The risk of falls in older adults correlates with diminished multitasking abilities. The cognitive-balance dual-task paradigm enables fall risk assessment through dual-task interference, the mechanism of which is linked to competition for attentional resources or neural pathways. Cognitive-balance dual-task training improves related functional abilities in older adults, making the elucidation of its brain activation mechanisms crucial for fall prevention interventions. Clinically, functional magnetic resonance imaging (fMRI), electroencephalography (EEG), and functional near-infrared spectroscopy (fNIRS) are commonly used to explore related neural mechanisms. Among these, fNIRS is particularly suitable for dual-task monitoring due to its advantages of portability and superior anti-artifact performance. This review summarizes key design considerations and application methods for fNIRS in cognitive-balance dual-task studies among older adults, offering recommendations for fall risk assessment and prevention. Standardized experimental paradigms, research designs, and regions of interest selection for fNIRS in cognitive-balance dual-tasks among older adults are progressively emerging. fNIRS analysis reveals distinct central mechanisms across elderly individuals with varying health status: cognitively healthy subjects exhibit compensatory bilateral prefrontal activation, while those with cognitive impairment (including those with subjective cognitive decline, mild cognitive impairment, and Alzheimer's disease) show diminishing activation levels corresponding to cognitive decline. Patients with Alzheimer's disease present widespread cortical activation deficits, and individuals with balance impairment exhibit distinct activation patterns in specific brain regions. fNIRS also supports dual-task training by reflecting cortical activation changes before and after training. Its neurofeedback technology holds potential applications but remains controversial. Current research faces challenges such as inconsistent experimental designs sample features, task types. Future efforts should be made to establish standardized protocols and explore combined multi-technique applications to provide theoretical support for fall risk assessment and prevention in older adults.

OBJECTIVE:To assess the efficacy and safety of transcutaneous auricular vagus nerve stimulation (taVNS) for acute ischemic stroke upper limb rehabilitation. DESIGN:Randomized controlled trial with taVNS and control groups. SETTING:Hospital. PARTICIPANTS:Sixty patients (N=60) diagnosed with acute ischemic stroke. INTERVENTIONS:The taVNS group received daily 30-minute taVNS sessions followed by conventional rehabilitation, versus the control group receiving sham stimulation with rehabilitation. Both groups received 5 weekly sessions over 2 weeks. MAIN OUTCOME MEASURES:Pre and postintervention assessments included the Fugl-Meyer Assessment for Upper Extremity (FMA-UE), the National Institutes of Health Stroke Scale (NIHSS), and the Modified Barthel Index (MBI). Heart rate, blood pressure changes, and adverse reactions were recorded throughout the treatment period. RESULTS:Both groups demonstrated comparable baseline FMA-UE, NIHSS, and MBI scores (P>.05). Postintervention, the taVNS group exhibited marked improvements in FMA-UE and MBI, alongside significant NIHSS reduction compared with controls (all P<.05). Heart rate and blood pressure changes were stable throughout the 2-week treatment period, with no significant daily changes (P>.05). CONCLUSIONS:This study supports the efficacy and safety of taVNS in acute ischemic stroke, demonstrating significant improvements in motor recovery, neurologic function, and independence in activities of daily living. By priming the nervous system for subsequent training, the noninvasive strategy acts synergistically with rehabilitation to enhance outcomes. These findings position taVNS as a promising adjunctive intervention for early stroke care.

