BackgroundStroke often leads to persistent upper-limb motor impairment, which significantly impairs quality of life. Conventional physical therapy (CPT) has limitations, including insufficient intensity, limited patient engagement, and inadequate feedback. Emerging technologies such as virtual reality (VR), robotics (ROT), and brain–computer interfaces (BCI) have shown promise; however, direct comparisons among these approaches are lacking, and their relative effectiveness remains unclear.ObjectiveThis study aimed to systematically evaluate and compare the relative effectiveness of VR, robotics, and BCI on upper limb motor function, motor performance, and activities of daily living in stroke survivors using network meta-analysis.MethodsPRISMA-NMA guidelines were followed. PubMed, Web of Science, Cochrane Library, and Embase were searched from inception to October 2025 for RCTs. Two reviewers independently screened studies, extracted data, and assessed risk of bias using RoB 2.0. A Bayesian random-effects network meta-analysis (R package gemtc) was performed to estimate relative treatment effects and calculate SUCRA values, along with sensitivity and subgroup analyses.Results25 RCTs (1,145 stroke survivors) were included. The network evidence geometry was star-shaped, with conventional physical therapy (CPT) as the common comparator. For FMA-UE, ROT-RFE achieved the highest SUCRA ranking, although this estimate was based on a single study. ROT-CPT and ROT, supported by two and three studies respectively, provided more consistent evidence. For secondary outcomes, ROT-CPT ranked highest for MBI (SUCRA = 0.89), whereas VR-CPT ranked highest for WMFT (SUCRA = 0.59). Sensitivity analyses generally supported robustness, and subgroup analyses suggested patient characteristics may influence treatment effects.ConclusionFor improving upper-limb motor function after stroke, robotics-based interventions were supported by stronger evidence than other modalities. Specifically, ROT (SUCRA = 0.71, 3 studies) and ROT-CPT (SUCRA = 0.70, 2 studies) demonstrated consistent and clinically meaningful improvements, representing more reliable options for clinical practice. While a single robotics variant (ROT-RFE, SUCRA = 0.91) achieved a numerically higher ranking, this estimate was based on one trial and should not be interpreted as definitive evidence of superiority. VR-based interventions showed modest benefits, whereas BCI-based interventions were supported by only one eligible study with extractable data and no reliable conclusions can be drawn.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251180631, identifier: CRD420251180631.
BackgroundMethanol poisoning is a significant public health problem associated with high mortality and severe neurological damage. This study aimed to evaluate the relationship between central nervous system (CNS) findings, blood methanol levels, and hospitalization duration in fatal methanol poisoning cases.Materials and methodsA total of 111 cases with confirmed death due to methanol poisoning, autopsied between January 1, 2021 and June 30, 2025, were retrospectively analyzed. Scene investigation, clinical, toxicological, and histopathological findings were evaluated. CNS findings were analyzed in relation to methanol concentrations and duration of hospitalization. Statistical analyses were performed using IBM SPSS Statistics version 27.ResultsThe majority of cases occurred during the COVID-19 period (66.7%), with a marked male predominance (92.8%). Exposure most frequently occurred in domestic settings (58.6%). The mean blood methanol level was 230.2 mg/dl (range: 12–827), and levels > 100 mg/dl were detected in 59.5% of cases. Higher blood methanol levels were significantly associated with shorter hospitalization duration (p < 0.001). A substantial proportion of high-dose cases resulted in death within the first 48 h. CNS findings, including necrosis, hemorrhage, and severe parenchymal softening, were significantly more frequent in cases with longer durations of hospitalization (p < 0.001).ConclusionNeuropathological findings were more frequently observed in cases with longer hospitalization durations. In high-dose methanol intoxication, rapid death may prevent the development of detectable structural CNS lesions; therefore, the absence of CNS pathology does not exclude fatal methanol intoxication. Furthermore, postmortem methanol levels may be reduced by medical treatment, emphasizing the need for a comprehensive forensic evaluation integrating toxicological, clinical, and treatment data.
