Zhenlan Li

Background: Post-stroke muscle hyper-resistance is produced by both neurogenic (spasticity) and non-neurogenic (contracture) factors. BoNT-A is the most effective intervention for post-stroke spasticity, yet whether concomitant contracture alters its therapeutic benefit remains unclear. Aims: To compare BoNT-A effectiveness in plantar-flexor hyper-resistance stratified by contracture. Methods: We retrospectively reviewed stroke survivors with spastic hemiplegia and ankle plantar-flexor hyper-resistance who received BoNT-A injections. Patients were stratified into two groups according to the presence of restricted passive ankle dorsiflexion: the spasticity group (PROM limitation <7°) and the spasticity-with-contracture group (PROM limitation ≥7°). Outcomes were assessed at baseline and at 2, 4 and 12 weeks post-injection, including the Modified Ashworth Scale (MAS) for plantar-flexors, Brunnstrom Recovery Stage (BRS), Fugl–Meyer Assessment (FMA) lower-extremity subscore and Barthel Index (BI). Results: A total of 107 patients were enrolled—54 in the spasticity group and 53 in the spasticity-with-contracture group. Baseline comparison revealed a significantly longer disease duration in the spasticity-with-contracture group; other characteristics were comparable. Both groups achieved improvements in MAS and BRS at all three follow-up visits. FMA and BI improved in the spasticity group at 4 and 12 weeks, whereas the spasticity-with-contracture group showed improvement only at 12 weeks. Between-group analyses indicated that MAS and BRS scores were consistently better in the spasticity group at each time point; although median FMA and BI were numerically higher in this group, the differences did not reach statistical significance. Conclusion: BoNT-A markedly reduces post-stroke hyper-resistance and enhances motor function and activities of daily living; by contrast, concomitant contracture is associated with delayed and attenuated improvement in MAS and BRS.

Aphasia is a language network disorder caused by organic brain lesions, which severely affects patients' daily communication and interaction. The therapeutic effect of conventional rehabilitation training alone is limited. Currently, Theta Burst Stimulation (TBS) is a novel therapeutic modality of repetitive Transcranial Magnetic Stimulation (rTMS) and is a commonly used patterned rTMS. It appears in the form of burst waves and mimics the natural firing pattern of hippocampal neurons under Theta rhythm. Based on rTMS, TBS embeds a pattern in which three 50 Hz pulse bursts are inserted into a 5 Hz pulse train. This stimulation pattern can induce cortical plasticity in a shorter period of time and is gradually being applied in the treatment of aphasia. Auditory comprehension, as the initial component of language input, involves the reception and storage of linguistic signals, as well as the analysis and integration of lexical semantics. The recovery of this ability plays a prerequisite role in the functional improvement of patients with post-stroke aphasia (PSA). In recent years, research on aphasia has mainly focused on speaking, reading, and writing abilities, with relatively less attention paid to auditory comprehension. Therefore, this article reviews the research progress related to the use of TBS in treating auditory comprehension in aphasia, aiming to provide new ideas and references for the clinical selection of TBS stimulation protocols.

Depressive disorders and coronary heart disease (CHD) are significant and pervasive global public health challenges, influenced by various factors such as diet, physical activity, social circumstances, and lifestyle habits. This study aim to investigate the relationship among regular walking, the systemic immune-inflammation index (SII), and depression in CHD patients. Additionally, it seeks to explore the mediating role of SII in the effect of regular walking on depression among these patients. This cross-sectional study involved 464 patients aged ≥ 65 years with CHD, admitted to the cadre ward of the First Hospital of Jilin University from September 2021 to December 2022. A comprehensive geriatric assessment (CGA) inventory was prepared by compiling and screening regular walking, calculated SII, and the Geriatric Depression Scale (GDS). Binary logistic regression was employed to examine the relationship among walking, ln(SII) and depression. After adjusting for confounding factors, linear regression analysis was used to assess the correlation among exercise-related factors, ln(SII) and depression. Sensitivity analyses were performed through stratified analysis, investigating the relationship between walking and depression within the strata of each variable, as well as the P-interaction among stratified variables. Additionally, the Process package in SPSS was used to explore the mediating role of ln(SII) in the association between regular walking and depression. Model 2: Elderly individuals who walk regularly are 72.2% less likely to experience depression compared to those who do not engage in regular walking (odds ratio (OR) = 0.278, 95% CI = 0.178–0.433, P < 0.001). However, one-unit increases in ln(SII) corresponds to an approximately sixfold in the likelihood of depression among elderly individuals (OR = 5.899, 95% CI = 4.183–8.318, P < 0.001). Model 3: Participants who walk regularly are 69.4% less likely to suffer from depression compared to those who do not walk regularly (OR = 0.306, 95% CI = 0.190–0.491, P < 0.001). Similarly, a one-unit increase in ln(SII) is associated with an approximately sixfold increase in the probability of depression elderly individuals (OR = 5.976, 95% CI = 4.126–8.656, P < 0.001). The stratified analysis examining the effect of regular walking on depression in patients with CHD confirms the robustness of these associations. Additionally, SII was found to mediate the relationship between regular walking and depression in CHD patients, accounting for 43.19% of the total effect. An interaction exists among SII, regular walking and depression in elderly patients with coronary heart disease. Furthermore, SII partially mediates the relationship between regular walking and depression. Not applicable.

