Yajun Mao

Background: Closed-loop motor imagery brain-computer interface (MI-BCI) training may support post-stroke upper-limb rehabilitation by coupling motor intention with contingent multisensory feedback. This randomized pilot trial examined its feasibility, safety, short-term clinical effects, and exploratory EEG correlates in patients with subacute stroke. Methods: In this single-center, assessor-blinded, two-arm pilot trial, 40 patients with first-ever subcortical stroke in the subacute phase were randomized 1:1 to a BCI group or an active control group after a 2-day motor imagery familiarization phase. Both groups received routine medical management, standardized conventional rehabilitation, and dose-matched motor imagery-based hand training for 4 weeks. The BCI group received EEG-contingent closed-loop MI-BCI-assisted training with a soft rehabilitation glove, whereas the control group received non-EEG-contingent glove-assisted motor imagery training under matched training duration, task instructions, device exposure, and multisensory feedback. The primary outcome was the Fugl-Meyer Assessment for the Upper Extremity (FMA-UE). Secondary outcomes included the Action Research Arm Test (ARAT) and Modified Barthel Index (MBI). Exploratory EEG outcomes included FFT%α and FFT%β during motor imagery. Clinical and EEG outcomes were analyzed using baseline-adjusted ANCOVA models, with week-4 values as dependent variables and corresponding baseline values as covariates. Results: All randomized participants completed the 4-week assessment. In baseline-adjusted ANCOVA models, the BCI group showed higher week-4 scores than the control group for FMA-UE (adjusted mean difference, 13.40 points; 95% CI, 10.71–16.08; p < 0.001), ARAT (7.31 points; 95% CI, 4.55–10.07; p < 0.001), and MBI (12.21 points; 95% CI, 8.55–15.87; p < 0.001). Exploratory EEG analyses also showed higher week-4 FFT%α and FFT%β in the BCI group, with adjusted mean differences of 6.78 percentage points (95% CI, 5.22–8.34; p < 0.001) and 3.95 percentage points (95% CI, 2.53–5.36; p < 0.001), respectively. No serious adverse events occurred. Conclusion: Closed-loop MI-BCI-assisted training was feasible and well tolerated in selected patients with subacute stroke. The observed short-term improvements in upper-limb impairment and activity capacity provide preliminary signals of potential benefit beyond dose-matched non-EEG-contingent feedback training. Exploratory EEG findings suggest task-related modulation of alpha- and beta-band sensorimotor rhythmic activity, but should be interpreted as hypothesis-generating rather than confirmatory evidence of neural reorganization. Larger multicenter trials with longer follow-up, rigorous neurophysiological analyses, and real-world upper-limb use outcomes are needed. Clinical Trial Registration: ChiCTR2400083992. https://www.chictr.org.cn/showproj.html?proj=229529

Background: Inflammation and liver function are associated with cognitive decline and dementia. Little is known about the serum albumin-to-globulin ratio on cognitive function.Objective: The objective of this study was to investigate the association between albumin-to-globulin ratio and cognitive function among the American older people.Methods: The public data available on the US National Health and Nutrition Examination Survey (NHANES) from 2011 to 2014 was used for this cross-sectional study. Participants aged ≥60 years completed the cognitive function assessments, including word learning and recall modules from the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD), the animal fluency (AF) test, and the digit symbol substitution test (DSST). A composite cognition score was calculated to evaluate global cognition. The univariate and multivariate linear regression analysis, curve fitting, a threshold effect, along with a subgroup analysis and interaction tests were conducted.Results: Serum albumin-to-globulin ratio (per 0.1 unit) was positively associated DSST score (β = 0.36, 95% CI: 0.21, 0.51), AF score (β = 0.1, 95% CI: 0.04, 0.16) and global cognition score (β = 0.05, 95% CI: 0.02, 0.07), after being fully adjusted, while albumin-to-globulin ratio was not related to CERAD score (β = 0.05, 95% CI: −0.02, 0.12). A non-linear was observed in the dose–response relationship between albumin-to-globulin ratio and global cognition (P for non-linearity < 0.001). The subgroup analysis was overall stable, yet the interaction test was significant for age on global cognition (P for interaction = 0.036).Conclusion: The findings of this cross-sectional study suggested a positive and non-linear association between albumin-to-globulin ratio and cognitive function in the American older people. Maintaining albumin-to-globulin ratio with an appropriate range may be one of the therapeutic strategies to limit the progression of cognitive decline for the older people.

Background: Gait adaptability is essential for stroke survivors to achieve efficient and safe community ambulation. However, conventional treadmill rehabilitation is only a repetitive practice of leg movement. This study compared the effects of augmented reality (AR) treadmill-based gait adaptation training with regular treadmill programs for patients with stroke. Methods: Forty patients with stroke (N = 40) were randomly assigned to the gait adaptation training (n = 20, age: 49.85 (SD 8.44) years; onset of stroke: 107.80 (SD 48.31) days) and regular training (n = 20, age: 50.75 (SD 8.05) years, onset of stroke: 111.60 (SD 49.62) days) groups. Both groups completed three sessions of training per week for five weeks (15 sessions). The primary outcomes were the 10-meter walk test, and success rate of obstacle avoidance, while secondary outcomes included the Berg balance scale, component timed-up-and-go, and fall rate in a six-month follow-up period. Assessments were performed before and after the intervention. The paired t-test was applied to compare the differences within groups and independent sample t-test was performed to compare the differences between groups. Results: The 10-meter walk test, success rate of obstacle avoidance, Berg balance scale, component timed-up-and-go all significantly improved in both groups (P < 0.001). The success rate of obstacle avoidance (P = 0.02, 95% CI: -21.07, -1.64), Berg Balance Scale (P = 0.02, 95% CI: -8.03, -0.67), “turning around time” (P = 0.04, 95% CI: 0.08, 2.81), “stand-to-sit” (P = 0.03, 95% CI: 0.16, 2.41) and “total time” (P = 0.048, 95% CI: 0.04, 10.32) improved significantly in gait adaptation training group after intervention, while the 10-meter walk test (P = 0.09, 95% CI: -0.17, 0.01), timed “sit-to-stand” (P = 0.09, 95% CI: -0.14, 2.04) and “linear walking” (P = 0.09, 95% CI: -0.27, 3.25) in gait adaptation training group didn’t show statistical difference compared to the regular training group. Total fall rate during the follow-up period was statistically decreased in the gait adaptation training group (P = 0.045). Conclusions: Both interventions improved mobility outcomes, with AR treadmill-based gait adaptation indicating greater improvement in obstacle avoidance, balance, turning, and stand-to-sit. AR treadmill-based gait adaptation training emerges as an effective and promising intervention for patients with stroke in early rehabilitation.