BACKGROUND:This study evaluated the combined effects of Tongue-Nape Acupuncture (TNA) and Transcranial Direct Current Stimulation (tDCS) on 85 post-stroke dysphagia (PSD) patients. METHODS:Participants were assigned to either a tDCS-only group (n = 40) or a TNA + tDCS group (n = 45). Swallowing function (Water Swallowing Test, Standard Swallowing Assessment) and Quality of Life (QoL) were assessed. Serum levels of neural injury markers (S-100β, NSE, MMP-9, Hcy, hs-CRP) were measured, alongside brain activity (near-infrared imaging) and muscle function (EMG). RESULTS:The TNA + tDCS group achieved significantly greater improvements in swallowing scores and a higher overall clinical response rate (91.1% vs. 77.5%) compared to the tDCS-only group (p < 0.05). The combination therapy led to significant reductions in neural injury biomarkers and increased oxyhemoglobin concentrations in sensorimotor and prefrontal areas, indicating positive neurobiological changes and enhanced brain activity. EMG results also showed improved muscle function and coordination in the combined group. No significant difference in adverse reactions was observed between groups. In addition, serum biomarker assay results demonstrated that, post-intervention, the combination group exhibited significantly decreased levels of S-100β, NSE, MMP-9, homocysteine, and high-sensitivity C-reactive protein, indicating benign neurobiological alterations. CONCLUSION:The study concludes that combining TNA and tDCS is a promising strategy for improving swallowing and feeding functions, enhancing QoL, and offering potential neuroprotective benefits for patients with PSD.
BACKGROUND:Sepsis is a frequent complication in acute stroke that increases hospital morbidity, yet its repercussions remain poorly understood. This study investigates the functioning and quality of life in ischemic stroke patients who developed sepsis versus those who did not. METHODS:This study included 38 patients matched by sex, age, and admission score on the National Institutes of Health Stroke Scale (NIHSS). Functioning was evaluated by the World Health Organization Disability Assessment Schedule 2.0. (WHODAS 2.0) and quality of life by the World Health Organization Quality of Life - BREF Disabilities (WHOQOL-BREF/DIS), both assessed via proxy three months post-stroke. Statistical analysis used non-parametric tests and multiple linear regression. RESULTS:The stroke-sepsis group (n = 14) showed significantly longer hospital stays than the stroke-only group (n = 24) (median 23.64 vs. 8.04 days; p < 0.001) and higher Modified Rankin Score scores at discharge (4.29 vs. 3.46; p = 0.016), indicating greater disability. This group also exhibited worse Glasgow Coma Scale values (p < 0.001) and a higher risk of pressure injuries (OR: 3.22; p = 0.004). Pulmonary infection was the primary septic focus (92.8%). Importantly, no statistically significant differences were detected between the groups in mean WHODAS 2.0, WHOQOL-BREF, or WHOQOL-BREF-DIS scores. Conclusion: The presence of sepsis in ischemic stroke patients was not associated with worse functioning or quality of life three months post-event. However, sepsis was associated with a substantial increase in hospital length of stay as well as greater disability and dependence at hospital discharge, emphasizing its significant clinical and healthcare burden impact in this population.