Background: Over 80% of patients with stroke experience finger grasping dysfunction, affecting independence in activities of daily living and quality of life. In routine training, task-oriented training is usually used for functional hand training, which may improve finger grasping performance after stroke, while augmented therapy may lead to a better treatment outcome. As a new technology-supported training, the hand rehabilitation robot provides opportunities to improve the therapeutic effect by increasing the training intensity. However, most hand rehabilitation robots commonly applied in clinics are based on a passive training mode and lack the sensory feedback function of fingers, which is not conducive to patients completing more accurate grasping movements. A force feedback hand rehabilitation robot can compensate for these defects. However, its clinical efficacy in patients with stroke remains unknown. This study aimed to investigate the effectiveness and added value of a force feedback hand rehabilitation robot combined with task-oriented training in stroke patients with hemiplegia. Methods: In this single-blinded randomised controlled trial, 44 stroke patients with hemiplegia were randomly divided into experimental (n = 22) and control (n = 22) groups. Both groups received 40 min/day of conventional upper limb rehabilitation training. The experimental group received 20 min/day of task-oriented training assisted by a force feedback rehabilitation robot, and the control group received 20 min/day of task-oriented training assisted by therapists. Training was provided for 4 weeks, 5 times/week. The Fugl-Meyer motor function assessment of the hand part (FMA-Hand), Action Research Arm Test (ARAT), grip strength, Modified Ashworth scale (MAS), range of motion (ROM), Brunnstrom recovery stages of the hand (BRS-H), and Barthel index (BI) were used to evaluate the effect of two groups before and after treatment. Results: Intra-group comparison: In both groups, the FMA-Hand, ARAT, grip strength, AROM, BRS-H, and BI scores after 4 weeks of treatment were significantly higher than those before treatment (p < 0.05), whereas there was no significant difference in finger flexor MAS scores before and after treatment (p > 0.05). Inter-group comparison: After 4 weeks of treatment, the experimental group’s FMA-Hand total score, ARAT, grip strength, and AROM were significantly better than those of the control group (p < 0.05). However, there were no statistically significant differences in the scores of each sub-item of the FMA-Hand after Bonferroni correction (p > 0.007). In addition, there were no statistically significant differences in MAS, BRS-H, and BI scores (p > 0.05). Conclusion: Hand performance improved in patients with stroke after 4 weeks of task-oriented training. The use of a force feedback hand rehabilitation robot to support task-oriented training showed additional value over conventional task-oriented training in stroke patients with hand dysfunction. Clinical trial registration information: NCT05841108

Post-stroke depression is closely related to the poor prognosis of stroke, resulting in prolonged hospital stay, neurological dysfunction, and increased mortality. Post-stroke depression has a complex pathogenesis, and cannot be explained by a single pathophysiological mechanism; therefore, no treatment is definitely effective. Currently, the commonly used treatment methods include drug therapy, psychotherapy and noninvasive neuromodulation therapy, such as repetitive transcranial magnetic stimulation, and transcranial direct current stimulation. However, simple drugs have poor efficacy and are often accompanied by side effects. Although repetitive transcranial magnetic stimulation and transcranial direct current stimulation combined with drug therapy enhance drug efficacy, their application is limited in some cases. Light therapy can regulate the central nervous system through the light-sensitive retinal nerve pathway, which has been proven to have therapeutic effects in patients with depression. Light therapy has the advantages of no obvious side effects and a wider range of adaptation. This review summarizes the current research status of noninvasive neuromodulation and light therapy in post-stroke depression and explores the possibility of widespread application of physical factors modulation for post-stroke depression.