ObjectiveThis systematic review and meta-analysis evaluated the effects of robot-assisted gait training (RAGT) on balance, functional mobility, walking endurance, and spatiotemporal gait parameters in patients with Parkinson’s disease.MethodsPubMed, Embase, Web of Science, the Cochrane Library, CNKI, trial-registry sources, and supplementary search sources were searched from inception to the final search date. The protocol was retrospectively registered on the Open Science Framework (OSF; https://osf.io/njp39/) during manuscript revision. Randomized controlled trials comparing RAGT with conventional rehabilitation, treadmill training, balance training, medication, or usual care were included. In total, two reviewers independently screened records, extracted data, and assessed risk of bias. Hedges’ g and, in parallel, post-intervention mean differences (MDs) in the original clinical units were calculated using random-effects models. Subgroup, sensitivity, publication-bias, and GRADE analyses were conducted where data permitted; meta-regression analyses were treated as exploratory because each outcome included fewer than 10 studies and are reported only in the Supplementary Appendix.ResultsA total of 12 RCTs were included. RAGT was associated with better BBS scores (Hedges’ g = 1.08, 95% CI: 0.55 to 1.62; MD = 3.49 points, 95% CI: 1.85 to 5.12), shorter TUG time (Hedges’ g = −0.47, 95% CI: −0.77 to −0.16; MD = −1.82 s, 95% CI: −2.67 to −0.96), and a longer 6MWD (Hedges’ g = 2.21, 95% CI: 0.53 to 3.90; MD = 35.82 m, 95% CI: −0.94 to 72.58). Cadence increased by 4.14 steps/min (95% CI: 1.83 to 6.46), and step length increased by 5.70 cm (95% CI: 0.25 to 11.15). However, BBS, 6MWD, and step length showed substantial heterogeneity, and Egger’s tests suggested possible small-study effects or publication bias for several outcomes.ConclusionRAGT may be a promising adjunct to rehabilitation for PD, but the magnitude of benefit is uncertain, and the true effects may be smaller than the pooled estimates. Current evidence should be interpreted cautiously because of small trials, heterogeneous devices and comparators, underreported safety outcomes, risk of bias, and possible publication bias.Systematic review registrationhttps://osf.io/njp39/, identifier (njp39).
Non-invasive brain stimulation (NIBS), including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), has been widely used as an adjunctive intervention for upper limb motor recovery after stroke; however, the treatment completion rates and comparative safety profiles across different NIBS modalities have not been systematically evaluated. This systematic review and network meta-analysis aimed to assess and compare the treatment completion rates of various NIBS interventions for post-stroke upper limb rehabilitation. We systematically searched six databases and trial registries (PubMed, Embase, Cochrane CENTRAL, CINAHL, WHO ICTRP, and ClinicalTrials.gov) for randomized controlled trials (RCTs) published up to January 20, 2025, with an updated search conducted to April 15, 2026. Random-effects single-arm meta-analyses using the Freeman-Tukey double arcsine transformation were performed to pool completion rates, and a Bayesian random-effects network meta-analysis estimated relative risks (RRs) with 95% credible intervals (CrIs); treatments were ranked using surface under the cumulative ranking curve (SUCRA) values. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. The protocol was registered with PROSPERO (CRD420261309536). Fifty-five RCTs comprising 68 comparisons and 2,640 participants were included. The pooled intervention group completion rate was 94.9% (95% CI: 93.3–96.4%; I2 = 46.8%). The network meta-analysis showed no statistically significant differences in completion rate between any NIBS intervention and sham/control (all 95% CrIs included 1.00). SUCRA rankings indicated that intermittent theta burst stimulation (iTBS; 71.1%), bilateral rTMS (BL-rTMS; 60.9%), and dual transcranial direct current stimulation (Dual-tDCS; 58.1%) ranked highest. The overall adverse event (AE) rate was 16.4% (95% CI: 8.5–26.2%) in intervention groups, predominantly mild headache and skin tingling, with an AE-related dropout rate of only 1.1%. Subgroup analyses showed higher completion rates for tDCS (96.8%) than rTMS (93.9%), with the chronic phase highest (97.1%) and the mixed phase lowest (89.1%). The LFK index was 0.04, indicating no publication bias. In conclusion, NIBS for post-stroke upper limb rehabilitation demonstrates favorable tolerability and safety, with an overall completion rate of approximately 95%. Exploratory SUCRA rankings placed iTBS, BL-rTMS, and Dual-tDCS in the top three positions; however, these rankings should be considered hypothesis-generating rather than definitive, as four interventions were informed by only a single study, absolute differences in completion rates were minimal, and all pairwise credible intervals included 1.00. These observed phase-specific differences suggest that stroke phase may be an important factor to consider when designing adherence strategies, although prospective evaluation of tailored interventions is needed.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420261309536, PROSPERO (Registration ID: CRD420261309536).
