Modified Barthel Index Scores Research Articles

Comparison of the Modified Barthel Index (MBI) Score Trends Among Workers With Stroke Receiving Robotic and Conventional Rehabilitation Therapy.

Stroke is one of the top causes of adult-acquired disabilities and the fifth most prominent cause of death worldwide. Working-age populations contribute about 40% of the stroke cases which occur annually in Malaysia. The modified Barthel Index (MBI) score has been used for self-care assessment to determine if stroke patients can meet their fundamental needs. The study was designed to compare the trend of MBI scores of workers who had a stroke and underwent robotic rehabilitation therapy to those who had conventional therapy. A cohort study was conducted among workers who had a stroke in northeastern Malaysia. They were assigned either to undergo robotic or conventional rehabilitation therapy. The robotic therapy is performed three times per day for four weeks. Meanwhile, conventional therapy involved walking exercises five days per week for two weeks. Data were collected for both therapies on the admission, at week 2 and week 4. The MBI, modified Rankin Scale (mRS) and Hospital Anxiety and Depression Scale (HADS) trends were examined one month after the therapies. The R (version 4.2.1) (R Core Team, Vienna,Austria) and RStudio (R Studio PBC, Boston, USA) were applied to perform the descriptive analyses on the respective platforms. Repeated measures of analysis of variance were performed to evaluate the outcomes trend and the effectiveness of the two therapies was also compared. A total of 54 stroke patients participated in this study of which 30 (55.6%) of them received robotic therapy. The age of the subjects ranged from 24 to 59 years and the majority (74.1%) were male. Stroke outcomes were evaluated using mRS, HADS, and MBI scores. Except for their age, the individuals' characteristics did not significantly differ between those undergoing conventional therapy and those receiving robotic therapy. After four weeks, it was found that the good mRS had increased, whereas the poor mRS had decreased. Comparing the therapy groups, the MBI scores improved significantly with time, although there were no significant differences between the therapy groups. However, the interaction term between the treatment group (p=0.031) and improvements over time was significant (p=0.001), indicating that robotic was more effective than conventional therapy in improving the MBI scores. For HADS score, there was a significant difference between the therapy groups (p=0.001), with those receiving robotic therapy having higher HADS score. Functional recovery occurs in acute stroke patients when the mean Barthel Index score rises from the baseline (on admission) to week 2 (during therapy)and subsequently on discharge (week 4). Based on these findings, it appears that there was not one therapy superior to the other; nevertheless, robotic therapy may be better tolerated and more effective in certain individuals.

Subjective Memory Complaints and Their Relationship with the Objective Cognitive Performance of Stroke Patients

Introduction: Subjective memory complaints (SMCs) are common among patients with stroke, significantly affect long-term disability, and contribute to poor functional outcomes. We explored changes in the subjective memory complaints questionnaire (SMCQ) score of stroke patients, correlations among SMCs, objective cognitive performance (OCP), and functional status. We also explored whether participants could be divided into groups based on the presence or absence of SMCs and OCP impairment, which could be related to rehabilitation outcomes. Methods: A total of 102 stroke patients were recruited from a single rehabilitation center. Their OCP was determined on admission. The Mini-Mental State Evaluation (MMSE), SMCQ, and modified Barthel Index (MBI) scores were obtained at admission and at discharge. These variables were compared and time and group interactions were explored. Results: The SMCQ score did not show consistent patterns of change among individuals. The objective cognitive function and activities of daily living consistently improved after rehabilitation. The proposed cognitive impairment classification after stroke based on SMCs and objective cognitive decline was able to predict improvement attributable to rehabilitation. Conclusion: Changes in SMCQ scores of stroke patients were inconsistent and varied when compared to changes in MMSE and MBI scores, indicating that it is not a reliable metric on its own. SMCs have a clinical relationship with OCP and significant emotional and motivational effects. In clinical practice, it is important to understand and consider SMCs after stroke.

Effectiveness of soft robotic glove versus repetitive transcranial magnetic stimulation in post-stroke patients with severe upper limb dysfunction: A randomised controlled trial.

To explore the difference in rehabilitation effect between soft robot gloves and repetitive transcranial magnetic stimulation (rTMS) in patients with severe upper limb motor dysfunction after a stroke. A total of 69 post-stroke patients with severe upper limb dysfunction were randomly assigned to a repetitive transcranial magnetic group, a soft robotic glove group, and a conventional treatment group. The primary outcomes were the Fugl-Meyer Upper Extremity Assessment (FMA-UE) and the Modified Barthel Index (MBI). The secondary endpoints were the amplitude surface electromyogram of the extensor wrist muscle (sEMG) and the cerebral hemispheric resting motor threshold (RMT). The change of FMA-UE score in the soft robotic glove group was significantly better than that in the conventional treatment group (median difference: 2 points; 95% confidence interval [1, 3]; P < 0.05), but there was no significant difference compared with the repetitive transcranial magnetic stimulation group (median difference: 0 points; 95% confidence interval [-1, 2]; P [0.547] > 0.05). There was no significant difference in the change of MBI score between the soft robotic glove group and the conventional treatment and repetitive transcranial magnetic treatment groups [F = 2.458, P [0.093] > 0.05]. There was no significant difference in the change of sEMG score between the soft robotic glove group and the conventional treatment and repetitive transcranial magnetic treatment groups [H = 0.042, P [0.980] > 0.05]. Additionally, the change of RMT score in the soft robotic glove group was significantly inferior to that in the repetitive transcranial magnetic treatment group [difference: -1.09; 95% confidence interval [-2.048, 0.048]; P < 0.05], but there was no significant difference compared with the conventional treatment group [difference: 0.31 points; 95% confidence interval [-0.879, 0.358]; P [0.495] > 0.05]. For patients with severe dyskinesia after a stroke, soft robotic gloves are as effective as repetitive transcranial magnetic stimulation and may be a good choice for home rehabilitation. In addition, conventional treatment combined with repetitive transcranial magnetic stimulation (rTMS) or a soft robotic glove produced better rehabilitation outcomes than conventional treatment alone.

