Neurorehabilitation and Neural Repair最新文献

{"title":"Does Exercise Attenuate Disease Progression in People With Parkinson's Disease? A Systematic Review With Meta-Analyses.","authors":"Jiecheng A Li,&nbsp;Marte B Loevaas,&nbsp;Catherine Guan,&nbsp;Lina Goh,&nbsp;Natalie E Allen,&nbsp;Margaret K Y Mak,&nbsp;Jinglei Lv,&nbsp;Serene S Paul","doi":"10.1177/15459683231172752","DOIUrl":"https://doi.org/10.1177/15459683231172752","url":null,"abstract":"<p><strong>Introduction: </strong>Exercise has many benefits for people with Parkinson's disease (PD) and has been suggested to modify PD progression, but robust evidence supporting this is lacking.</p><p><strong>Objective: </strong>This systematic review (PROSPERO registration: CRD42020169999) investigated whether exercise may have neuroplastic effects indicative of attenuating PD progression.</p><p><strong>Methods: </strong>Six databases were searched for randomized controlled trials (RCTs) that compared the effect of exercise to control (no or sham exercise) or to another form of exercise, on indicators of PD progression (eg, brain-derived neurotrophic factor [BDNF], brain activation, \"off\" Unified Parkinson's Disease Rating Scale [UPDRS] scores). Trial quality was assessed using the Physiotherapy Evidence Database Scale. Random-effects meta-analyses were performed where at least 3 comparable trials reported the same outcome; remaining results were synthesized narratively.</p><p><strong>Results: </strong>Forty-nine exercise trials involving 2104 PD participants were included. Compared to control, exercise improved \"off\" UPDRS motor scores (Hedge's g -0.39, 95% CI: -0.65 to -0.13, <i>P</i> = .003) and BDNF concentration (Hedge's g 0.54, 95% CI: 0.10-0.98, <i>P</i> = .02), with low to very low certainty of evidence, respectively. Narrative synthesis for the remaining outcomes suggested that compared to control, exercise may have neuroplastic effects. The exercise versus exercise comparisons were too heterogenous to enable pooling of results.</p><p><strong>Discussion: </strong>This review provides limited evidence that exercise may have an attenuating effect on potential markers of PD progression. Further large RCTs are warranted to explore differential effects by exercise type, dose and PD stage, and should report on a core set of outcomes indicative of PD progression.</p>","PeriodicalId":56104,"journal":{"name":"Neurorehabilitation and Neural Repair","volume":"37 5","pages":"328-352"},"PeriodicalIF":4.2,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1c/50/10.1177_15459683231172752.PMC10272626.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10061714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New Artificial Intelligence-Integrated Electromyography-Driven Robot Hand for Upper Extremity Rehabilitation of Patients With Stroke: A Randomized, Controlled Trial.","authors":"Yuhei Murakami,&nbsp;Kaoru Honaga,&nbsp;Hidemi Kono,&nbsp;Koshiro Haruyama,&nbsp;Tomofumi Yamaguchi,&nbsp;Mami Tani,&nbsp;Reina Isayama,&nbsp;Tomokazu Takakura,&nbsp;Akira Tanuma,&nbsp;Kozo Hatori,&nbsp;Futoshi Wada,&nbsp;Toshiyuki Fujiwara","doi":"10.1177/15459683231166939","DOIUrl":"https://doi.org/10.1177/15459683231166939","url":null,"abstract":"<p><strong>Background: </strong>An artificial intelligence (AI)-integrated electromyography (EMG)-driven robot hand was devised for upper extremity (UE) rehabilitation. This robot detects patients' intentions to perform finger extension and flexion based on the EMG activities of 3 forearm muscles.</p><p><strong>Objective: </strong>This study aimed to assess the effect of this robot in patients with chronic stroke.</p><p><strong>Methods: </strong>This was a single-blinded, randomized, controlled trial with a 4-week follow-up period. Twenty patients were assigned to the active (n = 11) and control (n = 9) groups. Patients in the active group received 40 minutes of active finger training with this robot twice a week for 4 weeks. Patients in the control group received passive finger training with the same robot. The Fugl-Meyer assessment of UE motor function (FMA), motor activity log-14 amount of use score (MAL-14 AOU), modified Ashworth scale (MAS), <i>H</i> reflex, and reciprocal inhibition were assessed before, post, and post-4 weeks (post-4w) of intervention.