Although pharmacological treatments for insomnia remain widely prescribed, their long-term use is constrained by risks of tolerance, dependence, and residual daytime effects. This has prompted growing interest in non-pharmacological interventions that target insomnia’s underlying mechanisms. This narrative review examines five physical factor therapies for insomnia: auditory stimulation, phototherapy, thermotherapy, electrical stimulation, and magnetic stimulation. They are classified according to their primary sites of action into peripheral sensory modulation, central neuromodulation, or systemic autonomic regulation. In each context, research findings about circadian entrainment, thermoregulatory promotion of falling asleep, attenuation of cortical hyperarousal, and restoration of autonomic balance are discussed. Clinical evidence from randomized controlled trials and meta-analyses is critically appraised, with emphasis on therapeutic efficacy, safety, and limitations. Overall, physical factor therapies may constitute promising adjunctive options for selected insomnia phenotypes, but current evidence remains heterogeneous and preliminary for several modalities. Recent advances in portable and home-based technologies support their feasibility, although long-term effectiveness, adherence, and cost-effectiveness remain to be established. Future research should prioritize larger sham-controlled trials, objective sleep and circadian outcomes, standardized protocols, biomarker-guided stratification, and closed-loop intervention systems.

Robotic-assisted rehabilitation has been used to release the labor burden in manual practice for early stroke rehabilitation. However, its broader application is constrained by high costs, limited accessibility, and high dependence on professional operation. This study aimed to investigate the feasibility and effectiveness of semi-independent, bedside upper limb rehabilitation assisted by a wrist-hand exoneuromusculoskeleton (WH-ENMS) for individuals with subacute stroke via a randomized controlled trial compared with the outcomes achieved by conventional therapy and training programs assisted by an interlimb-coordinated (IC) robot. Fifty-four participants with subacute stroke were randomized into three groups: ENMS, IC, or conventional therapy. All groups underwent 21 rehabilitation sessions (60 min/day for 21 consecutive days), each including 30 min of standardized Bobath therapy. During the additional 30 min of training, the ENMS group engaged in semi-independent bedside training with minimal supervision, the IC group received supervised IC cycling, and the conventional group received proprioceptive neuromuscular facilitation. The rehabilitative effects were evaluated via clinical scores. The primary outcome was the Fugl-Meyer Assessment-Upper Extremity (FMA-UE), and the secondary outcomes included the action research arm test (ARAT), modified Ashworth scale (MAS), and modified Barthel index (MBI). The manpower consumption was quantified on the basis of the professional hours required during training. The ENMS group required significantly less total occupational therapist (OT) involvement (11.6 h) compared with the IC (22.9 h) and conventional (21.0 h) groups, representing a 49.4

PurposeThis study aimed to use three statistical methods to investigate the inter-rater and intra-rater reliability of the Chinese version of the Short Orientation-Memory-Concentration Test (C-SOMC) for people who have had a stroke.MethodsForty-four participants (31 men and 13 women) with a mean age of 59.05 ± 10.79 years who have had experienced a single episode of stroke were enrolled in this study. To determine the inter-rater reliability of the C-SOMC, the test was administered to each participant on the same day by two raters (A and B) who each had more than 1 year of work experience. To determine intra-rater reliability, rater B re-evaluated 36 of the 44 participants with the C-SOMC on the subsequent day. Intraclass correlation coefficients (ICCs), paired-samples t-tests, and Bland-Altman plots were used to analyze the inter-rater and intra-rater reliability.ResultsThe evaluation of inter-rater reliability for the total score and item 1, 4, 5, 6, and 3/7 showed respective ICCs of 0.959, 0.918, 1.000, 0.942, 0.905 and 0.913, indicating excellent inter-rater reliability for the C-SOMC. Item 2 had an ICC of 0.796, indicating moderate to good inter-rater reliability. The evaluation of intra-rater reliability showed an ICC of 0.978 for the total score, and respective ICCs of 1.000, 1.000, 1.000, 0.968, 0.973 and 0.929 for the individual items, indicating excellent intra-rater reliability for the C-SOMC. The paired-samples t-test for the C-SOMC showed no statistically significant differences (P > 0.05) between ratings made by two different raters or by the same rater on separate occasions. The minimal detectable change value at the 95% confidence threshold (MDC95) of the SOMC score was found to be 2.14. Bland-Altman plots showed a mean difference of 0.02 and 95% limits of agreement (95% LOA) ranging from −3.86 to 3.90 for the inter-rater measurements and a mean difference of 0.33 and 95% LOA of −2.71 to 3.37 for the intra-rater measurements.ConclusionsThe C-SOMC demonstrated excellent inter-rater and intra-rater reliability when administered to people who have had a stroke. The C-SOMC may be used to screen for cognitive impairment in people who have had a stroke.