BACKGROUND:Spatiotemporal gait parameters have been linked to clinical outcomes after stroke, but whether determinants differ between outcomes is untested in one cohort. OBJECTIVE:To determine how many dimensions eight routinely used outcomes represent, and whether between-outcome differences in determinants reflect construct or scale. METHODS:Cross-sectional study, 244 patients with subacute stroke (Functional Ambulation Category [FAC] ≥2). Fifteen walkway parameters were modeled, with one predictor pool, against Berg Balance Scale (BBS), gait velocity, Timed Up and Go (TUG), 10-meter (10MWT) and 2-minute (2MWT) walk tests, FAC, and Functional Independence Measure (FIM). Principal component analysis assessed dimensionality; partial-F tests and reciprocal transformation tested determinant exchangeability. RESULTS:The outcomes reduced to two components (90.6% of variance): walking capacity (78.0%), loaded by all walking measures and FAC, and one defined by FIM (12.6%); velocity and 10MWT shared 99.4%. Bilateral step length explained BBS, velocity and 2MWT; step-time asymmetry and cadence explained TUG and 10MWT (adjusted R2 0.83-0.92). The temporal block added variance only for time-denominated outcomes (ΔadjR2 = 0.073, 0.077), and reciprocal transformation reversed every profile. Cadence predicted FAC (OR = 1.027, 1.002-1.054, p = 0.037); FIM was unexplained (0.05). CONCLUSION:These outcomes represent two dimensions, and which parameters appear dominant depends on whether an outcome is expressed as a time or a rate, so outcome-specific models are not evidence for outcome-specific training targets. The implication is one of measurement: one primary walking outcome suffices, and independence must be assessed separately.
OBJECTIVE:To determine the effects and perception of intensive exergaming training on upper limb motor functions in subacute stroke patients. METHODS:This one-year interventional mixed-methods study was conducted at Pakistan Railway General Hospital, Rawalpindi, using a sequential quantitative-qualitative design. In the quantitative phase, 42 participants were recruited and randomly allocated to two groups - experimental (n = 21) and control (n = 21). The experimental group received Xbox 360 Kinect-based exergaming, in conjunction with task-oriented training five sessions per week for 6 weeks. For the qualitative study, 15 patients from the experimental group were included. Primary outcome measures for upper-limb function were the Fugl-Meyer Assessment upper limb (FMUE) and the Chedoke Arm and Hand Inventory-13. Secondary outcome measures included the Subjective Index of Physical and Social Outcome (SIPSO), the Fatigue Severity Scale (FSS), and the Visual Analogue Scale (VAS). The treatment duration for both groups spanned 6 weeks, with 1-hour sessions (30 minutes for exergaming and 30 minutes for task-oriented training) 5 times a week. RESULTS:After intervention experimental group had better results in all analyzed variables (shoulder, elbow, and forearm; wrist and hand) than the control group for FMUE (p < .01), Chedoke Arm & hand inventory (p < .01), FSS (p < .01), SIPSO (p < .01), and VAS (p < .01), suggesting that exergaming training combined with task-oriented training is more effective than task-oriented training alone. Patients' perception regarding gaming showed overall satisfactory improvement. CONCLUSION:The combination of exergaming and task-oriented training was effective for stroke patients. The participants' experiences were satisfactory, fun, and challenging, as they included visual and auditory feedback.Clinical Trial number: NCT05315089.
OBJECTIVE:The purpose of this study was to demonstrate that the construct of balance confidence, as measured by the Activities-Specific Balance Confidence (ABC) scale, consists of three factors in those with chronic stroke. DESIGN:This study was a cross-sectional analysis of preexisting data from a research registry. SETTING:Academic institution. PARTICIPANTS:248 community-dwelling adults with a history of one or more strokes, verified by CT/MRI report or past provider. MAIN OUTCOME MEASURE(S):We proposed that the ABC-scale items comprise three balance confidence domains: 1) anticipatory control, 2) walking balance, and 3) reactive balance. We assigned ABC Q1,2,8,10-12 to walking balance, Q3-7,9 to anticipatory control, and Q13-16 to reactive balance. A confirmatory factor analysis was performed to test this hypothesized structure, with outcomes including the Goodness-of-Fit indices (Root Mean Square Error of Approximation (RMSEA), Comparative Fit Index (CFI), and Tucker-Lewis Fit Index (TLI)). RESULTS:All indicators significantly loaded as hypothesized. CONCLUSION(S):These results suggest that the items in the ABC scale represent three domains of anticipatory control, walking balance, and reactive balance.
