse width (150 µs) more frequent sessions (≥5/week), shorter session duration (≤30 min), greater total sessions (>20), and longer intervention (>4 weeks) tended to be associated with larger effect sizes, though evidence is limited and based on few studies. Secondary outcomes (ARAT, WMFT, MBI) improved, and no serious adverse events were reported. Evidence certainty was moderate.ConclusionBCI-FES was associated with improvements in upper limb motor recovery after stroke, especially in subacute patients. Some stimulation and training features may relate to greater effects, but current evidence remains insufficient for definitive clinical guidance. Larger multicenter RCTs are needed to clarify dose-response relationships and support biomarker-guided, personalized interventions.

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.

Hirayama disease (HD) is a cervical flexion-induced myelopathy that causes asymmetrical distal upper limb atrophy and weakening. It usually affects males, with onset in early adolescence, and progression occurs over 3-5 years, resulting in irreversible functional deficits. In addition to classical HD, several rarer phenotypes are described, including distal bimelic amyotrophy, lower limb, proximal, and upper motor neuron variants. Dynamic flexion magnetic resonance imaging is critical in the diagnosis, with distinctive characteristics such as significant epidural flow voids and anterior displacement of the posterior dural sac involving lower cervical segments, with sensitivity and specificity of 93% and 98%, respectively. In progressive cases, apart from conservative management with a cervical collar, surgical management is considered early, with the ideal approach being anterior cervical discectomy and fusion with plating. This review aims to address the latest insights in the pathophysiology, HD variants, spine imaging, and various surgical procedures in the management and prevention of serious residual limb weakness.

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.

A minimally invasive floating-wire interface for transcranial deep brain stimulation.

Using cross-sectional data from 26 general hospitals in China that treated stroke patients in the Department of Rehabilitation Medicine, the aim of this research is to explore the potential association between upper limb motor function and balance function after stroke. We conducted a prospective cross-sectional study involving 1573 stroke patients hospitalized in the rehabilitation medicine departments of 26 hospitals across China. Upper limb motor function and balance were evaluated using the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and the Berg Balance Scale (BBS), respectively. Linear regression analysis and smoothing curve fitting were performed to examine the relationship between upper limb motor and balance functions. This study included 1573 non-pregnant adults aged 18years or older, with a mean age of 61.2 ± 12.5years, of whom 69.0% were male. After adjusting for potential confounders, a significant positive association was observed between upper limb motor function and balance function after stroke (β = 0.48, 95% CI: 0.44-0.51, p < 0.001). Subgroup analyses indicated that this association was more pronounced in the acute phase (≤ 7days) compared with the subacute and recovery phases. No significant interactions were detected across other subgroups (p > 0.05 for all interactions). Smooth curve fitting revealed distinct saturation effects for FMA-UE and BBS, with inflection points at 25 and 45, respectively. Sensitivity analyses further confirmed these results, supporting the robustness of the findings. This study identified a significant positive association between upper limb motor function and balance function following stroke, highlighting the potential role of upper limb motor recovery in predicting balance outcomes. Further large-scale and multidimensional studies are needed to clarify the underlying mechanisms linking upper limb motor control and post-stroke balance function.