</p><p><strong>Results: </strong>FMA was significantly improved at both post (<i>P</i> = .011) and post-4w (<i>P</i> = .021) in the active group. The control group did not show significant improvement in FMA at the post. MAL-14 AOU was improved at the post in the active group (<i>P</i> = .03). In the active group, there were significant improvements in wrist MAS at post (<i>P</i> = .024) and post-4w (<i>P</i> = .026).</p><p><strong>Conclusions: </strong>The AI-integrated EMG-driven robot improved UE motor function and spasticity, which persisted for 4 weeks. This robot hand might be useful for UE rehabilitation of patients with stroke.<b>Clinical Trial Registry Name:</b> The effect of robotic rehabilitation using XMM-HR2 for the paretic upper extremity among hemiparetic patients with stroke.<b>Clinical Trial Registration-URL:</b> https://jrct.niph.go.jp/<b>Unique Identifier:</b> jRCTs032200045.</p>","PeriodicalId":56104,"journal":{"name":"Neurorehabilitation and Neural Repair","volume":"37 5","pages":"298-306"},"PeriodicalIF":4.2,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9687765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebrospinal Fluid Pressure Dynamics as a Bedside Test in Traumatic Spinal Cord Injury to Assess Surgical Spinal Cord Decompression: Safety, Feasibility, and Proof-of-Concept.","authors":"Najmeh Kheram,&nbsp;Andrea Boraschi,&nbsp;Nikolai Pfender,&nbsp;Susanne Friedl,&nbsp;Maria Rasenack,&nbsp;Benjamin Fritz,&nbsp;Vartan Kurtcuoglu,&nbsp;Martin Schubert,&nbsp;Armin Curt,&nbsp;Carl M Zipser","doi":"10.1177/15459683231159662","DOIUrl":"https://doi.org/10.1177/15459683231159662","url":null,"abstract":"<p><strong>Background: </strong>Sufficient and timely spinal cord decompression is a critical surgical objective for neurological recovery in spinal cord injury (SCI). Residual cord compression may be associated with disturbed cerebrospinal fluid pressure (CSFP) dynamics.</p><p><strong>Objectives: </strong>This study aims to assess whether intrathecal CSFP dynamics in SCI following surgical decompression are feasible and safe, and to explore the diagnostic utility.</p><p><strong>Methods: </strong>Prospective cohort study. Bedside lumbar CSFP dynamics and cervical MRI were obtained following surgical decompression in N = 9 with mostly cervical acute-subacute SCI and N = 2 patients with non-traumatic SCI. CSFP measurements included mean CSFP, cardiac-driven CSFP peak-to-valley amplitudes (CSFPp), Valsalva maneuver, and Queckenstedt's test (firm pressure on jugular veins, QT). From QT, proxies for cerebrospinal fluid pulsatility curve were calculated (ie, relative pulse pressure coefficient; RPPC-Q). CSFP metrics were compared to spine-healthy patients. computer tomography (CT)-myelography was done in 3/8 simultaneous to CSFP measurements.</p><p><strong>Results: </strong>Mean age was 45 ± 9 years (range 17-67; 3F), SCI was complete (AIS A, N = 5) or incomplete (AIS B-D, N = 6). No adverse events related to CSFP assessments. CSFP rise during QT was induced in all patients [range 9.6-26.6 mmHg]. However, CSFPp was reduced in 3/11 (0.1-0.3 mmHg), and in 3/11 RPPC-Q was abnormal (0.01-0.05). Valsalva response was reduced in 8/11 (2.6-23.4 mmHg). CSFP dynamics corresponded to CT-myelography.</p><p><strong>Conclusions: </strong>Comprehensive bedside lumbar CSFP dynamics in SCI following decompression are safe, feasible, and can reveal distinct patterns of residual spinal cord compression. Longitudinal studies are required to define critical thresholds of impaired CSFP dynamics that may impact neurological recovery and requiring surgical revisions.