The effects of theta-burst stimulation (TBS) and repetitive transcranial magnetic stimulation (rTMS) on the motor symptoms in Parkinson’s disease (PD) were evaluated using a network meta-analysis (NMA). Studies (1 January 2003–1 January 2025) from four databases were screened for analyses. A Bayesian NMA model was employed, and the surface under the cumulative ranking curve (SUCRA) was used to predict the efficacy ranking of each intervention. The study protocol was registered on the International Prospective Register of Systematic Reviews platform (Identification number: CRD42025646363). A total of 28 randomized controlled trials were included. Subgroup analysis showed that multi-session cTBS was significantly superior to single-session cTBS in improving motor symptom. The main analysis (23 studies with multi-session protocols) revealed that, compared with sham stimulation, high-frequency (HF) rTMS-stimulating primary motor cortex (M1) and dorsolateral prefrontal cortex (DLPFC) and cTBS-stimulating supplementary motor area (SMA) significantly improved global motor function, ranking first and second in SUCRA values, respectively. For specific symptoms, HF + SMA showed the best improvement in Freezing of Gait Questionnaire and time up and go test (SUCRA: 0.774 and 0.982, respectively), low-frequency stimulating SMA ranked first for improving bradykinesia (SUCRA = 0.944), and HF + M1 significantly improved quality of life. All interventions were well tolerated. Multi-session TBS protocols are superior to single-session protocols. HF + M1 + DLPFC and cTBS + SMA represent the most promising protocols for improving global motor function in PD. For different motor symptoms, corresponding target-specific stimulation should be prioritized.

Background Post-stroke cognitive impairment (PSCI) is common and lacks well-established non-pharmacological treatment recommendations. Virtual reality (VR) and noninvasive brain stimulation (NIBS) are increasingly used in neurorehabilitation; however, their relative efficacies remain uncertain. Objective To evaluate the effects of VR and NIBS on PSCI using a network meta-analysis. Study design Systematic review and network meta-analysis of randomized controlled trials (RCTs). Methods The review protocol was registered in PROSPERO on May 1, 2025 (CRD420251043971), after formal study screening had commenced but before data extraction and statistical analysis. PubMed, Embase, Web of Science, and the Cochrane Library were searched from their inception to March 19, 2025, for RCTs. Two reviewers independently selected the studies, extracted the data, and assessed the risk of bias according to the Cochrane Handbook. RevMan 5.4 was used for pairwise meta-analyses, and Stata/MP 18.0 for frequentist network meta-analysis of Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores. Results Fourteen RCTs comprising 590 patients were included. Network meta-analysis showed that VR and transcranial magnetic stimulation (TMS) were associated with greater estimated improvements in global cognition than transcranial direct current stimulation (tDCS). For MMSE, the standardized mean differences (SMDs) versus control were 1.90 (95% Confidence Interval [CI] 0.41–3.39), 0.57 (95% CI 0.27–0.86), and 0.07 (95% CI −0.74–0.89) for VR, TMS, and tDCS, respectively. For MoCA, VR and TMS showed greater numerical improvements than the control, whereas the effect of tDCS remained uncertain. Conclusions Within this indirect evidence network, VR was associated with the largest estimated improvement in global cognitive function after stroke. Among the NIBS modalities, TMS has shown relatively more consistent estimated benefits, whereas the current evidence for tDCS remains inconclusive and requires further high-quality trials.