Objective: To evaluate the feasibility and efficacy of intraoperative neurophysiological monitoring (IONM) in endovascular repair (EVAR) procedures for aortic pathologies at high risk of spinal cord ischemia (SCI). Methods: This is a retrospective case series study. Clinical data of 19 patients with thoracoabdominal aortic aneurysms or other complex aneurysms involving branches in the aortic arch or visceral branch arteries who underwent elective fenestrated or branched endovascular aortic repair between August 2024 and May 2025 at the Department of Vascular Surgery, Zhongshan Hospital, Fudan University, were retrospectively reviewed. There were 15 male and 4 female patients, with an age of (63.9±13.3) years (range: 30 to 80 years). All patients were identified as at high risk for SCI based on a spinal cord ischemia risk stratification model and related clinical indicators. Multimodal IONM was applied intraoperatively in all patients, including transcranial electrical stimulation motor evoked potentials, somatosensory evoked potentials, and compound motor unit action potentials. Based on monitoring results, one or more managements would be employed accordingly, including increasing mean arterial pressure, reducing cerebrospinal fluid pressure, correcting anemia, temporary aneurysm sac perfusion, or staged surgery. The perioperative and prognostic conditions of 19 patients were observed. Results: Technical success was achieved in 19 patients without any monitoring-related complications. In 4 patients, no IONM alerts occurred and no SCI developed postoperatively. In 15 patients, monitoring alerts were detected; among them, 12 alerts were resolved after intraoperative management. In the remaining 3 patients, alerts persisted, including 1 patient who showed progressive deterioration in monitoring signals and developed postoperative paraplegia (bilateral lower limb motor strength was grade 0), which recovered to grade 5 after 3 months. The last 2 patients exhibited unilateral alarms without progressive deterioration, thus allowing the procedures to be completed. Conclusion: IONM could provide early intraoperative warnings of SCI in EVAR, enabling the surgical team to take timely interventions and minimize the incidence and damage of SCI.

Median nerve, a major peripheral nerve, connects the hand to the central nervous system, facilitating upper limb motor function and sensation by transmitting sensory data from the palm and fingers. Damage to this nerve can result in motor and sensory deficits, with carpal tunnel syndrome (CTS) causing compression, leading to tingling and numbness in the thumb, index, middle, and lateral ringfingers. This study aimed to develop an accurate deep-learning-based segmentation method for measuring the cross-sectional area (CSA) of the median nerve to facilitate the diagnosis of nerve entrapment syndromes and aid in surgical planning, with a focus onCTS. This study introduces MNSeg-Net, a novel lightweight multiscale feature fusion network with 2.46M parameters for median nerve segmentation in ultrasound (US) frames, specifically designed to enable a fully automated, end-to-end clinical setup supporting real-time segmentation and CSA computation. The dataset comprised 100 subjects and 30000 ultrasound frames, which were split into training (80%), validation (10%), and testing (10%) subsets with subject-wise separation to avoid data leakage. MNSeg-Net was benchmarked against state-of-the-art segmentation models, including UNet and its variants (UNet++ and U2Net). The performance was assessed using metrics such as the Dice similarity coefficient (DSC) and CSA difference. The statistical significance of performance differences was evaluated using paired t-tests, effect size (Cohen's d), and one-way ANOVA with Tukey's HSD correction for multiple comparisons at a -value threshold of 0.05, while statistical equivalence between models within predefined margins was formally assessed using the two one-sided test (TOST) procedure. Following quantitative validation, the model was deployed in a real-time clinical setup utilizing an Av.io HD Epiphan frame grabber to stream ultrasound images from the ultrasound machine to a GPU-equipped system. A secondary display running parallel to the original ultrasound screen visualized the segmented median nerve and computed the CSA values in realtime. MNSeg-Net achieved high segmentation performance, with average DSC scores of 94.7% at the wrist and 83.4% from the wrist to the elbow, and the lowest Hausdorff distance, matching the performance of the best-performing 44-million-parameter heavy U2Net model. Compared to U2Net, MNSeg-Net showed no statistically significant difference in DSC performance ( ; Cohen's ; mean difference = -0.001), with formal equivalence testing confirming equivalence across all tested margins ( ). For CSA estimation, MNSeg-Net also showed no statistically significant difference from clinician-annotated values ( ; Cohen's ; mean difference = -0.081), and equivalence was established at the margin, confirming a strong alignment with expert clinical assessments. MNSeg-Net demonstrated real-time performance by processing up to 43 frames per second on a single GPU, successfully segmenting the median nerve and computing CSA from ultrasoundframes. The developed MNSeg-Net-based clinical system represents an important step toward real-time median nerve assessment, enabling a fully automated solution for CTS diagnosis. By combining a lightweight architecture, real-time processing capability, and successful clinical deployment, it represents a substantial advancement in the CTS detection andmanagement.