Investigating the Impact of Voice Impairment on Quality of Life in Stroke Patients: The Voice Handicap Index (VHI) Questionnaire Study.

The Voice Handicap Index (VHI) is a patient-centered evaluation tool specifically designed for assessing voice-related quality of life. Although the VHI has been extensively used in patients with voice disorders, its applicability in stroke patients has not been fully established. This prospective cross-sectional study aimed to investigate the feasibility of using the VHI questionnaire in identifying stroke patients with voice problems. The study included a cohort of acute to subacute first-ever stroke patients (n = 48), with or without voice problems, as well as other non-stroke patients (n = 31) who agreed to complete the VHI questionnaire. Stroke patients with self-reported voice problems demonstrated significantly higher VHI scores and poorer life quality scores compared to the control groups. These patients also had lower Mini-Mental State Examination (MMSE), Modified Barthel Index (MBI), and Euro-QoL-5D-5L (EQ-5D-5L) scores. Spearman correlation analysis revealed an inverse association between VHI scores and EQ-5D-5L (rho = -0.77, p < 0.001), Korean Mann Assessment of Swallowing Ability (rho = -0.51, p < 0.001), and other functional parameters, including the National Institutes of Health Stroke Scale, MMSE, and MBI scores. Multiple regression analysis indicated that the VHI score was the biggest contributing factor to EQ scores. This is the first study to demonstrate that stroke patients with voice problems may experience reduced quality of life, even after controlling for other confounding factors such as dysphagia or neurological deficits. Future studies are needed whether addressing these issues by implementing the VHI may facilitate the improvement of patients' quality of life.

Safety and effectiveness of electromyography-induced rehabilitation treatment after epidural electrical stimulation for spinal cord injury: study protocol for a prospective, randomized, controlled trial.

Epidural electrical stimulation is a new treatment method for spinal cord injury (SCI). Its efficacy and safety have previously been reported. Rehabilitation treatment after epidural electrical stimulation is important to ensure and improve the postoperative efficacy of epidural electrical stimulation in patients with SCI. Considering that electromyography (EMG)-induced rehabilitation treatment can accurately match the muscle contraction of patients with SCI, we designed a study protocol for a prospective, randomized controlled trial. In this trial, on the premise of adjusting the spinal cord electrical stimulator to obtain the maximum EMG signal of the target muscle, patients with SCI receiving epidural electrical stimulation will undergo EMG-induced rehabilitation treatment. Recovery of muscle strength of key muscles, quality of life, safety and therapeutic effects will be monitored. Twenty patients with SCI who are scheduled to undergo epidural electrical stimulation in Shanghai Ruijin Rehabilitation Hospital will be randomly divided into two groups with 10 patients per group. The control group will receive conventional rehabilitation treatment. The EMG-induced rehabilitation group will receive EMG-induced rehabilitation treatment of the target muscles of the upper and lower limbs based on conventional rehabilitation treatment. After rehabilitation treatment, follow up for all patients will occur at 2 weeks and 1, 3 and 6 months. The primary outcome measure of this trial will be evaluation of target muscle recovery using the Manual Muscle Testing grading scale. Secondary outcome measures will include modified Barthel Index scores, integrated EMG values, the visual analogue scale, Spinal Cord Independence Measure scores, and modified Ashworth scale scores. The safety indicator will be the incidence of adverse events. This trial will collect data regarding the therapeutic effects of EMG-induced rehabilitation in patients with SCI receiving epidural electrical stimulation for 6 months after rehabilitation treatment. Findings from this trial will help develop rehabilitation methods in patients with SCI after epidural electrical stimulation. This study protocol was approved by Ethics Committee of Shanghai Ruijin Rehabilitation Hospital (Approval No. RKIRB2022-12) on February 15, 2022 and was registered with Chinese Clinical Trial Registry (registration number: ChiCTR2200061674; date: June 30, 2022). Study protocol version: 1.0.

Effects of Low-Frequency (0.5 Hz) and High-Frequency (10 Hz) Repetitive Transcranial Magnetic Stimulation on Neurological Function, Motor Function, and Excitability of Cortex in Ischemic Stroke Patients.

Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive neuromodulation technique. The purpose of our study is to explore the effects of low-frequency (0.5 Hz) and high-frequency (10 Hz) rTMS on neurological function, motor function, and excitability of cortex in Chinese ischemic stroke patients. A total of 240 ischemic stroke patients were collected. The National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), motor-evoked potential (MEP) cortical latency, central motor conduction time (CMCT), Fugel-Meyer assessment (FMA), Berg balance scale (BBS), and modified Barthel index (MBI) scores were recorded. After treatment, the NIHSS, mRS, MEP cortical latency, CMCT, FMA, BBS, and MBI scores of the high-frequency group and low-frequency group were significantly improved than the sham stimulation group, and the changes in the low-frequency group were more significant (adjusted P <0.05). Compared with the sham stimulation group, high-frequency stimulation reduced the NIHSS score by 9.5%, mRS score by 12.6%, MEP latency by 2.5%, and CMCT by 5.8%, and increased the upper limb FMA scale by 16.4%, lower limb FMA scale by 8.8%, BBS by 26.3%, and MBI by 9.3%, while low-frequency stimulation reduced the NIHSS score by 23.8%, mRS score by 25.3%, MEP Latency by 11.7%, and CMCT by 9.1%, and increased the upper limb FMA scale by 24.1%, lower limb FMA scale by 18.4%, BBS by 27.4%, and MBI by 23.7% in our cohort. Low-frequency rTMS is better than high-frequency rTMS stimulation in improving neurological function, motor function, and excitability of cortex in ischemic stroke.

Validating the Centre of Excellence on Longevity Self-AdMinistered (CESAM) Questionnaire: An Online Self-Reported Tool for Frailty Assessment of Older Adults.

Subjective health measures are often used to assess frailty, but the validity of self-reported online tools to identify frailty remains to be established. We aimed to assess concurrent, known-groups, convergent and predictive validity of the Centre of Excellence on Longevity Self-AdMinistered (CESAM) questionnaire for frailty assessment of older adults in an outpatient setting. Cross-sectional analysis of 120 participants. Participants of age ≥65 were recruited from an outpatient geriatric clinic. Individuals who had severe neurological, cognitive, or motor deficits were excluded. We assessed concurrent validity with area under receiver operating characteristic curve (AUC) against the Frailty Index (FI) and Clinical Frailty Scale (CFS). We analyzed known-groups validity between CESAM scores with frailty status (CFS and FI), Modified Barthel Index (MBI), and modified Chinese Mini-Mental State Examination (mCMMSE) using 1-way analysis of variance. We evaluated convergent validity using correlations with MBI, the Lawton index, mCMMSE, and Geriatric Depression Scale (GDS). Associations between CESAM-identified frailty for clinician-diagnosed geriatric syndromes, and health-related quality of life (HRQoL) was analyzed using regression analysis. The CESAM questionnaire demonstrated excellent diagnostic performance for frailty using FI ≥0.25 (AUC= 0.88; 95% CI: 0.82-0.94; P < .001) and CFS ≥4 (AUC= 0.78; 95% CI: 0.68-0.88; P < .001). CESAM scores increased significantly with increasing frailty (both CFS and FI), lower MBI, and lower mCMMSE scores (all P < .001), indicating concurrent validity. The moderate-good correlation of CESAM scores with MBI (r=-0.61; P < 0.001), Lawton Index (r=-0.54; P < .001), mCMMSE (r=-0.53; P < .001) and GDS (r= 0.58; P < .001) supports convergent validity. Using a cutoff of ≥8 for frailty identification, CESAM-identified frailty was associated with cognitive impairment (OR= 3.7; 95% CI: 1.7-8.2; P= .001) depression (OR= 4.0; 95% CI: 1.7-9.6; P= .002), falls (OR= 3.1; 95% CI: 1.2-8.2; P= .021) and poorer HRQoL (β=-0.1; 95% CI:-0.2 to-0.02; P= .017). Our results support the validity of an online self-reported tool to identify frailty and geriatric syndromes in an outpatient setting, an approach that is potentially applicable for remote screening of frailty.

The efficacy and safety of Jin's three-needle therapy vs. placebo acupuncture on anxiety symptoms in patients with post-stroke anxiety: A study protocol for a randomized controlled trial.