BACKGROUND:Behavioral health factors particularly depression/anxiety and smoking are common after stroke and directly influence secondary stroke prevention, rehabilitation engagement and outcomes, yet they remain under-integrated within routine physical therapy-led stroke care. OBJECTIVES:To estimate associations between stroke history, smoking, mental health burden and sociodemographic factors and propose pragmatic implications for integrated rehabilitation. METHODS:We conducted a cross-sectional analysis of pooled National Health Interview Survey (NHIS) data from 2019-2023 (N = 150,220 adults). Sex-stratified, survey-weighted logistic regression models estimated associations among stroke history, mental health burden, smoking, and sociodemographic factors. Among stroke survivors, models also examined the Covid-19 pandemic period. RESULTS:Stroke was associated with higher odds of mental health burden (females OR 1.33; males OR 1.57) and current smoking (females OR 1.27; males OR 1.35) versus controls. Among survivors, the pandemic period was associated with increased smoking risk in females (OR 1.38), while Medicaid/public insurance was associated with higher odds of both smoking (females OR 1.77; males OR 1.66) and mental health burden in females (OR 1.33). Partnership conferred protection for mental health burden (females OR 0.70; males OR 0.75) and smoking in males (OR 0.63). CONCLUSIONS:Our study suggests that national patterns support embedding behavioral health screening, smoking and substance use cessation into standard stroke rehabilitation, with prioritization of female, Medicaid-insured survivors, and those without partners, and ensuring continuity during public health crises. Since smoking cessation is central to secondary stroke prevention, embedding behavioral health screening, cessation counseling, and warm handoffs into physical therapy-led rehabilitation offers a concrete, sex-sensitive, and equity-oriented target for improving post-stroke outcomes.
BACKGROUND:The implementation of clinical guidelines by allied health professionals in post-acute stroke care is often inadequate. Utilization of information and communication technologies (ICTs) as a promising component of guideline implementation strategies remains underexplored. OBJECTIVES:This scoping review aims to identify and map ICTs in implementation strategies for stroke guidelines across health-care settings and professions. METHODS:A systematic literature search was conducted in MEDLINE Ovid, Embase Ovid, CINAHL, and gray literature sources. Studies were screened and selected through a two-step process by two independent screeners using CADIMA software. ICTs were categorized according to the targeted determinants of practice based on the TICD framework and compared across health-care professions and settings. RESULTS:The 22 included studies implemented 23 guidelines from six countries, with most published in the past 5 years. Multicomponent strategies were used in 86.4% of studies, and 77.3% were tailored to address identified needs and barriers. Web-based learning materials and electronic documents were the most frequently used ICTs. Most of the studies targeted health professionals' factors and resources, while no strategies addressing patient, guideline, and organizational factors were identified from the included literature. CONCLUSIONS:Although existing ICTs extensively support health professionals' factors and available resources, future research should explore the potential of ICTs in targeting patient engagement, organizational or policy factors, while considering contextual circumstances.
BACKGROUND:Transcutaneous spinal cord stimulation (tSCS) is an emerging noninvasive neuromodulation approach for rehabilitation in individuals with stroke. Studies have suggested benefits, but evidence remains fragmented and methodologically heterogeneous. OBJECTIVE:This scoping review maps and synthesizes current evidence on tSCS for stroke rehabilitation, focusing on study design, stimulation parameters, outcome measures, and reported effects. METHODS:Following PRISMA-ScR guidelines, we systematically searched five databases (PubMed, Embase, Web of Science, CINAHL, and Google Scholar) from inception to December 2025. Two independent reviewers screened titles and abstracts, with a third resolving discrepancies. We extracted data on participant characteristics, stimulation parameters, outcome measures, and findings. RESULTS:Thirteen studies met inclusion criteria, comprising five randomized and eight non-randomized designs, with sample sizes ranging from 2 to 21 participants. Most studies enrolled predominantly male individuals with chronic stroke. Four studies used multi-session protocols while nine single session protocols. Stimulation parameters varied widely amplitude (5-250 mA), frequency (15-100 Hz), carrier frequency (0-10 kHz), and pulse width (0.5-2 ms). Ten studies targeted lower-extremity function, two upper extremity functions, and one autonomic function. Multi-session trials pairing tSCS with task-specific training reported improvements in selected outcomes, though small sample sizes limit generalization. CONCLUSIONS:tSCS remains an exploratory adjunctive intervention in stroke rehabilitation. Future research should prioritize adequately powered controlled trials with standardized stimulation protocols, stratification by stroke severity and chronicity, and long-term follow-up to establish clinical efficacy and optimal implementation in stroke rehabilitation.
