With the rising incidence of cancer in China and the substantial prolongation of survival periods for breast cancer patients, the therapeutic focus has evolved from solely disease management to enhancing overall quality of life and functional restoration, rendering the adoption of a full-cycle, multifunctional rehabilitation model an imperative trend. Among the multifunctional rehabilitation demands, sleep disorders stand out as particularly prominent and prevalent. Sleep disorders not only exacerbate psychological distress, including anxiety and depression, in breast cancer patients but may also impair immune function, affect treatment tolerance, and severely constrain quality of life and disease prognosis. This study systematically elucidates the complex etiologies and underlying mechanisms of sleep disorders at various stages of breast cancer patients' disease trajectory from diagnosis and treatment to long-term survival and end-of-life care based on the "full-cycle rehabilitation" concept. It proposes conventional rehabilitation strategies, including cognitive behavioral therapy, mindfulness and relaxation training, exercise therapy and physical therapy, sleep hygiene education, pharmacological interventions, traditional Chinese medicine, and emerging rehabilitation technologies, as well as stage-specific rehabilitation strategies. These strategies aim to provide continuous, personalized sleep support, with the goal of effective whole-cycle sleep management to comprehensively enhance the overall rehabilitation outcomes and long-term quality of life for breast cancer patients.

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

OBJECTIVE:This single-blind, randomized controlled trial aims to observe the effect of Dual Mirror Therapy (DMT) on naming function in patients with post-stroke aphasia (PSA). DESIGN:Forty patients with post-stroke hand dysfunction and expressive aphasia were randomized to either a Dual Mirror Therapy group (DMTG, n=20) receiving combined DMT and conventional speech training, or a Control Group (CG, n=19) receiving speech training alone. Both groups completed the 4-week intervention. Naming ability and aphasia severity were assessed before and after using the Chinese Rehabilitation Research Center Aphasia Examination (CRRCAE) and the Boston Diagnostic Aphasia Examination (BDAE). Data were analyzed with t-tests, Chi-square, and rank-sum tests (significance at P<0.05). RESULTS:Following the intervention, CRRCAE naming scores improved significantly in both groups (P<0.001), with a greater increase observed in the DMTG versus the CG (t=2.689, P=0.011).Intergroup comparisons significantly favored the DMTG in: BDAE grade distribution (χ²=5.718, P=0.017), significant improvement rate (45.00% vs. 10.53%; χ² =5.718, P=0.017), and total effective rate (95.00% vs. 68.42%; χ²=4.467, P=0.031). CONCLUSION:DMT showed a good safety profile with no treatment-related adverse events. It significantly improves naming function and reduces aphasia severity in patients with PSA, presenting a safe and effective adjuvant therapy for aphasia.

Peripheral nerve injuries (PNI) commonly result in multiple dysfunctions in clinical practice. Repetitive peripheral magnetic stimulation (rPMS) and repetitive transcranial magnetic stimulation (rTMS) are non-invasive interventions for neuromodulation. Their benefits have been reported respectively in PNI rehabilitation, but little is known about their combined effect. Combined central-peripheral interventions were found to have better improvements than central- or peripheral-only intervention in numerous studies. Hence, we conducted a randomized controlled trial to assess the effect of rPMS combined with rTMS on postoperative median nerve injury (PMNI) and explore its mechanism. In this prospective, single-center, randomized clinical trial, we will enroll 60 participants with PMNI and randomize them into four groups (conventional intervention group, rPMS + sham rTMS group, sham rPMS + rTMS group, and rPMS + rTMS group) at a 1:1:1:1 ratio. All participants will undergo interventions for 12 weeks and be assessed at 0, 6, and 12 weeks during the treatment. Measurements will include grip strength, side pinch, Semmes-Weinstein monofilament test (SW), two-point discrimination test (2PD), Purdue pegboard test (PPT), motor conduction velocity test (MCV), and sensory conduction velocity test (SCV). Moreover, functional near-infrared spectroscopy (fNIRS) will be used to explore brain mechanisms. Statistical analysis will be performed using SPSS software with the significance level set at p < 0.05. The results of this study will develop innovative magnetic stimulation techniques for the rehabilitation of PMNI. This study prospective protocol was approved by the Medical Ethics Committee of Shanghai Jing’an District Central Hospital (ethical approval number 202437, study protocol version 1.0). The trial was prospectively registered at the Chinese Clinical Trial Registry on December 16, 2024, with the name “Effects of Repetitive Transcranial Magnetic Stimulation Combined with Repetitive Peripheral Magnetic Stimulation on Complete Postoperative Median Nerve Injury: Protocol of A Randomized Control Study” (registration number ChiCTR2400094038).

