Objective To investigate factors associated with achieving minimal clinically important difference (MCID) in upper limb motor function after rehabilitation in patients with acquired brain injury (ABI). Methods Patients receiving rehabilitation therapy in the Third Affiliated Hospital of Sun Yat-sen University Hospital between April 2015 and October 2022 were retrospective selected. Upper limb motor function was assessed using the Fugl-Meyer Assessment- Upper Extremity (FMA-UE) at baseline and discharge. An increase of ≥5 points in the FMA-UE score was defined as achieving MCID. Logistic regression analyses were used to identify factors associated with achieving the MCID. Stratified analyses were conducted based on baseline FMA-UE scores (≤21 vs. >21). Results A total of 236 patients were included. Among them, there were 156 males and 80 females; 138 cases met the MCID, and 98 cases did not; 115 cases had FMA-UE scores ≤21, and 121 cases had FMA-UE scores >21. FMA-UE scores significantly improved after rehabilitation therapy compared with admission scores [21 (12, 36) vs. 29 (18, 47) scores, P<0.001]. The results of the multi-factor logistic analysis showed that in the severe impairment group, length of stay was associated with achieving MCID [odds ratio=1.028, 95% confidence interval (1.004, 1.052), P=0.019]. In the mild-to-moderate impairment group, female sex was negatively associated with achieving MCID [odds ratio=0.306, 95% confidence interval (0.107, 0.872), P=0.027]. Conclusions Different lengths of stay and genders may affect the achievement of MCID in ABI patients. Further prospective studies are needed to validate these findings.
ObjectiveTo investigate the effects of transcranial direct current stimulation (tDCS) combined with virtual reality (VR) on upper limb dysfunction of stroke patients.MethodsPatients with stroke who were hospitalized in the Department of Rehabilitation Medicine, the Third Affiliated Hospital of Sun Yat-Sen University from July 2018 to January 2020 were selected. The patients were divided into tDCS group, VR group and combined treatment group by random number table method. All three groups received conventional rehabilitation treatment. Based on this, tDCS group received 2.0 mA tDCS treatment, VR group received 20 min VR treatment, and combined treatment group received the same tDCS and VR treatment. Before and 4 weeks after treatment, the Fugl-Meyer assessment-upper limb (FMA-UL), Wolf motor function test (WMFT) and modified barthel index (MBI) were used to evaluate the upper limb motor function and activities of daily life (ADL) of the three groups.ResultsA total of 45 patients were included, 15 in each group. No adverse reactions or fall off occurred during the treatment. Before treatment, there were no significant difference in FMA-UL, WMFT-Times, WMFT functional ability scores (WMFT-FAS), and MBI between the three groups (P>0.05). After 4 weeks of treatment, the FMA-UL, WMFT-Times, WMFT-FAS, and MBI scores of the three groups were significantly improved compared with those before treatment (P<0.05); the MBI score of the combination treatment group was significantly better than the tDCS group and VR group, and the FMA-UL was significantly better than the tDCS group, and the differences were statistically significant (P<0.05). Also, there were no significant differences in the improvement of FMA-UL, WMFT-Times, WMFT-FAS, and MBI scores between the tDCS group and the VR group (P>0.05); the differences of FMA-UL, WMFT-Times, WMFT-FAS, and MBI scores before and after treatment in the combined treatment group, which were significantly better than those in tDCS group and VR group (P<0.05). ConclusiontDCS combined with virtual reality can significantly improve the upper limb motor function and ADL ability of stroke patients, and the effect is superior to tDCS or VR treatment solely.
The transition of the residual motor network from inefficient compensation to adaptive integration serves as a crucial foundation for post-stroke motor recovery and the regulatory direction of non-invasive brain stimulation (NIBS). NIBS can modulate network relationships within and between hemispheres as well as distant brain regions through inhibitory/excitatory strategies within the disease-related plasticity window, promoting the shift from inefficient compensation to integrative recovery of the motor network. Multimodal imaging can reveal differences in network phenotypes during this process. This article explores technologies such as functional magnetic resonance imaging, functional near-infrared spectroscopy, and electroencephalography, systematically reviews the effects of transcranial direct current stimulation and repetitive transcranial magnetic stimulation on spectral power, functional connectivity, and network topology, aiming to provide a basis for personalized NIBS applications.