The effectiveness of intermittent theta burst stimulation for upper limb motor recovery after stroke: a systematic review and meta-analysis of randomized controlled trials.

Background: Intermittent theta burst stimulation (iTBS) is a promising noninvasive therapy to restore the excitability of the cortex, and subsequently improve the function of the upper extremities. Several studies have demonstrated the effectiveness of iTBS in restoring upper limb function and modulating cortical excitability. We aimed to evaluate the effects of iTBS on upper limb motor recovery after stroke. Objective: The purpose of this article is to evaluate the influence of intermittent theta-burst stimulation on upper limb motor recovery and improve the quality of life. Method: A literature search was conducted using PubMed, EMBASE, MEDLINE, The Cochrane Library, Web of Science, and CBM, including only English studies, to identify studies that investigated the effects of iTBS on upper limb recovery, compared with sham iTBS used in control groups. Effect size was reported as standardized mean difference (SMD) or weighted mean difference (WMD). Results: Ten studies were included in the meta-analysis. The results of the meta-analysis indicated that when compared to the control group, the iTBS group had a significant difference in the Fugl-Meyer Assessment (FMA) and Action Research Arm Test (ARAT) (WMD: 3.20, 95% CI: 1.42 to 4.97; WMD: 3.72, 95% CI: 2.13 to 5.30, respectively). In addition, there was also a significant improvement in the modified Ashworth scale (MAS) compared to the sham group (WMD: -0.56; 95% CI: -0.85 to -0.28). More evidence is still needed to confirm the effect of Barthel Index (BI) scores after interventions. However, no significant effect was found for the assessment of Motor Evoked Potential (MEP) amplitude and MEP latency (SMD: 0.35; 95% CI: -0.21 to 0.90; SMD: 0.35, 95% CI: -0.18 to 0.87; SMD: 0.03, 95% CI: -0.49 to 0.55; respectively). Conclusion: Our results showed that iTBS significantly improved motor impairment, functional activities, and reduced muscle tone of upper limbs, thereby increasing the ability to perform Activities of Daily Living (ADL) in stroke patients, while there were no significant differences in MEPs. In conclusion, iTBS is a promising non-invasive brain stimulation as an adjunct to therapy and enhances the therapeutic effect of conventional physical therapy. In the future, more randomized controlled trials with large sample sizes, high quality, and follow-up are necessary to explore the neurophysiological effects. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023392739.

EEG Changes in Time and Time-Frequency Domain During Movement Preparation and Execution in Stroke Patients.

This study investigated electroencephalogram (EEG) changes during movement preparation and execution in stroke patients. EEG-based event-related potential (ERP) technology was used to measure brain activity changes. Seventeen stroke patients participated in this study and completed ERP tests that were designed to measure EEG changes during unilateral upper limb movements in preparation and execution stages, with Instruction Response Movement (IRM) and Cued Instruction Response Movement (CIRM) paradigms. EEG data were analyzed using motor potential (MP) in the time domain and the mu-rhythm and beta frequency band response mean value (R-means) in the time-frequency domain. In IRM, the MP amplitude at Cz was higher during hemiplegic arm movement than during unaffected arm movement. MP latency was shorter at Cz and the contralesional motor cortex during hemiplegic arm movement in CIRM compared to IRM. No significant differences were found in R-means among locations, between movement sides in both ERP tests. This study presents the brain activity changes in the time and time-frequency domains in stroke patients during movement preparation and execution and supports the contralesional compensation and adjacent-region compensation mechanism of post-stroke brain reconstruction. These findings may contribute to future rehabilitation research about neuroplasticity and technology development such as the brain-computer interface.

[Effects of early treatment with ultrashort wave combined with sequential pressure on functional recovery of deeply burned hands].