BackgroundA large number of clinical RCTs have verified that Jin's three-needle therapy (JTNT) has a great contribution to promoting the function of paralyzed limbs and relieving anxiety disorders for patients with post-stroke anxiety (PSA). However, there is still a lack of sham needle control, and its placebo effect cannot be ruled out. This study firstly verifies the real effectiveness of JTNT. Besides, the changes in serum indexes on the hypothalamic-pituitary-adrenal axis (HPA axis) are observed dynamically by the Enzyme-Linked ImmunoSorbent Assay (ELISA). The activation of different brain regions by JTNT is recorded using resting functional magnetic resonance imaging (rs-fMRI). Therefore, we can provide more practical and powerful evidence-based medical evidence for clinical decisions.MethodThis is a 16 week parallel, single-blind, random, controlled trial, including baseline, 4 weeks of treatment, and 12 weeks of follow-up. A total of 114 participants will be randomly divided into three groups in the proportion of 1:1:1. Participants will receive Jin's three-needle therapy in the active acupuncture group and accept sham needle treatment in the sham acupuncture group. In the waitlist control group, patients will not receive any acupuncture treatment. Outcomes cover three types of indicators, including scale indicators, serum indicators, and imaging indicators. The primary outcome is the change in the performance of anxiety symptoms, which is estimated by the 14-item Hamilton Anxiety Rating Scale (HAMA-14) and the 7-item Generalized Anxiety Disorder scale (GAD-7). Secondary outcomes are physical recovery and daily quality of life, which are evaluated by the National Institute of Health stroke scale (NIHSS) and the Modified Barthel Index Score (MBI Scale). Therefore, the assessment of the scale is carried out at baseline, 2nd, 4th, 8, 12, and 16 weeks. Adrenocorticotropin and cortisol will be quantitatively detected by ELISA at baseline and 4 weeks after treatment. In addition, regional homogeneity analysis (ReHo) will be used to record the activity of brain regions at baseline and 4 weeks after intervention.DiscussionThe study aims to provide high-quality clinical evidence on the effectiveness and safety of JTNT for patients with PSA. In addition, this trial explores a possible mechanism of JTNT for patients with PSA.Clinical trial registrationChinese Clinical Trial Registry, identifier [ChiCTR2200058992].

The effect of pre-operative carbohydrate loading in femur fracture: a randomized controlled trial

BackgroundFemur fracture is a major burden among elderly people, leading patients to be bedridden for a long time in the hospital. The body is more likely to be in a catabolic state as a result of the prolonged fasting period required for surgery, leading to an increase in insulin resistance. Pre-operative carbohydrate loading has been shown to improve postoperative outcomes in several countries. The study aimed to evaluate the effect of pre-operative carbohydrate loading in femur fracture surgery.MethodsThis study was single-center, hospital-based, open-label, parallel-group randomized controlled trial conducted between August 2020 and November 2021. A total of 66 participants, aged 50 years and above having femur fractures planned for surgery were included in this study and assigned to the control (n = 33) and study (n = 33) groups through computer-generated random numbers. The control group was kept fasting from midnight to the next morning as in existence while the study group was intervened with carbohydrate loading according to the Enhanced Recovery After Surgery (ERAS) protocol. The pre-operative nutritional status was identified and the postoperative outcomes were measured using the Visual Analogue Score (VAS), Cumulative Ambulatory Score (CAS), and Modified Barthel Index (MBI) scoring systems. Statistical analyses were performed using the Chi-square test and the Student’s two-sample t-test to compare the outcomes between the two groups.ResultsAll the participants completed the study. There was a significant reduction in the average postoperative pain in the carbohydrate loading group (VAS: 4.8 (SD ± 1.8), 95% CI: 4.7–5.4) as compared to the control group (VAS: 6.1 (SD ± 2.1), 95% CI: 5.3–6.8). The average CAS showed a significant improvement in regaining the mobility function of participants in the study group (CAS: 8.1 (SD ± 2.8), 95% CI: 7.1–9.1) than that of the control group (CAS: 6.8 (SD ± 2.8), 95% CI: 5.8–7.8). The mean MBI score of the participants at the time of discharge from the hospital was higher in the study group (MBI:13.1 (SD ± 2.3), 95% CI: 12.2–13.9) compared to the control group (MBI: 11.8 (SD ± 3.1), 95% CI:10.6–12.9). Similarly, the length of hospital stay after surgery had decreased in the study group than in the control group.ConclusionsThe uptake of carbohydrate loading showed reduced post-operative pain, enhanced functional mobility, and decreased length of hospital stay. This study warrants larger trials to show the effect of pre-operative carbohydrate loading in a clinical setting.Trial registrationNCT04838366, first registered on 09/042021 (https://clinicaltrials.gov/ct2/show/NCT04838366).

Effect of Cognitive Behavioral Therapy on Stress Disorder, Cognitive Function, Motor Function, and Daily Living Ability of Patients with a Traumatic Brain Injury.

Purpose The aim of the study is to observe the effects of cognitive behavioral therapy on stress disorder, cognitive function, motor function, and daily living ability of traumatic brain injury (TBI) patients. Methods 84 patients with TBI admitted to our hospital from June 2019 to May 2021 were selected as the research subjects. They were divided into a control group (from June 2019 to May 2020) and an observation group (from June 2020 to May 2021), with 42 cases in each group. The control group received routine intervention; the observation group received cognitive behavioral therapy on the basis of the control group. Before and after intervention, the posttraumatic stress disorder (PTSD), cognitive function, motor function, and daily living ability of the two groups were observed. Results After intervention, the PTSD-self-rating scale (PTSD-SS) scores of both groups were lower than those before intervention, and the PTSD-SS scores of the observation group were lower than those of the control group (P < 0.05). After intervention, the scores of the Montreal cognitive assessment (MoCA) scale, Fugl-Meyer assessment (FMA), and modified Barthel index (MBI) in both groups were higher than those before intervention, and the scores of MoCA, FMA, and MBI in the observation group were higher than those in the control group (P < 0.05). Conclusion The application of cognitive behavioral therapy to TBI patients is beneficial to reduce the degree of PTSD and improve cognitive function, motor function, and daily living ability, which is worthy of clinical application.