Impaired pulmonary function and physical inactivity are established risk factors for cerebrovascular disease, yet their combined contribution to stroke risk has not been systematically evaluated across diverse populations. This study aimed to evaluate the joint association of peak expiratory flow (PEF) and physical activity (PA) with incident stroke risk in US and Chinese adults. This prospective cohort study enrolled 10,620 stroke-free participants aged 50 years or older from the Health and Retirement Study (HRS, n = 6,700) and the China Health and Retirement Longitudinal Study (CHARLS, n = 3,920). Participants were categorized into four groups based on cohort-specific median PEF and self-reported PA. Multivariable Cox proportional hazards models estimated hazard ratio (HR) for incident stroke over a 7-year median follow-up. Among HRS participants (n = 6,700, mean age 66.0 ± 10.3 years) and CHARLS participants (n = 3,920, mean age 61.5 ± 7.8 years), 590 incident strokes were recorded. Compared to the low PEF/inactive group, those with both high PEF and regular PA exhibited the lowest stroke risk in both cohorts (HRS: HR, 0.56 [95

Background:Balance impairment following stroke is a leading cause of disability and falls. Hemoglobin (Hb) affects systemic and cerebral oxygen delivery and may influence neuromuscular function and post-stroke balance, but evidence from large multicenter clinical samples is limited. We investigated the association between hemoglobin concentration and balance performance in a Chinese multicenter cross-sectional study of stroke patients. Methods:We studied 2,006 neuroimaging-confirmed stroke patients from 26 hospitals. Balance impairment was defined as BBS ≤ 40. Admission Hb (g/dL) was analyzed per 1 g/dL and by tertiles (<12.6 g/dL, 12.6-14.0 g/dL, ≥14.0 g/dL). Multivariable logistic regression with sequential adjustment, restricted cubic splines, and prespecified subgroup and sensitivity analyses evaluated associations. Results:Balance impairment occurred in 70.5% (1,414/2,006). Each 1 g/dL higher Hb was associated with lower odds of impairment in unadjusted (OR 0.83, 95% CI 0.78-0.87; p < 0.001) and fully adjusted models (OR 0.89, 95% CI 0.83-0.96; p = 0.002). This association remained robust after comprehensive adjustment for demographic, lifestyle, comorbidity, stroke characteristics, and lesion location factors. Compared with the lowest tertile, adjusted ORs were 0.72 (95% CI 0.53-0.99; p = 0.042) for the middle tertile and 0.62 (95% CI 0.45-0.85; p = 0.003) for the highest tertile. Spline analyses suggested a broadly linear inverse association; results were consistent across subgroups and sensitivity checks. Conclusion:Higher admission hemoglobin was independently associated with better balance after stroke. Prospective studies should test whether Hb optimization improves rehabilitation outcomes.

This study aimed to compare functional brain networks and identify recovery markers in 12 stroke patients (SG) and 14 healthy controls (HG) using EEG during three fist-task paradigms. Analyzing clustering coefficient (CC), characteristic path length (CPL), small-world index (SWI), and frontal node strength across frequency bands, passive task revealed significant alpha band differences in CC/CPL/SWI between groups. Lower SG strength in alpha/mu vs. controls predicted better recovery. An automated source imaging pipeline reduced volume conduction effects, providing new insights into stroke rehabilitation outcomes. Large-scale source imaging shows promise for broader disease applications.