Abstract Background The global dementia prevalence is surging, necessitating research into contributing factors. We aimed to investigate the association between metabolic syndrome (MetS), its components, serum uric acid (SUA) levels, and dementia risk. Methods Our prospective study comprised 466,788 participants without pre-existing MetS from the UK Biobank. We confirmed dementia diagnoses based on the ICD-10 criteria (F00-03). To evaluate the dementia risk concerning MetS, its components, and SUA levels, we applied Cox proportional hazards models, while adjusting for demographic factors. Results Over a median follow-up of 12.7 years, we identified 6845 dementia cases. Individuals with MetS had a 25% higher risk of all-cause dementia (hazard ratio [HR] = 1.25, 95% confidence interval [CI] = 1.19–1.31). The risk increased with the number of MetS components including central obesity, dyslipidemia for high-density lipoprotein (HDL) cholesterol, hypertension, hyperglycemia, and dyslipidemia for triglycerides. Particularly for those with all five components (HR = 1.76, 95% CI = 1.51–2.04). Dyslipidemia for HDL cholesterol, hypertension, hyperglycemia, and dyslipidemia for triglycerides were independently associated with elevated dementia risk (p < 0.01). MetS was further linked to an increased risk of all-cause dementia (11%) and vascular dementia (VD, 50%) among individuals with SUA levels exceeding 400 μmol/L (all-cause dementia: HR = 1.11, 95% CI = 1.02–1.21; VD: HR = 1.50, 95% CI = 1.28–1.77). Conclusions Our study provides robust evidence supporting the association between MetS, its components, and dementia risk. These findings emphasize the importance of considering MetS and SUA levels in assessing dementia risk, offering valuable insights for prevention and management strategies.

Abstract Background: Alzheimer's disease (AD) is characterized by neuroinflammation and oxidative stress, both contributing to disease progression. Uric acid (UA) has emerged as a potential therapeutic agent due to its anti-inflammatory and antioxidative properties. However, the precise mechanisms underlying UA's role in AD pathogenesis remain unclear. Methods: BV2 microglial cells were subjected to treatments with UA, lipopolysaccharide (LPS), or a combination of both. Analyses of gene expression profiling, protein assessment, ELISA, ROS assays, and proteomic analysis were performed. Statistical analyses involved one-way ANOVA followed by Dunnett's multiple comparison tests and Student’s unpaired t-test for group comparisons. Results: UA treatment markedly suppressed LPS-induced upregulation of NF-𝜅B and NLRP3 mRNA expression (p < 0.001). Inflammatory cytokine release (IL-1β and TNF𝜶) was reduced by up to 50% (p < 0.05) with UA treatment, while oxidative stress was mitigated, evidenced by an 84% reduction in ROS levels (p < 0.001) and a 32% increase in antioxidant enzyme activity (p < 0.01). Proteomic analysis unveiled significant alterations in key signaling pathways pertinent to AD pathology, including downregulation of cholesterol metabolism (p < 0.05) and upregulation of cGMP-PKG (p < 0.001) and Wnt signaling pathways (p < 0.001). Notably, UA treatment induced increased expression of Atp2b4, a pivotal regulator of calcium homeostasis, suggesting its potential role in mediating the observed antioxidative effects. Conclusions: UA exhibits promising anti-inflammatory and antioxidative effects in BV2 microglial cells, underscoring its potential as a therapeutic avenue for AD. These findings offer valuable insights into UA's molecular mechanisms and advocate for further investigation to validate its clinical efficacy in managing AD. Understanding UA's role in modulating neuroinflammatory pathways and oxidative stress could pave the way for novel therapeutic interventions in AD management.