BACKGROUND:Stroke incidence among working-age adults is increasing, making return to work (RTW) a key milestone in recovery and quality of life. However, post-stroke professional reintegration remains challenging, often requiring survivors to manage physical and cognitive impairments, fatigue, and insufficient workplace adaptations, in the absence of specific policies or guidelines and qualitative evidence. OBJECTIVES:This brief report explores Portuguese stroke survivors' RTW experiences, focusing on perceived consequences, barriers, and enablers. METHODS:This study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. A total of 1,175 stroke survivors completed a questionnaire 18-24 months after stroke, and a heterogeneous subsample participated in semi-structured interviews (n = 22). Qualitative data from stroke survivors who were employed before the event were analyzed using thematic analysis. RESULTS:Five major themes emerged. RTW was facilitated by employer and coworker support, workplace adaptations, and lower levels of post-stroke impairment. Survivors who returned to work reported positive emotional and social outcomes, such as restored normalcy and reduced social isolation, alongside negative experiences, including insecurity, stress, and fear of reduced performance. Barriers to RTW included persistent impairments, changes in workplace dynamics, and the lack of formal reintegration support. Participants highlighted the need for flexible working conditions, personalized and long-term monitoring, legal protection, and financial support. Conclusions: These findings emphasize the need for tailored, evidence-based professional reintegration strategies to support stroke survivors' sustainable RTW and overall well-being.
BACKGROUND:Neuropathic pain and pain catastrophizing are common after stroke and may be associated with poorer rehabilitation outcomes. However, their independent associations with functional recovery remain insufficiently explored. OBJECTIVES:This study aimed to determine the frequency of neuropathic pain and pain catastrophizing in patients with stroke and to examine their associations with post-treatment rehabilitation outcomes. METHODS:In this prospective observational study, patients with post-stroke hemiplegia undergoing inpatient rehabilitation were evaluated at baseline and after a 4-week rehabilitation program. Functional status was assessed using the Barthel Index, Brunnstrom Staging, Modified Ashworth Scale, and Functional Ambulation Classification. Quality of life was assessed using the SF-12. Neuropathic pain and pain catastrophizing were assessed using the painDETECT questionnaire and Pain Catastrophizing Scale. Baseline-adjusted linear regression models examined whether baseline painDETECT and Pain Catastrophizing Scale scores were independently associated with post-treatment outcomes. RESULTS:Eighty patients were included. At baseline, 10 patients (12.5%) had possible neuropathic pain, 17 (21.3%) had definite neuropathic pain, and 15 (18.8%) had clinically significant pain catastrophizing. After rehabilitation, possible and definite neuropathic pain were observed in 5 (6.3%) and 8 patients (10.0%), respectively, and clinically significant pain catastrophizing in 9 patients (11.3%). Functional and pain-related outcomes improved after rehabilitation. In adjusted models, higher baseline Pain Catastrophizing Scale scores were independently associated with lower post-treatment Barthel Index and Functional Ambulation Classification scores. Baseline painDETECT scores were not independently associated with post-treatment outcomes. CONCLUSIONS:Pain catastrophizing, but not painDETECT score, was independently associated with poorer post-treatment functional independence and ambulation.