In our previous study, we showed that a low dose of esketamine could alleviate propofol-induced injection pain during general anesthesia induction. However, the dose-response relationship of esketamine remains unclear. This study aims to evaluate the dose-dependent efficacy of esketamine in preventing propofol-induced injection pain. In this double-blind, randomized controlled trial, patients scheduled for elective ear surgery were randomized into five groups: Group NS (normal saline), Group L (40 mg lidocaine), Group S0.075 (0.075 mg/kg esketamine), Group S0.15 (0.15 mg/kg esketamine), and Group S0.3 (0.3 mg/kg esketamine). Study medications were administered intravenously 30 seconds before manual injection of propofol (2 mg/kg). The primary outcome was the incidence of propofol-induced injection pain. Secondary outcomes included the severity of injection pain, hemodynamic changes, and drug-related adverse events. A total of 171 patients were analyzed. The incidence of propofol-induced injection pain was 71

Objective This study aimed to evaluate the usability and user experience of the FLEXO-Arm1 upper limb rehabilitation robot among stroke survivors and rehabilitation therapists. Methods A mixed-methods approach was employed, incorporating System Usability Scale (SUS) and User Experience Questionnaire (UEQ) assessments alongside semi-structured interviews. Participants included stroke survivors with varying degrees of upper limb dysfunction and rehabilitation therapists who utilized the FLEXO-Arm1 for Passive Movement Training (PMT) and task-oriented training (TOT). Results Overall SUS scores indicated that stroke survivors rated the robot's usability higher (A-, 87%) than rehabilitation therapists (B-, 67%). UEQ analysis revealed positive evaluations across all scales, particularly in attractiveness and clarity, with stroke survivors providing higher ratings than therapists. Semi-structured interviews highlighted operational challenges, particularly for those with severe upper limb dysfunction, while affirming the robot's acceptance and potential as a supplementary rehabilitation tool. Conclusion The FLEXO-Arm1 robot demonstrates favorable usability and user experience for both stroke survivors and therapists. While the device shows promise in rehabilitation settings, enhancements are necessary for users with severe impairments. Further studies should explore the device's long-term impact on rehabilitation practices.

Patients with spinal cord injury (SCI) often face urinary and defecation dysfunction, and existing treatments have limited effectiveness. Brain-computer interface (BCI) technology has been shown to have positive effects on the rehabilitation of SCI patients, but its application in promoting the recovery of urinary and defecation functions has not been explored. This study proposes a new BCI application approach and develops an accurate decoding model targeted at urination and defecation motor attempt tasks. Specifically, we designed a Bidirectional Temporal Convolutional Network (UDCNN-BiTCN) to decode both the suppressed urination and defecation (S-UD) task and the urination and defecation (UD) task. Seventy-one participants (including 44 healthy controls and 27 SCI patients) were recruited for the experiment. The results showed that UDCNN-BiTCN achieved an average accuracy of 91.47% on the S-UD task and 91.81% on the UD task. The study also conducted within-subject cross-task transfer learning and cross-subject experiments, further validating the superiority of the model. In addition, we conducted a comprehensive analysis of this new paradigm from the perspective of classification performance. The research approach and findings in this study provide a valuable new perspective for BCI applications in the recovery of urinary and defecation functions.

