Background Impaired hand function can limit independence. Sensory electrical stimulation (SES) and alternating electromyography-guided electrical stimulation (Alt-EMG) differ in stimulation characteristics and voluntary effort requirements, but comparative evidence is limited. Objective To compare SES and Alt-EMG, each combined with conventional physical therapy, on upper-limb motor function, spasticity, and muscle strength in chronic stroke. Methods This three-arm, assessor-blinded randomized controlled trial included 60 adults aged 45–65 years, 6–18 months post-stroke, allocated equally to SES, Alt-EMG, or control groups (n = 20 each). The primary outcome was the Action Research Arm Test (ARAT); Modified Ashworth Scale (MAS) and Medical Research Council (MRC) scores were secondary outcomes. ARAT was analyzed using ANCOVA adjusted for baseline score and age; ordinal outcomes were analyzed nonparametrically. Benjamini–Hochberg and Holm corrections addressed multiplicity. Results All participants completed the 12-week intervention. Treatment group significantly predicted adjusted post-intervention ARAT scores (F (2,55) = 23.19, P < .001, partial η 2 =.46). Adjusted mean gains versus control were 12.05 points for SES and 12.44 points for Alt-EMG (both P < .001), with no significant difference between active groups. Significant between-group differences were observed for shoulder, elbow, and wrist spasticity and most muscle-strength measures, except finger extensors. Conclusions SES and Alt-EMG combined with conventional physical therapy produced greater improvement in upper-limb motor function than conventional physical therapy alone over 12 weeks. No difference was observed between SES and Alt-EMG for the primary outcome.
Background Stroke affects physical, psychological, and social functioning. Early changes in health-related quality of life (HRQoL) remain incompletely characterized. Objectives To assess early HRQoL changes after stroke and identify associated factors. Methods We assessed 111 patients with first-ever stroke at baseline, 1 month, and 3 months. Functional status, cognition, depressive symptoms, and HRQoL were evaluated using the Barthel Index, Functional Ambulation Scale, Mini-Mental State Examination, Beck Depression Inventory, Form-36 (SF-36) and the Stroke Impact Scale 3.0 (SIS 3.0). Paired tests, correlations with false discovery rate correction, and multivariable linear regression were used. Results Ninety-seven patients completed follow-up. Physical and psychosocial HRQoL showed divergent recovery trajectories. SF-36 physical component scores progressively improved across both intervals (baseline to 1 month, p = 0.006; 1 to 3 months, p = 0.033), whereas mental component scores improved only during the first month ( p = 0.021) and showed no further significant improvement thereafter ( p = 0.342). Similarly, SIS 3.0 emotion scores showed no significant change between 1 and 3 months ( p = 0.831) and no significant net change over 3 months ( q = 0.103), unlike the other domains, which continued to improve. In multivariable regression, functional ambulation at 3 months was independently associated with physical HRQoL change (β = 0.483, p < 0.001; adjusted R 2 = 0.450), whereas depressive symptom severity was independently associated with mental HRQoL change (β = −0.692, p < 0.001; adjusted R 2 = 0.667). Conclusion Physical and psychosocial HRQoL did not recover in parallel during the first 3 months after stroke. Ambulation and depressive symptoms warrant separate attention during early rehabilitation planning.