</p>","PeriodicalId":56104,"journal":{"name":"Neurorehabilitation and Neural Repair","volume":"37 4","pages":"171-182"},"PeriodicalIF":4.2,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/95/32/10.1177_15459683231159662.PMC10152574.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9403371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Subacute White Matter Hyperintensities and Recovery of Language After Stroke.","authors":"Veronika Vadinova,&nbsp;Aleksi J Sihvonen,&nbsp;Kimberley L Garden,&nbsp;Laura Ziraldo,&nbsp;Tracy Roxbury,&nbsp;Kate O'Brien,&nbsp;David A Copland,&nbsp;Katie L McMahon,&nbsp;Sonia L E Brownsett","doi":"10.1177/15459683231168384","DOIUrl":"https://doi.org/10.1177/15459683231168384","url":null,"abstract":"<p><strong>Background: </strong>White matter hyperintensities (WMH) are considered to contribute to diminished brain reserve, negatively impacting on stroke recovery. While WMH identified in the chronic phase after stroke have been associated with post-stroke aphasia, the contribution of premorbid WMH to the early recovery of language across production and comprehension has not been investigated.</p><p><strong>Objective: </strong>To investigate the relationship between premorbid WMH severity and longitudinal comprehension and production outcomes in aphasia, after controlling for stroke lesion variables.</p><p><strong>Methods: </strong>Longitudinal behavioral data from individuals with a left-hemisphere stroke were included at the early subacute (n = 37) and chronic (n = 28) stage. Spoken language comprehension and production abilities were assessed at both timepoints using word and sentence-level tasks. Magnetic resonance imaging (MRI) was performed at the early subacute stage to derive stroke lesion variables (volume and proportion damage to critical regions) and WMH severity rating.</p><p><strong>Results: </strong>The presence of severe WMH explained an additional 18% and 25% variance in early subacute (<i>t</i> = -3.00, <i>p</i> = .004) and chronic (<i>t</i> = -3.60, <i>P</i> = .001) language comprehension abilities respectively, after controlling for stroke lesion variables. WMH did not predict additional variance of language production scores.</p><p><strong>Conclusions: </strong>Subacute clinical MRI can be used to improve prognoses of recovery of aphasia after stroke. We demonstrate that severe early subacute WMH add to the prediction of impaired longitudinal language recovery in comprehension, but not production. This emphasizes the need to consider different domains of language when investigating novel neurobiological predictors of aphasia recovery.</p>","PeriodicalId":56104,"journal":{"name":"Neurorehabilitation and Neural Repair","volume":"37 4","pages":"218-227"},"PeriodicalIF":4.2,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e4/21/10.1177_15459683231168384.PMC10152219.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9403593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Center of Pressure Trajectory as Anticipatory Postural Adjustment Measurement in Parkinson's Disease With Freezing of Gait History.","authors":"Chien-Feng Kung,&nbsp;Yun-Ru Lai,&nbsp;Wen-Chan Chiu,&nbsp;Chia-Yi Lien,&nbsp;Chih-Cheng Huang,&nbsp;Ben-Chung Cheng,&nbsp;Wei-Che Lin,&nbsp;Yueh-Sheng Chen,&nbsp;Chiun-Chieh Yu,&nbsp;Yi-Fang Chiang,&nbsp;Yan-Ru Guo,&nbsp;Yin-Hong Chen,&nbsp;Cheng-Hsien Lu","doi":"10.1177/15459683231166934","DOIUrl":"https://doi.org/10.1177/15459683231166934","url":null,"abstract":"Background Evidence showed that patients with Parkinson’s disease (PD) who have a history of freezing of gait (FOG) have hypometric anticipatory postural adjustment (APA) during gait initiation (GI) compared to PD without FOG. Objectives This study aimed to test the feasibility of center of pressure (COP) displacement during GI as the measure of APA in PD with and without a history of FOG. Methods Patients with PD underwent COP trajectory measurements, including duration, length, velocity, and acceleration in different phases of APA (APA1, APA2a, APA2, and LOC), as well as evaluation of New Freezing of