ObjectiveTo retrospectively analyze the timing of rehabilitation initiation and the duration of rehabilitation among patients with occupational injuries at a designated rehabilitation hospital in Yancheng, China, and to identify the influencing factors. The findings aim to provide valuable insights to support the development of China’s occupational rehabilitation service system.MethodsA retrospective analysis was conducted on the medical records of workers with occupational injuries who received rehabilitation treatment at a designated occupational rehabilitation hospital in Yancheng from 2021 to 2025. Quantile regression analysis was employed to investigate the factors influencing the timing of rehabilitation initiation and the duration of rehabilitation.ResultsNo statistically significant differences were observed in the timing of rehabilitation initiation concerning sex, age group, injury site, surgical status, rehabilitation costs, or the duration of rehabilitation (p > 0.05), except for the administrative origin of injury certification (p < 0.001). In contrast, the duration of rehabilitation was significantly associated with all examined variables, including male sex, the age group of 60–69 years, injury site, surgical intervention, administrative origin of injury certification, and rehabilitation costs (p < 0.05).ConclusionThe timing of rehabilitation intervention for workers with occupational injuries depends on the administrative origin of injury certification. Meanwhile, the duration of rehabilitation is closely linked to factors, including sex, age group, injury site, surgical intervention, the administrative origin of injury certification, and rehabilitation costs. This study offers valuable evidence for optimizing occupational rehabilitation policies and services in Yancheng, China.

ObjectiveTo examine prefrontal hemodynamic changes in patients with post-stroke anxiety (PSA), both at rest and during cognitive task engagement, with the aim of elucidating the underlying neural mechanisms of PSA and identifying potential neural correlates for clinical application.MethodsFifty patients with PSA and 45 post-stroke patients without anxiety symptoms were recruited. PSA was diagnosed using the Hamilton Anxiety Rating Scale (HAMA ≥ 7), and comorbid depression was screened using the 17-item Hamilton Depression Rating Scale (HAMD-17 ≥ 8). Patients with significant cognitive impairment were excluded. Functional near-infrared spectroscopy (fNIRS) was used to measure resting-state functional connectivity in the frontopolar cortex (FPC) and dorsolateral prefrontal cortex (DLPFC), as well as task-evoked activation during the verbal fluency task (VFT). Demographic and clinical characteristics showed no significant differences between groups except for stroke type. Between-group comparisons were conducted to identify PSA-related differences in prefrontal network characteristics. Subgroup analyses were performed to explore the influence of comorbid depression on neural alterations.ResultsThere were no significant differences between the PSA and non-PSA groups in demographic or clinical characteristics, including age, sex, and disease duration (P > 0.05). Compared to the non-PSA group, patients with PSA exhibited significantly reduced activation in the bilateral FPC during the VFT (P < 0.05). Within the PSA group, those with comorbid depression showed further reductions in activation in the bilateral FPC and the left DLPFC (P < 0.05). No significant differences in resting-state functional connectivity were observed between groups (P > 0.05).ConclusionReduced activation in the bilateral FPC may represent a key neural substrate associated with post-stroke anxiety. In addition, altered activation patterns in the bilateral FPC and left DLPFC may reflect neural correlates related to depressive symptoms in patients with PSA, providing candidate targets for future mechanistic and clinical studies.