Background The International Physical Activity Questionnaire - Short Form (IPAQ-SF) and ActiGraph accelerometers are widely used and internationally recommended to assess physical activity (PA) and sedentary time (ST). However, their agreement in individuals with chronic stroke remains unclear. Objectives To quantify the magnitude of agreement between IPAQ-SF and ActiGraph-derived weekly moderate-to-vigorous PA (MVPA), total PA, and ST in chronic stroke survivors. Methods Fifty community-dwelling adults with chronic stroke who walked independently were enrolled in this cross-sectional study. Participants wore an accelerometer (ActiGraph GT3X+) on the non-paretic side of the waist for seven consecutive days. The IPAQ-SF was completed via interview on the following day. Results IPAQ-SF and ActiGraph-derived estimates showed substantial individual-level discrepancies, with wide limits of agreement (LoA) across outcomes. For MVPA, the mean ratio was 1.02 (95%CI: 0.49 to 2.11; ratio LoA: 0.01 to 154.62). For total PA, the median ratio was 0.08 (95% CI: 0.06 to 0.14; non-parametric ratio LoA: 0.00 to 1.33). For ST, the mean ratio was 0.85 (95%CI: 0.78 to 0.92; ratio LoA: 0.47 to 1.53). Conclusion Findings indicate poor individual-level agreement between the IPAQ-SF and ActiGraph-derived estimates, with wide LoA and evidence of heteroscedasticity. At the group level, the IPAQ-SF underestimated total PA and ST, whereas MVPA showed no evidence of fixed bias. Although the IPAQ-SF may provide a broad descriptive assessment of PA and ST at the group level, it should not be used interchangeably with ActiGraph for individual-level estimation in individuals with chronic stroke.
Aim We aimed to quantitatively synthesize observational evidence on the association between memorization ( Hifz ) and cognitive and mental health outcomes in students, using a quality-weighted evidence synthesis approach. Method For observational studies published between 2005 and 2026, a systematic multi-database search was carried out using PubMed/Medline , Scopus , ScienceDirect , and Google Scholar . The direction, strength, and consistency of the evidence across predetermined outcome domains were measured using a quality-weighted vote-counting synthesis. Seven observational studies involving 690 students were included. Results A statistically significant positive association between Hifz and at least one cognitive or psychological outcome was identified in 5 of 7 studies (71.4%). One study identified a neutral result, and one study (Magnetic Resonance Imaging morphology outcome) was reclassified as uncertain. No study reported a significant negative association. The quality-weighted evidence score was W = 71.5%, corresponding to moderate evidence. Memory performance, intelligence quotient, and quality of life showed the most consistent positive associations. Several studies reported more favourable cognitive or psychosocial outcomes among participants with higher levels of Quran memorization, although the observational design precludes causal interpretation. Conclusion Quality-weighted synthesis ( W = 71.5%) indicates generally favourable associations between Hifz and cognitive and psychological outcomes in students. Although all studies included were conducted in students rather than clinical rehabilitation samples, emerging neurophysiological and clinical research on Quranic engagement provides a preliminary rationale for investigating its cognitive-linguistic and neurorehabilitation potential. Accordingly, Hifz is considered as a promising, culturally sensitive, hypothesis-generating model of intensive cognitive-linguistic practice that warrants rigorous prospective evaluation in neurological populations.
Background Upper limb motor dysfunctions are common after stroke affecting daily activities. About 60% of survivors still have impairment despite rehabilitation. Objective To assess the effect of transcutaneous auricular vagal nerve stimulation (taVNS) on upper limb motor function in chronic stroke patients. Methods Forty patients with chronic ischemic stroke in the middle cerebral artery territory were randomly assigned equally to; real group received 30 min of real taVNS followed by 30 min of upper limb exercises and sham group received identical program with sham taVNS. Intervention was conducted three sessions / week for four weeks. Upper extremity motor functions; Isometric (shoulder abductor, elbow flexors) and isokinetic (elbow flexors, extensors) muscle strength; and hand grip were evaluated through Fugl-Meyer Assessment for upper extremity (FMA- UE), Biodex system, and electronic hand dynamometer, respectively pre and post intervention. Results Post-intervention between-group comparisons favored real taVNS for FMA-UE (MD = 3.95, 95% CI 0.21–7.69), IMSA (MD = 4.78, 95% CI 1.89–7.66), IMEF (MD = 4.16, 95% CI 1.02–7.30), IKEE (MD = 5.34, 95% CI 3.23–7.61), and IKEF (MD = 4.72, 95% CI 2.71–6.72, p < 0.05). The HG improved significantly within the real taVNS group; however, the between-group difference was not significant (MD = 1.33, 95% CI −1.21 −3.85, p = 0.297). Conclusions taVNS was associated with significant between-group improvements in upper-limb motor function and shoulder and elbow muscle strength. Clinical relevance of FMA-UE should be interpreted cautiously because its 95% CI was below the reported minimal clinically important difference.