Gait Questionnaire (NFOG-Q), Tinetti balance and gait score, and Postural Instability and Gait Difficulty (PIGD) score in the on and off medication states. Results The duration (seconds) of APA2a, APA2b, and LOC were highest while velocity in mediolateral direction (X) (m/s), including APA1, APA2a, APA2b, and LOC showed lowest in PD with FOG. Velocity in the mediolateral direction in different phases of APA increased in patients with FOG after dopaminergic therapy. APA2a (seconds) and APA2b (X) (m/s) were significantly associated with NFOG-Q part II, APA2b (X) (m/s) was significantly associated with NFOG-Q part III, and APA2a (seconds) was significantly associated with Tinetti balance and gait and PIGD score. Conclusions PD with FOG history showed a favorable response of APAs to dopaminergic replacement. The APA parameters by COP trajectory, especially lateral COP shift toward the stance foot (APA2b (X) (m/s) and APA2a (seconds)) are surrogate markers to assess PD with FOG history.","PeriodicalId":56104,"journal":{"name":"Neurorehabilitation and Neural Repair","volume":"37 4","pages":"240-250"},"PeriodicalIF":4.2,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9404621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Robot-Assisted Gait Training on Multiple Sclerosis: A Systematic Review and Meta-analysis of Randomized Controlled Trials.","authors":"Fu-An Yang,&nbsp;Chien-Lin Lin,&nbsp;Wan-Chien Huang,&nbsp;Hsun-Yi Wang,&nbsp;Chih-Wei Peng,&nbsp;Hung-Chou Chen","doi":"10.1177/15459683231167850","DOIUrl":"https://doi.org/10.1177/15459683231167850","url":null,"abstract":"<p><strong>Background: </strong>In recent meta-analyses, robot-assisted gait training for patients with multiple sclerosis (MS) have yielded limited clinical benefits compared with conventional overground gait training.</p><p><strong>Objective: </strong>To investigate the effect of robot-assisted gait training for patients with MS on clinical outcomes through a systematic review and meta-analysis.</p><p><strong>Methods: </strong>We searched for relevant studies in the PubMed, EMBASE, Cochrane Library, and Physiotherapy Evidence Database databases from their inception to April 7, 2022. We selected studies that (1) included participants with MS, (2) used robot-assisted gait training as the intervention, (3) included conventional overground gait training or another gait training protocol as control treatment, and (4) reported clinical outcomes. Continuous variables are expressed as standardized mean differences with 95% confidence intervals. Statistical analyses were performed using RevMan 5.4 software.</p><p><strong>Results: </strong>We included 16 studies enrolling 536 participants. Significant improvement was observed in the intervention group, with low heterogeneity at the end of the intervention with regard to walking velocity (standardized mean difference [SMD]: 0.38, 95% confidence interval [CI]: [0.15, 0.60]), walking endurance (SMD: 0.26, 95% CI [0.04, 0.48]), mobility (SMD: -0.37, 95% CI [-0.60, -0.14]), balance (SMD: 0.26, 95% CI [0.04, 0.48]), and fatigue (SMD: -0.27, 95% CI [-0.49, -0.04]). The results of subgroup analyses revealed improvements in these outcomes for the intervention group using grounded exoskeletons. No significant differences were noted in all the outcomes between the groups at follow-up.</p><p><strong>Conclusions: </strong>Robot-assisted gait training with grounded exoskeletons exerts a positive short-term effect and is an adequate treatment option for patients with MS.</p>","PeriodicalId":56104,"journal":{"name":"Neurorehabilitation and Neural Repair","volume":"37 4","pages":"228-239"},"PeriodicalIF":4.2,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9455254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differential Associations of Mobility With Fronto-Striatal Integrity and Lesion Load in Older Adults With and Without Multiple Sclerosis.","authors":"Mark E Wagshul,&nbsp;Frederick W Foley,&nbsp;Kapil Chaudhary,&nbsp;Michael L Lipton,&nbsp;Robert W Motl,&nbsp;Meltem Izzetoglu,&nbsp;Manuel E Hernandez,&nbsp;Mary Ann Picone,&nbsp;Roee Holtzer","doi":"10.1177/15459683231164787","DOIUrl":"https://doi.org/10.1177/15459683231164787","url":null,"abstract":"<p><strong>Background: </strong>Mobility impairment is common in older persons with multiple sclerosis (MS), and further compounded by general age-related mobility decline but its underlying brain substrates are poorly understood.