BACKGROUND:The contralesional dorsal premotor cortex has been proposed as a potential neuromodulatory target for patients with severe upper limb impairment due to subacute ischemic stroke. This proof-of-concept study aimed to compare behavioral outcomes and resting-state neuroimaging findings between high-frequency repetitive transcranial magnetic stimulation (rTMS) over the contralesional dorsal premotor cortex and guideline-supported low-frequency stimulation over the contralesional primary motor cortex. METHODS:In this randomized trial, 46 patients with severe upper limb impairment in the subacute stage after ischemic stroke were randomly assigned to receive either high-frequency rTMS over the contralesional dorsal premotor cortex or low-frequency rTMS over the contralesional primary motor cortex. Low-frequency stimulation over the contralesional primary motor cortex served as an evidence-supported active comparator for poststroke upper limb motor recovery. Stimulation was administered five times per week for two weeks using magnetic resonance imaging-guided neuronavigation. All participants received concurrent standard rehabilitation therapy. The primary outcome was the Fugl-Meyer Assessment for Upper Extremity. Secondary outcomes included the Arm Subscore of the Motricity Index, the Hong Kong version of the Functional Test for the Hemiplegic Upper Extremity, the Modified Barthel Index, and resting-state functional magnetic resonance imaging-derived degree centrality. RESULTS:Both groups showed significant improvements in the primary and secondary behavioral measures (p < 0.01), with no significant between-group differences in the magnitude of change (p > 0.05). In neuroimaging analyses, patients receiving high-frequency rTMS over the contralesional dorsal premotor cortex showed significantly greater degree centrality changes in the ipsilesional middle occipital gyrus, contralesional medial superior frontal gyrus, and contralesional middle frontal gyrus than those receiving low-frequency rTMS over the contralesional primary motor cortex (p < 0.05). Within the high-frequency stimulation group, degree centrality changes in the ipsilesional middle occipital gyrus were positively correlated with improvements in the Fugl-Meyer Assessment for Upper Extremity (r = 0.619, false discovery rate-corrected p = 0.018). CONCLUSIONS:High-frequency rTMS over the contralesional dorsal premotor cortex produced behavioral improvements comparable to guideline-supported low-frequency rTMS over the contralesional primary motor cortex, without establishing superiority or formal non-inferiority. Exploratory neuroimaging analyses showed greater degree centrality changes in the ipsilesional middle occipital gyrus after high-frequency premotor stimulation, and these changes correlated with upper-limb motor improvement. These findings support further investigation of contralesional dorsal premotor cortex-targeted high-frequency rTMS for severe subacute post-stroke upper limb impairment. REGISTRATION:URL: http://www.chictr.org.cn; Unique identifier: ChiCTR2000038049.

[This corrects the article DOI: 10.3389/fnagi.2025.1683808.].

According to the theory of bidirectional synaptic plasticity, the threshold for inducing long-term potentiation-like plasticity varies with neuronal activity. Continuous theta burst stimulation (cTBS) has been proposed as a priming protocol that may modulate neural responses to subsequent intermittent theta burst stimulation (iTBS). This study examined differences between priming and non-priming iTBS conditions in their associations with brain network modulation, assessed at rest and during motor tasks, when targeting the left primary motor cortex. In a randomized crossover design, 26 healthy adults completed six sessions involving two stimulation conditions (priming and non-priming iTBS) and three task paradigms (hand grasping, multi-joint movement, and resting task). The order of stimulation conditions and tasks was randomized. In each session, a single task was performed, and fNIRS data were acquired immediately before and after stimulation. Analyses focused on cortical activation, functional connectivity, and graph theory. During the grasping task, the priming iTBS condition was associated with greater task-evoked activation in the left primary motor cortex and premotor cortex compared with the non-priming iTBS condition. During the multi-joint movement task, priming iTBS condition showed stronger functional connectivity between the left primary motor cortex and left primary somatosensory cortex. No significant between-condition differences were observed during the resting task. In summary, priming and non-priming iTBS conditions differed in cortical activation and sensorimotor connectivity during motor task performance, whereas resting-state network properties remained largely unchanged. These results suggest that priming-related differences in brain network responses are more evident during active motor engagement than at rest. Further studies are required to clarify the underlying mechanisms and functional significance of these effects.

Background: The cortex and cerebellum have a closely connected closed-loop circuit. Intermittent theta burst stimulation (iTBS) targeting the cerebellum has shown promise in improving balance function and inducing neuroplasticity. This study investigates whether cerebellar iTBS can elicit cortical responses. Methods: One hundred healthy volunteers were randomly assigned to a real or sham iTBS stimulation group. Functional near-infrared spectroscopy (fNIRS) measured cortical activation during resting, walking, and unilateral support tasks. Results: During the unilateral support task, graph theory analysis revealed significant changes in brain network properties, suggesting a deviation from optimal small-world organization and reduced global integration. No significant changes were observed during the walking and resting-state tasks. Conclusions: These findings suggest that cerebellar iTBS can modulate cortical activity, though further studies are needed to confirm its clinical effects. Clinical Trial Registration: ChiCTR2300077916, https://www.chictr.org.cn/showproj.html?proj=207394.

