Journal of NeuroEngineering and Rehabilitation最新文献

Accurate assessment of traumatic brain injury (TBI) is critical for customization of neurorehabilitation treatments and clinical decision-making. Existing monitoring approaches either rely on subjective evaluation or isolated physiological signals, limiting real-time responsiveness and multimodal insight. This study introduces a novel framework integrating electroencephalography (EEG) and electrocardiography (ECG) to explore heart-brain synchronization as a biomarker for neurological state in TBI patients. We first define a synchronization metric using EEG delta power and heart rate variability (HRV), capturing both the degree and direction of synchronization. A two-stage contrastive learning approach is then proposed: Clinically Consistent Contrastive Learning (CCCL) leverages clinical metrics to guide positive sample selection, while Multimodal Heart-brain Contrastive Learning (MHCL) aligns synchronization features with clinical outcomes. Applied to long-term ICU recordings, the proposed approach identifies distinct synchronization patterns associated with recovery trajectories. Although the sample size (N=11) is expected to be extended, this work offers an exploratory, proof-of-concept demonstration of heart-brain synchronization as a potential real-time biomarker for neurophysiological recovery in severe TBI.

Background: Muscle synergy analyses often exclude low-level activity by segmenting electromyography signals to task-dependent epochs, potentially discarding physiologically relevant baseline signals. We evaluated how padding type (resting baseline, shuffled baseline, Gaussian noise, and zero) and padding length (0-2T, where T represents task-dependent duration identified using a threshold method) affect upper-limb synergy extraction in healthy adults and stroke survivors performing multidirectional reaching.

Methods: Synergies were identified with the non-negative matrix factorization. We compared synergy number and spatial structure across conditions, and quantified activation coefficient dynamics using onset/offset shifts, within-task shape similarity, and a Smearing Index (SI) that captures spillover into baseline segments.

Results: Including resting baseline slightly increased synergy number, with spatial synergies remaining highly stable across padding lengths and types. In contrast, temporal activation coefficient was sensitive: padding advanced onset, delayed offset, increased SI, and reduced within-task shape similarity relative to 0T in a length-dependent manner. Noise padding inflated dimensionality and perturbed synergy structure more than real baseline, whereas zero padding tended to simplify solutions. Synergy loss and merging were threshold-sensitive and may stem from methodological choices rather than purely pathological changes. Stroke participants showed greater sensitivity to padding and fewer synergies when the baseline was excluded.

Conclusions: Collectively, the results indicate that resting baseline contains structured, low-level activations that influence temporal expression rather than spatial composition of synergies. Modest baseline inclusion (e.g., 0.5T) can capture this information without distorting core structure. These findings highlight the limitations of current synergy analysis methods and their implications for interpreting pathological motor strategies.

Introduction: Stroke is a leading cause of death and disability, with survivors often facing upper extremity (UE) impairments. Mirror therapy (MT) can enhance motor function but is influenced by cognitive and emotional factors. Robot-assisted therapy (RT) has shown efficacy in restoring UE function. Robot-mirror therapy (RMT), which combines MT and RT, has been investigated in several trials, with some showing benefits while others reported limited effects. This meta-analysis aimed to evaluate RMT's effectiveness in improving UE function in stroke patients.

Methods: We included RCTs involving RMT in adult stroke patients. Searches covered ten databases (Cochrane Library, Scopus, PubMed, Web of Science, Embase, CNKI, CINAHL, PEDro, ClinicalTrials.gov, WHO ICTRP) through October 2025, with a grey literature search. Two independent reviewers conducted study selection, data extraction, and quality assessment. The risk of bias and the certainty of the evidence were assessed using the Cochrane collaboration's tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guideline, respectively.

Results: Sixteen RCTs (n=736) were analyzed. RMT significantly improved UE motor function (Fugl-Meyer Assessment-Upper Extremity (FMA-UE); MD 7.52, 95% CI 4.16-10.87; P<.0001 and Wolf Motor Function Test; MD 5.13, 95% CI 2.33-7.92; P=.0003), distal UE motor function (FMA-UE (distal); MD 2.92, 95% CI 1.43-4.42; P=.0001), hand motor function (SMD 1.06, 95% CI 0.15-1.97; P=.02), hand muscle strength (grip strength; SMD 1.34, 95% CI 0.17-2.51; P=.02), activities of daily living (Modified Barthel Index; MD 7.80, 95% CI 4.15-11.45; P<.0001 and Functional Independence Measure; MD 4.73, 95% CI 0.30-9.15; P=.04), and quality of life (SMD 1.00, 95% CI 0.00-1.99; P=.05). Subgroup analysis showed better outcomes in older patients (≥55), shorter interventions (<18 hours), and trial length of 3-6 weeks.