Analyzes of the ICF Domain of Activity After a Neurological Early Mobility Protocol in a Public Hospital in Brazil.

BackgroundEarly Mobility (EM) has been recognized as a feasible and safe intervention that improves functional outcomes in hospitalized patients. The International Classification of Functioning, Disability and Health (ICF) supports understanding of functioning and disability in multidimensional concepts and efforts have been taken to apply ICF in a hospital environment. EM protocols might be linked with the ICF component of activity and participation. The correlations between ICF, EM, and functional scales might help the multidisciplinary team to conduct the best rehabilitation program, according to patients' functional demands.ObjectivesThe primary outcome is to analyze the activity level of neurological inpatients on admission and delivery after a Neurological Early Mobility Protocol (NEMP) at intermediate care settings in a public hospital in Brazil using Activity Level categories, HPMQ, and MBI scores. The secondary outcome is to analyze the ICF performance qualifier, specifically in the activity domain, transposing HPMQ and MBI scores to the corresponding ICF performance qualifiers.DesignAn international prospective study.MethodsNEMP was used to promote patients' mobility during a hospital stay in neurological ward settings. First, patients were categorized according to their Activity Levels (ALs) to determine the NEMP phase to initiate the EM protocol. ALs also were evaluated in the first and last sessions of NEMP. Thereafter, the Hospitalized Patient Mobility Questionnaire (HPMQ) was applied to identify whether patients needed assistance during the performance of hospital activities as well as the Modified Barthel Index (MBI). Both measures were applied in NEMP admission and discharge, and the Wilcoxon Signed Rank Test was used to compare data in these two time points. HPMQ and MBI scores were re-coded in the correspondent ICF performance qualifier.ResultsFifty-two patients were included with age of 55 ± 20 (mean ± SD) years and a length of hospital stay of 33 ± 21 days. Patients were classified along ALs categories at the admission/discharge as follows: AL 0 n = 6 (12%)/n = 5 (9%); AL 1 n = 12 (23%)/n = 6 (12%); AL 2 n = 13 (25%)/n = 8 (15%); AL 3 n = 10 (19%)/n = 13 (25%); AL 4 n = 11 (21%)/n = 20 (39%). HPMQ data revealed progressions for the activities of bathing (p < 0.001), feeding (p < 0.001), sitting at the edge of the bed (p < 0.001), sit to stand transition (p < 0.001), orthostatism (p < 0.001) and walking (p < 0.001). Transposing HPMQ activities into ICF performance qualifiers, improvements were shown in bathing (d510.3 to d510.1—severe problem to mild problem) and sitting at the edge of the bed (d4153.2 to d4153.1—moderate problem to mild problem). At MBI score were observed an average of 36 [IQR−35. (95% CI 31.5; 41.1)] on NEMP admission to 52 at discharge [IQR−50 (95% CI 43.2; 60.3)] (p < 0.001). Recoding MBI scores into ICF there were improvements from severe problem (3) to moderate problem (2).LimitationsThe delay in initiating NEMP compared to the period observed in the literature (24–72 h). The study was carried out at only one center.ConclusionsThis study suggests that neurological inpatients, in a public hospital in Brazil had low activity levels as could be seen by MBI and HPMQ scores and in the ICF performance qualifier. However, improvements in the evaluated measures and ICF activity domain were found after NEMP. The NEMP protocol has been initiated much longer than 72 h from hospital admission, a distinct window than seen in the literature. This enlargement period could be a new perspective for hospitals that are not able to apply mobility in the earliest 24–72 h.

Electroacupuncture for acute ischemic stroke and its effect on plasma levels of IL-17 and IL-10

To compare the clinical efficacy on acute ischemic stroke (AIS) between electroacupuncture combined with conventional western medicine therapy and simple conventional western medicine therapy and its effect on plasma levels of interleukin (IL)-17 and IL-10. A total of 60 patients with AIS were randomized into an observation group (30 cases, 2 cases dropped off) and a control group (30 cases, 4 cases dropped off). The control group was treated with conventional western medicine therapy i.e neuroprotection and cerebral circulation improvement. On the basis of the treatment in the control group, in the observation group, acupuncture was applied at Baihui (GV 20), Yintang (GV 24+) and Quchi (LI 11), Zusanli (ST 36), Sanyinjiao (SP 6), etc. on the affected side, Baihui (GV 20)-Yintang (GV 24+), Quchi (LI 11)-Hegu (LI 4) and Zusanli (ST 36)-Sanyinjiao (SP 6) were connected with electroacupuncture, with disperse-dense wave, 2 Hz/15 Hz in frequency, once a day for consecutive 10 days. Before and after treatment, the scores of National Institution of Health stroke scale (NIHSS) and modified Barthel index (MBI) were observed, plasma levels of IL-17 and IL-10 were detected by ELISA method. After treatment, NIHSS scores were decreased while MBI scores were increased compared before treatment in both groups (P<0.01); compared with the control group, NIHSS score was decreased while MBI score was increased in the observation group (P<0.05). After treatment, IL-17 levels were decreased while IL-10 levels were increased compared before treatment in both groups (P<0.01); compared with the control group, IL-17 level was decreased while IL-10 level was increased in the observation group (P<0.05). Electroacupuncture combined with conventional western medinice therapy can improve the nerve function and activity of daily living in patients with AIS, its clinical efficacy is superior to simple conventional western medicine therapy, the mechanism may relate to the regulation on IL-17/IL-10 imbalance.