IntroductionCerebral palsy (CP) is a common movement disorder caused by abnormalities or injury to the developing brain. It affects more than 17 million people worldwide and is associated with substantial impairments in postural balance and gait control, particularly in children with spastic diplegic CP. This study aimed to examine differences in cortical activation during walking between children with spastic diplegic CP and children with typical development (CTD), and to explore the relationship between cortical activation and gross motor performance.MethodsFunctional near-infrared spectroscopy (fNIRS) was used to monitor cortical activity during walking in 15 children with spastic diplegic CP and 15 age-matched CTD participants. All participants walked at a self-selected pace while cortical hemodynamic responses were recorded. Cortical activation patterns were compared between groups, and correlation analyses were conducted to evaluate associations between cortical activation, gross motor function, and walking speed.ResultsCompared with CTD, children with spastic diplegic CP showed significantly greater cortical activation in the right prefrontal cortex (RPFC), left prefrontal cortex (LPFC), and right premotor cortex (RPMC) during walking. In addition, activation in the RPMC was negatively correlated with gross motor function and walking speed.DiscussionThese findings indicate that children with spastic diplegic CP exhibit cortical over-activation during walking, particularly in the prefrontal and premotor cortices. The observed negative association between RPMC activation and motor performance suggests that greater cortical recruitment may reflect increased compensatory demands during motor planning and gait control. Overall, the results support the notion that children with spastic diplegic CP rely more heavily on cortical compensatory mechanisms to maintain walking performance.

Introduction Single-modality motor rehabilitation is often insufficient to address the complex functional restoration needs of patients with chronic ankle injuries following surgery. Research indicates that non-invasive neuromodulation techniques, such as intermittent theta-burst stimulation (iTBS), may enhance motor recovery by increasing cortical excitability and facilitating neural network reorganisation. Compared with exercise therapy alone, this study aims to explore the rehabilitation efficacy of combining iTBS with exercise therapy in patients with chronic ankle injuries following surgery. It also investigates the associated cortical network modulation, providing scientific evidence to optimise rehabilitation strategies for these patients.Methods and analysis This study is a prospective, multicentre, randomised controlled trial with single-blind assessment. A total of 28 patients with chronic ankle injuries following surgery were enrolled and randomly assigned to either the experimental group or the control group according to centre-stratified randomisation. The experimental group will receive iTBS combined with exercise therapy, while the control group will receive sham iTBS combined with exercise therapy. Both groups will undergo one session per day, 5 days per week, for a total of 3 weeks. The primary outcome measure will be the American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Score (AOFAS). Secondary outcome measures will include isokinetic muscle strength assessment of the ankle dorsiflexor and plantarflexor muscles, Visual Analogue Scale (VAS) scores, ankle joint range of motion (ROM) and the 10-Metre Walk Test. Functional near-infrared spectroscopy (fNIRS) and transcranial magnetic stimulation (TMS) will also be used to assess cortical functional activity and neurophysiological changes. All outcome measures will be collected at baseline prior to enrolment, post-intervention at week 3, and at follow-up at week 6. Primary outcomes analyses will use group-by-time comparisons to examine between-group differences in functional and neurophysiological measures.Ethics and dissemination The study has received approval from the Medical Ethics Committee of Jiangsu Province (Suqian) Hospital (Application No. 2025-SR-0333). All participants will provide written informed consent before enrolment. Results will be disseminated through peer-reviewed journals and scientific conferences.Trial registration number ChiCTR2500110905.Protocol version V1.0.