IntroductionAcupuncture at Lianquan (CV23) is an effective intervention for post-stroke dysphagia (PSD); however, the central neural regulatory mechanisms remain unclear. This study used functional near-infrared spectroscopy (fNIRS) with deqi assessment to compare cortical activation during acupuncture at CV23 between PSD patients and healthy controls, and to examine the correlation between deqi intensity and cortical activation.MethodsIn this cross-sectional study, 21 PSD patients (PSD group) and 29 healthy controls (HC group) received acupuncture at CV23. fNIRS was used to monitor hemodynamic responses in the bilateral primary motor cortex (M1), premotor cortex/supplementary motor area (PMC/SMA), dorsolateral prefrontal cortex (DLPFC), supramarginal gyrus (SMG), primary somatosensory cortex (S1), and somatosensory association cortex (SAC) throughout a pre-stimulation baseline and three needle manipulation blocks. Deqi intensity was assessed with a visual analog scale (VAS). In patients with left-hemisphere lesions, fNIRS channels were mirrored to the right side, so “left” and “right” denoted the contralesional and ipsilesional sides.ResultsIn the PSD group, oxygenated hemoglobin (HbO) concentrations during the needle manipulation period were significantly higher than those at the pre-stimulation baseline in the contralesional M1 (p = 0.040), contralesional SAC (p = 0.040), and contralesional SMG (p = 0.040); meanwhile, deoxygenated hemoglobin (HbR) decreased in the contralesional S1 and SMG (p < 0.05), whereas no significant changes were observed in the HC group. Compared with the HC group, the PSD group exhibited significantly higher HbO concentrations in the contralesional SAC (p = 0.012), contralesional M1 (p = 0.014), contralesional S1 (p = 0.014), contralesional SMG (p = 0.014), and ipsilesional SAC (p = 0.014). The total deqi score, suan (aching or soreness), and zhang (fullness/distention or pressure) were significantly higher in the PSD group (p < 0.05). Significant correlations were observed between deqi sensations and cortical activation in the PSD group, while no significant correlations were observed in the HC group.ConclusionAcupuncture at CV23 in PSD may be associated with altered activation in the contralesional sensorimotor network (M1, S1, SAC, and SMG), and deqi intensity was associated with cortical activation, providing fNIRS evidence for the association between acupuncture and the central mechanisms of PSD.
BackgroundRestless Legs Syndrome (RLS) seriously affects the sleep and life quality of patients, yet it often leads to delay in diagnosis and treatment due to a lack of awareness. Clinical studies on RLS, particularly regarding its epidemiology in uremia patients, remain relatively scarce.ObjectiveThis study conducted a clinical analysis to assess the frequency of RLS among hemodialysis patients and to explore its impact on their sleep and quality of life.MethodsWe collected clinical data and laboratory results from 147 uremia patients undergoing maintenance hemodialysis at Xiangyang Central Hospital. Independent risk factors for RLS were evaluated using univariate and multivariate logistic regression. Sleep quality and quality of life were assessed using the Pittsburgh Sleep Quality Index (PSQI) and the 36-item Short-Form Health Survey (SF-36), respectively. We compared these outcomes between the RLS and non-RLS groups.ResultsAmong the 147 patients, 30 (20.41, 95% CI, 14.0–27.0%) were diagnosed with RLS. Multivariate logistic regression analysis, performed with caution due to the limited number of RLS cases (n = 30), identified β2-microglobulin, dialysis duration, and parathyroid hormone as potential independent risk factors for RLS in this population. Compared to the non-RLS group, patients with RLS had significantly lower physiological function scores on the SF-36 (p < 0.05). Furthermore, the RLS group exhibited significantly higher PSQI scores in the domains of subjective sleep quality, sleep persistence, habitual sleep efficiency, and daytime dysfunction (p < 0.05).ConclusionThe incidence of RLS is notably elevated in uremia patients on maintenance hemodialysis. RLS significantly impairs both sleep quality and the physiological function of these patients. Early identification and management of RLS are crucial for improving their overall well-being. Further large-scale studies are warranted to confirm the identified risk factors.Clinical trial registrationMedicalResearch.org.cn, MR-42-24-017773.