PURPOSE:This study aimed to explore the experiences of dysphagia and rehabilitation care needs of head and neck cancer patients across the pre-, intra-, and post-radiotherapy phases. The findings provide essential evidence for developing individualized rehabilitation care protocols for dysphagia. METHODS:A qualitative descriptive study was conducted at the Radiation Oncology Department of a cancer hospital in China from December 2024 to March 2025. Purposive sampling was used to select head and neck cancer patients at different radiotherapy phases. Semi-structured interviews were conducted to capture their experiences of dysphagia and rehabilitation care needs. All interviews were audio-recorded, transcribed verbatim, and analyzed qualitatively using a content analysis approach. RESULTS:Four key themes of patients' experiences of dysphagia and rehabilitation care needs were identified: (1) emotional experiences across peri-radiotherapy phases, (2) dynamic swallowing perceptions across peri-radiotherapy phases, (3) radiotherapy phase-specific critical distress points, and (4) evolving rehabilitation care needs in dysphagia management. CONCLUSION:Situated within the Chinese context, this study explores dysphagia experiences and rehabilitation care needs of head and neck cancer patients across the pre-, intra-, and post-radiotherapy phases. The findings reveal that these experiences and needs are diverse and differentiated. Healthcare providers should develop stage-specific rehabilitation care protocols for dysphagia that are tailored to the experiences and needs of head and neck cancer patients at different phases of radiotherapy.

Postoperative nausea and vomiting (PONV) remains a prevalent and distressing complication following tympanoplasty. Stimulation of the Pericardium 6 (PC6) acupoint has emerged as a promising non-pharmacological strategy for PONV management in various surgical procedures. Therefore, this study aimed to evaluate the efficacy of transcutaneous electrical acupoint stimulation (TEAS) at PC6 as an adjunct to standard antiemetic prophylaxis in patients undergoing tympanoplasty. In this prospective, single-blind, randomized, parallel-group trial, we enrolled 277 patients (aged 18–65 years; ASA physical status I–II) scheduled for tympanoplasty. Participants were randomized to receive either active transcutaneous electrical acupoint stimulation (TEAS group, n = 138) or sham TEAS (Sham-TEAS group, n = 139). The primary endpoint was the incidence of PONV within 48 h postoperatively. Secondary endpoints included the rate of complete response (CR), the severity of PONV, the requirement for rescue antiemetics, postoperative pain scores, and the incidence of other adverse events. Compared with the Sham group, the TEAS group exhibited a significantly lower incidence of nausea (17.4

This pilot study aimed to investigate the feasibility, safety, and preliminary efficacy of a rehabilitation program utilizing Syrebo™ SY-HR03E soft robotic glove with pneumatic actuators for hand function recovery in patients with early subacute stroke. A single-blind pilot randomized controlled trial was conducted in an inpatient clinical setting. The intervention was administered 5 days per week for 4 weeks (20 session’s total). During this period, the robotic therapy (RT) group (n = 10) received 30-min daily sessions with the soft robotic glove, while the conventional therapy (CT) group (n = 10) received 30-min daily sessions of conventional hand therapy. Both groups additionally participated in an identical 1-h daily conventional rehabilitation program excluding hand training. The outcome measures included the Fugl–Meyer Assessment for the hand (FM-Hand) and upper limb (FM-UL), the modified Barthel index (MBI), and the Brunnstrom stages (BS). Intervention effects were analyzed using two-way repeated-measures ANOVA. All participants completed the intervention without dropouts or adverse events, confirming the feasibility and safety of the protocol. Baseline motor impairment was comparable between groups (FM-Hand: 2.20±1.93 vs. 2.50±2.64; FM-UL: 19.60±14.76 vs. 16.70±14.50). A significant Group × Time interaction was found for the FM-Hand [F(1,18) = 4.743, p < 0.05] and the MBI [F(1,18) = 7.728, p < 0.05]. Simple effects analysis revealed that both groups improved significantly in FM-Hand, while only the RT group showed a significant improvement in MBI after interventions. For the FM-UL, a significant main effect of Time [F(1,18) =24.931, p < 0.001] in both groups was observed without an interaction. In the BS, a significant main effect of Time was found for both hand and upper limb, with only the RT group showing significant within-group improvement for the hand. SyreboTMSY-HR03E soft robotic glove is a feasible and safe tool for hand rehabilitation in early subacute stroke. The results provide preliminary signals for improving hand function and translating gains into activities of daily living compared to conventional therapy alone. However, because both groups were in the early subacute stage, the observed gains likely reflect a combination of intervention effects and spontaneous recovery. These findings justify further investigation through larger-scale, definitive trials. Trial Registration: ChiCTR2000034614||http://www.chictr.org.cn/ with the Clinical Trial Registry (2020/07/12).

