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Background: The global prevalence of stroke has been increasing. Motor dysfunction is observed in approximately 55 to 75% of stroke patients, with upper limb impairment affecting around 85% of them. Following upper limb dysfunction, the body's recovery time is not only slower compared to the lower limbs, but the restoration of its fine motor skills is significantly more challenging, greatly impacting the daily lives of patients. Consequently, there is an increasing urgency for study on the upper limb function in stroke. Methods: A search was conducted in the Web of Science Core Collection: Science Citation Index Expanded (SCI-Expanded) database for material published from January 1, 2004 to December 31, 2023. We included all relevant literature reports and conducted an analysis of annual publications, countries/regions, institutions, journals, co-cited references, and keywords using the software packages CiteSpace, VOSviewer, and Bibliometrix R. Next, we succinctly outlined the research trends and hotspots in post-stroke upper limb dysfunction. Results: This analysis comprised 1,938 articles from 1,897 institutions, 354 journals, and 53 countries or regions. A yearly rise in the production of publications was noted. The United States is the foremost nation on the issue. Northwestern University has the most amounts of papers compared to all other institutions. The journal Neurorehabilitation and Neural Repair is a highly significant publication in this field, with Catherine E. Lang serving as the principal author. The majority of the most-cited references focus on subjects such as the reliability and validity of assessment instruments, RCT of therapies, systematic reviews, and meta-analyses. The intervention measures primarily comprise three types of high-frequency phrases that are related, as determined by keyword analysis: intelligent rehabilitation, physical factor therapy, and occupational therapy. Current areas of focus in research include randomized clinical trials, neurorehabilitation, and robot-assisted therapy Conclusion: Current research has shown a growing interest in studying upper limb function assessment, occupational therapy, physical therapy, robotassisted therapy, virtual reality, brain-computer interface, telerehabilitation, cortical reorganisation, and neural plasticity. These topics have become popular and are expected to be the focus of future research. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Upper limb (UL) dysfunction rehabilitation in stroke patients is complicated in the clinic. Action observation therapy’s (AOT) impact on mirror neurons (MNs) has been observed and made applications in related brain disease treatment. Acupuncture mentioned in the present study mainly stimulates peripheral nerves for neuronal plasticity. However, the clinical effect of AOT impact on MNs and acupuncture irritate afferent nerve fibers in combination for UL motor impairment rehabilitation after stroke is still unclear. In the present study, we investigate the central and peripheral neural stimulation meanwhile for UL recovery with stroke patients. METHODS: In this clinical study, 82 stroke patients recruited with impaired UL were randomly assigned to three groups. Twenty-four cases were in the AOT group, 28 cases were in the AOT combined acupuncture treatment group, and 30 cases were in the acupuncture treatment group. All volunteers were scored for limb function through the Fugl–Meyer Assessment of the Upper Extremity (FMA-UE), the Action Research Arm Test, and the modified Barthel Index (BI) before and after a systematic treatment according to the groups. Meanwhile, conventional physical therapy was also implemented for all cases. RESULTS: Before the specific intervention, the scores of FMA-UE, FMA-UE, and BI with all stroke patients have no significant statistical difference (P > 0.05). After the corresponding treatment, we assessed UL function again at 4 and 8 weeks. At 4 weeks, the patients with AOT showed a significant increase in BI scores compared to the acupuncture group (P < 0.05). At 8 weeks, the FMA-UE scores of the patients with AOT combined with acupuncture were significantly increased than acupuncture alone (P < 0.05). We also observed that the BI scores of the combination and the AOT group both were improved compared to the acupuncture group with significant statistical analysis (P < 0.05). CONCLUSIONS: Based on the MNs theory, we adopted AOT impact on MNs which would be a promising rehabilitation technique, especially combined with acupuncture treatment in UL recovery of stroke. Mirror therapy seems to be effective for central neuronal plasticity, but for action or AOT, there is still insufficient evidence to recommend its optimal strategy and neuromodulation mechanism. Here, research on the MNs-based AOT technique with acupuncture in UL dysfunction with stroke patients is recommended. TRIAL REGISTRATION: http://www.chictr.org.cn (identifier: ChiCTR2300077010).

We share our experiences of instructing three patients with severe upper limb dysfunction on how to self‐adjust CPAP/NPPV masks. In Case 1, we simplified the procedure by suturing a part of the headband as the left forearm was amputated. In Case 2, the patient had congenitally short limbs with short stature; thus, we provided an additional belt to the headband to maintain the headband's configuration while wearing the mask. In Case 3, the patient had left hemiplegia due to stroke and, repetitive coaching was conducted during the recovery phase rehabilitation program. Difficulties with self‐adjusting NPPV/CPAP masks can occur whenever there is limited hand mobility above the head, including upper limb dysfunction. Simplifying procedures and providing sufficient time for instruction could help achieve independence. There have been no previous reports describing similar training details. We believe that sharing this knowledge will be helpful to both patients and healthcare professionals. [ABSTRACT FROM AUTHOR]

Abstract We share our experiences of instructing three patients with severe upper limb dysfunction on how to self‐adjust CPAP/NPPV masks. In Case 1, we simplified the procedure by suturing a part of the headband as the left forearm was amputated. In Case 2, the patient had congenitally short limbs with short stature; thus, we provided an additional belt to the headband to maintain the headband's configuration while wearing the mask. In Case 3, the patient had left hemiplegia due to stroke and, repetitive coaching was conducted during the recovery phase rehabilitation program. Difficulties with self‐adjusting NPPV/CPAP masks can occur whenever there is limited hand mobility above the head, including upper limb dysfunction. Simplifying procedures and providing sufficient time for instruction could help achieve independence. There have been no previous reports describing similar training details. We believe that sharing this knowledge will be helpful to both patients and healthcare professionals.