This study aims to develop an automatic assessment of after-stroke dyskinesias degree by combining machine learning and near-infrared spectroscopy (NIRS). Thirty-five subjects were divided into five stages (healthy, patient: Brunnstrom stages 3, 4, 5, 6). NIRS was used to record the muscular hemodynamic responses from bilateral femoris (biceps brachii) muscles during passive and active upper (lower) limbs circular exercise. We used the D-S evidence theory to conduct feature information fusion and established a Gradient Boosting DD-MLP Net model, combining the dendrite network and multilayer perceptron, to realize automatic dyskinesias degree evaluation. Our model classified the upper limb dyskinesias with high accuracy: 98.91% under the passive mode and 98.69% under the active mode, and classified the lower limb dyskinesias with high accuracy: 99.45% and 99.63% under the passive and active modes, respectively. Our model combined with NIRS has great potential in monitoring the after-stroke dyskinesias degree and guiding rehabilitation training.

PurposeThis study aimed to translate the English version of the Short Orientation-Memory-Concentration (SOMC) test into a Chinese version, denoted the C-SOMC test, and to investigate the concurrent validity, sensitivity, and specificity of the C-SOMC test against a longer and widely used screening instrument in people with a first cerebral infarction.MethodsAn expert group translated the SOMC test into Chinese using a forward–backward procedure. Eighty-six participants (67 men and 19 women, mean age = 59.31 ± 11.57 years) with a first cerebral infarction were enrolled in this study. The validity of the C-SOMC test was determined using the Chinese version of Mini Mental State Examination (C-MMSE) as the comparator. Concurrent validity was determined using Spearman’s rank correlation coefficients. Univariate linear regression was used to analyze items’ abilities to predict the total score on the C-SOMC test and the C-MMSE score. The area under the receiver operating characteristic curve (AUC) was used to demonstrate the sensitivity and specificity of the C-SOMC test at various cut-off values distinguishing cognitive impairment from normal cognition.ResultsThe total score for the C-SOMC test and the score for item 1 on this test exhibited moderate-to-good correlations with the C-MMSE score, with respective ρ-values of 0.636 and 0.565 (P < 0.001). The scores for each of items 2, 4, 5, 6, and 7 yielded fair correlations with C-MMSE score, with ρ-value from 0.272 to 0.495 (P < 0.05). The total score on the C-SOMC test and the item score were good predictors (adjusted R2 = 0.049 to 0.615) of the C-MMSE score, and six items were good predictors (adjusted R2 = 0.134 to 0.795) of the total score. The AUC was 0.92 for the C-SOMC test. A cut-off of 17/18 on the C-SOMC test gave optimal performance: correct classification of 75% of participants, with 75% sensitivity and 87.9% specificity.ConclusionThe C-SOMC test demonstrated good concurrent validity, sensitivity and specificity in a sample of people with a first cerebral infarction, demonstrating that it could be used to screen for cognitive impairment in stroke patients.

Background Gait disability affects the daily lives of patients with stroke in both home and community settings. An abnormal foot–ankle position can cause instability on the supporting surface and negatively affect gait. Our research team explored the ability of a portable peroneal nerve-targeting electrical stimulator to improve gait ability by adjusting the foot–ankle position during walking in patients with chronic stroke undergoing home-based rehabilitation. Methods This was a double-blinded, parallel-group randomized controlled trial. Thirty-one patients with chronic stroke and ankle–foot motor impairment were randomized to receive 3 weeks of gait training, which involved using the transcutaneous peroneal nerve stimulator while walking (tPNS group; n = 16, mean age: 52.25 years), or conventional home and/or community gait training therapy (CT group; n = 15, mean age: 54.8 years). Functional assessments were performed before and after the 3-week intervention. The outcome measures included spatiotemporal gait parameters, three-dimensional kinematic and kinetic data on the ankle–foot joint, and a clinical motor and balance function assessment based on the Fugl–Meyer Assessment of Lower Extremity (FMA-LE) and Berg Balance scales (BBS). Additionally, 16 age-matched healthy adults served as a baseline control of three-dimensional gait data for both trial groups. Results The FMA-LE and BBS scores improved in both the tPNS groups (p = 0.004 and 0.001, respectively) and CT groups (p = 0.034 and 0.028, respectively) from before to after training. Participants in the tPNS group exhibited significant differences in spatiotemporal gait parameters, including double feet support, stride length, and walking speed of affected side, and the unaffected foot off within a gait cycle after training (p = 0.043, 0.017, 0.001 and 0.010, respectively). Additionally, the tPNS group exhibited significant differences in kinematic parameters, such as the ankle angle at the transverse plane (p = 0.021) and foot progression angle at the frontal plane (p = 0.009) upon initial contact, and the peak ankle joint angle at the transverse plane (p = 0.023) and foot progression angle (FPA) at the frontal and transverse planes (p = 0.032 and 0.046, respectively) during gait cycles after 3 weeks of training. Conclusions Use of a portable tPNS device during walking tasks appeared to improve spatiotemporal gait parameters and ankle and foot angles more effectively than conventional home rehabilitation in patients with chronic stroke. Although guidelines for home-based rehabilitation training services and an increasing variety of market devices are available, no evidence for improvement of motor function and balance was superior to conventional rehabilitation. Trial registration Chictr, ChiCTR2000040137. Registered 22 November 2020, https://www.chictr.org.cn/showproj.aspx?proj=64424