BackgroundIntravenous tirofiban administered before endovascular treatment (EVT) did not improve 90-day outcomes compared to placebo in the RESCUE BT trial, and sex-specific heterogeneity remained uncertain. In this study, we aimed to evaluate the association between sex and tirofiban administration before EVT among patients enrolled in the RESCUE BT trial.Materials and methodsThis post hoc analysis used data from the RESCUE BT trial, which enrolled 948 patients with large vessel occlusion (LVO). Patients received intravenous tirofiban or a placebo before EVT. Comparisons between different groups were conducted using logistic regression. Additionally, the interaction between sex and treatment was tested. The primary effectiveness outcome was a modified Rankin Scale (mRS) score of 0–2 at 90 days; safety outcomes included symptomatic intracranial hemorrhage (sICH) within 48 h and mortality at 90 days.ResultsOf the 948 patients, 391 (41.2%) were women. The interaction between sex and treatment for a 90-day mRS score of 0–2 was not statistically significant (P for interaction = 0.103). However, in the tirofiban arm, women were less likely to achieve an mRS score of 0–2 at 90 days (adjusted odds ratio (aOR), 0.57; 95% confidence interval (CI), 0.36–0.90; p = 0.02) compared to men. In analyses stratified by sex, tirofiban was not associated with improved functional outcomes compared to placebo in either women or men. No sex-related differences were observed in symptomatic intracranial hemorrhage within 48 h or mortality at 90 days.ConclusionIn this exploratory analysis, no significant interaction between sex and treatment was identified, indicating that the association between tirofiban and 90-day outcomes did not differ by sex. Although women in the tirofiban arm had lower odds of achieving an mRS score of 0–2 at 90 days than men, this finding should be interpreted as hypothesis-generating and warrants further validation.
BackgroundThe present study aimed to evaluate the efficacy and safety of balloon dilatation for the treatment of swallowing disorders after stroke.MethodsPubMed, Embase, the Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), VIP, and the Chinese Wanfang database were searched from their inception to 30 October 2024. Two authors independently screened all studies, extracted data, and evaluated the risk of bias in the included studies. Review Manager 5.4 and Stata software (version 16) were used to assess study quality.ResultsA total of 25 studies involving 1,134 patients were included in the present analysis. The results suggest that balloon dilatation significantly improves the effective rate (OR = 6.11; 95% CI: 4.16, 8.98), videofluoroscopic swallowing study (VFSS) score (MD = 2.23, 95% CI: 1.98, 2.48), and Functional Oral Intake Scale (FOIS) score (MD = 1.93, 95% CI: 1.40, 2.47); it also shortens swallowing passage time (MD = −0.07; 95% CI: −0.08, −0.06), improves the Kubota Drinking Water Test (KDWT) score (MD = −1.01, 95% CI: −1.55, −0.47), and reduces the incidence of aspiration pneumonia (OR = 0.46; 95% CI: 0.21, 0.98).ConclusionCompared to routine rehabilitation training, balloon dilation is a safer and more effective method for improving swallowing function.
ObjectiveTo develop and validate an interpretable nomogram that integrates an imaging score, clinical characteristics, and machine-learning models to predict 90-day functional outcomes in patients with acute ischemic stroke (AIS) and large-vessel occlusion (LVO).MethodsWe analyzed 240 AIS patients with anterior circulation LVO who underwent one-stop multimodal CT between October 2019 and December 2024. Fifty-two variables, including pretreatment clinical features, conventional and advanced imaging, and angiographic characteristics, were assessed. The 90-day modified Rankin Scale (mRS-90) was used as the prognostic endpoint; good and poor outcomes were defined as mRS-90 ≤ 2 and > 2, respectively. Patients were randomly assigned to training (80%, n = 192) and testing (20%, n = 48) cohorts. Least absolute shrinkage and selection operator (LASSO) regression was used to derive the imaging score, which was then combined with key clinical predictors to construct a nomogram. Clinical, imaging, and hybrid models were developed separately and evaluated using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA). Repeated stratified 5-fold cross-validation repeated 20 times was performed as a stability analysis of the fixed final model structures. SHapley Additive Explanations (SHAP) was applied to identify influential features and visualize feature importance and interactions.ResultsAmong 240 patients, 162 (67.5%) had unfavorable 90-day functional outcomes. Patients with unfavorable outcomes were generally older, had higher admission NIHSS scores, and showed less favorable collateral and perfusion profiles. Age, admission NIHSS score, and onset-to-CT time were retained as clinical predictors, while eight imaging features were integrated into the imaging score. Adding the imaging score did not significantly improve discrimination in the testing cohort (ΔAUC, 0.0078; 95% CI, −0.0071 to 0.0227; P = 0.305). In repeated stratified 5-fold cross-validation performed 20 times, the mean AUCs were 0.942, 0.747, and 0.939 for the clinical, imaging, and hybrid models, respectively. SHAP analysis characterized the contributions of age, NIHSS, onset-to-CT time, and the composite imaging score within the four-input hybrid model.ConclusionsAn interpretable model combining routine clinical predictors with a multimodal CT-derived imaging score demonstrates promising predictive potential for 90-day functional outcome in patients with AIS-LVO.
