Intermittent theta-burst stimulation (iTBS) is a high-efficiency transcranial magnetic stimulation (TMS) paradigm that has been applied to post-stroke aphasia (PSA). However, its efficacy mechanisms have not been clarified. This study aimed to explore the immediate effects of iTBS of the primary motor cortex (M1) of the affected hemisphere, on the functional activities and connectivity of the brains of PSA patients. A total of 16 patients with aphasia after stroke received iTBS with 800 pulses for 300 s. All patients underwent motor, language, and cognitive assessments and resting-state functional MRI scans immediately before and after the iTBS intervention. Regional, seed-based connectivity, and graph-based measures were used to test the immediate functional effects of the iTBS intervention, including the fractional amplitude of low-frequency fluctuation (fALFF), degree centrality (DC), and functional connectivity (FC) of the left M1 area throughout the whole brain. The results showed that after one session of iTBS intervention, the fALFF, DC, and FC values changed significantly in the patients’ brains. Specifically, the DC values were significantly higher in the right middle frontal gyrus and parts of the left parietal lobe (p < 0.05), while fALFF values were significantly lower in the right medial frontal lobe and parts of the left intracalcarine cortex (p < 0.05), and the strength of the functional connectivity between the left M1 area and the left superior frontal gyrus was reduced (p < 0.05). Our findings provided preliminary evidences that the iTBS on the ipsilesional M1 could induce neural activity and functional connectivity changes in the motor, language, and other brain regions in patients with PSA, which may promote neuroplasticity and functional recovery.

Background: A serious game–based cellphone augmented reality system (CARS) was developed for rehabilitation of stroke survivors, which is portable, convenient, and suitable for self-training.Objective: This study aims to examine the effectiveness of CARS in improving upper limb motor function and cognitive function of stroke survivors via conducting a long-term randomized controlled trial and analyze the patient’s acceptance of the proposed system.Methods: A double-blind randomized controlled trial was performed with 30 poststroke, subacute phase patients. All patients in both the experimental group (n=15) and the control group (n=15) performed a 1-hour session of therapy each day, 5 days per week for 2 weeks. Patients in the experimental group received 30 minutes of rehabilitation training with CARS and 30 minutes of conventional occupational therapy (OT) each session, while patients in the control group received conventional OT for the full 1 hour each session. The Fugl-Meyer Assessment of Upper Extremity (FMA-UE) subscale, Action Research Arm Test (ARAT), manual muscle test and Brunnstrom stage were used to assess motor function; the Mini-Mental State Examination, Add VS Sub, and Stroop Game were used to assess cognitive function; and the Barthel index was used to assess activities of daily living before and after the 2-week treatment period. In addition, the User Satisfaction Evaluation Questionnaire was used to reflect the patients’ adoption of the system in the experimental group after the final intervention.Results: All the assessment scores of the experimental group and control group were significantly improved after intervention. After the intervention. The experimental group’s FMA-UE and ARAT scores increased by 11.47 and 5.86, respectively, and were both significantly higher than the increase of the control group. Similarly, the score of the Add VS Sub and Stroop Game in the experimental group increased by 7.53 and 6.83, respectively, after the intervention, which also represented a higher increase than that in the control group. The evaluation of the adoption of this system had 3 sub-dimensions. In terms of accessibility, the patients reported a mean score of 4.27 (SD 0.704) for the enjoyment of their experience with the system, a mean 4.33 (SD 0.816) for success in using the system, and a mean 4.67 (SD 0.617) for the ability to control the system. In terms of comfort, the patients reported a mean 4.40 (SD 0.737) for the clarity of information provided by the system and a mean 4.40 (SD 0.632) for comfort. In terms of acceptability, the patients reported a mean 4.27 (SD 0.884) for usefulness in their rehabilitation and a mean 4.67 (0.617) in agreeing that CARS is a suitable tool for home-based rehabilitation.Conclusions: The rehabilitation based on combined CARS and conventional OT was more effective in improving both upper limb motor function and cognitive function than was conventional OT. Due to the low cost and ease of use, CARS is also potentially suitable for home-based rehabilitation.Trial Registration: Chinese Clinical Trial Registry ChiCTR1800017568; https://tinyurl.com/xbkkyfyz

Background and Purpose. Poststroke aphasia (PSA) often coexists with upper extremity (UE) motor dysfunction. However, whether the presence of PSA affects UE motor performance, and if language function associates with UE motor performance, are unclear. This study is aimed at (1) comparing the motor status of UE between patients with PSA and without PSA and (2) investigating the association between language function and UE motor status in patients with PSA. Methods. Patients with stroke were compared and correlated from overall and three periods (1-3 months, 4-6 months, and >6 months). Fugl-Meyer assessment for the upper extremity (FMA-UE) and action research and arm test (ARAT) were used to compare the UE motor status between patients with PSA and without PSA through a cross-sectional study among 435 patients. Then, the correlations between the evaluation scale scores of UE motor status and language function of patients with PSA were analyzed in various dimensions, and the language subfunction most closely related to UE motor function was analyzed by multiple linear regression analysis. Results. We found that the scores of FMA-UE and ARAT in patients with PSA were 14 points ((CI) 10 to 18, ) and 11 points lower ((CI) 8 to 13, ), respectively, than those without PSA. Their FMA-UE ( , ) and ARAT ( , ) scores were positively correlated with language function. Regression analysis demonstrated that spontaneous speech ability may account for UE motor function ( , ; , ). Consistent results were also obtained from the analyses within the three time subgroups. Conclusion. Stroke patients with PSA have worse UE motor performance. UE motor status and language function showed positive correlations, in which spontaneous speech ability significantly accounts for the associations.