OBJECTS:We aimed to observe the association between executive function and mild to severe upper extremity deficits in stroke survivors. Meanwhile, applying functional Near-Infrared Spectroscopy (fNIRS) to investigate the resting-state functional connectivity (FC) patterns of patients with post-stroke executive impairment (PSEI). METHODS:122 stroke survivors with mild to severe upper extremity deficits were enrolled. The Montreal Cognitive Assessment (MoCA), Frontal Assessment Battery (FAB), and Stroop color-word test assessed cognitive and executive function. The Fugl-Meyer assessment of the upper extremity (FMA-UE) and Action Research Arm Test (ARAT) assessed motor function. They were collected fNIRS data at the resting state. RESULTS:(1) In patients with mild to moderate upper extremity deficits, PSEI patients exhibited decreased speed/coordination of the upper extremity compared to the NPSEI patients (P < 0.05). The MoCA (r = 0.280, P = 0.047) and FAB (r = 0.358, P = 0.010) were associated with the speed/coordination. PSEI patients showed a decreased FC between the left dorsolateral prefrontal cortex (DLPFC) and the right Pre-Motor and Supplementary Motor Cortex (PreM&SMC), the right primary Somatosensory Cortex (PSMC) (P < 0.05); (2) In patients with severe upper extremity deficits, PSEI patients showed a reduction in FMA and ARAT (P < 0.05). The MoCA was associated with ARAT (r = 0.296, P = 0.016) and FMA-UE (r = 0.317, P = 0.009). The FAB was related to ARAT (r = 0.263, P = 0.033) and FMA-UE (r = 0.295, P = 0.016). PSEI patients did not show a significant change in FC (P ＞ 0.05). CONCLUSION:Our study suggests that the association between executive function and upper extremity after stroke is associated with the degree of upper extremity deficits. Additionally, the FC among cortical and subcortical brain regions were different with varying degrees of upper extremity deficits in PSEI patients.

Although intermittent theta-burst stimulation (iTBS) has emerged as a promising time-efficient and non-invasive neuromodulatory strategy in post-stroke motor rehabilitation, its clinical efficacy remains variable across patients and studies. In this review, we propose a multiscale framework for understanding how iTBS may support post-stroke motor recovery while emphasizing the current limits of translational evidence. At the microscopic and mesoscopic levels, preclinical studies suggest that iTBS contributes to early post-stroke repair by modulating ferroptosis, endoplasmic reticulum stress-related apoptosis, pyroptosis, neuroimmune responses involving astrocytes, white matter integrity, neurovascular remodeling, and neurotrophic signaling. These mechanisms are acknowledged to provide a biological substrate for post-stroke plasticity. At the clinical neurophysiological and neuroimaging levels, the available human studies indicate that iTBS modulates corticospinal excitability, cortical oscillatory dynamics, interhemispheric interactions, and large-scale motor-network organization. We herein further discuss the determinants of treatment variability, including stroke stage, lesion location, corticospinal tract integrity, baseline impairment severity, stimulation target, dosage parameters, co-interventions, genetic polymorphisms, and endogenous brain state. Current evidence remains limited due to small-sample size, heterogeneous protocols, incomplete safety and dose reporting, and temporal and geographic concentrations of the available studies. We posit that investigators in their future studies prioritize standardized reporting, multicenter and internationally diverse trials, biomarker-guided stratification, individualized electric-field modeling, and closed-loop stimulation strategies. Overall, iTBS remains a promising but protocol-sensitive and patient-dependent intervention, and this review provides a hypothesis-generating framework for future mechanistic and clinical studies in post-stroke motor rehabilitation.