BACKGROUND:Stroke is a leading cause of long-term disability globally, substantially impairing quality of life (QoL) in survivors. While maladaptive metacognitive beliefs is regarded as a potentially influential factor, the underlying mechanism through which it influences QoL remains unclear. AIMS:To investigate QoL among stroke survivors, identify its influencing factors, and explore the mediating role of rehabilitation motivation between maladaptive metacognitive beliefs and QoL as well as the moderating role of education level. METHODS:In this cross-sectional study, 772 convalescent stroke survivors were recruited from four Grade A tertiary hospitals in Henan Province, China, between October 2024 and August 2025. Data were collected using general characteristics questionnaire, the Metacognition Questionnaire, the Stroke Rehabilitation Motivation Scale, the Short-Version Stroke-Specific Quality of Life Scale, and the Barthel Index. Model 7 in process version 4.1 was used to test the moderated mediation model. RESULTS:QoL was significantly correlated with occupation, residential status, stroke family history, stroke type, activities of daily living (ADL), metacognition, and rehabilitation motivation. The moderated mediation model involving rehabilitation motivation and education level for explaining how metacognition was associated with QoL was validated. Specifically, the mediating pathway through rehabilitation motivation was stronger among stroke survivors with higher education compared with those with lower education. CONCLUSION:Among stroke survivors, the association of metacognition with QoL is mediated by rehabilitation motivation, with this association being amplified by education level. For stroke survivors with varying education levels, interventions such as metacognitive therapy may improve metacognitive abilities, enhance rehabilitation motivation, and thereby promote QoL.
OBJECTIVE:This study aimed to compare cortical activation and functional connectivity (FC) during a thumb-to-finger opposition task in stroke patients stratified by hand function level, and to explore the modulatory role of hand dominance. METHODS:Fifty-two right-handed stroke patients were divided into low-function (LFG, n = 28) and high-function (HFG, n = 24) groups based on task performance. Using 49-channel functional near-infrared spectroscopy (fNIRS), activation and FC were assessed in bilateral premotor/supplementary motor area (PMC&SMA), sensorimotor cortex (SMC), primary motor cortex (M1), and dorsolateral prefrontal cortex (DLPFC). Activation was analyzed via paired t-tests, FC matrices using Pearson's correlation, and the effects of task and hand dominance via linear mixed models. RESULTS:Only the LFG showed a significant task-related increase in right DLPFC activation (q = 0.009), with a significant between-group difference (q = 0.019). FC analysis revealed stronger and more extensive connections in the HFG, particularly between M1 and PMC&SMA. In the LFG, FC significantly increased during the task (p = 0.006), and a significant task-by-hand dominance interaction was observed (p = 0.037), indicating that FC modulation depended on whether the affected hand was dominant. No such effects were found in the HFG. CONCLUSIONS:Post-stroke functional level distinctly influences cortical activation and FC during fine motor tasks. Lower-function patients rely more on cognitive resources (DLPFC) and exhibit FC modulated by task demands and hand dominance, whereas higher-function patients demonstrate efficient integration within core motor networks. These findings support function-level-dependent neural reorganization and highlight the need for stratified, individualized rehabilitation strategies that consider both functional capacity and hand dominance.
PURPOSE:This integrative review aimed to identify cognitive strategy interventions supporting rehabilitation engagement and activity-level outcomes for individuals with post-stroke cognitive impairments. MATERIALS AND METHODS:Following Joanna Briggs Institute (JBI) methodology and PRISMA-ScR checklist, comprehensive searches were conducted in Embase, CINAHL, Scopus, MEDLINE, and PsycINFO. Two reviewers independently performed study selection and data extraction, using the TIDieR checklist and QuADS for quality assessment. RESULTS:From 35,250 articles screened, 40 studies met the inclusion criteria, half (n = 20) were randomised controlled trials. Interventions were delivered between 6 days and 9.5 years post-stroke. Cognitive strategies included 20 domain-specific, 12 mental practice, and 8 global approaches. Global approaches were most consistent, though applicability across cognitive impairment type remains unclear. Domain-specific strategies target impairment directly and aim for transfer to functional outcomes, while mental practice approaches may only be suitable for mildly impaired cognition. Across studies, 47 different primary outcome measures were reported, with the Functional Independence Measure and Barthel Index used the most, across 10 studies each. CONCLUSIONS:Three cognitive strategy categories were identified. Outcome measures lacked consistency and there was a notable lack of stakeholder involvement. Future research should standardise interventions and outcome measures to enable systematic evidence synthesis and inform clinical guidelines.
