Effects of respiratory muscle training on post-stroke rehabilitation:A systematic review and meta-analysis

BACKGROUND Stroke often results in significant respiratory dysfunction in patients.Respiratory muscle training(RMT)has been proposed as a rehabilitative intervention to address these challenges,but its effectiveness compared to routine training remains debated.This systematic review and meta-analysis aim to evaluate the effects of RMT on exercise tolerance,muscle strength,and pulmonary function in post-stroke patients.AIM To systematically assess the efficacy of RMT in improving exercise tolerance,respiratory muscle strength,and pulmonary function in patients recovering from a stroke,and to evaluate whether RMT offers a significant advantage over routine training modalities in enhancing these critical health outcomes in the post-stroke population.METHODS Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines,a comprehensive search across PubMed,Embase,Web of Science,and the Cochrane Library was conducted on October 19,2023,without temporal restrictions.Studies were selected based on the predefined inclusion and exclusion criteria focusing on various forms of RMT,control groups,and outcome measures[including forced expiratory volume in the first second(FEV1),forced vital capacity(FVC),maximal voluntary ventilation(MVV),peak expiratory flow(PEF),maximal inspiratory pressure(MIP),maximal expiratory pressure(MEP),and 6-min walking test(6MWT)].Only randomized controlled trials(RCTs)were included.Data extraction and quality assessment were conducted independently by two reviewers using the Cochrane Collaboration's risk of bias tool.Statistical analyses,including those using the fixed-effect and random-effects models,sensitivity analysis,and publication bias assessment,were performed using Review Manager software.RESULTS A total of 15 RCTs were included.Results indicated significant improvements in MIP(12.51 cmH2O increase),MEP(6.24 cmH2O increase),and various pulmonary function parameters(including FEV1,FVC,MVV,and PEF).A substantial increase in 6MWT distance(22.26 meters)was also noted.However,the heterogeneity among studies was variable,and no significant publication bias was detected.CONCLUSION RMT significantly enhances walking ability,respiratory muscle strength(MIP and MEP),and key pulmonary function parameters(FEV1,FVC,MVV,and PEF)in post-stroke patients.These findings support the incorporation of RMT into post-stroke rehabilitative protocols.

An advanced cost-efficient IoT method for stroke rehabilitation using smart gloves

Stroke represents a severe,widespread,and widely acknowledged health crisis on both national and international levels.It is one of the most prevalent life-threatening conditions.Despite impressive advances in treating stroke,in addition to a need for effective patient care services,many sufferers still rely solely on physical interventions.The present paper describes and explains the use of a newly designed gadget for stroke survivors who cannot move their fingers.This is a sophisticated mobile device that enables stroke patients to regain their muscle memory and thus their ability to perform repetitive actions by continuing to tighten and stretch their muscles without the intervention of a physiotherapist.Gamification methodology is used to encourage patients to become involved in the process of rehabilitation.The device also has sensors that take information and transmit it to an app through an ESP32 connection.This enables physicians to view glove usage information remotely and keep track of an individual patient’s health.Communication between app and glove is facilitated by a broker in the Amazon Web Service IoT.With the robotic glove presented here,the recovery rate is found to be 90.23%over four weeks’duration,which represents a significant improvement compared with existing hospital-based rehabilitation techniques.

Comprehensive therapeutic effect of the stroke rehabilitation unit in a medium-sized comprehensive community hospital