BACKGROUND:Constraint-Induced Movement Therapy (CIMT) is a "rehabilitation strategy" supported by numerous basic studies. However, its clinical implementation is often limited by the poor ability of the affected limb. OBJECTIVES:To combine mCIMT plus a SaeboGlove for persons who would not normally qualify for mCIMT training. METHODS:Part A: mCIMT+Saebo group (n = 18) and mCIMT group (n = 19). Part B: mCIMT+Saebo group (n = 10) and control group (n = 9). Both parts were assessor-blinded, two-arm, parallel-group randomized controlled trials. In addition to conventional rehabilitation therapy, all groups, except the control group, underwent mCIMT. The mCIMT group wore a mitt for approximately 4 hours per day, 5 days a week, for 3 consecutive weeks. The mCIMT+Saebo group wore both the SaeboGlove and a mitt for the same duration. RESULTS:Part A: Wolf Motor Function Test (WMFT) showed that mCIMT+Saebo group scored 7.23 points higher (95% CI 1.93 to 12.53) than mCIMT group (P < 0.05). Hand grip strength (item 14 of WMFT) scored 3.29 points higher (95% CI 1.35 to 5.24) than in the mCIMT group (P < 0.01). Part B: The WMFT showed that mCIMT+Saebo group scored 5.45 points higher (95% CI 1.92 to 8.98) than the control group (P < 0.01). Hand grip strength was 2.66 points higher (95% CI 1.33 to 3.99) (P < 0.001), and ARAT was 10.75 points higher (95% CI 0.93 to 20.57) than in the control group (P < 0.05). CONCLUSIONS:The SaeboGlove may enhance the therapeutic advantages of mCIMT and expand the inclusion criteria for CIMT.

Stroke,as one of the leading causes of disability worldwide,severely impairs patients'quality of life.Motor imagery brain-computer interface(MI-BCI)technology based on electroencephalogram(EEG)provides a new approach for motor function rehabilitation after stroke by real-time decoding EEG signals related to patients'motor intentions and converting them into multimod-al external feedback.This systematic review summarizes the advancements in clinical applications of MI-BCI for upper and lower limb rehabilitation after stroke.Integrating MI-BCI with end-effectors such as rehabilitation robots,functional electrical stimulation(FES),and virtual reality can enhance upper limb motor function in stroke patients.Combining MI-BCI with neuromodulation tech-niques such as transcranial direct current stimulation or transcranial magnetic stimulation may further enhance decoding efficiency and rehabilitation outcomes.In lower limb rehabilitation,MI-BCI combined with lower limb rehabilitation robot,ergometers or FES has demonstrated positive potentials in improving gait,balance,and lower limb motor function in stroke patients.However,current research faces several limitations,including small sample sizes,inconsistent parameters(e.g.,training intensity,intervention dura-tion,feedback modes),and insufficient mechanistic studies.The"BCI illiteracy"phenomenon and low decoding accuracy in lower limbs also restrict the universal application of MI-BCI technology.Future research should conduct large-sample,multicenter random-ized controlled trials to determine the optimal combinations and efficacy of different intervention strategies.It is also necessary to further explore the mechanisms of MI-BCI that promote brain functional reorganization,thereby establishing a theoretical founda-tion for individualized precision rehabilitation.Furthermore,technological innovation should be focused on enhancing signal decod-ing accuracy and developing more intelligent and adaptive feedback modes to promote the clinical translation and application of MI-BCI in stroke rehabilitation.

Understanding the timing and factors related to the complications such as lymphedema and the limiting of upper limb mobility can help in taking timely measures to prevent them and contribute to the functional recovery of patients after breast cancer surgery. We aimed to observe the relationship between age and postoperative complications of breast cancer and the improvement of limb function after early rehabilitation intervention in patients of different ages. Sixty postoperative breast cancer patients were divided into three groups: young, middle-aged, and elderly. Rehabilitation treatment intervention was conducted within 1 week after surgery, and later rehabilitation training guidance was provided. Follow-up was conducted at 3 months postoperatively. The occurrence of lymphedema and shoulder joint restriction was assessed at enrollment and 3 months postoperatively. The comprehensive functional status of patients was evaluated using the International Classification of Functioning, Disability, and Health (ICF) Activity and Participation Assessment Scale. At 3 months postoperatively, there was no significant difference in the incidence of lymphedema among the three groups (P > 0.05). However, the incidence of shoulder joint restriction in the young group was significantly lower than that in the middle-aged and elderly groups (P < 0.05). At 3 months postoperatively, the scores of the ICF Activity and Participation Assessment Scale in all three groups were significantly lower than those at enrollment. The scores in the young group were significantly lower than those in the middle-aged and elderly groups (P < 0.05). The improvement in the ICF Activity and Participation Assessment Scale scores at 3 months postoperatively compared to enrollment was higher in the young group than in the middle-aged and elderly groups (P < 0.05). Our study found that the incidence of postoperative shoulder restriction and the recovery of limb function are related to age in breast cancer patients. In the future, studies with larger sample sizes and longer follow-up durations are warranted.