Objective: This single-blind, randomized controlled trial aims to observe the effect of Dual Mirror Therapy (DMT) on naming function in patients with post-stroke aphasia (PSA). Design: Forty patients with post-stroke hand dysfunction and expressive aphasia were randomized to either a Dual Mirror Therapy group (DMTG, n=20) receiving combined DMT and conventional speech training, or a Control Group (CG, n=19) receiving speech training alone. Both groups completed the 4-week intervention. Naming ability and aphasia severity were assessed before and after using the Chinese Rehabilitation Research Center Aphasia Examination (CRRCAE) and the Boston Diagnostic Aphasia Examination (BDAE). Data were analyzed with t-tests, Chi-square, and rank-sum tests (significance at P <0.05). Results: Following the intervention, CRRCAE naming scores improved significantly in both groups ( P <0.001), with a greater increase observed in the DMTG versus the CG (t=2.689, P =0.011).Intergroup comparisons significantly favored the DMTG in: BDAE grade distribution (χ²=5.718, P =0.017), significant improvement rate (45.00% vs. 10.53%; χ² =5.718, P =0.017), and total effective rate (95.00% vs. 68.42%; χ²=4.467, P =0.031). Conclusion: DMT showed a good safety profile with no treatment-related adverse events. It significantly improves naming function and reduces aphasia severity in patients with PSA, presenting a safe and effective adjuvant therapy for aphasia.

Persistent upper limb deficits after stroke necessitate reliable candidate biomarkers to support precision rehabilitation. While electroencephalogram (EEG) provides a highly accessible tool to characterize post-stroke neurophysiology, its clinical translation is hindered by fragmented evidence. This systematical review critically synthesizes the directional associations between EEG biomarkers and upper limb outcomes, and introduces a novel functional framework to classify these biomarkers into assessment, prognostic, and monitoring roles for natural upper limb recovery under conventional rehabilitation. A systematic search was conducted in MEDLINE, SCOPUS, EMBASE, EBSCO CINAHL, and IEEE Xplore up to March 10, 2026. Studies investigating associations between quantitative EEG measures and upper limb motor outcomes in stroke adults were included. Two reviewers independently screened studies and assessed risk of bias. Data extraction classified EEG biomarkers by assessment, prognosis, and monitoring roles. Forty-two studies were included, comprising 23 cross-sectional and 19 longitudinal designs. We categorized the evidence into three biomarker roles: (i) assessment, where measures like the brain symmetry index (BSI), β-band interhemispheric connectivity, and network efficiency correlated with impairment severity; (ii) prognostic, where baseline asymmetry and functional connectivity showed predictive potential; and (iii) monitoring, where longitudinal changes in oscillatory power, connectivity, and network topology paralleled functional gains. Across roles, the BSI emerged as one of the most frequently reported candidate metrics. EEG-derived metrics, particularly the BSI, serve as frequently reported candidate biomarkers for potential clinical application in stroke rehabilitation. However, their immediate clinical translation is currently limited by the predominantly fair methodological quality of the underlying evidence. Our proposed framework helps to bridge the gap between current observational findings and future clinical utility. Future progress hinges on standardizing protocols and validating these biomarkers in large-scale rehabilitation trials to facilitate their transition toward potentially clinically useful tools.