BackgroundPredementia, encompassing subjective cognitive decline (SCD) and mild cognitive impairment (MCI), represents an early phase of neurodegeneration with a heightened risk of progression to dementia. This stage offers a critical window for intervention. Virtual reality (VR) enhances neuroplasticity in predementia via multisensory stimulation, addressing research gaps.​​ObjectiveTo assess the impact of VR-based interventions on cognitive abilities, emotional well-being, and instrumental activities of daily living (IADL) in individuals with predementia conditions.MethodsA search of seven databases identified studies involving seniors aged ≥65 with SCD or MCI. Eligible studies compared conventional cognitive training or usual care as controls. Quality was assessed using the Cochrane Risk of Bias Tool, and evidence certainty was graded using the GRADE framework.ResultsTwelve randomized controlled trials were included. The meta-analysis revealed that, in comparison to control groups, VR-based cognitive interventions had superior effects on subjective cognitive complaints (SMD = -4.06, 95% CI [-4.86, -3.25]), learning and memory (SMD = 0.41, 95% CI [0.02, 0.80]), working memory (SMD = -0.06, 95% CI [-0.08, -0.03]), verbal fluency (SMD = 0.49, 95% CI [0.03, 0.94]), spatial cognition (SMD = 1.43, 95% CI [0.77, 2.10]), and IADL (SMD = 0.77, 95% CI [0.14, 1.40]).ConclusionsVR-based cognitive interventions could improve objective cognitive performance, subjective cognitive complaints, and IADL in predementia. Future research should prioritize optimizing the intervention protocols and enhancing the geriatric-specific VR-based cognitive intervention.

Background: Aging-related decline in multitasking abilities increases the risk of falls, particularly during cognitive-balance dual-tasks. Previous studies have predominantly focused on cognition and balance performance, neglecting research on cortical activation related to balance. The study aims to explore differences in homeostatic control and cortical activation under different sensory conditions during single-tasks (STs) and dual-tasks (DTs) in older and younger adults. Methods: 20 elderly and 19 young participants completed balance STs and cognitive-balance DTs. Balance was assessed using an improved Clinical Test of Sensory Interaction on Balance (mCTSIB), while the cognitive task involved a "subtract 7 countdown." Functional near-infrared spectroscopy (fNIRS) monitored activation in the left and right sensorimotor cortex, premotor cortex, and prefrontal cortex. Diverse sensory conditions, including restrictions on visual and proprioceptive inputs, were systematically incorporated into the experimental design. Results: Older adults exhibited lower balance performance under DTs compared to STs when only vision was impaired. However, when both vision and proprioception were simultaneously impaired, the opposite was observed. Analysis of brain activation revealed a broader activation pattern in the older group during DT conditions compared to the younger group. Conclusion: Older adults adopted a "posture-first" strategy for balance control during DT to prevent falls. In terms of cortical activation, the older group showing a more extensive pattern, suggesting a potential compensatory mechanism. Our findings provide a theoretical basis for reducing fall risk in the elderly through dual-task training and Cortical intervention.

Introduction Combining repetitive transcranial magnetic stimulation (rTMS) with robotic training could result in more significant improvements in motor function than either treatment alone. The efficacy of this combination may depend on the sequencing of the interventions. However, few studies have explored the possibility of interleaving or alternating between the two treatment modalities within a single session or over a shorter time frame. The objective of this study is to evaluate the efficacy of alternating rTMS and soft-hand rehabilitation robot therapy to enhance upper limb and hand function in patients with ischaemic stroke.Methods and analysis This multicentre study will be conducted as a single-blind, controlled, randomised trial, enrolling 132 post-stroke patients with a disease duration ranging from 1 week to 3 months. The study participants will be randomly assigned to group A (n=44), group B (n=44) and group C (n=44). All participants will undergo a 4-week neurological rehabilitation programme, which includes standardised physical and occupational therapy administered by experienced therapists. Group A will receive 10 Hz high-frequency rTMS (HF-rTMS) over the ipsilesional primary motor cortex (iM1) for 20 min, followed by 20 min of soft-hand rehabilitation robot training. Group B will receive 5 min of 10 Hz HF-rTMS over the iM1 followed by 5 min of soft-hand rehabilitation robot training, repeated four times. Group C will receive sham rTMS with other parameters identical to those of group A. The above treatments will be administered once daily, 5 days a week, for 4 weeks. The primary outcome measurement is the Fugl-Meyer assessment of upper extremity (FMA-UE). The secondary outcome measurements include the Hong Kong edition of Functional Test for the Hemiplegic Upper Extremity (FTHUE-HK), the Modified Ashworth Scale (MAS), and the International Classification of Functioning, Disability and Health upper extremity entries (ICF-Upper Extremity Entries). Assessments will be conducted at baseline and after 4 weeks of treatment.Ethics and dissemination This study has been approved by the Ethics Committee of the First Affiliated Hospital of Nanjing Medical University (2024-SR-515). The findings of this study will be spread through networks of scientists, professionals and the general public, as well as peer-reviewed scientific papers and presentations at pertinent conferences.Trial registration number ChiCTR2400089583.