Stroke is a group of cerebrovascular diseases with high prevalence and mortality rate. Stroke can induce many impairments, including motor and cognitive dysfunction, aphasia/dysarthria, dysphagia, and mood disorders, which may reduce the quality of life among the patients. Constraint-induced therapy has been proven to be an effective treatment method for stroke rehabilitation. It has been widely used in the recovery of limb motor dysfunction, aphasia, and other impairment like unilateral neglect after stroke. In recent years, constraint-induced therapy can also combine with telehealth and home rehabilitation. In addition, constraint-induced therapy produces significant neuroplastic changes in the central nervous system. Functional magnetic resonance imaging, diffusion tensor imaging, and other imaging/electrophysiology methods have been used to clarify the mechanism and neuroplasticity. However, constraint-induced therapy has some limitations. It can only be used under certain conditions, and the treatment time and effectiveness are controversial. Further research is needed to clarify the mechanism and effectiveness of CI therapy.

Multiple sclerosis is a slowly progressive disease, immunosuppressants and other drugs can delay the progression and progression of the disease, but the most patients will be left with varying degrees of neurological deficit symptoms, such as muscle weakness, muscle spasm, ataxia, sensory impairment, dysphagia, cognitive dysfunction, psychological disorders, etc. From the early stage of the disease to the stage of disease progression, professional rehabilitation treatment can reduce the functional dysfunction of multiple sclerosis patients, improve neurological function, and reduce family and social burdens. With the development of various new rehabilitation technologies such as transcranial magnetic stimulation, virtual reality technology, robot-assisted gait, telerehabilitation and transcranial direct current stimulation, the advantages of rehabilitation therapy in multiple sclerosis treatment have been further established, and more treatment means have also been provided for patients.

Spasticity is one of the most common complications after stroke. With the gradual intensification of spasticity, stroke patients will have a series of problems such as joint ankylosis and movement restriction, which affect the daily activities and increase the burden on patients' families, medical staff and society. There are many ways to treat post-stroke spasticity before, including physical therapy and exercise therapy, drug therapy, surgery and so on, but not satisfied because of a few shortcomings. In recent years, many researchers have applied extracorporeal shock wave therapy (ESWT) for the treatment of post-stroke spasm and achieved good clinical effect, because it is non-invasive, safe, easy to operate, low cost and other advantages compared with other treatment methods. This article reviews the research progress and existing problems of ESWT in the treatment of post-stroke spasticity.

Background: Hemichorea is a common post-stroke movement disorder. Although the general prognosis is good, permanent functional impairment remains in a substantial number of patients with post-stroke hemichorea. Anti-choreic drugs may alleviate symptoms in mild cases, but they often incur unacceptable side effects like tardive dyskinesia and parkinsonism. Surgery is rarely indicated for the treatment of vascular chorea, except in refractory cases. Case presentation: Here we reported a case of a 71-year-old man with severe choreatic movements after stroke, which caused the inability to perform the activities of daily living. Computed tomography revealed signs of former bleeding in the left caudate nucleus. Due to poor response to pharmacologic treatment, he was subjected to physical therapy and repetitive magnetic stimulation (rTMS) using a parabolic coil with 1 Hz over the left M1 area. The patient reported reduced symptoms after the 1^st week of stimulation. rTMS substantially reduced choreatic movements and improved functional scores, including Brunnstrom recovery stage, Fugl–Meyer Assessment, Barthel index, Berg balance scale, and Dyskinesias scale. After 4 weeks of therapy, he was discharged with only a slight involuntary movement on the left side. No relapse occurred during the 1-year follow-up. Conclusions: Further studies are needed to reveal the mechanism of the observed effects and confirm the efficacy of rTMS as an alternative treatment for severe post-stroke hemichorea.