Objective: This study aimed to elucidate the efficacy, safety, and long-term implications of vagus nerve stimulation (VNS) as a viable therapeutic option for patients with upper limb dysfunction following a stroke. Methods: Data from the following libraries were searched from inception to December 2022: PubMed, Wanfang, Scopus, China Science and Technology Journal Database, Embase, Web of Science, China Biology Medicine Disc, Cochrane Library, and China National Knowledge Infrastructure. Outcomes included indicators of upper limb motor function, indicators of prognosis, and indicators of safety (incidence of adverse events [AEs] and serious AEs [SAEs]). Two of the authors extracted the data independently. A third researcher arbitrated when disputes occurred. The quality of each eligible study was evaluated using the Cochrane Risk of Bias tool. Meta-analysis and bias analysis were performed using Stata (version 16.0) and RevMan (version 5.3). Results: Ten trials (VNS combined with rehabilitation group vs. no or sham VNS combined with rehabilitation group) with 335 patients were included in the meta-analysis. Regarding upper extremity motor function, based on Fugl-Meyer assessment scores, VNS combined with other treatment options had immediate (mean difference [MD] = 2.82, 95% confidence interval [CI] = 1.78-3.91, I² = 62%, p < 0.00001) and long-term (day-30 MD = 4.20, 95% CI = 2.90-5.50, p < 0.00001; day-90 MD = 3.27, 95% CI = 1.67-4.87, p < 0.00001) beneficial effects compared with that of the control treatment. Subgroup analyses showed that transcutaneous VNS (MD = 2.87, 95% CI = 1.78-3.91, I² = 62%, p < 0.00001) may be superior to invasive VNS (MD = 3.56, 95% CI = 1.99-5.13, I² = 77%, p < 0.0001) and that VNS combined with integrated treatment (MD = 2.87, 95% CI = 1.7²-3.91, I² = 62%, p < 0.00001) is superior to VNS combined with upper extremity training alone (MD = 2.24, 95% CI = 0.55-3.93, I² = 48%, p = 0.009). Moreover, lower frequency VNS (20Hz) (MD = 3.39, 95% CI = 2.06-4.73, I² = 65%, p < 0.00001) may be superior to higher frequency VNS (25Hz or 30Hz) (MD = 2.29, 95% CI = 0.27-4.32, I² = 58%, p = 0,03). Regarding prognosis, the VNS group outperformed the control group in the activities of daily living (standardized MD = 1.50, 95% CI = 1.10-1.90, I² = 0%, p < 0.00001) and depression reduction. In contrast, quality of life did not improve (p = 0.51). Safety was not significantly different between the experimental and control groups (AE p = 0.25; SAE p = 0.26). Conclusion: VNS is an effective and safe treatment for upper extremity motor dysfunction after a stroke. For the functional restoration of the upper extremities, noninvasive integrated therapy and lower-frequency VNS may be more effective. In the future, further high-quality studies with larger study populations, more comprehensive indicators, and thorough data are required to advance the clinical application of VNS. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42023399820 [ABSTRACT FROM AUTHOR]

Upper limb dysfunction (ULD) is common following a stroke, spinal cord injury, trauma, and occupational accidents. Post-stroke patients with ULD need long-term assistance from therapists for their rehabilitation, which generally occurs at the hospital or outpatient clinic. Physical therapists are unavailable because of geographical, financial, and scheduling concerns, and continuity of care needs to be improved due to the need to travel to multiple locations for therapy. As a result, providing specific, tailored therapy programs is challenging due to the absence of feedback and real-time monitoring. An effective telerehabilitation system can address this issue and is more cost-effective for healthcare providers and patients than traditional inpatient or person-to-person rehabilitation. Remotely operating robotic devices and using advanced technology improves patient and healthcare provider safety and reduces injuries. In this study, we developed a novel telerehabilitation framework for rehabilitation robots utilizing PTC’s Industrial Internet of Things (IIoT) platform to remotely provide robot-aided therapies for individuals with ULD. With the developed telerehabilitation framework, an operator can teleoperate the rehab robots to deliver Upper-limb (UL) exercises via an Augmented Reality (AR) based graphical user interface (GUI). This AR platform communicates bidirectionally using ThingWorx IIOT. It leverages the digital twin (DT) structure facilitated by Vuforia studio to visualize the physical robot motions happening in remote places. The telerehabilitation framework was validated through a commercially available robot (xArm 5), an exoskeleton (SREx), and an end-effector type rehabilitation robot (DMRbot) developed at Biorobotics Lab, UWM. The experiment results show that the telerehabilitation system can successfully provide UL rehab exercises in 2D and 3D planes via AR. The proposed framework is developed to facilitate robust and more promising robot-aided rehabilitation sessions remotely, and it can also be applied in other medical applications.