BACKGROUND： Acute stroke unit （stroke care unit） is developing in some domestic large-sized hospitals, but most stroke patients need stroke rehabilitation unit therapy, so setting stroke rehabilitation unit in medium-sized comprehensive community hospital （secondary hospital）, where medical facility is relatively insufficient, is a new pathway to satisfy stroke patients. OBJECTIVE： To observe the comprehensive effect of developing stroke rehabilitation unit based on the facility of secondary hospital and its feasibility. DESIGN： Non-randomized concurrent controlled observation SETTING： Department of Neurology, Beijing Longfu Hospital PARTICIPANTS： Totally 264 stroke reconvalescents who suffered stroke for 7 days and received treatment in the Department of Neurology, Beijing Longfu Hospital during June 2003 to June 2005 were involved in the study. All the involved patients were confirmed by CT or MRI. The patients were scored by using Modified Edinbergh-Scandinavia stroke scale （SSS） 〉 16 points. Written informed consents were obtained from all the patients. The patients were assigned into 2 groups according to the willing of patients and their relatives： （1）treatment group, in which, there were 134 patients, 76 males and 58 females, aged 43 to 74 years; cerebral infarction was found in 116 cases and cerebral hemorrhage in 18 cases;（2） control group, in which, there were 130 patients, 66 males and 64 females, aged 45 to 77 years, cerebral infarction was found in 115 cases and cerebral hemorrhage in 15 cases. There were significant differences in baseline data of the patients between two groups. METHODS： A same basic treatment was conducted in the patients of the two groups. （1） Patients in the treatment group admitted to stroke rehabilitation unit and received comprehensive rehabilitation treatment. The rehabilitation flow-sheet： randomization-letting the patients of treatment group go into the unit-making comprehensive assessment in the initial stage-making therapy plan-talking with patients and their other family members-general rehabilitation-making metaphase assessment-adjusting therapy plan-making final assessment-letting the patients discharge and doing follow-up visits. （2） The patients in the control group admitted to common wards, and they were encouraged to do activities by themselves in the early stage, but did not receive rehabilitation training under the instructions from professional physicians. MAIN OUTCOME MEASURES： The following assessments were conducted on admission and 7 and 28 days after admission： （1） Severity of stroke and motor function： scored as 0 to 45 points by SSS, the higher points, the severer damage. （2）Activities of daily living： Evaluated by Barthel index, 110 points in total, 110 points meant normal, 0 point meant extremely poor. （3）Mental status： evaluated by Hopkin＇s symptom scale with a 5-point scoring. The symptom was scored with low to high points. （4）Cognitive function： Quantification measurement was conducted with LOTCA method. The higher points, the better therapeutic effects. RESULTS： （1） Three cases dropped out and one died in the treatment group, 11 cases dropped out and 4 died in the control group. （2）The neurologic impairment points on 7 and 28 days after therapy in the treatment group were lower than those in the control group separately [7 days：（9.73±6.43） points vs. （12.63± 7.87） points, t =2.28, P〈 0.05;28 days：（7.88±4.81） points vs. （9.84±7.03）points, t =2.04, P〈 0.05]. Barthel index on 7 and 28 days after therapy in the treatment group were higher than those in the control group separately [7 days：（54.28±8.38） points vs. （39.76±7.31） points, t =2.206, P 〈 0.05; 28 days： （89.72±7.94） points vs. （67.34±8.63） points, t =2.812, P 〈 0.01]. （4） Patients were allocated into different age groups based on age and evaluated with LOTCA. Results showed that there were no significant differences among different age groups （P 〉 0.05）. （5） Totally 160 patients in the two groups accomplished the Hopkin＇s test, among them, 94 （58.7%） had different mental disorders; Among the patients with mental disorder, depression, obsessive-compulsive and anxiety were found mostly, being 53.8%, 52.5% and 46.2%, respectively. CONCLUSION： （1） Developing stroke rehabilitation unit therapy in the secondary hospital can obviously improve the motor function and activities of daily living of stroke reconvalescents. （2） More than half of the stroke reconvalescents accompany the symptoms of depression, obsessive-compulsive, anxiety and other mental disorders. （3） The cognitive function of stroke reconvalescents is not related to age.