BACKGROUND:Post-stroke upper-limb spasticity can limit motor recovery and functional use of the affected arm. This randomized controlled trial investigated whether repetitive transcranial magnetic stimulation combined with soft robotic glove training improves wrist flexor spasticity and upper-limb motor function in patients with stroke. METHODS:Fifty-four patients were randomized to the rTMS + SRG group or the sham rTMS + SRG group. Four participants withdrew for reasons unrelated to the trial or early hospital discharge, and 50 participants completed the intervention and post-intervention assessment. Both groups received 12 treatment sessions over two weeks in addition to conventional rehabilitation. The primary outcome was wrist flexor spasticity assessed using the Modified Ashworth Scale (MAS). Secondary outcomes included the Fugl-Meyer Assessment for Upper Extremity (FMA-UE) and the Hmax/Mmax ratio. RESULTS:Wrist flexor spasticity decreased significantly in the rTMS + SRG group after treatment (p = 0.0051), but not in the sham rTMS+SRG group (p = 0.98). The between-group comparison of change scores also favored the rTMS+SRG group (p = 0.021). FMA-UE scores improved significantly in both groups (both p < 0.0001), with greater improvement in the rTMS + SRG group (p = 0.038). The Hmax/Mmax ratio decreased significantly in the rTMS + SRG group (p = 0.030), whereas the between-group difference in change scores was not statistically significant (p = 0.086). CONCLUSION:Compared with sham rTMS combined with soft robotic glove training, rTMS combined with soft robotic glove training produced greater reductions in wrist flexor spasticity and greater improvements in upper-limb motor function after stroke.
BACKGROUND:Collaborative management has been proposed as an effective strategy to enhance disease management. Common coping, positive illness perceptions, and strong resilience are crucial to enhancing collaborative management. The relationship between these variables is still unclear. AIMS:This study aimed to explore the influence of common coping on collaborative management among spousal caregivers, and to examine the mediating role of illness perception and the moderating effect of resilience. METHODS:This study was conducted on spousal caregivers of stroke survivors between May 2024 and September 2024 in Zhengzhou. Self-reported questionnaires were used to assess general information, illness perception, resilience, common coping, and collaborative management. Data analysis was performed using SPSS version 27.0. Pearson correlation and multiple linear regression analyses were conducted to examine relationships among the variables. Mediation and moderated mediation models were tested using PROCESS macro. RESULT:A total of 578 dyads completed the questionnaire. Spousal caregivers' collaborative management was at a moderate level. A significant association was found between common coping and collaborative management. Illness perception significantly mediated this relationship, while resilience moderated the path from illness perception to collaborative management. Notably, the mediating effect of illness perception was not significant among spousal caregivers with high resilience. CONCLUSION:Among spousal caregivers of stroke survivors, common coping directly influenced collaborative management. This relationship was partially mediated through illness perception, with resilience moderating the association between common coping and collaborative management. Interventions targeting common coping, illness perception, and resilience may enhance collaborative management among spousal caregivers.