Background Stroke is among the leading causes of long-term disability worldwide. Motor impairments after stroke not only impact the individuals quality of life but also lay substantial burdens on the society. Motor planning is a key component of cognitive function that impacts motor control. Hand movements such as grasping or reaching to grasp require the application of correct force and the coordination of multiple limb segments. Successful completion of hand motor task requires a certain degree of cognitive function to anticipate the requirement of the task. Cognitive function may thus be a confounding factor to rehabilitation outcomes. Objective This study aims to explore the impact of cognitive function on functional outcomes in people with subacute stroke after VR intervention. Methods Patients with stroke were first stratified into cognitively normal (CN) and cognitively impaired (CI), followed by allocation to the VR or control group (CG). Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Barthel Index (BI), and Instrumental Activities of Daily Living (IADL) were recorded at baseline, 3 weeks after the intervention, and 3 and 6 months after the intervention. The between-group and within-group differences were assessed by repeated-measures analysis of variance (ANOVA). Results The between-group comparison indicated that FMA-UE, BI, and IADL (time effect P<.001 for all) scores improved significantly in both groups after the intervention. Repeated-measures ANOVA indicated that FMA-UE, BI, and IADL (time effect P<.001 for all) were significantly different in each subgroup after the intervention. For BI score, the ANOVA results showed obvious interaction effects (treatment × time × cognitive effect, P=.04). Conclusions VR intervention was as effective as traditional conventional therapy in improving upper limb function regardless of the cognitive functional level. Patients with stroke with impaired cognitive function may gain more improvement in upper limb function and independency in performing activities of daily living after a VR-based intervention. Trial Registration Chinese Clinical Trial Registry ChiCTR-IOC-15006064; https://tinyurl.com/4c9vkrrn

BACKGROUND:Total knee arthroplasty (TKA) is the only effective treatment of end-stage knee osteoarthritis (OA). Lower limb neutral alignment has been a criterion to predict prosthesis life; however, there has been recent controversy over this. Some researchers believe that lower limb static alignment does not significantly affect prosthesis life and some researchers have found that dynamic mechanical alignment may affect prosthesis life, which needs to be further studied.METHODS:Eighty-seven patients with knee OA were evaluated by a three-dimensional (3D) gait analysis system before TKA and six months after TKA, dynamic mechanical alignment and basic gait parameters were then calculated. Based on the static alignment of the lower limb on the postoperative X-radiographs, they were divided into a neutral alignment group (58 cases), varus alignment group (20 cases), and valgus alignment group (9 cases). Simple linear regression was used to assess the correlation between static and dynamic alignment. One-way analysis of variance (ANOVA) was used to compare the differences in gait parameters between and within groups.RESULTS:Eighty-seven patients were followed up for an average of six months after the operation. There was no significant difference in all gait parameters among the three groups after TKA. There was no correlation found between static alignment and dynamic alignment/knee adduction moment (KAM) after TKA, although patients showed a significant linear correlation before operation. There was a significant linear correlation between dynamic alignment and KAM before and after the operation.CONCLUSIONS:Static alignment has no significant effect on postoperative gait function. Static alignment is no longer an effective predictor of the dynamic alignment or KAM six months after TKA, although they are correlated before TKA. The dynamic alignment allows for better prediction of KAM, which may be a risk factor for the life of the prosthesis.