OBJECTIVE: To study the effects of ultrashort wave combined with sequential pressure treatment on the functional recovery of deeply burned hands in the early stage of healed wounds in hands. METHODS: Sixty-five patients with burn of unilateral hand were hospitalized from July 2012 to June 2013 in our center. Injured hands of 35 patients were treated with active movement, ultrashort wave, sequential pressure therapy, and pressure gloves, and the other 30 patients were treated with active movement and pressure gloves 10-31 days after the wounds were healed according to the will of patients. The former 35 patients were regarded as comprehensive treatment (CT) group, and the latter 30 patients were regarded as routine treatment (RT) group. Before treatment and 4 weeks after treatment, the appearance of injured hands was observed; the circumference of the proximal segment of thumb, index, and middle fingers and that of the palmar crease and wrist crease were measured to evaluate swelling of injured hand; score and grade of function of injured hands were evaluated with a Carroll Upper Extremity Functional Test. Data were processed with t test and rank sum test. RESULTS: (1) Four weeks after treatment, appearance of 30 injured hands in group CT was improved, which was close to that of the normal hand of each patient, while contracture deformity of metacarpophalangeal joints and interphalangeal joints was observed in the other 5 injured hands. Four weeks after treatment, no obvious change in the appearance of 17 injured hands in group RT was observed compared with that before treatment, while hyperextension of metacarpophalangeal joints, flexion of interphalangeal joints, and adduction deformity of thumb were observed in the other 13 hands. (2) Four weeks after treatment, the circumferential values of the proximal segment of thumb, index, and middle fingers and the palmar crease and wrist crease of injured hands in group CT were respectively lower than those before treatment (with t values 3.26-4.24, P values below 0.01), and the circumferential values of the proximal segment of thumb and middle fingers and the wrist crease of injured hands in group RT were respectively lower than those before treatment (with t values 2.02-2.44, P values below 0.05). The difference values of circumference values of the proximal segment of thumb, index, and middle fingers and the palmar crease and wrist crease of injured hands between before treatment and 4 weeks after treatment were respectively (0.491 ± 0.022), (0.583 ± 0.089), (0.486 ± 0.021), (1.100 ± 0.076), (0.751 ± 0.053) cm in group CT, which were significantly higher than those in group RT [(0.306 ± 0.021), (0.277 ± 0.022), (0.320 ± 0.027), (0.700 ± 0.052), (0.483 ± 0.048) cm, with t values respectively 5.94, 3.11, 5.02, 4.22, 3.68, P values below 0.01]. (3) Four weeks after treatment, scores of function of injured hands in groups CT and RT were respectively higher than those before treatment (with t values respectively 14.40 and 4.00, P values below 0.001), and the grades of function of injured hands were respectively improved (with u values respectively 6.93 and 3.29, P values below 0.01). The difference value of scores of function of injured hands between before treatment and 4 weeks after treatment was (51.1 ± 2.2) points in group CT, which was significantly higher than that of group RT [(32.5 ± 4.8) points, t = 3.52, P < 0.001]. CONCLUSIONS: Ultrashort wave combined with sequential pressure and routine rehabilitation treatment of deeply burned hands in the early stage after wounds in hands are healed can obviously reduce the swelling of injured hands, which provides a favorable condition for active movements and systematic rehabilitation treatment later.

[Important role of orthoses in the management of postburn scar contracture].

Joints involved in deep burn often result in joint contracture, limb dysfunction, psychological disorder, or even loss of living and working abilities. The management of post-burn joint contracture will directly orientate the functional recovery of the patients. Comprehensive intervention may prevent the contracture process of the affected joints. Orthoses application is an important measure and should be maintained throughout the whole process of burn care, from positioning the joints at the early stage to maintaining the range of joint motion at the late stage. Orthoses should be used on the premise of protecting the joint functions. In order to maintain the tissue tension while enhancing the joint mobility and muscle strength, the static orthoses and the dynamic orthoses are often alternately used. It is showed in clinical practice that orthoses are designed and applied on the basis that biomechanics will lead to a better outcome.

[A cost-effectiveness analysis of comprehensive rehabilitation treatment of hand burn].