Stroke seriously endangers human well-being and brings a severe burden to family and society. Different post-stroke dysfunctions result in an impaired ability to perform activities of daily living. Standard rehabilitative therapies may not meet the requirements for functional improvement after a stroke; thus, alternative approaches need to be proposed. Currently, vagus nerve stimulation (VNS) is clinically applied for the treatment of epilepsy, depression, cluster headache and migraine, while its treatment of various dysfunctions after an ischemic stroke is still in the clinical research stage. Recent studies have confirmed that VNS has neuroprotective effects in animal models of transient and permanent focal cerebral ischemia, and that its combination with rehabilitative training significantly improves upper limb motor dysfunction and dysphagia. In addition, vagus-related anatomical structures and neurotransmitters are closely implicated in memory-cognition enhancement processes, suggesting that VNS is promising as a potential treatment for cognitive dysfunction after an ischemic stroke. In this review, we outline the current status of the application of VNS (invasive and non-invasive) in diverse functional impairments after an ischemic stroke, followed by an in-depth discussion of the underlying mechanisms of its mediated neuroprotective effects. Finally, we summarize the current clinical implementation challenges and adverse events of VNS and put forward some suggestions for its future research direction. Research on VNS for ischemic stroke has reached a critical stage. Determining how to achieve the clinical transformation of this technology safely and effectively is important, and more animal and clinical studies are needed to clarify its therapeutic mechanism. [ABSTRACT FROM AUTHOR]

Background: Upper extremity dysfunction after stroke is an urgent clinical problem that greatly affects patients' daily life and reduces their quality of life. As an emerging rehabilitation method, brain-machine interface (BMI)-based training can extract brain signals and provide feedback to form a closed-loop rehabilitation, which is currently being studied for functional restoration after stroke. However, there is no reliable medical evidence to support the effect of BMI-based training on upper extremity function after stroke. This review aimed to evaluate the efficacy and safety of BMI-based training for improving upper extremity function after stroke, as well as potential differences in efficacy of different external devices. Methods: English-language literature published before April 1, 2022, was searched in five electronic databases using search terms including "brain-computer/machine interface", "stroke" and "upper extremity." The identified articles were screened, data were extracted, and themethodological quality of the included trials was assessed. Meta-analysis was performed using RevMan 5.4.1 software. The GRADE method was used to assess the quality of the evidence. Results: A total of 17 studies with 410 post-stroke patients were included. Meta-analysis showed that BMI-based training significantly improved upper extremity motor function [standardized mean difference (SMD) = 0.62; 95% confidence interval (CI) (0.34, 0.90); I² = 38%; p < 0.0001; n = 385; random-effects model; moderate-quality evidence]. Subgroup meta-analysis indicated that BMI-based training significantly improves upper extremitymotor function in both chronic [SMD = 0.68; 95% CI (0.32, 1.03), I² = 46%; p = 0.0002, random-effects model] and subacute [SMD = 1.11; 95%CI (0.22, 1.99); I² = 76%; p = 0.01; random-effects model] stroke patients compared with control interventions, and using functional electrical stimulation (FES) [SMD = 1.11; 95% CI (0.67, 1.54); I² = 11%; p < 0.00001; random-effects model]or visual feedback [SMD = 0.66; 95% CI (0.2, 1.12); I² = 4%; p = 0.005; random-effects model;] as the feedback devices in BMI training was more effective than using robot. In addition, BMI-based training wasmore effective in improving patients' activities of daily living (ADL) than control interventions [SMD = 1.12; 95% CI (0.65, 1.60); I² = 0%; p < 0.00001; n = 80; random-effects model]. There was no statistical difference in the dropout rate and adverse effects between the BMI-based training group and the control group. Conclusion: BMI-based training improved upper limbmotor function and ADL in post-stroke patients. BMI combined with FES or visual feedback may be a better combination for functional recovery than robot. BMI-based trainings are well-tolerated and associated with mild adverse effects. [ABSTRACT FROM AUTHOR]

Background: The global prevalence of stroke has been increasing. Motor dysfunction is observed in approximately 55 to 75% of stroke patients, with upper limb impairment affecting around 85% of them. Following upper limb dysfunction, the body's recovery time is not only slower compared to the lower limbs, but the restoration of its fine motor skills is significantly more challenging, greatly impacting the daily lives of patients. Consequently, there is an increasing urgency for study on the upper limb function in stroke., Methods: A search was conducted in the Web of Science Core Collection: Science Citation Index Expanded (SCI-Expanded) database for material published from January 1, 2004 to December 31, 2023. We included all relevant literature reports and conducted an analysis of annual publications, countries/regions, institutions, journals, co-cited references, and keywords using the software packages CiteSpace, VOSviewer, and Bibliometrix R. Next, we succinctly outlined the research trends and hotspots in post-stroke upper limb dysfunction., Results: This analysis comprised 1,938 articles from 1,897 institutions, 354 journals, and 53 countries or regions. A yearly rise in the production of publications was noted. The United States is the foremost nation on the issue. Northwestern University has the most amounts of papers compared to all other institutions. The journal Neurorehabilitation and Neural Repair is a highly significant publication in this field, with Catherine E. Lang serving as the principal author. The majority of the most-cited references focus on subjects such as the reliability and validity of assessment instruments, RCT of therapies, systematic reviews, and meta-analyses. The intervention measures primarily comprise three types of high-frequency phrases that are related, as determined by keyword analysis: intelligent rehabilitation, physical factor therapy, and occupational therapy. Current areas of focus in research include randomized clinical trials, neurorehabilitation, and robot-assisted therapy., Conclusion: Current research has shown a growing interest in studying upper limb function assessment, occupational therapy, physical therapy, robot-assisted therapy, virtual reality, brain-computer interface, telerehabilitation, cortical reorganisation, and neural plasticity. These topics have become popular and are expected to be the focus of future research., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Tang, Yang, Sun, He, Sa, Zhang, Zhu and Li.)