ObjectiveThis systematic review and meta-analysis aims to comprehensively analyze the effects of mind–body exercise on cognitive function, brain structure, and brain function in individuals with mild cognitive impairment (MCI) by assessing randomized controlled trials.MethodsA systematic search was conducted using four databases: Cochrane Library, EMBASE, PubMed, and Web of Science, from inception until December 2023. The study quality was assessed using the Cochrane risk-of-bias tool. Systematic review and meta-analyses were performed for outcome measures such as the Montreal Cognitive Assessment (MoCA), gray matter volume (GMV), functional connectivity at rest (rsFC), amplitude of low-frequency fluctuation (ALFF) and event-related potential (ERP) P300 latency. Three-dimensional coordinates of brain regions with notable variances were extracted from imaging and delineated in the brain map.ResultsAfter screening 433 studies, nine met the eligibility inclusion criteria. In 4 studies using the MoCA scale, meta-analysis showed a significant effect of aerobic exercise intervention on global cognitive function improvement (MD = 1.6; 95% CI: 0.70 to 2.50; p = 0.0005). Most of the included studies reported that mind–body exercise improved gray matter volume in the hippocampus, bilateral anterior cingulate gyrus, frontotemporo-occipital regions, altered functional connectivity of the default mode network (DMN) and dorsal attentional network (DAN), neural activity in key brain regions in older adults with MCI.ConclusionThis systematic review demonstrates that mind–body exercise is associated with improved cognitive function and neuroplastic changes in older adults with mild cognitive impairment, with changes particularly evident in regions vulnerable to neurodegeneration such as the hippocampus and anterior cingulate cortex.Systematic review registrationCRD42022251115; https://www.crd.york.ac.uk/PROSPERO/view/CRD42022251115.

This study investigated how varying time intervals between priming continuous theta burst stimulation (cTBS) and intermittent theta burst stimulation (iTBS) affect motor cortex plasticity in healthy adults. Using a randomized crossover design, 31 participants underwent four cTBS-iTBS protocols with intervals of 0, 5, 10, or 15 min, with motor-evoked potential (MEP) amplitudes measured at baseline and post-intervention. The results revealed significant main effects of both the stimulation condition and time point on normalized MEP amplitudes. Among the four protocols, the cTBS-10 min-iTBS protocol elicited the greatest facilitatory effect, producing significantly greater MEP enhancement than the 0-, 5-, and 15-minute intervals. The normalized MEP amplitudes showed a time-dependent decline, with the highest values observed at 0 min and the lowest at 30 min post-intervention. These findings suggest that the time intervals between cTBS and iTBS may influence the resulting facilitation effects, offering preliminary evidence that may inform future optimization of TBS-based therapeutic applications.

ObjectiveTo explore the effects of postural control and cognition interference on cortical activation during balance tasks in stroke patients.MethodsfNIRS was used to measure cortical activation in the SMC, PMC, and PFC in 30 subjects with supratentorial stroke while performing a postural single task (PST), cognitive single task (CST), and postural-cognitive dual task (DT). Differences in activation and correlations with patient balance or cognitive performance were analyzed.ResultsCST induced a higher level of activation in the unaffected SMC and bilateral PMC compared to PST. While DT resulted in more activation of the bilateral SMC and bilateral PMC compared to PST. No difference was found between DT and CST. Correlation analysis showed that activation of ROIs during balance tasks showed a positive correlation with the balance ability and cognitive performance of subjects.ConclusionBoth postural control and cognitive interference led to cortical activation changes during the tasks. Cognitive load was more likely to elicit greater cortical activation and approach the activation ceiling. These activations were intimately related to the patient’s ability to balance and cognitive performance. Subjects with better balance have a greater reserve of resources to allocate, enabling them to cope with tasks and improve task performance.Clinical trial registrationClinicalTrials.gov. Identifier ChiCTR2300077916.

