Journal of NeuroEngineering and Rehabilitation最新文献

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.

Background: Stroke is a leading cause of disability, with up to 80% of survivors experiencing motor impairments. These impairments are attributed to various factors, including reduced neural drive and altered motor unit firing patterns. Rehabilitation aims to restore motor function by enhancing motor unit recruitment and synchronization. High-density electromyography (HD-EMG) is a valuable tool for evaluating these changes in motor unit activity.

Methods: We tested a wearable HD-EMG forearm sleeve to investigate the relationship between motor function and motor unit properties including firing rate, motor unit module activation, and coherence. Seven individuals with chronic stroke and seven able-bodied individuals attempted 12 cued hand and wrist movements while EMG was recorded. Motor units were decomposed across all movements using convolutive blind source separation.

Results: Fewer motor units were detectable in individuals with stroke compared to able-bodied participants. There was a significant reduction in motor unit firing rate during specific movements such as wrist flexion and hand open. Motor unit coupling and activation were altered following stroke, with reduced module activation in 8 of the 12 attempted movements. Furthermore, a reduction in coherence for gross movements and an increase in coherence for more dexterous thumb movements suggest altered neural drive to motor units after stroke that is differentially tuned to the complexity of movement. A combined neural control signature, consisting of multiple motor unit features, demonstrated strong correlation ([Formula: see text]) with clinical motor function scores.

Conclusions: This study demonstrates that HD-EMG can capture detailed motor unit activity and neural control characteristics across multiple forearm muscles in individuals with chronic stroke. By integrating multiple HD-EMG features, this approach provides new insights into neuromuscular alterations linked to hand motor function after stroke. These findings support the use of HD-EMG for monitoring recovery, predicting outcomes, and guiding more targeted rehabilitation, thus advancing both stroke research and patient care.