</p><p><strong>Objective: </strong>Examine fronto-striatal white matter (WM) integrity and lesion load as imaging correlates of mobility outcomes in older persons with and without MS.</p><p><strong>Methods: </strong>Fifty-one older MS patients (age 64.9 ± 3.7 years, 29 women) and 50 healthy, matched controls (66.2 ± 3.2 years, 24 women), participated in the study, which included physical and cognitive test batteries and 3T MRI imaging session. Primary imaging measures were fractional anisotropy (FA) and WM lesion load. The relationship between mobility impairment, defined using a validated short physical performance battery cutoff score, and neuroimaging measures was assessed with stratified logistic regression models. FA was extracted from six fronto-striatal circuits (left/right): dorsal striatum (dStr)-to-anterior dorsolateral prefrontal cortex (aDLPFC), dStr-to-posterior DLPFC, and ventral striatum (vStr)-to-ventromedial prefrontal cortex (VMPFC).</p><p><strong>Results: </strong>Mobility impairment was significantly associated with lower FA in two circuits, left dStr-aDLPFC (<i>P</i> = .003) and left vStr-VMPFC (<i>P</i> = .004), in healthy controls but not in MS patients (<i>P</i> > .20), for fully adjusted regression models. Conversely, in MS patients but not in healthy controls, mobility impairment was significantly associated with greater lesion volume (<i>P</i> < .02).</p><p><strong>Conclusions: </strong>Comparing older persons with and without MS, we provide compelling evidence of a double dissociation between the presence of mobility impairment and two neuroimaging markers of white matter integrity, fronto-striatal fractional anisotropy, and whole brain lesion load.</p>","PeriodicalId":56104,"journal":{"name":"Neurorehabilitation and Neural Repair","volume":"37 4","pages":"205-217"},"PeriodicalIF":4.2,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10251307/pdf/nihms-1880526.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9659570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Choice of Arm Use in Stroke Survivors is Largely Driven by the Energetic Cost of the Movement.","authors":"Hien Nguyen,&nbsp;Thanh Phan,&nbsp;Reza Shadmehr,&nbsp;Sang Wook Lee","doi":"10.1177/15459683231164788","DOIUrl":"https://doi.org/10.1177/15459683231164788","url":null,"abstract":"<p><strong>Background: </strong>The decision of which arm to use to achieve a goal depends on energetic costs and performance abilities of each arm. Following a stroke, there is a reduction in the use of the more-impaired arm. Is it because the energetic costs of the more-impaired arm are increased, or because its use dictates a lower chance of success?</p><p><strong>Objective: </strong>We sought to elucidate the impact of energetic cost and task success on the arm choice of stroke survivors.</p><p><strong>Methods: </strong>Thirteen chronic stroke survivors and thirteen neurologically-intact subjects participated in an experiment where they reached towards visual targets in a virtual-reality environment. Energetic cost of reaching with their less-used arm (nondominant/more-impaired) was adjusted by amplifying the range of motion, while task accuracy requirement was independently modulated by changing target size.</p><p><strong>Results: </strong>Reducing the energic cost of reaching increased the use of the less-used arms in both groups, but by a greater amount in the stroke survivors. In contrast, lowering task accuracy requirement altered arm choice similarly in the two groups. The time spent in decision-making (reaction time) reflected different impacts of energetic cost and task success on the arm choice of the two groups. Conversely, velocity changes were similar between the groups.