This study aimed to detect alterations in intra- and inter-network functional connectivity (FC) of multiple networks in acute brainstem ischemic stroke patients, and the relationship between FC and movement assessment scores to assess their ability to predict upper extremity motor impairment. Resting-state functional magnetic resonance imaging (rs-fMRI) data were acquired from acute brainstem ischemic stroke patients (n = 50) and healthy controls (HCs) (n = 45). Resting-state networks (RSNs) were established based on independent component analysis (ICA) and the functional network connectivity (FNC) analysis was performed. Subsequently, correlation analysis was subsequently used to explore the relationship between FNC abnormalities and upper extremity motor impairment. Altered FC within default mode network (DMN), executive control network (ECN), the salience network (SN), auditory network (AN), and cerebellum network (CN) were found in the acute brainstem ischemic stroke group relative to HCs. Moreover, different patterns of altered network interactions were found between the patients and HCs, including the SN-CN, SN-AN, and ECN-DMN connections. Correlations between functional disconnection and upper limb dysfunction measurements in acute brainstem ischemic stroke patients were also found. This study intimated that widespread FNC impairment and altered integration existed in brainstem ischemic stroke at acute stage, suggesting that FNC disruption may be applied for early diagnosis and prediction of upper limb dysfunction in acute brainstem ischemic stroke. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to examine the effectiveness and safety of the Brain-computer interface (BCI) in treatment of upper limb dysfunction after stroke. Methods: English and Chinese electronic databases were searched up to July 2021. Randomized controlled trials (RCTs) were eligible. The methodological quality was assessed using Cochrane's risk-of-bias tool. Meta-analysis was performed using RevMan 5.4. Results: A total of 488 patients from 16 RCTs were included. The results showed that (1) the meta-analysis of BCI-combined treatment on the improvement of the upper limb function showed statistical significance [standardized mean difference (SMD): 0.53, 95% CI: 0.26–0.80, P < 0.05]; (2) BCI treatment can improve the abilities of daily living of patients after stroke, and the analysis results are statistically significant (SMD: 1.67, 95% CI: 0.61–2.74, P < 0.05); and (3) the BCI-combined therapy was not statistically significant for the analysis of the Modified Ashworth Scale (MAS) (SMD: −0.10, 95% CI: −0.50 to 0.30, P = 0.61). Conclusion: The meta-analysis indicates that the BCI therapy or BCI combined with other therapies such as conventional rehabilitation training and motor imagery training can improve upper limb dysfunction after stroke and enhance the quality of daily life. [ABSTRACT FROM AUTHOR]

ObjectiveThis study aimed to examine the effectiveness and safety of the Brain-computer interface (BCI) in treatment of upper limb dysfunction after stroke.MethodsEnglish and Chinese electronic databases were searched up to July 2021. Randomized controlled trials (RCTs) were eligible. The methodological quality was assessed using Cochrane’s risk-of-bias tool. Meta-analysis was performed using RevMan 5.4.ResultsA total of 488 patients from 16 RCTs were included. The results showed that (1) the meta-analysis of BCI-combined treatment on the improvement of the upper limb function showed statistical significance [standardized mean difference (SMD): 0.53, 95% CI: 0.26–0.80, P < 0.05]; (2) BCI treatment can improve the abilities of daily living of patients after stroke, and the analysis results are statistically significant (SMD: 1.67, 95% CI: 0.61–2.74, P < 0.05); and (3) the BCI-combined therapy was not statistically significant for the analysis of the Modified Ashworth Scale (MAS) (SMD: −0.10, 95% CI: −0.50 to 0.30, P = 0.61).ConclusionThe meta-analysis indicates that the BCI therapy or BCI combined with other therapies such as conventional rehabilitation training and motor imagery training can improve upper limb dysfunction after stroke and enhance the quality of daily life.