Muscle weakness is a common impairment following neurological disorders, yet traditional high-load training aimed at addressing this is often impractical or unsafe for these patients. Blood flow restriction (BFR) training has emerged as a viable method, capable of eliciting physiological adaptations comparable to high-load training while using significantly lower mechanical loads. This study aimed to summarize the clinical applications of BFR training for neurological disorders and assess its effectiveness and safety in improving muscle strength and functional outcomes. The systematic review and meta-analysis followed PRISMA guidelines. PubMed, Embase, PEDro, Cochrane, CINAHL, CNKI were searched for intervention studies comparing BFR with diverse control interventions. The primary outcomes were muscle strength and functional outcomes. Sensitivity analyses, subgroup analysis and meta-regression were also performed. Thirty-seven studies involving 963 participants were included, with individuals having stroke (n = 639), Parkinson's disease (n = 18), multiple sclerosis (n = 128), spinal cord injury (n = 170), cerebral palsy (n = 1), peripheral nerve injury (n = 2), and transverse myelitis (n = 1). Our results revealed that the addition of BFR significantly increased muscle strength, with effect sizes of 0.752 (95

ObjectiveTo evaluate how Centres of Clinical Excellence criteria align with routine clinical practice in international stroke rehabilitation centres and explore the factors influencing practices across diverse health systems.DesignMixed-methods study.SettingInternational stroke rehabilitation centres across diverse geographic and economic contexts.ParticipantsClinicians and service leaders representing 15 centres from 10 countries (two lower-middle-income, two upper-middle-income, and six high-income).InterventionEvaluation of how international stroke rehabilitation centres demonstrate performance that aligns with the multidimensional Centre of Clinical Excellence criteria, and exploration of the contextual factors influencing practices across diverse health systems.Main measuresSurvey responses and semi-structured interview data examining patient-centred care, interprofessional practice, workforce development, research, mentorship and organisational structures supporting clinical excellence.ResultsStrong alignment was observed for patient-centred outcomes, interprofessional teamwork, and staff education, supported by established clinical pathways and outcome measurement processes. High-income and metropolitan centres more frequently reported protected time, funding, and formal workforce development structures. Centres in low- and middle-income and regional settings relied more on informal processes due to resource constraints. Across all contexts, leadership development, mentorship, advocacy, research engagement, and continuity of care were inconsistently implemented and documented.ConclusionsCore domains of stroke rehabilitation are well established internationally; however, system-level supports that sustain evidence-based practice vary considerably. Embedding structured leadership, workforce development, research engagement, and advocacy mechanisms alongside routine care may strengthen sustainability, improve consistency of evidence-based practice, and reduce inequities in rehabilitation outcomes.

Chronic stress and anxiety severely affect breast cancer survivors’ (BCSs) mental health and well-being. Peer support has been shown to enhance psychological empowerment, while biofeedback offers a promising approach to improve physiological relaxation through self-regulation. However, few studies explored combining both for BCSs. We conducted a formative study with clinicians and BCSs to identify requirements and preferences for VR biofeedback. Informed by the findings, we proposed a VR-based dyadic biofeedback system, Cobreath, which integrates breathing and heart rate variability (HRV) feedback into a calming virtual environment, allowing two users to practice breathing-focused relaxation simultaneously. Through a clinical user study with ten clinicians and a between-subjects study with 32 BCSs, we demonstrated that Cobreath’s dyadic mode improved biofeedback effectiveness and provided a better user experience compared to the individual mode. We further discuss insights and design considerations for developing dyadic VR-biofeedback applications to support the mental well-being of BCSs and potential applications.