Introduction This study was conducted to evaluate whether a non-immersive virtual reality (VR)-based intervention can enhance lower extremity movement in patients with cerebral infarction and whether it has greater short-term and long-term effectiveness than conventional therapies (CTs). Materials and methods This was a single-blinded, randomized clinical controlled trial. Forty-four patients with subacute cerebral infarction were randomly allocated to the VR or CT group. All intervention sessions were delivered in the inpatient unit for 3 weeks. Outcomes were measured before (baseline) and after the interventions and at 3-month, 6-month and 1-year follow-ups. The outcomes included clinical assessments of movement and balance function using the Fugl–Meyer Assessment of Lower Extremity (FMA-LE) and Berg Balance Scale (BBS), and gait parameters in the sagittal plane. Results In the VR group, the walking speed after intervention, at 3-month, 6-month, and 1-year follow-ups were significantly greater than baseline (p = 0.01, <0.001, 0.007, and <0.001, respectively). Compared with baseline, BBS scores after intervention, at 3-month, 6-month, and 1-year follow-ups were significantly greater in both the VR group (p = 0.006, 0.002, <0.001, and <0.001, respectively) and CT group (p = <0.001, 0.002, 0.001, and <0.001, respectively), while FMA-LE scores after intervention, at 3-month, 6-month, and 1-year follow-ups were significant increased in the VR group (p = 0.03, <0.001, 0.003, and <0.001, respectively), and at 3-month, 6-month, and 1-year follow-ups in the CT group (p = 0.02, 0.004 and <0.001, respectively). In the VR group, the maximum knee joint angle in the sagittal plane enhanced significantly at 6-month follow-up from that at baseline (p = 0.04). Conclusion The effectiveness of the non-immersive VR-based intervention in our study was observed after the intervention and at the follow-ups, but it was not significantly different from that of CTs. In sum, our results suggest that non-immersive VR-based interventions may thus be a valuable addition to conventional physical therapies to enhance treatment efficacy. Clinical trial registration http://www.chictr.org.cn/showproj.aspx?proj=10541, ChiCTR-IOC-15006064.

Measures of knee stability by symptoms, physical examination, and imaging do not accurately reflect the condition of knee movement. Therefore, this study aimed to introduce a model for assessing knee stability during walking in patients with knee osteoarthritis (OA). Three dimensional(3D) gait analysis system was used to quantify the gait of patients and display the clinical diagnosis model of knee instability with nomogram to guide clinical diagnosis and treatment. This cross-sectional study performed a 3D gait analysis in 93 participants with knee OA and 40 healthy control subjects. Multiple linear regression analysis investigated the correlation between gait parameters and knee extension/flexion stability. The predicting models were built applied multinomial logistic regression analysis and calibration plot, C-index, decision curve analysis, bootstrapping validation were used to assess the predicting nomograms' clinical usefulness and internal validation. Multiple linear regression analysis indicated knee extension stability was correlated with walking speed (β = 0.256, P = 0.006), knee extensor strength (β = −0.196, P = 0.03), static HKA (β = 0.218, P = 0.016), width of the femoral diaphysis (β = −0.282, P = 0.002) and WOMAC score (β = 0.281, P = 0.002); however, knee flexion stability was correlated with walking speed (β = 0.340, P < 0.001), knee flexor strength (β = −0.327, P < 0.001), posterior tibial slope (PTS) (β = 0.291, P < 0.001), knee flexion/extension range of motion (ROM) (β = 0.177, P = 0.018) and HSS score (β = −0.173, P = 0.028). We developed and internally validated a knee instability risk nomogram in patients with knee OA. These results indicated that using the 3D motion analysis system is feasible to quantify knee instability. The current prediction models could serve as a reliable tool to quantify the possibility of knee instability in OA patients. ChiCTR2100051302; Date of registration: Sep 18, 2021; retrospectively registered.

IntroductionThis study was conducted to evaluate whether a non-immersive virtual reality (VR)-based intervention can enhance lower extremity movement in patients with cerebral infarction and whether it has greater short-term and long-term effectiveness than conventional therapies (CTs).Materials and methodsThis was a single-blinded, randomized clinical controlled trial. Forty-four patients with subacute cerebral infarction were randomly allocated to the VR or CT group. All intervention sessions were delivered in the inpatient unit for 3 weeks. Outcomes were measured before (baseline) and after the interventions and at 3-month, 6-month and 1-year follow-ups. The outcomes included clinical assessments of movement and balance function using the Fugl–Meyer Assessment of Lower Extremity (FMA-LE) and Berg Balance Scale (BBS), and gait parameters in the sagittal plane.ResultsIn the VR group, the walking speed after intervention, at 3-month, 6-month, and 1-year follow-ups were significantly greater than baseline (p = 0.01, <0.001, 0.007, and <0.001, respectively). Compared with baseline, BBS scores after intervention, at 3-month, 6-month, and 1-year follow-ups were significantly greater in both the VR group (p = 0.006, 0.002, <0.001, and <0.001, respectively) and CT group (p = <0.001, 0.002, 0.001, and <0.001, respectively), while FMA-LE scores after intervention, at 3-month, 6-month, and 1-year follow-ups were significant increased in the VR group (p = 0.03, <0.001, 0.003, and <0.001, respectively), and at 3-month, 6-month, and 1-year follow-ups in the CT group (p = 0.02, 0.004 and <0.001, respectively). In the VR group, the maximum knee joint angle in the sagittal plane enhanced significantly at 6-month follow-up from that at baseline (p = 0.04).ConclusionThe effectiveness of the non-immersive VR-based intervention in our study was observed after the intervention and at the follow-ups, but it was not significantly different from that of CTs. In sum, our results suggest that non-immersive VR-based interventions may thus be a valuable addition to conventional physical therapies to enhance treatment efficacy.Clinical trial registrationhttp://www.chictr.org.cn/showproj.aspx?proj=10541, ChiCTR-IOC-15006064.