</p><p><strong>Conclusions: </strong>The impact of energetic cost on arm choice of stroke survivors is greater than neurologically-intact subjects. Thus, the reduction in the use of the impaired arm following stroke may be primarily due to a subjective increase in the effort it takes to use that arm.</p>","PeriodicalId":56104,"journal":{"name":"Neurorehabilitation and Neural Repair","volume":"37 4","pages":"183-193"},"PeriodicalIF":4.2,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9751712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Effectiveness of Combined and Single Neurostimulation and Traditional Dysphagia Therapies for Post-Stroke Dysphagia: A Network Meta-Analysis.","authors":"Kondwani Joseph Banda, Ko-Chiu Wu, Hsiu-Ju Jen, Hsin Chu, Li-Chung Pien, Ruey Chen, Tso-Ying Lee, Sheng-Kai Lin, Shih-Han Hung, Kuei-Ru Chou","doi":"10.1177/15459683231166940","DOIUrl":"10.1177/15459683231166940","url":null,"abstract":"<p><strong>Background: </strong>Comparative therapeutic benefits of combined and single neurostimulation therapies including neuromuscular electrical stimulation (NMES), pharyngeal electrical stimulation (PES), repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), and traditional dysphagia therapy (TDT) remain unknown in post-stroke dysphagia (PSD) rehabilitation. Therefore, we performed the first network meta-analysis (NMA) to determine comparative effectiveness of combined and single neurostimulation and traditional dysphagia therapies for PSD.</p><p><strong>Methods: </strong>A frequentist NMA model was performed with therapy effect sizes presented as standardized mean differences (SMD) and corresponding 95% confidence interval (95% CI) for therapy comparisons while netrank function ranked the therapies in R-Software. Meta-regression models for study characteristics were analyzed using Bayesian NMA Model.</p><p><strong>Results: </strong>Overall, 50 randomized controlled studies with 2250 participants were included. NMES + TDT 3.82 (95% CI, 1.62-6.01), tDCS + TDT 3.34 (95% CI, 1.09-5.59), rTMS + TDT 3.32 (95% CI, 1.18-5.47), NMES 2.69 (95% CI, 0.44-4.93), and TDT 2.27 (95% CI, 0.12-4.41) demonstrated very large effect in improving swallowing function. NMES + TDT -0.50 (95% CI, -0.68 to -0.32, rTMS + TDT -0.44 (95% CI, -0.67 to -0.21), TDT -0.28 (95% CI, -0.46 to -0.10), and NMES -0.19 (95% CI, -0.34 to -0.04) demonstrated medium to small effect in reducing pharyngeal transit time (PTT). rTMS -0.51 (95% CI, -0.93 to -0.08) demonstrated medium effect in reducing oral transit time (OTT). No significant therapy comparison differences were found for reducing aspiration/penetration. The highest ranked therapy was NMES + TDT for better swallowing function and reduction of PTT, rTMS for reduction of OTT, and tDCS + TDT for reduction of aspiration/penetration. Therapeutic effects of the therapies were moderated by frequency, sessions, and duration.</p><p><strong>Conclusion: </strong>Combined therapies including NMES + TDT, tDCS + TDT, and rTMS + TDT demonstrate better therapeutic effect for improved swallowing function and reduction of PTT, OTT, and aspiration/penetration for PSD.</p>","PeriodicalId":56104,"journal":{"name":"Neurorehabilitation and Neural Repair","volume":"37 4","pages":"194-204"},"PeriodicalIF":3.7,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9399138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acknowledgment of Reviewers.","authors":"","doi":"10.1177/15459683231153760","DOIUrl":"https://doi.org/10.1177/15459683231153760","url":null,"abstract":"","PeriodicalId":56104,"journal":{"name":"Neurorehabilitation and Neural Repair","volume":" ","pages":"15459683231153760"},"PeriodicalIF":4.2,"publicationDate":"2023-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10696683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}