Background: The obstacle of limb motor caused by stroke, especially the decline of motor function of upper limbs, can directly affect the activities of daily living of stroke patients with hemiplegia. Based on long-term clinical practice, the treatment effect of electrical stimulation methods for stroke limb dysfunction has been widely recognized and supported by authoritative guidelines and systematic reviews. However, which electrical stimulation method is the optimum in the treatment of stroke limb dysfunction is still a controversial issue. Objective: In this paper, we adopted Network Meta-Analysis (NMA) to rank the priorities of various electrical stimulation methods, so as to select the optimal electrical stimulation method and discuss its rationality in guiding clinical practice. Methods: We carried out a systematic review by searching a total of 6806 studies from 8 databases and 2 clinical trial registries, and finally screened out 34 studies for further investigation. Then, pairwise meta-analysis and Bayesian network meta-analysis were employed to evaluate the effectiveness and ranking of various interventions. The primary outcome measure was Fugl-Meyer Assessment Upper Extremity (FMA-UE), and the secondary outcome measures were Modified Barthel Index (MBI) and Modified Ashworth Scale (MAS). Finally, the risk of bias, publication bias and sensitivity of the Randomized Controlled Trials (RCTs) were evaluated. Results: On the basis of comprehensive rehabilitation treatment (RT), the Functional Electrical Stimulation (FES) was superior than other electrical stimulation methods in improving both FMA-UE and MBI. Meanwhile, the results indicated that the Transcutaneous Electrical Acupoint Stimulation (TEAS) was the only electrical stimulation method that showed treatment advantages in reducing MAS. Conclusion: The study showed that FES had the optimal overall rehabilitation effect on upper limb dysfunction of stroke patients based on the comprehensive RT, while the treatment effect of TEAS on upper limb spasticity after stroke was the most significant. [ABSTRACT FROM AUTHOR]

To evaluate the effect of Ding talk on improving the compliance of Baduanjin in the intervention of upper limb dysfunction of postoperative breast cancer survivors. This prospective, randomized, controlled study included 32 participants. The participants in the experimental group were given a 12-week routine baduanjin exercise plus home continuing nursing intervention based on Ding Talk group. The participants in the control group only were given a 12-week routine baduanjin practice intervention. Our primary endpoint was compliance in Baduanjin Exercise and range of motion of the shoulder joint. The compliance score and shoulder range of motion of baduanjin exercise in the experimental group were higher than those in the control group, and the difference was statistically significant (P < 0.05). Home continuing nursing intervention based on Ding Talk group can significantly improve the compliance of Baduanjin in the intervention of upper limb dysfunction of postoperative breast cancer survivors, promote the rehabilitation effect, and it is worthy of clinical promotion and application. [ABSTRACT FROM AUTHOR]

Abstract Background Upper limb dysfunction is common after stroke, posing an important challenge for post-stroke rehabilitation. The clinical efficacy of acupuncture for the recovery of post-stroke upper limb function has been previously demonstrated. Mirror therapy (MT) has also been found to be effective. However, the effects of acupuncture and MT have not been systematically compared. This trial aims to elucidate the synergistic effects of acupuncture and MT on upper limb dysfunction after stroke. Methods A 2 × 2 factorial randomized controlled trial will be conducted at the rehabilitation hospitals affiliated with Fujian University of Traditional Chinese Medicine. A total of 136 eligible subjects will be randomly divided into acupuncture treatment (AT), MT, combined treatment, and control groups in a 1:1:1:1 ratio. All subjects will receive conventional treatment. The interventions will be performed 5 days per week for 4 weeks. AT, MT, and combined treatment will be performed for 30 min per day (combined treatment: AT 15 min + MT 15 min). The primary outcomes in this study will be the mean change in scores on both the FMA and WMFT from baseline to 4 weeks intervention and at 12 weeks follow-up between the two groups and within groups. The secondary outcomes are the mean change in the scores on the Visual Analogue Scale, Stroke Impact Scale, and modified Barthel index. Medical abstraction of adverse events will be assessed at each visit. Discussion The results of this trial will demonstrate the synergistic effect of acupuncture and MT on upper limb motor dysfunction after stroke. In addition, whether AT and MT, either combined or alone, are more effective than the conventional treatment in the management of post-stroke upper limb dysfunction will also be determined. Trial registration Chinese Clinical Trial Registry: ChiCTR-IOR-17011118. Registered on April 11, 2017. Version number: 01.2016.09.1.

Objectives: Identify the prevalence of shoulder impairment in ICU survivors within 6 months of discharge from ICU. Evaluate the impact of shoulder impairment on upper limb functional status in patients treated on an ICU. Identify risk factors for the development of shoulder impairment.Design: Prospective cohort study.Setting: A tertiary care medical-surgical-trauma ICU at a U.K. hospital over 18 months, with a further 6-month follow-up after hospital discharge.Subjects: Adult patients with an ICU length of stay of greater than 72 hours with no preexisting or new neurologic or traumatic upper limb injury.Interventions: None.Measurements and Main Results: Patients underwent targeted shoulder assessments (pain, range of movement, Constant-Murley Score, shortened version of the disabilities of the arm, shoulder, and hand [DASH] score [QuickDASH] score) at hospital discharge, 3 and 6 months after hospital discharge. Assessments were undertaken on 96 patients, with 62 patients attending follow-up at 3 months and 61 patients at 6 months. Multivariate regression analysis was used to investigate risk factors for shoulder impairment. ICU-related shoulder impairment was present in 67% of patients at 6 months following discharge from hospital. Upper limb dysfunction occurred in 46%, with 16% having severe dysfunction (equivalent to shoulder dislocation). We were unable to identify specific risk factors for shoulder impairment.Conclusions: Shoulder impairment is a highly prevalent potential source of disability in ICU survivors. This persists at 6 months after discharge with a significant impact on upper limb function. More research is needed into potential mechanisms underlying shoulder impairment and potential targeted interventions to reduce the prevalence. [ABSTRACT FROM AUTHOR]