Objective To assess the reliability and validity of the Finger Flexor Spastic Scale (FFSS), designed to quantify the spasticity of the finger flexor, including Y1 (muscle reaction length), Y2 (anatomical length), Y2-Y1 (dynamic component of spasticity), X (type of resistance). Design This is a reliability and validity study. Each patient included was examined with FFSS by two evaluators for inter-rater reliability assessment. For intra-rater reliability assessment, follow-up evaluation was repeated 1 week after the initial assessment. Modified Ashworth scale (MAS) was used to evaluate validity. Setting the rehabilitative inpatient unit of a university hospital. Participants patients (N=66) after acquired brain injury. Interventions Not applicable. Main Outcome Measures Either Wilcoxon signed-rank test or paired sample t-test, Spearman rank correlation coefficient or Pearson linear correlation coefficient, Intra-class correlation (ICC), and weighted kappa were used for inter-rater and intra-rater reliability assessment. Validity was assessed using the Spearman correlation coefficient Results Good correlations were observed between two raters as well as between test and retest measurements. For Y2, ICC was 0.944–0.963 for inter-rater reliability and 0.949–0.974 for intra-rater reliability. For Y1, ICC was 0.853–0.915 for inter-rater reliability and 0.891–0.915 for intra-rater reliability. For Y2-Y1, ICC ranged from 0.757 to 0.917 for inter-rater reliability and from 0.794 to 0.917 for intra-rater reliability. For X, ICC was 0.802–0.997 for inter-rater reliability and 0.642–0.986 for intra-rater reliability. Kappa values of X were 0.734–0.904 for inter-rater reliability and 0.661–0.926 for intra-rater reliability. Across all five fingers, spearman correlation coefficients between MAS and Y2-Y1 were 0.612–0.762 (intra-rater) and 0.572–0.738 (inter-rater); those between MAS and Y1 ranged −0.670 to −0.393 (intra-rater) and −0.686 to −0.331 (inter-rater); and those between MAS and X spanned 0.177–0.630 (intra-rater) and 0.238–0.519 (inter-rater). Conclusions FFSS is a reliable and valid scale to assess spasticity in patients with acquired brain injury.

With the progression of population aging，cognitive impairment has garnered increasing attention. It not only reduces the overall quality of life and lifespan of patients，but also imposes tremendous burdens on caregivers and the social economy. Repetitive transcranial magnetic （rTMS） is a neuroelectrophysiological technique used for neurological and psychiatric，which has been proven by studies to exert ameliorative effect on multiple cognitive functions. Theat burst stimulation （TBS），as a novel rTMS treatment protocol，has been increasingly adopted in the treatment of cognitive impairment. Compared with conventional rTMS，TBS requires lower stimulation intensity，fewer pulses and shorter application time，leading to higher patient compliance. By reviewing and optimizing previous research findings and clinical practice experience，this expert consensus thoroughly analyzes issues pertaining to the origin，mechanism of action，efficacy and safety of TBS，and formulates clinically applicable TBS intervention protocols and workflows，which are expected to provide a more effective therapeutic approach for patiens with cognitive impairment.