OBJECTIVE: To observe the effect of comprehensive rehabilitation treatment on hand burn, and to make a cost-effectiveness analysis. METHODS: Sixty-two patients with ninety-eight affected hands were divided into rehabilitation group (32 cases, 48 hands) and control group (30 cases, 50 hands). Patients in rehabilitation group received comprehensive rehabilitation treatment at early stage after burn; patients in control group were given instructions for function training at the same time. The functions of the hands to be restored including grasp, hold, pinch, nip, forearm pronation and supination, fetching, laying, and writing abilities of patients in both groups were quantitatively evaluated with Carroll's upper extremity function test before treatment and 5 months after. Direct medical costs of patients in both groups within 5 months were respectively added up to make a cost-effectiveness analysis. RESULTS: In rehabilitation group, function of digital opposition, palmar opposition, holding, and pinching of 37 hands recovered well, with which patients could pick food, put on clothes, go to toilet, and self-care etc. independently. Function of digital opposition, palmar opposition, holding, pinching half recovered in 7 hands, accompanied with well recovered of metacarpophalangeal function, but recovery of function of interphalangeal joint was less satisfactory. Although patients could grasp and hold, they were still poor in fine and harmonized activities. Joint ranges of motion of 4 hands were poor with limited function, and this was resulted from not strictly following treatment for remaining granulation wound. In control group, 23 hands received reconstructive surgery, 14 of them recovered with good function, but were poor in most of fine and harmonized activities. Severe claw hands were found in 13 hands. The ratio between total mean cost value and total function increment value in rehabilitation group (181 +/- 11) was obviously lower than that in control group (298 +/- 30, P < 0.01). CONCLUSIONS: Comprehensive rehabilitation treatment at early stage after hand burn has a good effect on prevention and treatment of hand deformity, promoting recovery of hand function and improving hand appearance. It is also less costly.

[Application with a series of orthotic splints for recovery of hand function after burn].

OBJECTIVE: To observe the effect of static and dynamic splints on recovery of hand functions in burn patients. METHODS: Thirty-two burn patients with 52 injured hands were treated with orthotic splints (single or combined application) during different therapeutic stages. Carroll's upper limb functional test was used to evaluate the function of upper limbs and hands from rough to fine movements, including grasp, pinch, nip, forearm pronation and supination, fetching, etc. The hand functions were compared before and after treatment. RESULTS: There were 7 hands with grade IV function, 15 hands with grade III, 23 hands with grade II, and 7 hands with grade I before treatment, while 9 hands achieved grade IV function, 28 hands grade V, 9 hands grade VI, and 6 hands grade III after treatment for three months. Twenty-eight patients with 46 hands recovered well enough to handle daily chores, including digital opposition, palmar opposition, grasp, pinch, etc. CONCLUSION: The manual splints offer good effects on preventing and treatment scar contracture of hand after burn, and they can promote the recovery of hand functions.

[Observation of the L929 cell membrane after infrasound exposure with atomic force microscope].

OBJECTIVE: To observe the changes of L929 cell membrane with atomic force microscope (AFM) after infrasound exposure and to explore the mechanisms of effect of infrasound on cell membrane. METHODS: After primary culture, the L929 cells were exposed to infrasound with intensity output of 130 dB and frequency of 16 Hz 2 hours each day for 3 days. The subsequent changes in the membrane of the control cells and the cells exposed to the infrasound were determined by nano-scale scanning with AFM. RESULTS: After infrasound exposure, the normal prominence of the membrane became short and the dent became shallow in the 7.5 microm x 7.5 microm and 4.0 microm x 4.0 microm photographs. The prominence appeared as cobblestones. The surface of the membrane became smooth. CONCLUSION: The membrane structure of the L929 cells can be changed by infrasound exposure with intensity of 130 dB and frequency of 16 Hz. The change might be one of the characteristics of effect of infrasound on cell membrane.