Background: Over the past decade, many studies in the field of transcranial direct current stimulation (tDCS) in stroke have been published in scholarly journals. However, a scientometric analysis focusing on tDCS after stroke is still missing. The purpose of this study is to deliver a bibliometric analysis to investigate the global hotspots and frontiers in the domain of tDCS in stroke from 2012 to 2021. Methods: Articles and reviews related to tDCS in stroke were retrieved and obtained from the Web of Science core collection database from 2012 to 2021. Data visualization and analysis were conducted by using CiteSpace, VOSviewer, and Microsoft Excel 2019. Results: Finally, 371 publications were included in the scientometric analysis, including 288 articles and 83 reviews. The results showed that the number of publications per year increased from 15 to 68 in the last 10 years. Neurosciences was the main research hotspot category (n = 201). Frontiers in Human Neuroscience was the most published journal with 14 papers. The most productive author, institution, and country were Fregni F (n = 13), the League of European Research Universities (n = 37), and the United States of America (n = 98), respectively. A burstness analysis of keywords and the literature indicated that current studies in the field of tDCS in stroke focused on poststroke aphasia, tDCS combined with robotic therapy, and anatomical parameters. Conclusion: The research of tDCS in stroke is predicted to remain a research hotspot in the future. We recommend investigating the curative effect of other different tDCS closed-loop rehabilitation methods for different stroke dysfunctions. In conclusion, this bibliometric study presented the hotspots and trends of tDCS in stroke over the last decade, which may help researchers manage their further studies.

Integrated speech and hand-motor training is an effective post-stroke rehabilitation method. However, few interactive systems and assistive technologies were developed in this field. Driven by this challenge, we leverage Mixed Reality technology, which merges immersive virtual scenarios with physical hands-on tools in the real world, to provide patients with multi-modal interactions and engaging training experiences. Following a user-centered design approach, we first interviewed seven therapists to identify user requirements and design considerations. We further designed MRehab, an interactive rehabilitation system that allows patients to regain speech and hand skills through MR scenarios that depict daily living activities. We conducted a preliminary user test with 12 patients and 5 therapists to validate the feasibility and understand the user experience with MRehab. The results confirmed its feasibility for hand-motor training. Additionally, the patients expressed high motivation, engagement, and a positive attitude toward using MRehab. Our findings demonstrate the potential of MR technology in integrated speech and hand function rehabilitation training.

Background and Purpose: Intermittent theta‐burst stimulation (iTBS) targeting the cerebellum represents a promising therapeutic approach, demonstrating efficacy in the rehabilitation of motor and cognitive impairments after stroke. This study aims to evaluate the real‐time and immediate effects of cerebellar iTBS on the cerebral cortex of stroke patients. Methods: This study was conducted in a crossover design, initiating with sham‐iTBS followed by iTBS after a 24‐h washout period. The functional near‐infrared spectroscopy (fNIRS) was applied to observe cortical activation from cerebellar iTBS in stroke patients and changes in resting‐state functional connectivity (FC) and amplitude of low‐frequency fluctuations (ALFF) poststimulation. Results: Compared to sham stimulation, significant enhancement of cortical activation was observed in the left dorsolateral prefrontal cortex (DLPFC; Channel 26, t = 2.47, p = 0.036, Cohen’s d = 0.783) and left primary motor cortex (PMC; Channel 61, t = 2.88, p = 0.018, Cohen’s d = 0.907; Channel 62, t = 2.62, p = 0.028, Cohen’s d = 0.826). Compared to the resting period after sham‐iTBS, the resting period following iTBS demonstrated significantly enhanced FC between the temporal cortex (TC) and the somatosensory cortex (SSC) ( p = 0.029), as well as between the frontal eye field (FEF) and the PMC ( p = 0.031). Additionally, the ALFF value of the medial superior frontal gyrus (SFGmed) also increased significantly during the resting period after iTBS (Channel 20, t = 5.79, p = 0.027, Cohen’s d = 0.63). Conclusion: The application of iTBS to the cerebellum significantly enhances the activation of cognitive and motor areas in the cerebral cortex. Additionally, improved FC between brain regions and increased spontaneous neuronal activity were observed following stimulation. These findings reveal the potential mechanisms by which cerebellar iTBS may facilitate functional recovery in stroke patients.