PurposeDistal intracranial aneurysms (IAs) of the posterior circulation are rare and often pose significant surgical challenges. Although endovascular treatment (EVT) has emerged as an alternative, clear management guidelines remain lacking. We report a single-center experience with EVT for these complex lesions, focusing on procedural outcomes, complications, and follow-up results.MethodsWe retrospectively reviewed patients with distal posterior circulation IAs who underwent EVT at our institution between January 2017 and December 2024. Treatment strategies were individualized based on aneurysm morphology, vascular access tortuosity, parent artery (PA) caliber, distal collateral circulation, and the functional importance of the PA territory. Outcomes assessed included technical success, perioperative complications, angiographic occlusion, and clinical status at the last follow-up, as measured by the modified Rankin Scale (mRS).ResultsNineteen patients (10 men, 9 women; median age 58 years) with 19 aneurysms were included. Aneurysm locations were posterior cerebral artery (n = 8), posterior inferior cerebellar artery (n = 7), anterior inferior cerebellar artery (n = 3), and superior cerebellar artery (n = 1). Fifteen aneurysms were ruptured, and 15 were dissecting in nature. EVT was technically successful in all cases with no intraprocedural complications. Treatment modalities included intra-aneurysmal coiling (n = 7), stent-assisted coiling (SAC, n = 2), and parent artery occlusion (PAO, n = 10). Immediate complete occlusion was achieved in 5/7 coiled aneurysms, 2/2 SAC aneurysms, and all 10 PAO aneurysms. No new neurological deficits occurred in patients who underwent intra-aneurysmal coiling or SAC, while five patients with insufficient collateral circulation who underwent PAO developed territorial infarction with neurological deficits. At a mean follow-up of 8.4 months, all PAO and SAC aneurysms remained stably occluded. However, three of seven coiled aneurysms—all of which were saccular-configured dissecting aneurysms—showed recurrence. No rebleeding occurred. Favorable functional outcomes (mRS ≤ 2) were achieved in 18 patients (94.7%).ConclusionFor surgically intractable distal posterior circulation aneurysms, EVT represents a viable alternative. Individualized treatment strategies should be formulated according to aneurysm characteristics, vascular access tortuosity, parent artery caliber, distal collateral perfusion, and whether the PA supplies eloquent brain territories. Appropriate individualized management can yield favorable clinical outcomes in the majority of patients.
IntroductionVirtual reality has become increasingly important in neurorehabilitation and has shown considerable potential for the management of musculoskeletal disorders. Although an increasing number of systematic reviews and meta-analyses have summarized the effectiveness of VR interventions for musculoskeletal disorders, a comprehensive overview of the development of this research field is still lacking. Therefore, this bibliometric analysis aimed to identify the knowledge structure and emerging research hotspots in the field of virtual reality for musculoskeletal disorders from 2010 to 2025.MethodsPublications were retrieved from the two databases, Web of Science Core Collection and Scopus. After merging the databases and removing duplicates, two independent reviewers screened the titles and abstracts according to predefined criteria. Finally, a total of 433 eligible publications were included for bibliometric analysis. BibliometriX and VOSviewer were used to identify knowledge structure and emerging research hotspots in this research field. A LOESS curve was applied to visualize the trend of the annual number of publications over time. The BIBLIO reporting checklist was used to enhance transparency and reproducibility.ResultsThe annual number of publications increased steadily from 2010 to 2025, with rapid growth after 2019, reaching a peak of 97 publications in 2025. A total of 1,878 authors from 60 countries contributed to at least one publication in this field. The USA produced the largest number of publications, followed by several European countries. Keyword analysis identified chronic pain, rehabilitation, and low back pain as major research topics. Thematic evolution indicated a shift from early technological exploration toward clinically oriented research focusing on rehabilitation outcomes, pain management, and the neurophysiological mechanisms underlying immersive VR interventions.ConclusionThis bibliometric analysis provides a comprehensive overview of the development of VR for musculoskeletal disorders and highlights an ongoing transition from technology-driven exploration to clinically oriented and mechanism-informed research. These findings may help guide future interdisciplinary research and support the development of more evidence-based VR rehabilitation strategies.