Objective: To explore the effect of acupuncture at different acupoints on upper limb function in patients after stroke. Methods: A total of 201 stroke patients who underwent rehabilitation in our hospital were randomly divided into groups A, B and C, 67 cases in each. In the 3 groups, conventional exercise therapy and occupational therapy were used. On the basis of this, group A was given acupuncture at the head, group B was given acupuncture at the upper extremity, and group C was given acupuncture combined with group A and group B. The FMA score, Barthel index, upper limb neurological deficit index and 6 monthly stock quality scores (SS-QQL) were observed before and after treatment. Results: After treatment, FMA score and Barthel were significantly higher in the three groups (P < 0.05), and there was no significant difference between group B and group A (P > 0.05); group C, group B and group A were significantly higher compared with the same time (P < 0.05). After treatment, the scores of nerve function defect of upper extremity in the three groups were significantly lower than those before treatment (P < 0.05), and the scores in group C were significantly higher than those in group A and group B at the same time (P < 0.05). There was no significant difference in SSQQL score between group A and group B at the end of follow-up (P > 0.05). The score of group C was higher than that of group A and group B (P < 0.05). Conclusion: Both scalp acupuncture and upper limb acupuncture combined with rehabilitation training have good rehabilitation effect on upper limb function of stroke patients, and the combination of them can enhance the rehabilitation effect. [ABSTRACT FROM AUTHOR]

• Experiences of rehabilitation technology using mixed methods have been rarely explored in people with multiple sclerosis. • Robot-mediated upper limb therapy resulted in positive experiences on upper limb impairments for people with multiple sclerosis. • Expectations of participants were rather low at baseline but increased with observed functional benefits. • Long-term rehabilitation programs involving rehabilitation technology should be considered for people with multiple sclerosis. Robot-mediated training is increasingly considered as a rehabilitation intervention targeting upper limb disability. However, experiences of such an intervention have been rarely explored in the multiple sclerosis population. This mixed methods study sought to explore the impact of an eight week upper limb robotic intervention on experiences of people with multiple sclerosis. Eleven participants (Median EDSS- score: 6.5) with moderate to severe upper limb impairment, performed eight week robot- mediated training of the most affected arm. The training involved a virtual learning platform called I-TRAVLE with duration of 30 min per training session, twice to three times per week. Two subjective questionnaires with items from the Intrinsic Motivation Inventory (IMI) and Credibility and Expectancy Questionnaire (CEQ) were collected bi-weekly during the intervention. Approximately one month after completing the training, three focus groups were conducted. Main themes were identified using thematic analysis. Results from the IMI and CEQ indicated high patient satisfaction and expectation that the intervention will be beneficial for them. Two main themes were identified: (1) Effect of the intervention on impairment and activity in that participants felt that there was a positive impact of the training on strength, endurance and during activities of daily living and that it met their expectations; (2) Experiences based on system usage from the system in that participants expressed feelings of motivation and self-improvement. The participants also perceived the training as enjoyable and concluded that the use of games instigated a competitive spirit between the participants. Robot-mediated training could have a motivating effect and induce a general positive experience while reducing disabilities of people with multiple sclerosis. [ABSTRACT FROM AUTHOR]

Background:Virtual reality (VR) has the potential to provide intensive, repetitive, and task-oriented training, and game-based therapy can enhance patients' motivation and enjoyment. Objective: The objective of the present study was to develop a mobile game-based upper extremity VR program for patients who have experienced stroke, and to evaluate the feasibility and effectiveness of the program. Methods: This randomized, double-blind, controlled trial included 24 patients with ischemic stroke. The intervention group (n = 12) received 30 min of conventional occupational therapy (OT) and 30 min of the mobile upper extremity rehabilitation program using a smartphone and a tablet PC (MoU-Rehab). The controls (n = 12) received conventional OT alone for 1 h per day. Rehabilitation consisted of 10 sessions of therapy, 5 days per week, for 2 weeks. The outcome measures (Fugl-Meyer Assessment of the upper extremity [FMA-UE], Brunnström stage [B-stage] for the arm and the hand, manual muscle testing [MMT], modified Barthel index [MBI], EuroQol-5 Dimension [EQ-5D], and Beck Depression Inventory [BDI]) were assessed at the beginning and end of treatment, and at 1 month. User satisfaction was evaluated by a questionnaire. Results: A greater improvement in the FMA-UE, B-stage, and MMT was found after treatment with the MoU-Rehab than with conventional therapy. The extent of improvements in the MBI, EQ-5D, and BDI was not significantly different between the two groups. Patients in the experimental group completed the 2-weeks treatment without adverse effects, and they were generally satisfied with MoU-Rehab. Conclusion: This mobile game-based VR rehabilitation program appears to be feasible and effective for promoting upper limb recovery after ischemic stroke. [ABSTRACT FROM AUTHOR]