The interaction of modified constraint-induced movement therapy (mCIMT) and intermittent theta-burst stimulation (iTBS) in enhancing stroke recovery is not well understood. This study investigated the effects of mCIMT combined with iTBS therapy on behavioral-functional recovery in stroke rats, with a particular focus on the role of hippocampal synaptic plasticity. We evaluated the behavioral functions of rats post-stroke using the fault footsteps test, modified neurology severity score (mNSS), elevated plus maze (EPM), and Y-maze tests, subsequently employing Golgi staining and transmission electron microscopy to further examine synaptic plasticity in the hippocampal region. In addition, the Pearson correlation coefficient was employed to analyze how synaptic plasticity-related metrics (the dimension of postsynaptic density and the proportion of mature dendritic spines) relate to motor metrics (the fault footsteps ratio) and emotional metrics (EPM: the proportion of open-arm entries and the proportion of time in open arms). Our research indicated that mCIMT combined with iTBS therapy may differentially affect the hippocampal CA1 and CA3 regions. This combined therapy may primarily enhance motor performance and alleviate anxiety-like behavior in stroke rats by promoting synaptic plasticity in the ipsilateral hippocampal CA1 region while exerting a limited impact on spatial memory. The present study provides evidence at the structural and functional levels for the potential mechanisms of mCIMT combined with iTBS therapy in stroke rehabilitation. The significance of synaptic plasticity in the CA1 region regarding therapy efficacy may be further investigated in the future.

Objectives:This study aims to assess the interrater reliability and criterion validity of a three-dimensional (3D) scanning method in evaluating hand volume in patients with stroke. Patients and methods:This observational study was conducted with 20 stroke patients (11 males, 9 females; mean age: 59.5±13.3 years; range, 28 to 74 years) between February 2023 and June 2023. Two trained therapists (Operators A and B) used a hand-held 3D laser scanner to measure bilateral hand volumes sequentially to assess the consistency of measurements between operators. Operator A also used a split cup to measure bilateral hand volumes to assess the accuracy of measurements between 3D scanning and the gold standard water displacement (WD) method. Results:The intraclass correlation coefficient between the two operators was 0.923 (p<0.001) for the volume of the non-affected hand measured using the 3D scanning method and 0.945 (p<0.001) for the affected hand. The volume of the non-affected hand measured by Operator A using the 3D scanning method highly correlated with the volume measured by the WD (r=0.938, p<0.001), and the volume of affected hand measured by using the 3D scanning method highly correlated with the volume of that measured by the WD (r=0.927, p<0.001). Conclusion:The 3D scanning method has good interrater reliability and criterion validity in the measurement of hand volume of affected and non-affected hands in patients with stroke.

The effect of Constraint-induced movement therapy (CIMT) or Intermittent theta-burst stimulation (iTBS) alone is limited in improving motor function after a stroke. In this study, we explored the efficacy and possible mechanisms in combination of CIMT and iTBS through behavioral evaluation, RNA sequencing, Golgi staining, transmission electronic microscope (TEM), high-performance liquid chromatography (HPLC), western blotting (WB) and immunofluorescence. Firstly, we observed that combination therapy is safe and effective, and it can significantly reduce the number of immature dendritic spines and increase the number of functional dendritic spines, the amount of glutamate (Glu) and the expression of Glu1 receptor (Glu1R). Meanwhile, we have found a significant reduction in neutrophil extracellular traps (NETs) in the combination group, and correlation analysis showed that the number of NETs is negatively correlated with the number of functional dendritic spines and the expression of Glu1R. After Cl-amidine ((S) - N - (1-amino-5- (2-chloroacetamiprid) -1-oxopentan-2-yl) benzamide 2,2,2-trifluoroacetate salt, PAD4 inhibitors) application, combined therapy did not further improve motor function and the expression of Glu1R. Our results proved that CIMT combined with iTBS therapy is a better therapeutic intervention. It improved motor function and synaptic plasticity after a stroke by promoting the transformation of functional dendritic spines and the expression of Glu1R in the ipsilateral primary motor cortex. The reduction of NETs generation is one of the key targets within it.