ObjectiveTo investigate the association between large language model (LLM)-assisted support and caregiver burden as well as psychosocial outcomes among family caregivers of patients with epilepsy.MethodsThis single-center, prospective cohort study enrolled primary caregivers of patients with epilepsy. Participants were classified into an LLM group and a control group based on whether they had used DeepSeek for epilepsy caregiving-related support. Caregiver burden was assessed using the Zarit Burden Interview (ZBI). Secondary outcomes included anxiety, depression, perceived stress, social support, quality of life, and caregiving self-efficacy, measured at baseline, 1 month, and 3 months. Adjusted generalized estimating equation (GEE) models were used to evaluate longitudinal associations between LLM use and the study outcomes, and dose-response analyses were performed within the LLM group.ResultsA total of 296 caregivers were included (149 in the control group and 147 in the LLM group). The two groups were comparable at baseline. At 3 months, the LLM group had lower caregiver burden (median ZBI: 23.00 vs. 25.00), anxiety, depression, and perceived stress scores, as well as a higher perceived social support score, than the control group. Adjusted GEE analyses revealed significant between-group differences in changes in caregiver burden and depression at both follow-up assessments and in anxiety, perceived stress, and psychological quality of life at 3 months, favoring the LLM group. Within the LLM group, no significant dose–response associations were observed between weekly usage time or the weekly number of effective conversations and caregiver burden at 3 months.ConclusionsAmong caregivers of patients with epilepsy, use of LLM-assisted support was associated with lower caregiver burden and better psychosocial outcomes over 3 months. LLMs may serve as a low-threshold, scalable supportive tool in epilepsy family caregiving, though further studies are needed to evaluate long-term effectiveness and safety.
IntroductionRobot-assisted gait training (RAGT), virtual reality (VR), and other emerging technology-assisted interventions are increasingly used in pediatric neurorehabilitation, but their effects across functional domains and follow-up periods in children with cerebral palsy (CP) remain unclear.MethodsPubMed, Embase, the Cochrane Library, and Web of Science were searched from inception to February 23, 2026. Randomized controlled trials (RCTs) comparing these interventions with conventional rehabilitation in children with CP were included. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the revised Cochrane Risk of Bias tool (RoB 2). Random-effects meta-analyses generated mean differences (MDs) with 95% confidence intervals (CIs). Subgroup analyses examined technology type and follow-up duration. The certainty of evidence for each outcome was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.ResultsForty-six RCTs involving 1,812 children were included. Emerging technology-assisted interventions improved performance on the 10-Meter Walk Test (10MWT; MD = −2.83, 95% CI −4.39 to −1.27), 6-Minute Walk Test (6MWT; MD = 43.56, 95% CI 25.55 to 61.57), Timed Up and Go Test (TUG; MD = −2.17, 95% CI −3.60 to −0.75), Pediatric Balance Scale (PBS; MD = 5.21, 95% CI 4.06 to 6.37), Gross Motor Function Measure (GMFM) dimension D (MD = 3.99, 95% CI 1.61 to 6.37), and GMFM dimension E (MD = 8.90, 95% CI 5.18 to 12.62). RAGT favored gait outcomes, whereas VR favored balance outcomes. Upper-limb spasticity measured by the Modified Ashworth Scale (MAS) decreased (MD = −0.40, 95% CI −0.59 to −0.21). ABILHAND-Kids questionnaire scores showed no immediate improvement (MD = 2.00, 95% CI −1.01 to 5.01) but improved at ≥6 weeks (MD = 2.54, 95% CI 0.41 to 4.66). Most gains were immediate; only balance and manual ability remained significant at longer follow-up.ConclusionEmerging technology-assisted rehabilitation improves gait, mobility, balance, gross motor function, and upper-limb outcomes in children with CP. RAGT and VR show domain-specific advantages. Evidence certainty ranged from high to very low, and further high-quality RCTs with extended follow-up are needed.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251157757, Identifier CRD420251157757.
IntroductionThe aim of this study was to explore potential effects of lower extremity Constraint-Induced Movement Therapy (LE-CIMT) on Health-Related Quality of Life (HRQoL) after stroke, and the possible influence of descriptive characteristics.Materials and methodsTwenty men and 10 women (median age 53 years, IQR 45–59) participated in a single-arm, intervention study at an outpatient physiotherapy clinic. Participants underwent intensive, task-specific LE-CIMT for 6 h/day over 10 consecutive weekdays, followed by a home-exercise program until a 3-month follow-up. HRQoL was assessed using the SF-36 questionnaire, and motor function was evaluated with part of the Fugl-Meyer Assessment, Berg Balance Scale, 10-Meter Walk Test, 6-Minute Walk Test, and Timed Up and Go. Assessments were performed pre-intervention and at 3-month follow-up.ResultsThe SF-36 response rate was 50%. HRQoL improved significantly in the Physical Functioning (median change 10, IQR 5–15, p < 0.001, ES 0.75) and Vitality domains median change 5 (IQR 0–20, p = 0.013, ES 0.46). A negative correlation was observed between time from stroke to LE-CIMT and improvement in Physical Functioning (rS = −0.456, p = 0.013), but not the Vitality domain.ConclusionOur findings suggest that LE-CIMT may be associated to improvements in HRQoL, particularly in the Physical Functioning and Vitality domains after stroke. Earlier initiation of intervention appears beneficial. These findings need to be validated in randomized controlled trials.