BACKGROUND:Gait alterations after stroke may lead to knee pain, limiting rehabilitation and reducing quality of life. OBJECTIVES:To estimate the prevalence of knee pain and identify associated factors in ambulatory chronic stroke survivors. METHODS:We conducted a cross-sectional study in 12 outpatient rehabilitation units in Vietnam, enrolling 212 patients with stroke. We recorded demographics, morbidities, knee pain, clinical examination findings and gait parameters. Weight-bearing asymmetry was measured using a two-scale method. Minimal knee flexion during the stance phase was derived from markerless gait analysis. Factors associated with knee pain were assessed using modified Poisson regression with robust standard errors to estimate adjusted prevalence ratios (aPRs). Multinomial logistic regression was performed to identify factors associated with pain laterality. RESULTS:The prevalence of knee pain was 19.8%. The following factors were independently associated with knee pain: age (aPR: 1.03; 95% CI: 1.01-1.06), stroke type (aPR: 2.51; 95% CI: 1.55-4.09), time since stroke onset (aPR: 1.08; 95% CI: 1.04-1.12), prior knee osteoarthritis (aPR: 2.27; 95% CI: 1.31-3.91), obesity (aPR: 1.84; 95% CI: 1.14-2.96), and quality of life (aPR: 0.02; 95% CI: 0.01-0.06). Smaller minimal knee flexion was associated with a higher risk of ipsilateral knee pain (p = 0.009). CONCLUSION:The prevalence of knee pain among ambulatory chronic stroke survivors was approximately 20%. Older age, hemorrhagic stroke, longer poststroke time, obesity, prior knee osteoarthritis, and poorer quality of life were independently associated with knee pain. Greater hyperextension during stance was associated with a higher risk of knee pain in the affected limb.
BACKGROUND:Dysphagia is a highly prevalent condition among patients with stroke. Cervical auscultation serves as a crucial screening method for dysphagia detection. The advancement of artificial intelligence has enabled acoustic analysis to emerge as a viable alternative to manual auscultation. While high-quality breath sound recordings are fundamental for reliable acoustic analysis in dysphagia screening, current clinical practice lacks standardized protocols for acquiring cervical respiratory sounds during auscultation. OBJECTIVE:To investigate the optimal acquisition protocol for cervical breath sounds in dysphagia patients after stroke using orthogonal experimental design. METHOD:The experimental design incorporated three key factors (auscultation position, dressing material, and tape type) with three levels each, configured into an L9(33) orthogonal array. Cervical breath sound data were systematically acquired from 298 dysphagia patients across nine protocol variations. Acoustic signal processing quantified three parameters: signal-to-noise ratio (SNR), aggregate entropy, and average power. RESULTS:Statistical analysis revealed that Factor A (auscultation position), Factor B (dressing material), and Factor C (tape type) demonstrated significant effects (p < 0.05) on signal-to-noise ratio (SNR), aggregate entropy, and average power. The optimal configuration (A1B1C3) achieved maximum SNR (37.35 dB), maximum average power (78.79 dB), and minimum aggregate entropy (1.51 bits). CONCLUSIONS:The optimal acquisition protocol involves positioning the stethoscope on the lateral trachea immediately below the cricoid cartilage, maintaining direct skin contact without interposing dressing materials, and secured with medical-grade pressure-sensitive tape. These evidence-based specifications offer technical guidance and standardized procedures for clinical implementation of cervical auscultation in the assessment of dysphagia after stroke.