For decades, scientists have explored the patterns of neural network remodeling that occur after a stroke. Several studies have shown that both motor cortexes (MCs) undergo crucial remodeling after cerebral ischemia. However, the mechanism by which corticofugal fibers are remodeled is not well understood. Therefore, this study was aimed at investigating the changes in the bilateral red nucleus (RN) and MC-RN projections during recovery from a large-area stroke in a rat stroke model with or without constraint-induced movement therapy (CIMT). A large-area middle cerebral artery occlusion (MCAO) model was established in rats using the Longa method. CIMT was initiated 7 days after MCAO and continued for 1, 2, or 3 weeks. Rats in the control group underwent spontaneous recovery. Locomotor impairment was evaluated using the CatWalk automated gait analysis system, and overall neurological function was evaluated with the modified neurological severity score. Bilateral MC-RN projections were visualized by labeling fiber tracts with an anterograde tracer. Postsynaptic density 95 (PSD95), growth-associated protein 43 (GAP43), and synaptophysin expression levels in the RN were detected using western blotting and immunohistochemistry. The results showed that CIMT promoted motor recovery after a stroke, increased levels of GAP43 and PSD95 in the contralesional but not ipsilesional RN, and increased projections from the MC to the bilateral RN. Thus, CIMT promotes neuroplasticity after a large-area stroke by stimulating axon outgrowth, improving postsynaptic membrane function in the contralesional RN, and increasing bilateral projections of the MC-RN. These results provide evidence for the therapeutic efficacy of CIMT in restoring motor function and help with understanding RN plasticity after a large-area stroke.

PURPOSE:This study aims to evaluate the efficacy of vibration therapy (VT) in reducing lower limb spasticity and its potential implications for rehabilitation strategies. METHODS:A comprehensive search was conducted in multiple databases PUBMED, and Web Of Science, EMBASE(Ovid), Cochrane Library, Clinical Trials and Chi CTR up to 1 June, 2024. Meta-analysis was performed using the RevMan 5.4 software to calculate standardized mean differences (SMD) with 95% confidence intervals (CI). RESULTS:A total of seven RCTs were included in the meta-analysis. The results indicated that VT significantly reduced lower limb spasticity in post-stroke individuals (SMD= -0.65, 95% CI -1.29 to -0.02, p < 0.05). However, subgroup analyses revealed no significant differences in treatment efficacy based on session duration, targeted joints, number of sessions, or vibration frequency. CONCLUSIONS:Vibration therapy shows potential in reducing lower limb spasticity in stroke survivors. While the overall findings support its effectiveness, the lack of consistent effects across subgroups suggests that future studies should further explore how specific intervention parameters influence outcomes. Well-designed RCTs are warranted to determine optimal VT protocols and to clarify its role within comprehensive rehabilitation programs.

Continuous theta burst stimulation (cTBS), as a neuromodulation mode, has a long after-effect and a short stimulation time, which can significantly improve the cost-effectiveness. However, the application of cTBS is limited due to the heterogeneity of its effects on cortical excitability. Animal experiments provide the possibility to explore the neurobiological mechanism of cTBS. In this study, post-stroke rats were given cTBS once daily on the unaffected hemisphere. Rats were randomly divided into MCAO and cTBS groups. Each group was further divided into mild-medium stroke and large stroke subgroups according to magnetic resonance imaging and modified neurological severity score. The treatment began on day 4 after stroke and continued for 2 weeks. We found that cTBS could improve motor function in rats with mild-medium stroke and large stroke. cTBS increased the number of neurons and the activation of neurons in the bilateral motor cortex. The results of Golgi staining and MAP-2 staining suggested that cTBS promoted dendritic remodeling in the bilateral motor cortex regardless of the degree of injury. In addition, cTBS enhanced synaptic plasticity in bilateral motor cortex, including synaptic number, synaptic structure, and synaptic function. cTBS induced synapse regeneration via the astrocyte-mediated TSP1 pathway, but other mechanisms were involved in the functionalization of synapses. In conclusion, the present study demonstrated that cTBS had a significant effect on neuronal and synaptic plasticity in the bilateral motor cortex after cerebral ischemia.