Anatomical priors are often assumed to improve medical image segmentation, but their role can be ambiguous when strong image evidence is available. We study this question in a controlled small-sample dual-modal brain MRI setting with 13-class coarse brain-region segmentation from T1 and FLAIR images. Using a quality-controlled 78-case subset and a subject-disjoint five-fold protocol, we compare compact U-Net variants, coordinate channels, modality dropout, fold-wise index-space atlas conditioning, and a full-to-missing modality consistency variant, FW-AtlasMC. Fold-wise probabilistic spatial priors are built only from training labels, and an atlas-only baseline quantifies spatial prior strength without model training. Under full T1+FLAIR input, learned methods are tightly clustered in Dice, and atlas-informed models do not significantly improve full-modality Dice over a 2.5D U-Net baseline. However, among learned image-conditioned models under missing-modality inference, FW-AtlasMC improves FLAIR-only Dice and reduces average performance drop compared with 2.5D U-Net, modality dropout, and FW-Atlas. FW-AtlasMC combines atlas-informed inputs with missing-modality training and full-to-missing consistency. Validation-only sensitivity analysis further indicates that the chosen consistency weight represents a reasonable trade-off within the tested range. These results suggest that anatomical priors are better understood as structural stabilizers under degraded modality information, rather than as universal full-modality accuracy boosters.
BackgroundSleep disorders and stroke share a bidirectional relationship. Sleep disturbances are independent stroke risk factors and frequent post-stroke complications. Obstructive sleep apnea (OSA), through intermittent hypoxia, systemic inflammation, endothelial dysfunction, and autonomic dysregulation, increases stroke risk by approximately 2- to 3-fold. Post-stroke sleep disorders affect up to 59.9% of patients, impeding neurological recovery.ObjectivesTo examine the epidemiology, pathophysiology, and clinical impacts of sleep disorders on stroke recovery, and to summarize evidence-based management strategies.MethodsA narrative review was guided by a writing outline developed from clinical observations and preliminary synthesis. A theme-driven literature search was conducted in PubMed, Embase, Cochrane, Web of Science, CNKI, and Wanfang (March 10–13, 2026) using targeted keywords (e.g., “sleep disorders,” “obstructive sleep apnea,” “rehabilitation,” “stroke”), limited to 2000–2026 publications in English or verified Chinese translations. Reference lists were also screened.ResultsPost-stroke sleep disorder prevalence ranges from 25 to 84%; OSA affects 40–78% of stroke patients. Sleep disorders correlate with worse functional outcomes, prolonged hospitalization, cognitive decline, and elevated stroke recurrence. Mechanistically, intermittent hypoxia, oxidative stress, systemic inflammation, glymphatic dysfunction, autonomic dysregulation, and impaired neuroplasticity are implicated. Management: CPAP is first-line for OSA; CBT-I improves insomnia symptoms; rTMS has been shown to improve sleep quality in clinical studies; exercise, melatonin, and light therapy show emerging evidence. Pharmacotherapy for RLS/PLMD requires caution regarding fall risk and cognitive side effects.ConclusionSleep disorders are highly prevalent and negatively impact stroke recovery. Evidence-based strategies—CPAP, CBT-I, and rTMS—improve sleep and functional outcomes, though evidence heterogeneity exists. High-quality RCTs are needed to optimize individualized protocols.
Persistent postural-perceptual dizziness (PPPD) is a chronic functional vestibular disorder characterized by persistent non-spinning dizziness, subjective unsteadiness, and symptom exacerbation induced by upright posture, movement, and complex visual motion. Abnormal vestibular sensory reweighting, increased visual dependence, postural hypervigilance, and comorbid anxiety are considered to contribute to the persistence of symptoms. Neurotransmitter systems, including serotonin, norepinephrine, dopamine, gamma-aminobutyric acid, glutamate, histamine, acetylcholine and neuropeptides, may participate in the disease-related neural network imbalance by modulating vestibular signal processing, emotional responses, and central compensation. However, direct evidence for PPPD-specific neurotransmitter abnormalities remains limited. In treatment, selective serotonin reuptake inhibitors and serotonin–norepinephrine reuptake inhibitors are commonly employed in clinical practice, yet evidence from placebo-controlled randomized trials remains insufficient. Vestibular and balance rehabilitation therapy, cognitive behavioral therapy, and transcranial magnetic stimulation may be incorporated into comprehensive management; however, the level of evidence and long-term efficacy differ across interventions. Future studies should integrate clinical phenotypes, comorbidities, and neural network features to develop stratified diagnostic and therapeutic strategies, while also strengthening neurotransmitter-related imaging, biomarker discovery, and multicenter randomized controlled trials.