Reduced illumination diminishes visual input, while footwear cushioning alters impact absorption. How these factors affect joint loading and muscle activation during the stair-to-ground transition remains unclear. This study investigated the effects of illumination and footwear on joint kinetics and muscle coordination during the transition step of stair descent, elucidating regulatory mechanisms and potential interactions. Twenty-four healthy adults performed a stair-to-level transition under four conditions (illumination: bright vs. dim; footwear: shoed vs. barefoot). Kinematic trajectories, ground reaction forces, and electromyographic signals were recorded for the dominant side during the transition step's stance phase. Analysis used two-way repeated-measures ANOVA and one-dimensional statistical parametric mapping. Illumination effects primarily manifested as increased hip flexion-extension negative work in bright conditions, whereas dim conditions decreased knee abduction moments and adduction-abduction negative work. The shoed condition increased ground reaction force loading rates and joint moments across multiple degrees of freedom at the hip, knee, and ankle, significantly elevating knee flexion-extension and hip rotational positive work. Conversely, the barefoot condition showed higher midstance ground reaction forces, greater ankle plantarflexion moments, increased hip rotational negative work, and higher knee and ankle muscle coactivation indices. Compared with illumination, footwear exerts a more pronounced effect on lower limb joint moments, negative work, and muscle activation during the stair descent transition phase. These findings provide directions for future research on footwear-ground interaction properties and lower limb motor control.NEW & NOTEWORTHY This study reveals that footwear impacts lower limb biomechanics more significantly than illumination during the stair-to-ground transition. Although dim light alters knee stability and hip work, footwear cushioning fundamentally redistributes joint moments and negative work. Notably, barefoot conditions trigger higher muscle coactivation and ankle loading to manage impact. These findings highlight how environmental and equipment factors interact, offering critical insights for improving footwear design and motor control strategies during high-risk locomotor transitions.

Adults with spinal cord injury (SCI) often experience reduced or lost sensation and movement, impairing the ability of the brain to locate paralyzed body parts, which, in turn, compromises sensorimotor recovery. This disruption of the internal body map of the brain, or mental body representations (MBR), also contributes to neuropathic pain in about 69% of adults with SCI. Medications for neuropathic pain are often ineffective and can cause adverse reactions. Our previous pilot clinical trial showed that Cognitive Multisensory Rehabilitation (CMR), a physical therapy that restores MBR, produced significant, lasting reductions in neuropathic pain, improved sensorimotor function, and enhanced brain function. Building on these results, we examined whether 8 weeks of CMR or adaptive fitness (1) improved sensorimotor function and reduced pain; (2) greater brain activity and connectivity related to sensorimotor function and MBR in adults with SCI. Sixteen participants (52+/-8 years old, 13+/-10 years post-SCI) were randomized to 8 weeks of CMR or adaptive fitness (45 min, 3x/week). Ten participants had neuropathic pain of 3/10 or greater. Pain and sensorimotor function were assessed at baseline, post-intervention, and 3-month follow-up using the Numeric Pain Rating Scale (NPRS), ASIA Impairment Scale (AIS), and Neuromuscular Recovery Scale (NRS). Functional MRI included resting-state and 4 tasks: imagining feeling the left leg, imagining moving the left leg, whole-body movement imagery, and a sensation task. After CMR, participants improved on AIS with large effect sizes (touch: d=1.54; pinprick: d=1.83; lower limb motor function: d=1.32), while adaptive fitness had small/moderate effects (touch: d=0.49; pinprick: d=0.53; lower limb motor function: d=0.74). CMR also showed larger effect sizes for NRS (core: d=2.19; upper limb: d=0.69; lower limb: d=0.74) than fitness (core: d=0.73; upper limb: d=0.34; lower limb: d=0.00). Benefits persisted at follow-up. Highest neuropathic pain intensity reduced post-CMR and at 3-month follow-up (d=0.48; d=0.63). Pain increased slightly after fitness (n=6; d=-0.19; d=-0.41). CMR increased brain connectivity and activation during the leg imagery task. Increased activation during whole-body imagery was greater after CMR than fitness. These preliminary results support the potential of CMR to improve function and reduce neuropathic pain in adults with SCI, warranting larger confirmatory trials. Clinicaltrial.gov : NCT05167032.