A Clinical Randomized Controlled Study of Low-Frequency rTMS Therapy on Lower Limb Motor Dysfunction after Stroke

Objective:To investigate the efficacy and safety of low-frequency repetitive transcranial magnetic stimulation(rTMS)for the treatment of lower limb motor dysfunction after stroke.Methods:A total of 96 patients with stroke and lower limb motor dysfunction were enrolled in this study,and were randomly divided into the experimental group and the sham stimulation group using the method of calculator-generated random numbers.Both groups received conventional medication and rehabilitation therapy.The experimental group received 4 weeks of 1 Hz rTMS treatment in the primary cortical motor area(M1)of the healthy side,with the treatment coil tangent to the skull surface;the sham stimulation group underwent the same procedures as the experimental group,but the treatment coil was perpendicular to the skull surface instead.Lower-extremity subscale of the Fugl-Meyer Assessment(FMA-LE),Berg Balance Scale(BBS),gait analysis,and lower-extremity surface electromyography(LESEM)were performed in both groups before and after rTMS treatment.Results:All 96 patients completed the test with no shedding and no adverse reactions.After treatment,the FMA-LE score and BBS score of the 2 groups of patients were significantly improved as compared with the pre-treatment(P<0.05),and the TUG test time was reduced as compared with the pre-treatment(P<0.05).The true stimulation group had greater improvement in all assessment indexes than that of the sham stimulation group(P<0.05).After treatment,the electromyographic activity of the tibialis anterior and rectus femoris muscles in the true simulation group improved significantly.The step length,step speed,and step frequency were also significantly improved in both groups after treatment,and the symmetrical ratio of step length and support time was reduced(P<0.05).Comparison between the groups revealed that the true simulation group significantly improved after rTMS treatment as compared to the sham stimulation group(P<0.05).Conclusion:1Hz rTMS treatment safely and effectively improved motor and balance function in patients with post-stroke lower limb motor dysfunction.

The scope and potential of music therapy in stroke rehabilitation

There is a growing interest in the use of music therapy in neurological rehabilitation. Of all the major neurological illnesses, stroke rehabilitation has been observed to have some of the strongest potential for music therapy’s beneficial effect. The current burden of stroke has raised the need to embrace novel,cost-effective, rehabilitation designs that will enhance the existing physical, occupation, and speech therapies. Music therapy addresses a broad spectrum of motor, speech, and cognitive deficits, as well as behavioral and emotional issues. Several music therapy designs have focused on gait, cognitive, and speech rehabilitation, but most of the existing randomized controlled trials based on these interventions have a high risk of bias and are statistically insignificant. More randomized controlled trials with greater number of participants are required to strengthen the current data. Fostering an open and informed dialogue between patients, healthcare providers, and music therapists may help increase quality of life, dispel fallacies, and guide patients to specific musical interventions.

Bioinspired Musculoskeletal Model-based Soft Wrist Exoskeleton for Stroke Rehabilitation

Exoskeleton robots have demonstrated the potential to rehabilitate stroke dyskinesia.Unfortunately,poor human-machine physiological coupling causes unexpected damage to human of muscles and joints.Moreover,inferior humanoid kinematics control would restrict human natural kinematics.Failing to deal with these problems results in bottlenecks and hinders its application.In this paper,the simplified muscle model and muscle-liked kinematics model were proposed,based on which a soft wrist exoskeleton was established to realize natural human interaction.Firstly,we simplified the redundant muscular system related to the wrist joint from ten muscles to four,so as to realize the human-robot physiological coupling.Then,according to the above human-like musculoskeletal model,the humanoid distributed kinematics control was established to achieve the two DOFs coupling kinematics of the wrist.The results show that the wearer of an exoskeleton could reduce muscle activation and joint force by 43.3%and 35.6%,respectively.Additionally,the humanoid motion trajectories similarity of the robot reached 91.5%.Stroke patients could recover 90.3%of natural motion ability to satisfy for most daily activities.This work provides a fundamental understanding on human-machine physiological coupling and humanoid kinematics control of the exoskeleton robots for reducing the post-stroke complications.