BackgroundPeripheral facial palsy (PFP) is a common cranial nerve disorder that may result in persistent impairments extending beyond facial muscle weakness, including facial asymmetry, synkinesis, altered emotional expression, and reduced quality of life. Traditional rehabilitation approaches have predominantly focused on motor recovery and facial muscle function. However, emerging evidence suggests that somatosensory processing, body awareness, body image, and sensorimotor integration may play a more substantial role in recovery and long-term outcomes than previously recognized.Aims and methodsThis narrative review aims to synthesize current evidence regarding multimodal rehabilitation strategies for PFP, with particular emphasis on craniofacial somatosensory disturbances and their clinical implications. The literature was reviewed across three domains: (A) peripheral facial palsy and related diagnoses, (B) assessment of facial somatosensory distortion and body representation, and (C) interventions targeting somatosensory dysfunction. In addition to established clinical examinations and patient-reported outcome measures, emerging assessment strategies addressing body representation, self-perception, and sensory discrimination are discussed.ResultsThe review highlights growing evidence supporting the integration of somatosensory and neurocognitive approaches into clinical management. Altered facial perception and disrupted sensorimotor integration may contribute to persistent dysfunction and reduced participation. To address these mechanisms, a structured neurocognitive rehabilitation framework, the 8-E model, is presented. Furthermore, targeted somatosensory interventions, including two-point discrimination training, auditory acuity training, and trigeminal blink reflex training, and pre- and post-lesion experience using autobiographical memory are proposed to enhance sensory discrimination, cortical representation, and sensorimotor integration.ConclusionCurrent findings suggest that a broader biopsychosocial and neurocognitive perspective may complement conventional motor rehabilitation in PFP. Future research should investigate the clinical effectiveness of somatosensory-based interventions and further clarify their role in optimizing functional recovery, participation, and quality of life.
ObjectiveMeniere’s disease is a disabling inner-ear disorder whose molecular basis remains poorly understood. Immune dysregulation and genetic susceptibility have been implicated in disease etiology, but the genes and immune-cell programs linking genetic susceptibility to disease-associated molecular alterations remain incompletely defined. Focusing on zinc transport and immune signaling, we aimed to prioritize genetically supported candidate genes and identify the immune-cell programs in which they are embedded.MethodsWe combined bulk peripheral blood transcriptomes, single-cell RNA sequencing of peripheral blood mononuclear cells, large-scale blood eQTL data, and genome-wide association summary statistics for Meniere’s disease. Differential expression analysis and WGCNA were used to define bulk transcriptional signatures, which were then integrated with scRNA-seq-derived cell-type marker genes to generate a candidate-gene set with complementary bulk disease-association and cell-type localization evidence. Two-sample Mendelian randomization and colocalization were applied to test whether genetically predicted expression of these candidate genes influences Meniere’s disease risk. Prioritized genes were then mapped to immune-cell subsets, ligand–receptor communication networks, and CD4+ T-cell differentiation trajectories at single-cell resolution, and their expression changes were validated at the mRNA and protein levels in an independent clinical cohort.ResultsBulk and single-cell analyses yielded 202 Meniere’s disease-associated candidate genes enriched in RNA processing, chromatin regulation, and immune-related pathways. Two-sample Mendelian randomization identified nominal associations between genetically predicted expression of SLC39A10, GAB1, and XCL2 and Meniere’s disease risk. Integration with bulk transcriptomic evidence prioritized increased SLC39A10 expression and reduced GAB1 and XCL2 expression for further analysis. Immune-signature enrichment and single-cell analyses localized their expression-related programs to CD4+ T cells, NK cells, monocytes, B cells, and other peripheral immune populations. CellChat and pseudotime analyses provided complementary descriptions of inferred intercellular communication and CD4+ T-cell state transitions. In an independent clinical cohort, SLC39A10, GAB1, and XCL2 showed concordant changes at the transcript and protein levels.ConclusionOur multi-layered genomic and single-cell analyses prioritize SLC39A10, GAB1, and XCL2 as candidate genes associated with Meniere’s disease and map their expression-related programs to CD4+ T-cell, NK-cell, and other peripheral immune compartments. Together, these findings support a putative zinc transport–immune framework that may contribute to systemic immune dysregulation in Meniere’s disease. This framework should be regarded as a hypothesis generated by integrative genomic and transcriptomic evidence and requires direct validation through measurements of zinc homeostasis, transporter activity, and downstream immune function.