Background Hemiplegic shoulder pain is a common issue after stroke and affects many stroke survivors. Emerging studies have shown the positive effects of functional electrical stimulation in the management of hemiplegic shoulder pain. However, a systematic review evaluating its efficacy is lacking. Objective To systematically review the effects of functional electrical stimulation for hemiplegic shoulder pain in patients who experienced stroke. Study design A systematic review and meta-analysis. Methods A systematic review of Embase, PubMed, Web of Science, Scopus, Cumulative Index to Nursing Information and Allied Health Literature (CINAHL), China National Knowledge Infrastructure (CNKI), Wan Fang Database, and China Science and Technology Journal Database (VIP) from the establishment of the databases to July 1, 2024, was carried out. Two researchers independently searched, screened, and extracted data from each database according to the search strategy and resolved any disagreements through negotiation. Results Of the 560 articles identified, 7 were included in the final synthesis. We analyzed data from 457 stroke survivors, the results showed that the functional electrical stimulation group had a better performance in relieving shoulder pain (standardized mean difference [SMD] = −1.66; 95 % confidence interval [CI]: −2.58 to −0.74; P = 0.0004), but there was no statistical significance in Fugl-Meyer assessment scores (SMD = 0.32; 95 % CI: −1.00 to 1.63; P = 0.64). Conclusion Functional electrical stimulation may be an effective management method to relieve pain for hemiplegic shoulder pain patients. However, these results should be interpreted with caution because of the limited number of studies and potential bias. More rigorous, reasonably designed randomized controlled trial with large sample sizes and long-term follow-up are needed in the future.

BACKGROUND: There is limited research on the Minimal Important Change (MIC) of the Chinese Western Aphasia Battery (WAB). Since an MIC for Chinese WAB has yet to be established, the clinical implications of data using the Chinese WAB remain unclear.AIM: This study was to establish the MIC of the Aphasia Quotient (AQ) of the Chinese WAB.DESIGN: The study is a prospective, longitudinal study.SETTING: The rehabilitation department of a Class A tertiary hospital.POPULATION: One hundred six patients with aphasia after stroke were included and analyzed in the study.METHODS: Patients were evaluated by a speech and language therapist using the Chinese version of WAB before and after the 2 week intervention. Patients and their primary therapist and caregiver provided a global rating of changes in patients' oral communication ability using the 7-point Likert Scale after the speech and language therapy. Three anchor-based methods were used to examine the MIC: the ROC-based method (MICROC), the predictive modeling method (MICpred), and the MICpred-based method adjusted for the proportion of improvement (MICadj).RESULT: MICadj was the best parameter in this study. The participant, caregiver, and therapist anchor-based MICadj estimated in the present study was 6.98, 6.73, and 6.00, respectively.CONCLUSIONS: Our data provide the first estimate of MIC value for the Chinese WAB-AQ. Future studies with larger sample sizes are needed to refine the estimated value.CLINICAL REHABILITATION IMPACT: The current study has advanced the research on the properties of Chinese WAB.

AIMS:Limited understanding of neurobiological mechanisms of repetitive transcranial magnetic stimulation (rTMS) prevents us from choosing optimal therapeutic regimen for patients to improve therapeutic efficiency. Resting-state functional magnetic resonance imaging (rs-fMRI) has been demonstrated to obtain comparable functional readouts across species. METHODS:Intermittent and continuous theta burst stimulation were used to stimulate ipsilesional and contralesional hemisphere, respectively, during the subacute phase after stroke. We used a rat middle cerebral artery occlusion stroke model. The amplitude of low-frequency fluctuations and functional connectivity analyses of rs-fMRI were chosen to detect neuron activity and functional connectivity. The expression of neuron activation marker c-Fos and axonal plasticity marker GAP43 was examined by an immunochemistry method to corroborate the results of rs-fMRI. RESULTS:iTBS altered the long-term neuronal activity in bilateral sensorimotor cortex, whereas cTBS influenced immediate neuronal activity of bilateral sensorimotor cortex. In addition, cTBS enhanced interhemispheric and intrahemisheric functional connectivity in contralesional hemisphere, accompanied by axonal and dendritic remodeling in the perilesional cortical areas and contralesional homologous areas after large stroke. CONCLUSION:rTMS exerted complex effects on brain structural and functional connectivity in addition to affecting cortical excitability. cTBS promoted the compensatory effect of contralesional hemisphere after stroke with large lesions.