Altered effective connectivity in the emotional network induced by immersive virtual reality rehabilitation for post-stroke depression.

Post-stroke depression (PSD) is a serious complication of stroke that significantly restricts rehabilitation. The use of immersive virtual reality for stroke survivors is promising. Herein, we investigated the effects of a novel immersive virtual reality training system on PSD and explored induced effective connectivity alterations in emotional networks using multivariate Granger causality analysis (GCA). Forty-four patients with PSD were equally allocated into an immersive-virtual reality group and a control group. In addition to their usual rehabilitation treatments, the participants in the immersive-virtual reality group participated in an immersive-virtual reality rehabilitation program, while the patients in the control group received 2D virtual reality rehabilitation training. The Hamilton Depression Rating Scale, modified Barthel Index (MBI), and resting-state functional magnetic resonance imaging (rsfMRI) data were collected before and after a 4-week intervention. rsfMRI data were analyzed using multivariate GCA. We found that the immersive virtual reality training was more effective in improving depression in patients with PSD but had no statistically significant improvement in MBI scores compared to the control group. The GCA showed that the following causal connectivities were strengthened after immersive virtual reality training: from the amygdala, insula, middle temporal gyrus, and caudate nucleus to the dorsolateral prefrontal cortex; from the insula to the medial prefrontal cortex; and from the thalamus to the posterior superior temporal sulcus. These causal connectivities were weakened after treatment in the control group. Our results indicated the neurotherapeutic use of immersive virtual reality rehabilitation as an effective non-pharmacological intervention for PSD; the alteration of causal connectivity in emotional networks might constitute the neural mechanisms underlying immersive-virtual reality rehabilitation in PSD.

Effect of Liuzijue Training on Balance and Respiratory Function of Stroke Patients in Recovery Stage

<bold>Objective</bold> To observe the effect of Liuzijue training on balance and respiratory function of stroke patients in recovery stage. <bold>Methods</bold> A total of 63 stroke patients in recovery stage who were treated in the department of rehabilitation medicine of Haishu Rehabilitation Hospital (a teaching hospital of Ningbo college of Health Sciences) from January 2020 to March 2021, were recruited and randomly divided into control group and observation group, with 31 cases, 32 cases respectively. Both groups received conventional rehabilitation treatment such as physiotherapy and occupational therapy. Besides, the control group received core stability training while the observation group received Liuzijue training. Both groups received conventional rehabilitation treatment for 30 minutes a time, and core stability training or Liuzijue training for 20 minutes a time, once a day, five times a week, lasting for four weeks. The pronunciation order of the Liuzijue were "Xu, He, Hu, Si, Chui, Xi", and the training was conducted by nasal inhalation and oral exhalation, combined with movement guidance. Before and four weeks after treatment, Berg balance score (BBS) was used to evaluate the balance function; Fugl-Meyer assessment (FMA) was used to evaluate the motor functions; the modified Barthel index (MBI) was used to evaluate the activities of daily living; maximum phonation time (MPT) was used to evaluate the respiratory efficiency; color Doppler ultrasound was used to measure diaphragm thickness, mobility and diaphragm thickening fraction (DTF) and to evaluate diaphragm function. <bold>Results</bold> Compared with that before treatment, the BBS score, FMA score, MBI score, MPT, diaphragm thickness and mobility at quiet inspiration and at the end of maximum exhalation were significantly increased of both groups after treatment, the difference was statistically significant (<italic>P</italic>&lt;0.05). Compared with the control group, the BBS score, MBI score, MPT, diaphragm mobility at quiet inspiration and at the end of maximum exhalation of the observation group after treatment were all significantly higher, and the difference was statistically significant (<italic>P</italic>&lt;0.05), while there were no statistically significant differences in FMA score, DTF, diaphragm thickness at quiet inspiration and at the end of maximum exhalation (<italic>P</italic>&gt;0.05). <bold>Conclusion</bold> Liuzijue training can effectively improve the balance function, activities of daily living, and respiratory function, and is recommended for clinical application.

Outcomes of ultra-old vs old patients after hip fracture surgery: a matched cohort analysis of 1524 patients.