Resting-state and task-state fNIRS fusion assessment method for upper limb motor function in stroke patients.

Background/Objectives: Abnormal muscle tone and impaired motor control commonly limit gait recovery after stroke. Robot-assisted gait training has been introduced to augment conventional rehabilitation; however, its effects on stage-based motor recovery, functional ambulation, and muscle tone during the subacute phase remain unclear. Methods: This prospective, single-center, randomized controlled trial enrolled 30 patients with subacute stroke who received robot-assisted gait training plus conventional rehabilitation (R-BoT Plus group, n = 15) or conventional rehabilitation alone (control group, n = 15) over 4 weeks. The primary outcome was the change in Brunnstrom recovery stage of the lower extremities (BRS-LE). Secondary outcomes included Functional Ambulation Category (FAC), Fugl-Meyer Assessment for the Lower Extremity (FMA-LE), clinical spasticity measures (Modified Ashworth Scale and Modified Tardieu Scale), and muscle mechanical properties (MyotonPRO). Exploratory analyses were conducted to examine the associations between changes in stage-based motor recovery (ΔBRS-LE), functional ambulation (ΔFAC), and MyotonPRO parameters. Within-group changes were assessed using the Wilcoxon signed-rank test. Between-group effects were primarily evaluated using baseline-adjusted ANCOVA with HC3 robust standard errors, with Wilcoxon rank-sum tests on change scores as sensitivity analyses. Associations between changes in clinical outcomes and MyotonPRO parameters were evaluated using Spearman's rank correlation coefficient (ρ). Results: BRS-LE (p = 0.014) and functional ambulation (p = 0.041) were significantly improved in the R-BoT Plus group. Changes in FMA-LE and clinical spasticity measures did not differ significantly between groups. Quantitative myotonometry revealed selective muscle- and parameter-specific changes. No robust correlations were observed between MyotonPRO parameters and changes in BRS-LE. Conclusions: The addition of robot-assisted gait training to conventional rehabilitation was associated with greater improvements in stage-based lower-limb motor recovery and functional ambulation in patients with subacute stroke. In contrast, cumulative impairment scores and conventional clinical spasticity measures demonstrated limited changes between groups. Quantitative muscle mechanical assessment revealed selective muscle-specific adaptations, supporting its role as a complementary tool for mechanistic characterization rather than as a surrogate marker of motor recovery. Future studies incorporating dose-matched designs and longer follow-up periods are warranted to clarify the independent and long-term effects of robot-assisted gait training.

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.

Wearable robots show promise for gait assistance in stroke patients, yet the clinical characteristics predicting a positive ambulatory response to exoskeletal assistance remain unclear. To identify appropriate candidates for torque-assisted exoskeletal wearable robots in stroke patients. A subgroup analysis using data from an international, multicenter, randomised controlled trial. Inpatient. Fifty-five early subacute stroke patients who completed four weeks of robot-assisted gait training (RAGT) with the wearable exoskeletal robot (ANGEL LEGS M20, Angel Robotics Co., Ltd.). Immediately after RAGT for the four weeks, ambulatory function with the exoskeleton on and off was evaluated using the 10-Meter Walk Test (10MWT), 6-Minute Walk Test (6MWT), and Physiological Cost Index (PCI). At the same time, additional assessments included the Functional Ambulatory Category (FAC), Fugl-Meyer Assessment-Lower Extremity, Motricity Index-Lower Limb, Trunk Control Test, and Berg Balance Score. Participants were classified as good-responder, no-responder, or negative-responder groups based on changes in walking performance with exoskeletal assistance. Univariate and multivariate ordinal logistic regression analyses identified factors associated with responsiveness. In the good-responder group, 10MWT, 6MWT and PCI showed significant improvements in the robot-on state compared with the robot-off state, respectively (P<0.05). Good responders had significantly lower baseline ambulatory, balance, and lower limb motor function compared to negative-responders (P<0.05). Multivariate analysis identified lower FAC as the only independent predictor of positive response to exoskeletal assistance (P<0.05). Torque-assisted exoskeletal wearable robots may improve ambulatory function in stroke patients with low ambulatory function. To achieve meaningful effects through exoskeleton robots, patient selection must be adjusted according to clinical needs.