Background: The efficacy of interlimb-coordinated training on gait and upper limb functional improvement remains unclear. The latest published randomized controlled trials have supported the potential benefits of interlimb-coordinated training to enhance gait function. Upper limb functional recovery may also benefit from interlimb-coordinated training since most everyday activities require the coordinated use of both hands to complete a task. This study investigates the efficacy of interlimb-coordinated training on gait and upper limb functional recovery over a short-medium term period. Methods: A total of 226 acute stroke patients will be recruited from four centres over four years. Patients will be randomly allocated to either conventional therapy or conventional therapy plus interlimb-coordinated training. Outcomes will be recorded at baseline, after 2 weeks of intervention, and at 3- and 6-months post-intervention. Gait speed is the primary outcome measure. Secondary outcome measures include Fugl–Meyer Assessment of Motor Recovery, Berg Balance Scale, Timed Up and Go test, Action Research Arm Test, electroencephalography, and magnetic resonance imaging. Conclusion: The results of this trial will provide an in-depth understanding of the efficacy of early interlimb-coordinated intervention on gait and upper functional rehabilitation and how it may relate to the neural plasticity process.

Background: Gait disability affects the daily lives of patients with stroke in both home and community settings. An abnormal foot–ankle position can cause instability on the supporting surface and negatively affect gait. Our research team explored the ability of a portable peroneal nerve-targeting electrical stimulator to improve gait ability by adjusting the foot–ankle position during walking in patients with chronic stroke undergoing home-based rehabilitation. Methods: This was a double-blinded, parallel-group randomized controlled trial. Thirty-one patients with chronic stroke and ankle–foot motor impairment were randomized to receive 3 weeks of gait training, which involved using the transcutaneous peroneal nerve stimulator while walking (tPNS group; n = 16, mean age: 52.25 years), or conventional home and/or community gait training therapy (CT group; n = 15, mean age: 54.8 years). Functional assessments were performed before and after the 3-week intervention. The outcome measures included spatiotemporal gait parameters, three-dimensional kinematic and kinetic data on the ankle-foot joint, and a clinical motor and balance function assessment based on the Fugl–Meyer Assessment of Lower Extremity (FMA-LE) and Berg Balance scales (BBS). Additionally, 16 age-matched healthy adults served as a baseline control of three-dimensional gait data for both trial groups. Results: The FMA-LE and BBS scores improved in both the tPNS groups (p = .004 and .001, respectively) and CT groups (p = .034 and .028, respectively) from before to after training. Participants in the tPNS group exhibited significant differences in spatiotemporal gait parameters, including opposite foot off, double support, stride length, and walking speed, after training (p = .010, .042, .017 and .001, respectively). Additionally, the tPNS group exhibited significant differences in kinematic parameters, such as the ankle angle at the transverse plane (p = .021) and foot progression angle at the frontal plane (p = .009) upon initial contact, and the peak ankle joint angle at the transverse plane (p = .023) and foot progression angle at the frontal and transverse planes (p = .032 and .046, respectively) during gait cycles after 3 weeks of training. Conclusions: Use of a portable tPNS device during walking tasks appeared to improve spatiotemporal gait parameters and ankle and foot angles more effectively than conventional home rehabilitation in patients with chronic stroke. Although guidelines for home-based rehabilitation training services and an increasing variety of market devices are available, no evidence for improvement of motor function and balance was superior to conventional rehabilitation. Trial registration: Chictr, ChiCTR2000040137. Registered 22 November 2020, https://www.chictr.org.cn/showproj.aspx?proj=64424