Conclusion: Moderate-quality evidence supports the effectiveness of RMT-based interventions for improving UE motor function and activities of daily living in stroke patients. Trial Registration PROSPERO CRD420251077740.

Background: Spinal cord injury (SCI) often results in impaired motor control and coordination. Previous studies have highlighted the role of muscle synergies in coordinating motor tasks and their alterations following SCI. However, the adaptation in muscle synergy patterns at the motor unit (MU) level after SCI remains unexplored. This study aimed to investigate MU synergies and clustering in the synergetic soleus and gastrocnemius medialis (GM) muscles and to explore how these patterns are altered in persons with SCI.

Methods: High-density electromyography (HD-EMG) was used to record MU activity in the soleus and GM muscles of fifteen participants with incomplete SCI and ten non-disabled participants during 20% and 50% maximal voluntary isometric contraction tasks. The HD-EMG signals were decomposed into individual MU spike trains. Inter-muscle coherence analysis was employed to evaluate the shared neural drive between the soleus and GM muscles, and factor analysis was performed to identify synergistic clusters of MUs innervating each muscle.

Results: The results showed that both participant groups demonstrated high coherence between the soleus and GM muscles, highlighting a shared neural drive for coordinated function. However, participants with SCI showed altered coherence in the delta frequency band, with significantly higher coherence observed at 50% maximal voluntary contraction (p = 0.047). Additionally, factor analysis revealed that participants with SCI had a reduced proportion of MUs in the shared cluster within the GM muscle at 20% maximal voluntary contraction (p < 0.01).

Conclusions: These findings suggested that SCI may disrupt MU synergies and clustering, potentially impairing motor coordination. This research offered valuable insights into the underlying mechanism of muscle synergies and the neural adaptations following SCI, providing crucial information for the development of future rehabilitation strategies.

Background: Motion sickness arises from sensory conflict between visual, vestibular, and somatosensory inputs, causing nausea, dizziness, and vomiting. Non-pharmacological interventions are underexplored despite their potential for accessibility and safety. This study evaluated (1) Computer-Assisted Rehabilitation Environment (CAREN) as a novel tool to induce motion sickness and (2) the efficacy of fluid-filled motion sickness glasses which create an artificial horizon to counteract peripheral visual-vestibular mismatch and reduce symptoms.

Methods: A randomized controlled trial was conducted with thirty motion sickness-susceptible participants (23 females, 7 males; median age 34.2 years). Participants were exposed to a standardized "scrambler" ride simulation via CAREN, which combined vestibular and visual motion stimuli. The intervention group (n = 15) wore fluid-filled frames, while the placebo group (n = 14) wore identical glasses with drained fluid. Symptoms were assessed pre/post using the Motion Sickness Assessment Questionnaire (MSAQ) and every 60 s during exposure using the Motion Illness Symptoms Classification (MISC) scale. Wilcoxon signed-rank and Mann-Whitney U tests compared outcomes.

Results: CAREN significantly induced motion sickness, with median MSAQ scores increasing from 17.0 (IQR: 16.0-19.0) pre-exposure to 40.5 (IQR: 27.0-57.0) post-exposure (p < 0.001). No significant difference was observed between intervention and placebo groups in symptom reduction (median MSAQ increase: 31.0 vs. 16.0, p = 0.15) or glasses-wearing duration (p = 0.89).

Conclusions: CAREN reliably induced motion sickness, supporting its utility for controlled research. However, the motion sickness glasses did not significantly alleviate symptoms compared to placebo in this pilot study. It is possible that peripheral visual cues from fluid-filled glasses may be insufficient to counteract sensory mismatch. Further research should explore larger sample sizes and alternative non-pharmacological interventions using CAREN's controlled environment.

Trail registration: This trial was not prospectively registered in a public registry as it was a limited internal study within the Midwestern University community. The study received ethical approval from our Institutional Review Board (IRB #24-0155), and informed consent was obtained from all participants.