Restoration of independent walking ability is the primary objective of stroke rehabilitation; however, not all patients achieve this goal due to diverse impairments in the paretic lower limb and compensatory mechanisms that lead to an asymmetrical and mechanically inefficient gait. This investigation aimed to examine alterations in cortical activation in post-stroke patients while walking with a wearable two-channel functional electrical stimulation (FES) in comparison to walking without FES. This observational study was conducted to discern distinct activation patterns in 19 stroke patients during sessions with and without FES, while using functional near-infrared spectroscopy (fNIRS) to monitor changes in blood oxygen levels. Our findings revealed only a significant reduction in ΔOxy-Hb in the contralesional pre-motor cortex (z = −2.803, p = 0.005) during the FES-on walking sessions compared to the FES-off sessions. Furthermore, all regions in the FES-on session exhibited lower ΔOxy-Hb. Conversely, no significant differences were observed in ΔDeoxy-Hb. Moreover, a significant correlation was found between decrease in cPMC and the reduced cost time of walking under FES-on condition. The fNIRS analysis revealed diminished activation in the contralesional pre-motor cortex when walking with FES, implying that FES may facilitate a more automatic gait pattern while reducing a patient’s reliance on contralesional cortical resources. The findings of this study lay the groundwork for long-term neural rehabilitation.

Background:Upper limb hemiplegia faces the challenge of slow and difficult recovery. A "closed-loop method" based on brain plasticity has been proposed, combining central and peripheral interventions to enhance the upper limb function. Based on the theory, we aimed to investigate the effect of transcranial direct current stimulation (tDCS) concurrent with virtual reality (VR)-based robotic intervention on upper limb recovery and cortical excitability. Methods:In this single-blinded, randomized, controlled trial, 40 patients with subacute ischemic stroke were recruited and randomized to experimental (tDCS concurrent with VR-based robotic intervention) and control (sham tDCS concurrent with VR-based robotic intervention) groups. All patients received 15 sessions (20 min per day, 5 sessions per week). Outcome measures included the Fugl-Meyer Assessment Upper Limb Scale (FMA-UL), the Action Research Arm Test (ARAT), the Modified Barthel Index (MBI), and functional near-infrared spectroscopy (fNIRS). Results:All 40 patients completed the intervention, with 34 included in the fNIRS analysis. FMA-UL (F = 22.239, p < 0.001) and ARAT (F = 10.984, p=0.002) scores showed significant time-by-group interaction effects. Greater improvements were observed in the experimental group compared to the control group for both FMA-UL (p < 0.001) and ARAT (p=0.001). MBI scores increased significantly in both groups over time (F = 55.415, p < 0.001), but the change scores did not differ significantly between groups (p=0.369). fNIRS analysis revealed a significant time-by-group interaction effect in the ipsilesional primary motor cortex (M1) (F = 4.762, p=0.037) and contralesional prefrontal cortex (PFC) (F = 10.881, p=0.002). Greater increases in activation were found in the experimental group for both ipsilesional M1 (p=0.025) and contralesional PFC (p=0.002). Conclusions:Compared with sham tDCS concurrent with VR-based robotic intervention, tDCS concurrent with VR-based robotic intervention can effectively enhance upper limb function and promote activation of ipsilesional M1 and contralesional PFC in subacute ischemic patients with stroke. However, there was no obvious advantage in improving activities of daily life (ADL). Trial Registration: Chinese Clinical Trial Registry: ChiCTR2100047442.