This study investigated electroencephalogram (EEG) changes during movement preparation and execution in stroke patients. EEG-based event-related potential (ERP) technology was used to measure brain activity changes. Seventeen stroke patients participated in this study and completed ERP tests that were designed to measure EEG changes during unilateral upper limb movements in preparation and execution stages, with Instruction Response Movement (IRM) and Cued Instruction Response Movement (CIRM) paradigms. EEG data were analyzed using motor potential (MP) in the time domain and the mu-rhythm and beta frequency band response mean value (R-means) in the time-frequency domain. In IRM, the MP amplitude at Cz was higher during hemiplegic arm movement than during unaffected arm movement. MP latency was shorter at Cz and the contralesional motor cortex during hemiplegic arm movement in CIRM compared to IRM. No significant differences were found in R-means among locations, between movement sides in both ERP tests. This study presents the brain activity changes in the time and time-frequency domains in stroke patients during movement preparation and execution and supports the contralesional compensation and adjacent-region compensation mechanism of post-stroke brain reconstruction. These findings may contribute to future rehabilitation research about neuroplasticity and technology development such as the brain-computer interface.

目的 应用脑电事件相关电位(ERP)技术,研究脑卒中偏瘫病人运动过程中脑电活动时域和时频域方面的特征性表现.方法 17例脑卒中病人参加脑电ERP试验,试验范式为上肢伸腕运动的指令运动和提示下指令运动.选择初级运动皮层代表区C3、Cz和C4位置,进行两侧及不同ERP范式下运动相关脑电信号的时域和时频域分析.结果 患侧指令运动较健侧运动电位(MP)波幅在对侧运动皮层及Cz位置显著增高(P<0.05).提示后指令运动双侧运动皮层代表区MP波幅差异无统计学意义.患肢提示后指令运动时Cz及损伤对侧皮层MP潜伏期缩短,波幅增高(P<0.05).事件相关去同步(ERD)平均反应值在不同ERP范式间C3、Cz、C4位置间及两侧运动间比较差异均无统计学意义.结论 脑卒中病人患侧上肢运动时受损皮层表现出更大程度的能耗及更广范围的激活,视觉提示可通过激活损伤对侧运动皮层的代偿作用易化运动,ERP技术可应用于脑卒中病人的运动相关脑电活动研究并展示其特征性改变.

Purpose This study aimed to translate the English version of the Action Research Arm Test (ARAT) into Chinese and to evaluate the initial validation of the Chinese version (C-ARAT) in patients with a first stroke. Methods An expert group translated the original ARAT from English into Chinese using a forward-backward procedure. Forty-four patients (36 men and 8 women) aged 22–80 years with a first stroke were enrolled in this study. The participants were evaluated using 3 stroke-specific outcome measures: C-ARAT, the upper extremity section of the Fugl–Meyer assessment (UE-FMA), and the Wolf Motor Function Test (WMFT). Internal consistency was analysed using Cronbach's α coefficients and item-scale correlations. Concurrent validity was determined using Spearman's rank correlation coefficients. Floor and ceiling effects were considered to be present when more than 20% of patients fell outside the preliminarily set lower or upper boundary, respectively. Results The C-ARAT items yielded excellent internal consistency, with a Cronbach's α of 0.98 (p < 0.001) and item-total correlations ranging from 0.727 to 0.948 (p < 0.001). The C-ARAT exhibited good-to-excellent correlations with the UE-FMA and WMFT functional ability (WMFT-FA) scores, with respective ρ values of 0.824 and 0.852 (p < 0.001), and an excellent negative correlation with the WMFT performance time (WMFT-time), with a ρ value of -0.940 (p < 0.001). The C-ARAT subscales generally exhibited good-to-excellent correlations with stroke-specific assessments, with ρ values ranging from 0.773 to 0.927 (p < 0.001). However, the gross subscale exhibited moderate-to-good correlations with the UE-FMA and WMFT-FA scores, with respective ρ values of 0.665 and 0.720 (p < 0.001). No significant floor effect was observed, and a significant ceiling effect was observed only on the WMFT-time. Conclusions The C-ARAT demonstrated excellent internal consistency and good-to-excellent concurrent validity. This test could be used to evaluate upper extremity function in stroke patients without cognitive impairment.