Surgical management of geriatric hip fractures yields improved functional outcomes with decreased morbidity and mortality. Cohort studies have suggested that the older patients within the geriatric age group have worse outcomes with surgery, However, these studies inherently report inflated risks due to poor handling of confounders and have inadequately age-stratified their geriatric population. This study aims to investigate the effect of age alone on the 1-year mortality and functional status of geriatric patients after hip fracture surgery. This is a retrospective single institution cohort study based on the prospectively-maintained registry of hip fracture patients. 2603 patients aged 60years and above were treated surgically under a geriatric-orthopaedic hip fracture pathway from January 2014 to December 2018. Patients were split into two age groups: ultra-old (≥ 85years) vs old (< 85years). Baseline demographics and the ASA (American Society of Anaesthesiologists) status and the Modified Barthel's Index (MBI) were obtained at admission and 1year after the fracture. Adverse outcomes from the fracture and surgery were recorded during a follow-up period of minimally 2years. A 2:1 matching process based on the gender, fracture type, ASA status, CCI and MBI categories was conducted. There were 1009 and 515 patients in the old and ultra-old age groups, respectively. 1-year mortality was similar for both age groups (4.0% ultra-old vs 3.6% old, p = 0.703). 30-day morbidity was similar except for higher rates of postoperative pneumonia in the ultra-old (14.0 vs 6.3%, p < 0.001). MBI scores at 1-year were lower in the ultra-old (severe dependence: 16.4 vs 10.0%; p = 0.001). Ultra-old patients were less likely to be community ambulant at 12months (21.2 vs 36.0%) with the deterioration in ambulatory status significant after correction for baseline status (p < 0.001). The 1-year mortality of surgically-managed geriatric hip fracture patients older than 85years of age is not determined by age alone. Patients aged 85years and above are at higher risk for pneumonia postoperatively. Ultra-old hip fracture patients with an intertrochanteric fracture are more likely to have poorer function at 1year after hip fracture surgery.

Clinical observation on wrist-ankle acupuncture for shoulder-hand syndrome phaseⅠafter stroke

To compare the clinical efficacy between wrist-ankle acupuncture and conventional acupuncture on shoulder-hand syndrome (SHS) phaseⅠafter stroke. A total of 64 patients with SHS phaseⅠafter stroke were randomized into a wrist-ankle acupuncture group and a conventional acupuncture group, 32 cases in each group. On the basis treatment of internal medicine and conventional rehabilitation, wrist-ankle acupuncture was applied at upper 4 area, upper 5 area and upper 6 area on the affected side in the wrist-ankle acupuncture group, while acupuncture was applied at Jianyu (LI 15), Quchi (LI 11), Shousanli (LI 10), etc. on the affected side in the conventional acupuncture group. The treatment was given 30 min each time, once a day, 5 days a week for 3 weeks in both groups. Before and after treatment, the visual analogue scale (VAS) score, degree of hand swelling, shoulder-hand syndrome scale (SHSS) score, Fugl-Meyer assessment for upper extremity (FMA-UE) score and modified Barthel index (MBI) score were observed, and the clinical therapeutic effect was evaluated in both groups. After treatment, the VAS scores, degree of hand swelling and SHSS scores were decreased (P<0.05), and the FMA-UE scores and MBI scores were increased (P<0.05) compared before treatment in both groups; in the wrist-ankle acupuncture group, the VAS score, degree of hand swelling and SHSS score were lower (P<0.05), and the FMA-UE score and MBI score were higher (P<0.05) than those in the conventional acupuncture group. The total effective rate was 96.9% (31/32) in the wrist-ankle acupuncture group, which was superior to 90.6% (29/32) in the conventional acupuncture group (P<0.05). Wrist-ankle acupuncture can effectively relieve pain and hand swelling, improve motor function of upper extremity and self-care ability of daily life in patients with shoulder-hand syndrome phaseⅠafter stroke, the therapeutic effect is superior to conventional acupuncture.

Cross-Validation of Machine Learning Models for the Functional Outcome Prediction after Post-Stroke Robot-Assisted Rehabilitation.

The state of the art is still lacking an extensive analysis of which clinical characteristics are leading to better outcomes after robot-assisted rehabilitation on post-stroke patients. Prognostic machine learning-based models could promote the identification of predictive factors and be exploited as Clinical Decision Support Systems (CDSS). For this reason, the aim of this work was to set the first steps toward the development of a CDSS, by the development of machine learning models for the functional outcome prediction of post-stroke patients after upper-limb robotic rehabilitation. Four different regression algorithms were trained and cross-validated using a nested 5×10-fold cross-validation. The performances of each model on the test set were provided through the Median Average Error (MAE) and interquartile range. Additionally, interpretability analyses were performed, to evaluate the contribution of the features to the prediction. The results on the two best performing models showed a MAE of 13.6 [13.4] and 13.3 [14.8] on the Modified Barthel Index score (MBI). The interpretability analyses highlighted the Fugl-Meyer Assessment, MBI, and age as the most relevant features for the prediction of the outcome. This work showed promising results in terms of outcome prognosis after robot-assisted treatment. Further research should be planned for the development, validation and translation into clinical practice of CDSS in rehabilitation. Clinical relevance- This work establishes the premises for the development of data-driven tools able to support the clinical decision for the selection and optimisation of the robotic rehabilitation treatment.

Ruyi Zhenbao Pills for Patients with Motor and Sensory Dysfunction after Stroke: A Double-Blinded, Randomized Placebo-Controlled Clinical Trial.