BACKGROUND:Recent advances have highlighted the interplay between intermittent theta-burst stimulation (iTBS) and transcranial direct current stimulation (tDCS) in neuroplasticity modulation. However, the synergistic potential of these modalities in optimizing plasticity, particularly with cathodal tDCS preconditioning before iTBS, remains poorly understood. OBJECTIVE:This study examined the effects of cathodal high-definition tDCS (HD-tDCS) preconditioning on iTBS-induced neuroplasticity in the primary motor cortex at different timing intervals. MATERIALS AND METHODS:Twenty healthy participants underwent four stimulation sessions in a randomized cross-over design, receiving iTBS either immediately or at 10-minute and 30-minute intervals after cathodal HD-tDCS preconditioning, in addition to a control session with iTBS immediately after sham HD-tDCS. Motor evoked potentials (MEPs) were measured at baseline and 5, 10, 15, and 30 minutes after iTBS to assess changes in neuroplasticity. Each session was separated by ≥one week to prevent carry-over effects. RESULTS:Compared with sham sessions, immediate cathodal HD-tDCS preconditioning significantly enhanced MEPs across all measured intervals after iTBS, with sustained neuroplasticity persisting for up to 30 minutes. Immediate preconditioning produced significant MEP enhancements at 5 and 10 minutes when compared with the 30-minute delayed condition. CONCLUSIONS:The effectiveness of cathodal tDCS preconditioning in enhancing iTBS-induced neuroplasticity decreased with increasing intervals between tDCS and iTBS application. These findings highlight the essential role of precise timing in tDCS preconditioning for maximizing the neuroplastic effects of iTBS and offer valuable insights for optimizing neurorehabilitation protocols.

Objective To verify the reliability and validity of a portable Right Gait&Posture® gait detection system based on wearable sensors.Methods A total of 36 healthy volunteers were recruited in the Jiangsu Zhongshan Geriatric Rehabilitation Hos-pital from August to November 2023.Right Gait&Posture® system was used to detect the gait of each subject for three times by two trained assessors.The assessor 1 completed the first and second tests,and the assessor 2 completed the third test.All tests were com-pleted on the same day.Gait parameters such as gait cycle,swing phase proportion,stance phase proportion,walking speed,stride frequency,stride length,foot deviation angle,ground contact angle,ground contact inward rotation angle and propulsion angle were recorded.The intragroup correlation coefficient(ICC)was used to calculate the inter-tester reliability and the relative reliability of the repeated tests,and the standard error of measurement(SEM)and the minimum detectable change(MDC)were calculated as the absolute reliability of the repeated tests.With video gait analysis as a control,Bland-Altman method was used to calculate the 95%consistency limit,and the validity of the Right Gait&Posture® gait detection system in detecting gait cycle,swing phase ratio,stance phase proportion and walking speed was analyzed.Results(1)Inter-tester reliability:the ICC values of gait cycle,swing phase proportion,stance phase proportion,walking speed,stride frequency,stride length,foot deviation angle,ground contact angle,ground contact inward rotation angle,forward propulsion angle and foot deviation angle between two assessors were 0.901 to 0.981.(2)Test-retest reliability:the ICC values of gait cycle,swing phase proportion,stance phase proportion,walking speed,stride fre-quency,stride length,ground contact angle,ground contact inward rotation angle and forward propulsion angle and foot deviation angle between the two tests of the same assessor were 0.822 to 0.983.The SEM and SEM%values of gait parameters were 0.02 to 2.17 and 0.49%to 13.83%,respectively.The MDC and MDC%values were 0.06 to 6.02 and 1.37%to 38.34%,respectively.(3)Va-lidity analysis:Bland-Altman plot showed that the mean absolute errors and 95%CI of gait cycle,swing phase proportion,stance phase proportion and walking speed were 0.003 s,(-0.059,0.064);0.756%,(-3.048,4.560);-0.756%,(-4.560,3.048);-0.001 m/s,(-0.155,0.152),respectively.Conclusion Right Gait&Posture® gait detection system shows good reliability in spatio-temporal parameters and ankle kinematics parameters,and has high validity in gait cycle,swing phase proportion,stance phase proportion and walking speed,which is recommended for clinical application.