Background/Objectives: Stroke is among the leading causes of disability in adults, as hemiparesis affects motor function and daily activities. Constraint-induced movement therapy (CIMT) has proven effective in functional recovery through intensive use of the affected limb. This study aimed to assess the impact of CIMT on upper limb (UL) rehabilitation in stroke patients, with a focus on motor recovery, integration into activities of daily living (ADLs), and overcoming clinical implementation barriers. Methods: A systematic review was conducted by searching PubMed, Scopus, and Web of Science from their inception to March 2026. Systematic reviews and meta-analyses evaluating the effectiveness of CIMT in adult patients after stroke were included. The outcome variables included motor function, movement quality, independence in ADLs, and quality of life (QoL). Results: Twenty-five systematic reviews and sixteen meta-analyses were included. The participants were adults who had suffered a stroke at acute, subacute, or chronic stages and were aged between 18 and 95 years. With respect to upper limb motor function, ten studies reported statistically significant results in favor of CIMT. With respect to ADLs, four studies reported significant differences in favor of CIMT, with strong effects in intensive interventions. With respect to QoL, three studies reported significant improvements after the intervention. Conclusions: The results of this umbrella review support the effectiveness of CIMT in UL rehabilitation after stroke, especially in the subacute and chronic phases. CIMT, alone or in combination with adjuvant therapies, contributes to improving motor function, independence in ADLs, and QoL in patients.

Objective This study aimed to investigate the efficacy of acupuncture based on “Zhenjiu Dacheng” by Yang Jizhou, specifically the “treating left-sided disorders from the right” principle, in improving lower limb dysfunction after ischemic stroke and explore the underlying neural mechanisms using resting-state functional magnetic resonance imaging (rs-fMRI). Methods This single-center, randomized controlled trial enrolled 84 adults aged 40–75 years with first-episode ischemic stroke and unilateral lower limb dysfunction. The participants were randomized in a 1:1 ratio to the “left disease, right treatment” acupuncture group (contralateral acupoint) or the conventional acupuncture group (ipsilateral acupoint). Both groups received standardized conventional rehabilitation therapy plus 20 sessions of acupuncture over 4 weeks. Outcome measures included Fugl–Meyer Assessment for Lower Extremity (FMA-LE), Modified Barthel Index, Modified Ashworth Scale (MAS), gait speed, and rs-fMRI regional homogeneity (ReHo) at baseline, posttreatment (T1), and 3-month follow-up (T2). Results At T1 and T2, the “left disease, right treatment” acupuncture group showed significantly greater improvements in FMA-LE, MAS, and gait speed compared with the conventional acupuncture group (all P &lt; 0.05). rs-fMRI revealed posttreatment ReHo increases in the “left disease, right treatment” acupuncture group in the claustrum, putamen, and inferior parietal lobule and decreases in the superior frontal gyrus and precentral gyrus—distinct from changes in the conventional acupuncture group. Only mild adverse events occurred in both groups. Conclusion Acupuncture guided by the “Zhenjiu Dacheng” theory effectively improves lower limb motor function after ischemic stroke, potentially via modulation of brain functional connectivity in sensorimotor networks. It is safe and merits further clinical translation. Clinical trial registration: National Universal Health Security Information Platform (Medical Research Registration and Filing Information System) ( https://www.medicalresearch.org.cn/login , MR-33-22-001799).