Background:Malnutrition, frequently indicated by hypoalbuminemia, is prevalent post-stroke and associated with adverse functional outcomes. However, the independent role of serum albumin (ALB) in multidomain functional recovery-encompassing motor, balance, cognitive, and daily living domains-remains underexplored in Chinese populations. This multicenter study aimed to quantify the independent association between serum ALB levels and functional impairment in Chinese post-stroke patients. Methods:In this cross-sectional study, 1,741 patients from rehabilitation centers across China were enrolled. ALB levels were categorized into quartiles (Q1: <37.7 g/L; Q2: 37.7-40.0 g/L; Q3: 40.0-42.8 g/L; Q4: ≥42.8 g/L). Outcomes included motor function (Fugl-Meyer Assessment), activities of daily living (Modified Barthel Index), balance (Berg Balance Scale), and cognition (Montreal Cognitive Assessment). Multivariable linear regression models adjusted for demographics, comorbidities, lesion characteristics, and illness duration. Subgroup analyses tested interactions by age, sex, BMI, and lesion topography. Results:Each 1-g/L ALB increase independently predicted functional gains: FMA (β = 1.35, 95% CI: 0.99-1.72), ADL (β = 1.77, 1.44-2.10), BBS (β = 1.02, 0.78-1.26), MoCA (β = 0.30, 0.21-0.40) (all p < 0.001). Dose-dependent improvements were observed across quartiles (Q4 vs. Q1: FMA Δβ = 15.11 [11.09-19.12]; ADL Δβ = 19.35[15.76-22.93]; P trend < 0.001). Sex significantly modified ALB-FMA associations (P interaction = 0.017), with females showing stronger effects (β = 1.81 [1.12-2.51]) than males (β = 1.15 [0.72-1.58]). Cerebellar lesions demonstrated non-significant trend toward amplified associations (FMA: β = 2.16 [0.72-3.59]). Conclusion:ALB levels are independently and dose-dependently associated with motor, ADL, balance, and cognitive function in post-stroke patients. Compared to lower quartiles, patients with ALB ≥42.8 g/L (highest quartile) exhibit superior functional outcomes. A sex-specific pattern is observed solely in motor function, where the correlation is more pronounced in females. ALB may serve as a biological indicator for risk stratification during stroke rehabilitation.

Objective To evaluate whether right neurotomy of the seventh cervical nerve (C7) at the intervertebral foramen plus intensive speech and language therapy (SLT) improves language function compared intensive SLT alone in patients with chronic aphasia after stroke. Design Multicentre, assessor blinded, randomised controlled trial. Setting Four centres in mainland China. Participants 50 adults aged 40-65 years with aphasia for more than one year after a single left hemispheric stroke. Interventions Participants were randomised 1:1 to receive either C7 neurotomy plus three weeks of intensive SLT or three weeks of intensive SLT only, stratified by treatment centre. Main outcome measures The primary outcome was change in score on the 60 item Boston naming test (BNT, scores 0-60, with higher scores indicating better naming function) from baseline to one week after C7 neurotomy plus intensive SLT for three weeks or intensive SLT for three weeks after deferral for one week (control group). Secondary outcomes included change in severity of aphasia using the aphasia quotient, calculated using the western aphasia battery, and patient reported outcomes on quality of life and depression after stroke. Results From 25 July 2022 to 31 July 2023, 322 out of 1086 patients received a diagnosis of post-stroke aphasia and were screened for eligibility. 50 eligible participants were randomly assigned to treatment groups (25 in each). Mean increase in BNT score was 11.16 points in the neurotomy plus SLT group and 2.72 points in the control group at one month (difference 8.51 points, 95% confidence interval (CI) 5.31 to 11.71, P<0.001). The between group difference in BNT score remained stable at six months (difference 8.26 points, 4.16 to 12.35, P<0.001). In addition, the aphasia quotient improved significantly in the neurotomy plus SLT group versus control group (difference at one month 7.06 points, 4.41 to 9.72, P<0.001), as did patient reported activities of daily living and post-stroke depression. No treatment related severe adverse events were reported. Conclusions C7 neurotomy plus three weeks of intensive SLT was associated with a greater improvement in language function compared with three weeks of intensive SLT alone over a period of six months. No severe adverse events or long term troublesome symptoms or functional loss were reported. Trial registration Chinese Clinical Trial Register ChiCTR2200057180.