Introduction: Breast cancer is the most frequently occurring cancer with increasing surviving rates thanks to improving accuracy of detecting methods, early diagnosis and advances in cancer treatment. However, many breast cancer survivors (BCS) suffer of persistent upper limb (UL) dysfunctions. Therefore, the aim of this study is to identify the contributing factors to persistent UL dysfunctions in terms of identifying targets for prospective evaluation and specific treatment approaches at specific time points during breast cancer treatment. Methods: A cohort study will be performed in 250 BCS with a unilateral primary cancer, assessing different aspects of the International Classification of Function, Disease and Health (ICF). The BCS will be assessed at 5 different timepoints (baseline, 1 month post-surgery, 1 month post-chemotherapy, 1 and 6 months post-radiotherapy). Results: Candidate contributors to persistent UL dysfunctions are: specific pain characteristics, soft tissue stiffness, lymph node and lymph vessels functions, breast cancer treatment modalities, personal factors such as, pain catastrophizing, self-efficacy, depression, anxiety, stress and fear of movement, access to healthcare and movement alterations of the upper limb. Discussion: A prediction model for persistent UL dysfunctions will be formed covering all aspects of the ICF. Process evaluation: The study is now prepared for ethical committee, with appreciated assistance of a clinical trial assistant who guide us through the complex process. [ABSTRACT FROM AUTHOR]

Background: Modified radical mastectomy is a frequent surgery employed as a therapeutic procedure in patients with breast carcinoma with involvement of axillary lymph nodes. Many patients suffer from severe shoulder complaints after axillary lymph node dissection even with postoperative rehabilitation. Pre-operative exercise and education are recommended to reduce the incidence of breast cancer related upper limb dysfunction; it will shorten the recovery time. The objectives of the study are to determine the influence of pre-operative physiotherapy on shoulder ROM using goniometer in subjects with modified radical mastectomy and to determine the influence of pre-operative physiotherapy on functional activities using shoulder pain and disability index (SPADI) in subjects with modified radical mastectomy. Methods: 30 Subjects of adult women included in the study who met the inclusion criteria, divided into 2 groups. Experimental Group received preoperative physical therapy education and exercises 1-2 weeks before surgery and routine physical therapy protocol after surgery. Control Group received standard education brochure preoperatively and routine physical therapy post operatively. Measurements included shoulder ROM and functional evaluation using goniometer and SPADI. Measurements were taken at baseline i.e., pre operatively, post operatively at 4th day after removal of drains, and 1month after surgery. Results: All measures were significantly reduced after surgery, but most recovered after 1month of surgery and attained functional level in experimental Group. Conclusion: This study provides experimental evidence that preoperative education and exercise influence the postoperative shoulder ROM and functional activities after modified radical mastectomy.

Stroke seriously endangers human well-being and brings a severe burden to family and society. Different post-stroke dysfunctions result in an impaired ability to perform activities of daily living. Standard rehabilitative therapies may not meet the requirements for functional improvement after a stroke; thus, alternative approaches need to be proposed. Currently, vagus nerve stimulation (VNS) is clinically applied for the treatment of epilepsy, depression, cluster headache and migraine, while its treatment of various dysfunctions after an ischemic stroke is still in the clinical research stage. Recent studies have confirmed that VNS has neuroprotective effects in animal models of transient and permanent focal cerebral ischemia, and that its combination with rehabilitative training significantly improves upper limb motor dysfunction and dysphagia. In addition, vagus-related anatomical structures and neurotransmitters are closely implicated in memory-cognition enhancement processes, suggesting that VNS is promising as a potential treatment for cognitive dysfunction after an ischemic stroke. In this review, we outline the current status of the application of VNS (invasive and non-invasive) in diverse functional impairments after an ischemic stroke, followed by an in-depth discussion of the underlying mechanisms of its mediated neuroprotective effects. Finally, we summarize the current clinical implementation challenges and adverse events of VNS and put forward some suggestions for its future research direction. Research on VNS for ischemic stroke has reached a critical stage. Determining how to achieve the clinical transformation of this technology safely and effectively is important, and more animal and clinical studies are needed to clarify its therapeutic mechanism., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Cheng, Wang, Bai, Xiong, Chen and Ni.)

Restricted shoulder mobility is a major upper limb dysfunction related to lower quality of life and disability after breast cancer surgery. We hypothesized that sodium hyaluronate-carboxymethyl cellulose (HA-CMC) applied to the surface of the pectoralis major muscle after mastectomy would significantly reduce pain and improve range of motion (ROM) of the shoulder in breast cancer patients. We conducted a double-blind, randomized controlled study to evaluate the clinical efficacy and safety of HA-CMC in the prevention of upper limb dysfunction after total mastectomy (TM). A total of 99 women with breast cancer were randomly assigned to one of two groups. In the HA-CMC group ( n = 50), a mixed HA-CMC was applied to the surface of the pectoralis major and serratus anterior muscle after TM. In the control group ( n = 49), TM was performed without the use of HA-CMC. The primary outcomes were ROM of the shoulder and motion-related pain assessed using a numeric rating scale measured before surgery (T0) and 3 (T1) and 6 months (T2) after surgery. Secondary outcomes included disabilities of the arm, shoulder, and hand (DASH) and the pectoralis minor length test. Compared with the control group, the HA-CMC group showed greater reductions in postoperative restriction of total shoulder ROM (sum of flexion and horizontal abduction) at 3 months (10.20°, P = 0.004). Mean pain levels related to flexion and horizontal abduction were significantly lower in the HA-CMC group (−1.32 and −0.93, respectively, P < 0.05). The DASH score was lower (−4.94; P = 0.057) in the HA-CMC group at T2. No adverse effect was observed in either group. These results provide evidence that HA-CMC may provide pain relief and improve ROM of the shoulder without causing adverse effects. The effect on pectoralis tightness should be investigated in further studies. [ABSTRACT FROM AUTHOR]