To evaluate the efficacy and safety of Tibetan medicine Ruyi Zhenbao Pills (RZPs) in the treatment of patients with motor and sensory dysfunction after stroke. A total of 120 convalescent stroke patients hospitalized in the Rehabilitation Department of Guangdong Provincial Hospital of Chinese Medicine from June 2017 to December 2019 were enrolled in this trial. Patients were assigned to control (60 cases) and research (60 cases) groups by computer random assignment. All patients received internal treatment and modern rehabilitation training. On this basis, the research group was given oral RZPs for 4 weeks, while the control group was given oral placebo. The primary outcome was motor function of the affected side evaluated by simplified Fugl-Meyer Motion Assessment Scale (FMA-M). The secondary outcomes included sensory function, activity of daily living (ADL), quality of life, balance function, and pain, which were assessed by Fugl-Meyer Sensory Assessment Scale (FMA-S), Modified Barthel Index (MBI), Special Scale of the Quality of Life (SS-QOL), Berg Balance Scale (BBS), and Visual Analogue Scale (VAS), respectively. All of the assessments were performed before treatment, and 4 and 8 weeks after treatment. Vital signs, liver and kidney functions, routine blood test, blood coagulation profile, and routine urinalysis of patients were monitored. After 4-week treatment, the FMA-M, BBS and FMA-S scores in the research group significantly increased compared with the control group (P<0.05). At 8-week follow-up, the BBS and MBI scores in the research group were higher than the control group (P<0.05). There was no statistical difference between the 2 groups in the SS-QOL and VAS scores at 4 and 8 weeks (P>0.05). Moreover, after treatment, there was no significant difference in vital signs, liver and kidney functions, blood coagulation function, blood routine and urinalysis between the 2 groups (P>0.05). RZPs improved limb motor, balance, and sensory functions of stroke patients during recovery period with good safety. (Trial registration No. NCT04029701).

A Case Report on Korean Medical Treatment for Delayed Neuropsychiatric Sequelae of Carbon Monoxide Poisoning

Objective: This clinical study describes the effect of Korean medicine on a patient with Delayed Neuropsychiatric Sequelae after Carbon Monoxide Poisoning.Case presentation: A patient with the delayed neuropsychiatric effects of carbon monoxide exposure was treated with herbal medicine, acupuncture, moxibustion, and cupping. Clinical symptoms were measured with the Korean Mini Mental State Examination (K-MMSE), Functional Independence Measure (FIM), and the Modified Barthel Index (MBI). After 32 days of treatment, the patient’s K-MMSE score increased from 11 to 21 points, the FIM score from 52 to 94 points, and the MBI score from 46 to 84 points. There were no side effects.Conclusion: According to this case study, Korean medicine may be considered an effective treatment for delayed neuropsychiatric sequelae, although more studies are needed to confirm its validity.

Effects of eye acupuncture on motor evoked potential and somatosensory evoked potential in patients with incomplete spinal cord injury based on neuroelectrophysiological technology

To observe the effects of eye acupuncture on motor evoked potential (MEP) and somatosensory evoked potential (SEP) in the patients with incomplete spinal cord injury so as to evaluate its clinical efficacy. According to the random number table, 90 patients were divided into exercise therapy group, eye acupuncture group and eye acupuncture combined exercise therapy group (combined treatment group), 30 cases in each. In the exercise therapy group, patients were treated with the routine exercise and occupational therapy. Patients of the eye acupuncture group were treated with eye acupuncture at upper jiao region, lower jiao region, liver region and kidney region bilaterally. Patients of the combined treatment group were given the routine exercise and occupational therapy combined with eye acupuncture. All the treatments were conducted once daily, 7 days as one treatment course for 4 treatment courses. Before treatment and 4 weeks after treatment, the motor function, light touch sensation and pinprick sensation, injury grade and clinical efficacy were assessed separately, using the criteria developed by the American Spinal Injury Association. The modified Barthel index(MBI) was adopted to evaluate the activities of daily livings. By monitoring SEP and MEP, the neurophysiological conditions were assessed for spinal cord injury. The total effective rate was 56.7% (17/30), 66.7% (20/30) and 90.0% (27/30) in the exercise therapy group, the eye acupuncture group and the combined treatment group, respectively. The total effective rate in the combined treatment group was higher than those in the other two groups (P<0.05). Compared with those before treatment, the scores of motor function, light tough sensation and pinprick sensation were all increased after treatment in three groups (P<0.05), MBI score was increased in both the exercise therapy group and the combined treatment group (P<0.05), and the latency of SEP (N11, N20, N23, P38) and the Cortical (hand region), Csp, Cortical (leg region) and Lsp of MEP were all shortened in the three groups separately (P<0.05). After treatment, compared with the exercise therapy group, the score of motor function was increased (P<0.05), MBI score decreased (P<0.05) and MEP latency shortened (P<0.05) in the eye acupuncture group. After treatment, compared with the exercise therapy group and the eye acupuncture group, the scores of motor function, light touch sensation and pinprick sensation, as well as MBI score were all increased (P<0.05), and the latency of SEP (N11,N20,N23,P38) and MEP shortened (P<0.05) in the combined treatment group. In treatment of incomplete spinal cord injury, eye acupuncture combined with exercise therapy can significantly increase the excitability of sensory and motor nerve conduction in the spinal cord and cerebral cortex of patients, effectively promote the recovery of patients' motor and sensory function and improve the activities of daily living.