A review on functional near-infrared spectroscopy and application in stroke rehabilitation

Functional near-infrared spectroscopy(fNIRS)has gained great interest as a noninvasive modality to study the changes in cerebral hemodynamics related to brain activity.The unique and beneficial characteristics of fNIRS allow ecologically effective investigations of all ages and conditions in more realistic and clinical environments.In this review,we provide a comprehensive description of fNIRS basics,analytical method developments and applications in stroke rehabilitation.We first review various new methods for the time-series processing and functional analysis of fNIRS data.Then,we review the fNIRS-based application in clinical research for stroke rehabilitation and highlight the exciting developments based on fNIRS.Finally,we discuss the possible technical limitations of the implementation of fNIRS and provide suggestions from different aspects for practical application.

A new 2-class unilateral upper limb motor imagery tasks for stroke rehabilitation training

The rehabilitation training based on motor imagery brain-computer interface(MI-BCI)is considered to be an effective method.We designed a new 2-class unilateral upper limb motor imagery tasks.Data from 15 healthy subjects and 10 stoke patients are collected in the study.The results of event-related desynchronization/synchronization(ERD/ERS)and power spectral density(PSD)analysis showed the significant different features on health subjects and stroke patients.The improved 2-Conv-FBCNET is used to classify Electroencephalogram(EEG)signals and the accuracy is(health:61.0%,stroke:59.4%).The new two types of tasks provide a new training method for MI-BCI rehabilitation training system.

Photobiomodulation with Super-Pulsed Laser Shows Efficacy for Stroke and Aphasia: Case Studies

Background: Brain disorders have become more and more common today, due to both the aging population and the ever-expanding sports community. However, a new therapeutic technology called photobiomodulation (PBM) is giving hope to thousands of individuals in need. Traumatic brain injury (TBI), dementia, post traumatic stress (PTSD) and attention deficit (ADD) disorders are in many cases quickly and safely improved by PBM. PBM employs red or near-infrared (NIR) light (600 - 1100 nm) to stimulate healing, protect tissue from dying, increase mitochondrial function, improve blood flow, and tissue oxygenation. PBM can also act to reduce edema, increase antioxidants, decrease inflammation, protect against apoptosis, and modulate the microglial activation state. All these effects can occur when light is delivered to the head, and can be beneficial in both acute and chronic brain conditions. Methods: In this case series, we used a high power, FDA-approved superpulsed laser system applied to the head to treat four chronic stroke patients. Patients received as few as three 6 - 9 minute treatments over a one-week period. The follow up time varied, but in one case was two years. Results: Patients showed significant improvement in their speech and verbal skills. Improvements were also noticed in walking ability, limb movement, less numbness, and better vision. Conclusion: The use of PBM in stroke rehabilitation deserves to be tested in controlled clinical trials, because this common condition has no approved pharmaceutical treatment at present.

Caregiver empowerment program based on the adaptation model increase stroke family caregiver outcome

Objective:Post-stroke disability and psychosocial disorders cause burdens for the families of stroke patients,including physical and financial burdens.The physical and psychological health of family caregivers determines the quality of care they provide to patients.The purpose of this study was to identify the effectiveness of the Caregiver Empowerment Program Based on the Adaptation Model(CEP-BAM)in increasing the family caregiver’s coping ability against various problems and reducing their burden while caring for the stroke patient.Methods:This research was a quasi-experimental study with pre-and post-test control group design.The intervention group received CEP-BAM,while the control group received a conventional intervention in the form of a discharge planning program for family caregivers in the hospital.The samples were caregivers who care for and facilitate the recovery of stroke patients during their convalescence at home.We selected the samples from the population using the stratified random sampling method.The number of samples completed in the study was 40 in the intervention group and 40 in the control group.Measurement of outcome variables(coping and caregiver burden)was carried out 4 times including pre-test before the intervention,post-test 1 at 4 months after the intervention,post-test 2 at 5 months after the intervention,and post-test 3 at 6 months after the intervention.Results:There were significant differences in caregiver’s coping(P=0.016)and caregiver’s burden(P=0.009)in measurements between the two groups.Conclusions:The CEP-BAM interventions were effective in increasing adaptive coping strategies and reducing the burden of caregivers 4 months and continuing 6 months after the intervention.