OBJECTIVES:Thismeta-analysis compared the efficacy of advanced nursing program and usualnursing on the prognosis and quality of life of patients with stroke. METHODS:TheCochrane Library, PubMed, Web of Science, and Scopus were systematically searchedfrom their establishment to 13 July 2025, to identify randomized controlledtrials comparing the effect of advanced nursing program with usual nursing careon perceived stroke severity, quality of life, and psychological outcomes ofpatients suffering from stroke. This meta-analysis was conducted using arandom-effects model. RESULTS:Finally, 18 randomized controlled trials with 2845 participantswere eligible for inclusion. Compared to usual nursing care, advancednursing program significantly increased the Barthel index (SMD 0.70),suggesting an improvement in activities of daily living. Furthermore, advancednursing program significantly increased SS-QOL (SMD 4.12), EQ-5D-5 (SMD 0.73), SF-36general health (SMD 2.23), SF-36 mental health (SMD 1.49), and SF-36 physicalfunction (SMD 1.69) scores, suggesting an improvement in health-related qualityof life. Advanced nursing program markedly decreased the NIHSS score (SMD -0.82),indicating decreased disease severity. Moreover, advanced nursing program significantlydecreased SAS (SMD -4.78), HADS-anxiety (SMD -0.40), SDS (SMD -3.68), andHADS-depression (SMD -0.30) scores, suggesting great improvement in depressionand anxiety. CONCLUSION:The integration of advancednursing program can significantly improve the function, quality of life,anxiety, and depression in patients with stroke.
PURPOSE:To evaluate the synergistic mechanisms and clinical efficacy of integrating acupuncture with modern rehabilitation (including functional swallowing training and neuromuscular electrical stimulation) for post-stroke dysphagia (PSD). MATERIALS AND METHODS:This is a narrative review with a systematic literature approach.This review synthesizes evidence from recent randomized controlled trials, meta-analyses, and mechanistic studies on combined acupuncture and rehabilitation interventions for PSD. Key outcomes assessed include swallowing function (VFSS, FOIS), aspiration pneumonia rates, and quality-of-life measures. RESULTS:Current evidence demonstrates that combining acupuncture with conventional rehabilitation yields superior improvements in swallowing function, oral intake, and aspiration reduction compared to rehabilitation alone. Acupuncture enhances neuroplasticity, modulates central and peripheral swallowing circuits, and reduces inflammation, while rehabilitation strengthens neuromuscular coordination. Synergistic effects arise as acupuncture primes neural substrates, facilitating more efficient gains from rehabilitative exercises. However, challenges include heterogeneity in acupuncture protocols, limited mechanistic clarity, and practitioner variability. CONCLUSIONS:Integrative therapy combining acupuncture and modern rehabilitation represents a potentially promising strategy that requires further validation through ri-gorously designed studies for managing PSD. With further standardization, mechanistic research, and international collaboration, this approach could become a widely accepted, effective treatment to improve swallowing recovery and quality of life among stroke survivors.
OBJECTIVE:To compare the effects of different exercise modalities on lower-limb balance and functional motor performance after stroke and to examine their nonlinear dose-response relationships to identify potentially optimal exercise doses using a Bayesian network meta-analysis. METHODS:A systematic search of PubMed, Embase, Web of Science, the Cochrane Library, and SPORTDiscus identified 54 randomized controlled trials (RCTs). A Bayesian random-effects dose-response network meta-analysis examined associations between total exercise dose, exercise modalities, and lower-limb balance and functional mobility after stroke. RESULTS:Both lower-limb balance and functional movement outcomes showed clear nonlinear improvements with increasing total exercise doses, peaking at approximately 1,800-2,200 MET×min/week. Beyond this range, marginal benefits plateaued or declined, with greater inter-individual variability. For lower-limb balance, gains stabilized or slightly decreased past 2,200 MET×min/week. Functional movement improvements formed an early plateau at around 1,800 MET×min/week, sustained up to 2,200, then gradually diminished. Exercise modalities displayed distinct dose sensitivities: integrated aerobic training (IAT) rapidly achieved peak benefits at moderate loads, supporting early rehabilitation; motor control training (MCT) maintained stable effects over a broader range, facilitating long-term neuromuscular reinforcement; virtual reality training (VRT) showed localized peaks at low to moderate doses but exhibited increased uncertainty at higher levels. CONCLUSIONS:This study suggests that moderate weekly exercise doses may improve lower-limb balance and functional mobility after stroke, with dose-response patterns differing across exercise modalities. These findings support dose regulation and individualized exercise prescription, although further high-quality trials are needed to confirm the observed dose ranges and modality-specific effects.
