The effect of motor relearning on balance, mobility and performance of activities of daily living among post-stroke patients: Study protocol for a randomised controlled trial

The effect of a motor relearning on balance and postural control in patients after stroke: An open-label randomized controlled trial

INTRODUCTION

Balance and postural control impairments are common in stroke patients, increasing fall risk and limiting their daily and social activities. Current research lacks comprehensive studies evaluating the efficacy and long-term effects of task-specific training on balance and postural control among stroke patients, especially when considering biomechanical and posturographic assessments.

PATIENTS AND METHODS

A randomized controlled trial included 63 subacute stroke patients recruited from the outpatient rehabilitation department. Participants were randomly assigned to the MRP group (n=32), receiving task-specific training based on MRP, or the CPT group (n=31), receiving conventional physical therapy. Both groups completed an 8-week intervention (3 sessions/week; 1 h./session). Balance and postural control were assessed at baseline, post-intervention, and 3-month follow-up using the Berg Balance Scale (BBS) and posturography.

RESULTS

The MRP group exhibited significantly larger improvements than the CPT group in both BBS scores (p=0.001, d=2.98, 95% CI [2.25, 3.70]) and Balance Index scores (p=0.001, d=2.83, 95% CI [2.12, 3.53]) after the intervention. These improvements were sustained at 3-month follow-up.

DISCUSSION

The findings suggest that task-specific training based on MRP is more effective than CPT for improving balance and postural control. The MRP intervention may enhance the motor learning and neural plasticity of the patients, leading to better functional outcomes. However, the study's open-label design represents a limitation, and further research with adequate blinding is needed.

CONCLUSION

Task-specific training based on MRP was superior to CPT for improving balance and postural control in subacute stroke patients. Participants undergoing MRP exhibited significant and clinically relevant improvements that were sustained at follow-up.

A Real-Time Control Method for Upper Limb Exoskeleton Based on Active Torque Prediction Model

Exoskeleton rehabilitation robots have been widely used in the rehabilitation treatment of stroke patients. Clinical studies confirmed that rehabilitation training with active movement intentions could improve the effectiveness of rehabilitation treatment significantly. This research proposes a real-time control method for an upper limb exoskeleton based on the active torque prediction model. To fulfill the goal of individualized and precise rehabilitation, this method has an adjustable parameter assist ratio that can change the strength of the assist torque under the same conditions. In this study, upper limb muscles' EMG signals and elbow angle were chosen as the sources of control signals. The active torque prediction model was then trained using a BP neural network after appropriately extracting features. The model exhibited good accuracy on PC and embedded systems, according to the experimental results. In the embedded system, the RMSE of this model was 0.1956 N·m and 94.98%. In addition, the proposed real-time control system also had an extremely low delay of only 40 ms, which would significantly increase the adaptability of human-computer interactions.

Determining the Optimal Stimulation Sessions for TMS-Induced Recovery of Upper Extremity Motor Function Post Stroke: A Randomized Controlled Trial

To find out the optimal treatment sessions of repetitive transcranial magnetic stimulation (TMS) over the primary motor cortex (M1) for upper extremity dysfunction after stroke during the 6-week treatment and to explore its mechanism using motor-evoked potentials (MEPs) and resting-state functional magnetic resonance imaging (rs-fMRI), 72 participants with upper extremity motor dysfunction after ischemic stroke were randomly divided into the control group, 10-session, 20-session, and 30-session rTMS groups. Low-frequency (1 Hz) rTMS over the contralesional M1 was applied in all rTMS groups. The motor function of the upper extremity was assessed before and after treatment. In addition, MEPs and rs-fMRI data were analyzed to detect its effect on brain reorganization. After 6 weeks of treatment, there were significant differences in the Fugl-Meyer Assessment of the upper extremity and the Wolf Motor Function Test scores between the 10-session group and the 30-session group and between the 20- and 30-session groups and the control group, while there was no significant difference between the 20-session group and the 30-session group. Meanwhile, no significant difference was found between the 10-session group and the control group. The 20-session group of rTMS decreased the excitability of the contralesional corticospinal tract represented by the amplitudes of MEPs and enhanced the functional connectivity of the ipsilesional M1 or premotor cortex with the the precentral gyrus, postcentral gyrus, and cingulate gyrus, etc. In conclusion, the 20-session of rTMS protocol is the optimal treatment sessions of TMS for upper extremity dysfunction after stroke during the 6-week treatment. The potential mechanism is related to its influence on the excitability of the corticospinal tract and the remodeling of corticomotor functional networks.

Concepts and Application of Tai Ji in Stroke Rehabilitation: A Narrative Review

Stroke remains a leading cause of adult disability, and it decreases the health-related quality of life due to functional disability and poor functional recovery in stroke. Tai Ji has been recently introduced to overcome disabilities. This review aims to explain the effects of Tai Ji on functional recovery in stroke patients, linking it to current approaches, concepts and therapies such as Bobath and proprioceptive neuromuscular facilitation techniques. A compilation of recent literature on Tai Ji's use in stroke rehabilitation from Google scholar and PubMed Central (2018 to 2022). The benefits of Tai Ji in stroke functional recovery were studied and explained based on its similarity in concepts to current conventional stroke rehabilitation approaches. There were few randomized controlled trials on Tai Ji in functional recovery among stroke patients. However, all literature identified Tai Ji as beneficial in stroke rehabilitation. However, there was no literature on explaining the Tai Ji movement based on current conventional stroke rehabilitation approaches. Tai Ji carries similar theories to the current neurorehabilitation approach. Tai Ji can be modified and incorporated into stroke rehabilitation programs based on patients' needs to produce promising outcomes.