Axonal remodeling in the corticospinal tract after stroke： how does rehabilitative training modulate it？

Stroke causes long-term disability, and rehabilitative training is commonly used to improve the consecutive functional recovery. Following brain damage, surviving neurons undergo morphological alterations to reconstruct the remaining neural network. In the motor system, such neural network remodeling is observed as a motor map reorganization. Because of its significant correlation with functional recovery, motor map reorganization has been regarded as a key phenomenon for functional recovery after stroke. Although the mechanism underlying motor map reorganization remains unclear, increasing evidence has shown a critical role for axonal remodeling in the corticospinal tract. In this study, we review previous studies investigating axonal remodeling in the corticospinal tract after stroke and discuss which mechanisms may underlie the stimulatory effect of rehabilitative training. Axonal remodeling in the corticospinal tract can be classified into three types based on the location and the original targets of corticospinal neurons, and it seems that all the surviving corticospinal neurons in both ipsilesional and contralesional hemisphere can participate in axonal remodeling and motor map reorganization. Through axonal remodeling, corticospinal neurons alter their output selectivity from a single to multiple areas to compensate for the lost function. The remodeling of the corticospinal axon is influenced by the extent of tissue destruction and promoted by various therapeutic interventions, including rehabilitative training. Although the precise molecular mechanism underlying rehabilitation-promoted axonal remodeling remains elusive, previous data suggest that rehabilitative training promotes axonal remodeling by upregulating growth-promoting and downregulating growth-inhibiting signals.

Characteristics of basal ganglia aphasia after stroke and the rehabilitative interventions

OBJECTIVE: To introduce the characteristics of basal ganglia aphasia after stroke and the rehabilitative interventions. DATA SOURCES: Articles related to stroke, subcortical aphasia, basal ganglia aphasia and language rehabilitation published in Chinese from January 1988 to December 2005 were searched in Chinese journal full-text database (CJFD) using the Keywords of 'stroke, basal ganglia aphasia, language rehabilitation' in Chinese. Meanwhile, English articles about aphasia published from January 1982 to December 2005 were searched in and Pubmed database. Besides, several books associated with the contents were looked through manually. STUDY SELECTION: The data were checked primarily, the articles about the pathomechanism and neurolinguistic characteristics of basal ganglia aphasia, diagnostic methods of aphasia and language rehabilitation were selected, and those had no obvious relation with the above contents were excluded. Inclusive criteria: literatures explain the clinical characteristics of basal ganglia aphasia, neurolinguistic pathogenesis and methods of rehabilitation therapy in details. The repetitive studies were excluded. DATA EXTRACTION: Totally 95 literatures about basal ganglia aphasia were collected, including 31 about the clinical characteristics of basal ganglia aphasia, 45 about its neurolinguistic pathogenesis, 5 about the evaluation and classification of aphasia, and 14 about its rehabilitation therapy. Thirty accorded with the inclusive criteria were used for review, and the other 65 were excluded. DATA SYNTHESIS: Concisely introduced the definition, past investigation of basal ganglia aphasia after stroke, then dwelled on the multiplicity neurolinguistics characteristics. Aphasia evaluation was dependent upon clinical aphasic symptoms. The relationship between symptom and focus of infection was explored, and the mechanism of pathosis language behavior on basal ganglia aphasia patients was understood to provide consequence data that could authenticate the processing of language in brain. On the other hand, the method of rehabilitation on basal ganglia aphasia after stroke was explained. CONCLUSION: Basal ganglia aphasia is manifested as atypical aphasic symptom, the mechanism for the structure of basal ganglia in the speech formation should be further confirmed. It is effective to select pertinent language rehabilitation for basal ganglia aphasia after stroke.