ObjectiveTo systematically evaluate the effect of contralaterally controlled functional electrical stimulation (CCFES) on motor function after acquired brain injury (ABI).Data SourcesWe searched the Pubmed, Embase, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database (PEDro), Web of Science, SinoMed, CNKI, VIP Database for Chinese Technical Periodicals and Wanfang Database, from inception to December 2023.Study SelectionStudies were included if they were randomized controlled trials assessing the effect of CCFES on motor function compared with routine rehabilitation or routine electrical stimulation after ABI. Two independent reviewers screened 894 articles for inclusion.Data ExtractionThe extracted data included study information, sample size, study population, interventions, measurement evaluated and the test interval.Data SynthesisThis study included 24 trials with 28 intervention-control pairs and 1148 participants with stroke. Meta-analysis showed that the CCFES group demonstrated more significant improvement than the control group in the Fugl-Meyer Assessment Scale (FMA) (standardized mean difference (SMD)=0.66, 95% confidence interval (CI)=0.44-0.88, P<.001), active range of motion (AROM) (SMD=0.77, 95% CI=0.54-1.01, P<.001), Modified Barthel Index (MBI) (SMD=0.55, 95% CI=0.29-0.81, P<.001), Motricity Index (MI) (SMD=0.60, 95% CI=0.26-0.94, P<.001) surface electromyography (sEMG) (SMD=0.81, 95% CI=0.56-1.06, P<.001), and Functional Ambulation Category (FAC) (SMD=0.53, 95% CI=0.24-0.83, P<.001). The CCFES group showed no significant improvement over the control group in the Action Research Arm Test (ARAT) (SMD=0.24, 95% CI=-0.10-0.58, P=.17).ConclusionsOur synthesized evidence suggests that CCFES could improve motor function in patients with stroke. More RCTs with other brain injury patients are required to provide future evidence on the therapy effect of CCFES and make a contribution to the uniform standard of CCFES.

PURPOSE:The aim of this study was to investigate the efficacy of manual lymphatic drainage (MLD) combined with repetitive transcranial magnetic stimulation (rTMS) on the recovery of upper limb in patients with post-stroke complex regional pain syndrome (CRPS). METHODS:This pilot study was conducted with 54 patients with post-stroke CRPS. Patients were randomized into three groups: the MLD combined with rTMS group (MLD + rTMS group), the rTMS group and the sham-rTMS group. The results of numeric rating scale (NRS), volumetric measurement, Fugl-Meyer assessment of upper extremity (FMA-UE), CRPS severity score (CSS), generalized anxiety disorder-7 (GAD-7) and patient health questionnaire-9 (PHQ-9) before and after the intervention were analyzed. RESULTS:Fifty-four participants (37 males, 17 females; mean age 66.11 ± 8.43 years; range, 18 to 85) were included in the study. Among groups, improvements were statistically significant with superiority of rTMS + MLD group after treatment (p < 0.05). NRS, GAD-7, and PHQ-9 in the rTMS + MLD group improved more significantly than those in the rTMS group (p < 0.05). CONCLUSION:MLD combined with rTMS has an add-on efficacy on the basis of rTMS therapy in post-stroke patients, especially in pain. MLD could also have an effect on anxiety and depression.