Background. To determine total upper limb function following selective neck dissection over a mean follow-up of 1.6 years. Methods. A retrospective questionnaire study in a tertiary head and neck surgical unit. One hundred forty-eight patients who underwent selective neck dissection for head and neck cancer from January 2000 to December 2005 were invited to participate. The main outcome measure was ipsilateral upper limb dysfunction as measured by the Disability of Arm, Shoulder and Hand (DASH) questionnaire. Results. Sixty-five patients responded to the invitation to join the study from 148 invited. Despite accessory nerve conserving surgery for all the selective neck dissections studied, 23% reported no upper limb dysfunction, 54% reported mild upper limb dysfunction, 15% reported moderate, and 8% reported a severe dysfunction. Conclusions. Long-term upper limb dysfunction is common following nerve preserving surgery. The DASH questionnaire is a useful preoperative and postoperative clinical tool for those patients undergoing selective neck dissections. © 2009 Wiley Periodicals, Inc. Head Neck, 2009 [ABSTRACT FROM AUTHOR]

Background: Upper limb dysfunction is common after stroke, posing an important challenge for post-stroke rehabilitation. The clinical efficacy of acupuncture for the recovery of post-stroke upper limb function has been previously demonstrated. Mirror therapy (MT) has also been found to be effective. However, the effects of acupuncture and MT have not been systematically compared. This trial aims to elucidate the synergistic effects of acupuncture and MT on upper limb dysfunction after stroke.Methods: A 2 × 2 factorial randomized controlled trial will be conducted at the rehabilitation hospitals affiliated with Fujian University of Traditional Chinese Medicine. A total of 136 eligible subjects will be randomly divided into acupuncture treatment (AT), MT, combined treatment, and control groups in a 1:1:1:1 ratio. All subjects will receive conventional treatment. The interventions will be performed 5 days per week for 4 weeks. AT, MT, and combined treatment will be performed for 30 min per day (combined treatment: AT 15 min + MT 15 min). The primary outcomes in this study will be the mean change in scores on both the FMA and WMFT from baseline to 4 weeks intervention and at 12 weeks follow-up between the two groups and within groups. The secondary outcomes are the mean change in the scores on the Visual Analogue Scale, Stroke Impact Scale, and modified Barthel index. Medical abstraction of adverse events will be assessed at each visit.Discussion: The results of this trial will demonstrate the synergistic effect of acupuncture and MT on upper limb motor dysfunction after stroke. In addition, whether AT and MT, either combined or alone, are more effective than the conventional treatment in the management of post-stroke upper limb dysfunction will also be determined.Trial Registration: Chinese Clinical Trial Registry: ChiCTR-IOR-17011118 . Registered on April 11, 2017. Version number: 01.2016.09.1. [ABSTRACT FROM AUTHOR]

Background: Virtual reality (VR) has the potential to provide intensive, repetitive, and task-oriented training, and game-based therapy can enhance patients' motivation and enjoyment., Objective: The objective of the present study was to develop a mobile game-based upper extremity VR program for patients who have experienced stroke, and to evaluate the feasibility and effectiveness of the program., Methods: This randomized, double-blind, controlled trial included 24 patients with ischemic stroke. The intervention group (n = 12) received 30 min of conventional occupational therapy (OT) and 30 min of the mobile upper extremity rehabilitation program using a smartphone and a tablet PC (MoU-Rehab). The controls (n = 12) received conventional OT alone for 1 h per day. Rehabilitation consisted of 10 sessions of therapy, 5 days per week, for 2 weeks. The outcome measures (Fugl-Meyer Assessment of the upper extremity [FMA-UE], Brunnström stage [B-stage] for the arm and the hand, manual muscle testing [MMT], modified Barthel index [MBI], EuroQol-5 Dimension [EQ-5D], and Beck Depression Inventory [BDI]) were assessed at the beginning and end of treatment, and at 1 month. User satisfaction was evaluated by a questionnaire., Results: A greater improvement in the FMA-UE, B-stage, and MMT was found after treatment with the MoU-Rehab than with conventional therapy. The extent of improvements in the MBI, EQ-5D, and BDI was not significantly different between the two groups. Patients in the experimental group completed the 2-weeks treatment without adverse effects, and they were generally satisfied with MoU-Rehab., Conclusion: This mobile game-based VR rehabilitation program appears to be feasible and effective for promoting upper limb recovery after ischemic stroke.