Management of post-stroke depression(PSD)by electroencephalography for effective rehabilitation

Post-stroke depression(PSD)has negative impacts on the daily life of stroke survivors and delays their neuro-logical recovery.However,traditional post-stroke rehabilitation mainly focused on motor restoration,whereas little attention was given to the affective deficits.Effective management of PSD,including diagnosis,intervention,and follow-ups,is essential for post-stroke rehabilitation.As an objective measurement of the nervous system,electroencephalography(EEG)has been applied to the diagnosis and evaluation of PSD.In this paper,we re-viewed the literature most related to the clinical applications of EEG for PSD and offered a cross-section that is useful for selecting appropriate approaches in practice.This study aimed to gather EEG-based empirical ev-idence for PSD diagnosis,review interventions for managing PSD,and analyze the evaluation approaches.In total,33 diagnostic studies and 19 intervention studies related to PSD and depression were selected from the literature.It was found that the EEG features analyzed by both band-based and nonlinear dynamic approaches were capable of quantifying the abnormal neural responses on the cortical level for PSD diagnosis and interven-tion evaluation/prediction.Meanwhile,EEG-based machine learning has also been applied to the diagnosis and evaluation of depression to automate and speed up the process,and the results have been promising.Although brain-computer interface(BCI)interventions have been widely applied to post-stroke motor rehabilitation and cognitive training,BCI emotional training has not been directly used in PSD yet.This review showed the need for understanding the cortical responses of PSD to improve its diagnosis and precision treatment.It also revealed that future post-stroke rehabilitation plans should include training sessions for motor,affect,and cognitive functions and closely monitor their improvements.

Effects of different frequencies of repetitive transcranial magnetic stimulation on the recovery of upper limb motor dysfunction in patients with subacute cerebral infarction

Studies have confirmed that low-frequency repetitive transcranial magnetic stimulation can decrease the activity of cortical neurons, and high-frequency repetitive transcranial magnetic stimulation can increase the excitability of cortical neurons. However, there are few studies concerning the use of different frequencies of repetitive transcranial magnetic stimulation on the recovery of upper-limb motor function after cerebral infarction. We hypothesized that different frequencies of repetitive transcranial magnetic stimulation in patients with cerebral infarction would produce different effects on the recovery of upper-limb motor function. This study enrolled 127 patients with upper-limb dysfunction during the subacute phase of cerebral infarction. These patients were randomly assigned to three groups. The low-frequency group comprised 42 patients who were treated with 1 Hz repetitive transcranial magnetic stimulation on the contralateral hemisphere primary motor cortex （M1）. The high-frequency group comprised 43 patients who were treated with 10 Hz repetitive transcranial magnetic stimulation on ipsilateral M1. Finally, the sham group comprised 42 patients who were treated with 10 Hz of false stimulation on ipsilateral M1. A total of 135 seconds of stimulation was applied in the sham group and high-frequency group. At 2 weeks after treatment, cortical latency of motor-evoked potentials and central motor conduction time were significantly lower compared with before treatment. Moreover, motor function scores were significantly improved. The above indices for the low- and high-frequency groups were significantly different compared with the sham group. However, there was no significant difference between the low- and high-frequency groups. The results show that low- and high-frequency repetitive transcranial magnetic stimulation can similarly improve upper-limb motor function in patients with cerebral infarction.

Efficacy evaluation of acupuncture plus rehabilitation training for post-stroke deglutition disorders of qi-deficiency blood stasis pattern

Objective:To observe the clinical efficacy of acupuncture plus rehabilitation training in treating post-stroke deglutition disorders of qi-deficiency blood stasis pattern.Methods:Sixty-six patients with post-stroke deglutition disorders of qi-deficiency blood stasis patter were divided into an observation group and a rehabilitation group using the random number table method.The two groups both received conventional medications and supportive treatment for stroke.In addition,the observation group received acupuncture plus rehabilitation training while the rehabilitation group only received the same rehabilitation training.The interventions were conducted 3 times a week for a total of 4 weeks in both groups.They were evaluated using Kubota water swallowing test(KWST),Fujishima Ichiro food intake level scale(FILS)and symptoms score of traditional Chinese medicine(TCM)before and after treatment,and at the 1-month follow-up.The therapeutic efficacy was assessed at the 1-month follow-up.Results:The KWST grading and FILS result after treatment and at the follow-up were significantly different from those before treatment in both groups(all P<0.001);the results of these two items at the follow-up were not significantly different from those after treatment in the two groups(all P>0.05).There were significant differences in the KWST grading and FILS result between the two groups after treatment and at the follow-up(all P<0.05).The TCM symptoms score changed significantly after treatment and at the follow-up compared with that before treatment in both groups(all P<0.001).The TCM symptoms grading efficacy at the follow-up was significantly different from that after treatment in the observation group(P<0.05),while the difference was statistically insignificant in the rehabilitation group(P>0.05).The TCM symptoms grading efficacy in the observation group was significantly different from that in the rehabilitation group after treatment and at the follow-up(both P<0.05).Conclusion:Based on the conventional treatment for stroke,acupuncture plus rehabilitation training or use of rehabilitation training alone both can improve the clinical symptoms in post-stroke deglutition disorders of qi-deficiency blood stasis pattern,but acupuncture plus rehabilitation training can produce more significant efficacy and better long-term efficacy in improving TCM symptoms.

Real-time and wearable functional electrical stimulation system for volitional hand motor function control using the electromyography bridge method

Voluntary participation of hemiplegic patients is crucial for functional electrical stimulation therapy.A wearable functional electrical stimulation system has been proposed for real-time volitional hand motor function control using the electromyography bridge method.Through a series of novel design concepts,including the integration of a detecting circuit and an analog-to-digital converter,a miniaturized functional electrical stimulation circuit technique,a low-power super-regeneration chip for wireless receiving,and two wearable armbands,a prototype system has been established with reduced size,power,and overall cost.Based on wrist joint torque reproduction and classification experiments performed on six healthy subjects,the optimized surface electromyography thresholds and trained logistic regression classifier parameters were statistically chosen to establish wrist and hand motion control with high accuracy.Test results showed that wrist flexion/extension,hand grasp,and finger extension could be reproduced with high accuracy and low latency.This system can build a bridge of information transmission between healthy limbs and paralyzed limbs,effectively improve voluntary participation of hemiplegic patients,and elevate efficiency of rehabilitation training.

Therapeutic observation of Gao's nape acupuncture plus swallowing training for pharyngeal deglutition disorder after stroke

Objective: To observe the clinical efficacy of Gao's nape acupuncture plus swallowing training in treating pharyngeal deglutition disorder after stroke. Methods: One hundred patients with post-stroke pharyngeal deglutition disorder were randomized into a treatment group and a control group, with 50 cases in each group. The two groups both received routine neurological intervention. In addition, the treatment group was given Gao's nape acupuncture plus swallowing training, while the control group was intervened by swallowing training alone. After eight-week treatment, the two groups were observed in terms of the changes in repetitive saliva swallowing test (RSST), modified water swallowing test (MWST), standardized swallowing assessment (SSA) and swallowing-related quality of life (SWAL-QOL). The clinical efficacies of the two groups were also compared. Results: After treatment, the RSST grading, and scores of MWST, SSA and SWAL-QOL changed significantly in both groups (P<0.05 or P<0.01). The RSST grading, and scores of MWSX SSA and SWAL-QOL in the treatment group were significantly different from those in the control group after treatment (P<0.05 or P<0.01). The total effective rate and markedly effective rate were respectively 100.0% and 72.3% in the treatment group, versus 97.9% and 34.0% in the control group. There was a significant differenee in the markedly effective rate between the two groups (P<0.01). The differenee in the clinical efficacy between the two groups was statistically significant (P<0.01). Con elusion: Gao's n ape acupu ncture plus swallowi ng training is an effective approach for post-stroke phary ngeal deglutiti on disorder. Its therapeutic efficacy is more significant than that of swallowing training alone.

Observation on mind-refreshing and orifice-opening needling method plus swallowing disorder therapeutic apparatus for deglutition disorder of stroke patients in the convalescent stage

Objective： To observe the clinical effect of mind-refreshing and orifice-opening needling method plus swallowing disorder therapeutic apparatus for deglutition disorder of stroke patients in convalescence stage. Methods： A total of 136 patients conforming to the inclusion criteria were randomized into three groups by the random number table, including group A of 46 cases, group B of 44 cases and group C of 46 cases. Patients in group A received swallowing disorder therapeutic apparatus treatment, patients in group B received mind-refreshing and orifice-opening needling method treatment, and patients in group C received mind-refreshing and orifice-opening needling method plus swallowing disorder therapeutic apparatus treatment. The treatment was given once a day for 10 d as a course, the whole treatment lasted for 4 courses. Therapeutic evaluation items including water-swallowing test （WST）, standardized swallowing assessment （SSA） and modified Barthel index （MBI） were measured before treatment, after treatment and at follow-up visit （2 months after treatment）. Results： After treatment, scores of WST and MBI in all three groups increased significantly （all P〈0.05）, while the SSA score dropped significantly （all P〈0.05）. After treatment and during follow-up visit period, score of WST in group C was significantly higher than that in group A and group B （both P〈0.05）, while the difference between group A and group B showed no statistical significance （P〉0.05）; the SSA score in group C was substantially lower than that in group A and group B （all P〈0.05）, the difference between group A and group B showed no statistical significance （P〉0.05）; the MBI scores in group B and group C were substantially higher than that in group A （all P〈0.05）, the difference between group B and group C showed no statistical significance （P〉0.05）. After treatment and during follow-up visit period, the differences in overall therapeutic effect between group A and group B showed no statistical significance （P〉0.05）, while the overall therapeutic effect in group C was substantially better than that in group A and group B （all P〈0.05）. Conclusion： Both mind-refreshing and orifice-opening needling method and swallowing disorder therapeutic apparatus can alleviate symptoms of deglutition disorder of stroke patients respectively, and the combination of two methods can improve the therapeutic effect.

Research progress on the effect and mechanism of Tai Ji Quan in the treatment of post-stroke depression

To explore the clinical efficacy and possible mechanism of Tai Ji Quan for post-stroke depression(PSD),literature related to Tai Ji Quan and PSD were retrieved from China National Knowledge Infrastructure(CNKI),Wanfang Academic Journal Full-text Database(Wanfang),Chongqing VIP Database(CQVIP),China Biology Medicine Disc(CBM),and PubMed,screened and then summarized.The results showed that Tai Ji Quan could effectively improve the depression and quality of life of stroke patients,and there were differences in the clinical efficacy among different training programs.Tai Ji Quan has the characteristics of“regulating mind”,“regulating breath”,and“regulating body”.It may achieve the effect of“combined physique-spirit treatment”by improving social psychology,increasing the level of neurotrophin,regulating neuroendocrine,reducing inflammatory factors,and regulating neural circuits.

Quantitative Progress Evaluation of Post-stroke Patients Using a Novel Bimanual Cable-driven Robot

Rehabilitation is the most effective way to reduce motor impairments in post-stroke patients.This process demands several hours with a specialized therapist.Given resources and personnel shortages,the literature reports a high interest in robotic assisted rehabilitation solutions.Recently,cable-driven robotic architectures are attracting significant research interest for post-stroke rehabilitation.However,the existing cable-driven robots are mostly unilateral devices allowing the rehabilitation only of the most affected limb.This leaves unaddressed the rehabilitation of bimanual activities,which are predominant within the common Activities of Daily Living(ADL).Thus,this paper presents a specific novel design to achieve bimanual rehabilitation tasks that has been named as BiCAR robot.Specifically,this paper provides a full insight on the BiCAR system as well as on its dedicated developed software BiEval.In particular,BiEval software has been developed as based on a serious game strategy and a virtual reality environment to track the patient exercising duration,motion ranges,speeds,and forces over time for achieving a quantitative assessment of the rehabilitation progress.Finally,the paper presents the BiCAR/BiEval capabilities by referring to a pilot Randomized Controlled Trial(RCT).The clinical trials have been used to validate the BiCAR/BiEval in terms of engineering feasibility and user acceptance to achieve an innovative cost-oriented integrated hardware/software device for the bimanual assistive rehabilitation of post-stroke patients.