Coordinated reaching and grasping movements may be impaired in patients with poststroke hemiplegia. Patients frequently adopt compensatory strategies, which require investigation. This pilot study used kinematic parameters to examine compensatory strategies by assessing the reach-to-grasp-pen movements in patients with stroke and unaffected participants. Twelve patients with stroke with mild impairment (45.16 ± 12.62 years, 2.41 ± 1.97 months), twelve with moderate impairment (50.41 ± 12.92 years, 3.83 ± 3.58 months), and ten healthy individuals (20.6 ± 0.69 years) performed a reach-to-grasp-pen task. Kinematics parameters of upper limb and fingers, such as movement time, number of movement units, index of curvature, spectral arc length, trunk forward transition, trunk lateral transition, elbow extension, shoulder flexion, shoulder abduction, trunk rotation, arm-plane angle, the joint angles of interphalangeal joints of the thumb, index, middle, ring, and little fingers were examined in the study. These parameters were evaluated with two Microsoft Azure Kinect and Leap Motion, which belong to markerless motion capture systems. Patients with stroke showed longer reaching movement time, less smooth movement trajectories, and more trunk rotation ( ). In patients with stroke, the metacarpophalangeal joint (MCP) and proximal interphalangeal joint (PIP) of the thumb were flexed in the starting position; the MCP and PIP joints of the index finger in the stroke group were more extended during pen grasp; the range of motion of the MCP of the middle finger and the PIP joints of the middle, ring, and little fingers became greater, suggesting a larger peak aperture ( ). The more significant extension was observed in the index finger at the end of the grasp, suggesting inadequate flexion ( ). In clinical practice, the reach-to-grasp-pen task using markless sensing technology can effectively distinguish patients with stroke from healthy individuals and evaluate the recovery and compensation strategies of upper limb and hand functions. It can potentially become an evaluation tool in hospital and community scenes. Accurate identification of abnormal trunk, arm, and finger strategies is crucial for therapists to develop targeted upper limb treatment methods and evaluate treatment effects.

Background: This study aimed to explore attention alteration in mild cognitive impairment (MCI) patients and their association with abnormalities of autonomic brain activity within the attention network to reveal the neuroimaging basis behind these changes. Methods: A total of 25 MCI patients and 31 normal controls (NCs) were recruited for the study. The Test of Attention Performance (TAP) version 2.3 was used to evaluate alertness, selective attention, and divided attention in MCI patients and NCs. Subsequently, participants underwent resting-state magnetic resonance imaging (MRI) scans to compare whole-brain autonomic activity characteristics between groups using the amplitude of low-frequency fluctuation (ALFF). Data preprocessing and analysis were conducted using Data Processing & Analysis of Brain Imaging in MATLAB R2018b. Results: There were significant differences in omissions of intrinsic alertness, total omissions of divided attention, omissions and correct of visual divided attention between the two groups. Meanwhile, independent sample t-tests indicated that the MCI group exhibited higher z-scored ALFF (zALFF) in the left middle occipital gyrus, left superior frontal gyrus (orbital part), and right inferior frontal gyrus (orbital part) when compared with the NC group. The MCI group exhibited reduced zALFF in the left median cingulate and paracingulate gyrus, left precuneus, and right rolandic operculum. Notably, the decreased zALFF in the left precuneus showed a significant negative correlation with divided attention. Conclusions: Our findings suggest that patients with MCI exhibit relatively normal performance in selective attention and phase alertness tasks, while they demonstrate a decline in capacity for divided attention and intrinsic alertness tasks. Divided attention in MCI patients may be associated with abnormalities in spontaneous neural activity in the left precuneus. This study provides new and complementary insights into the neural basis of divided attention in patients with MCI.

Background and purpose: Upper limb dysfunction is a prevalent challenge post-stroke, necessitating innovative rehabilitation approaches. This pilot study evaluated the usability and feasibility of a novel multimodal virtual reality (VR) rehabilitation system that integrates an automated functional test for the hemiparetic upper extremity (FTHUE) assessment with personalized, task-oriented training in a clinical setting. Methods: The single-center, parallel-group pilot trial was conducted at the Rehabilitation Hospital of Fujian University of Traditional Chinese Medicine. Ninety-eight individuals were screened, from which 15 occupational therapists (mean clinical experience: 3.87 ± 4.84 years) and 15 stroke patients with mild upper limb impairment (Fugl–Meyer assessment score: 56.00 ± 5.25) were recruited. The intervention (a 1-hour hands-on VR session) was consistent across all participant groups, which incorporated neuroplasticity-based principles to deliver integrated sensorimotor training and multisensory feedback. Usability was evaluated using the system usability scale (SUS) and a custom-designed questionnaire. Results: All recruited participants completed the evaluation and were included in the analysis. Both groups exceeded the established usability threshold (SUS > 68). Therapists achieved a mean SUS score of 72.00 ± 6.69 (33% scoring ≥ 70) and patients scored 73.00 ± 7.69 (47% scoring ≥ 70). On the custom questionnaire (max 50), therapists scored 20.20 ± 2.74 and patients 19.20 ± 1.26. Therapists rated training enjoyment highest, exceptionally .superior to conventional therapy”u(4.47/5), while patients most valued ease of operation (4.20/5). No adverse events occurred during the trial. Conclusions: The VR system demonstrated good usability and was well-accepted by therapists and patients. Integrating automated assessment with personalized training shows promise as a complement to conventional rehabilitation. These findings, while promising, require confirmation in a larger definitive trial. Future work should optimize adaptive difficulty mechanisms and explore implementation in community and home settings. Trial registration: Chinese Clinical Trial Registration Center, ChiCTR2200060214. Registered May 22, 2022. https://www.chictr.org.cn/bin/project/edit?pid = 170137 .

Stroke-induced upper limb dysfunction requires functional assessment and rehabilitation. The intelligent rehabilitation assessment and virtual reality training system for upper limb motor function in stroke can accurately and objectively assess patients’ motor function and guide their rehabilitation training. Our study aims to verify the clinical efficacy of the virtual reality training system in improving upper limb motor dysfunction in poststroke patients. This study will be a single-center, single-blind, randomized controlled clinical study. Fifty eligible patients will be randomized in a 1:1 ratio into a virtual reality training group (VR) and a conventional upper extremity treatment (CT) group. The intervention will be performed five times per week for 4 weeks. The primary outcome will be the Fugl-Meyer Motor Function Assessment—Upper Extremity (FMA-UE), and the secondary effects will be kinematic and electromyographic assessments. Adverse events will be recorded, and serious adverse events will be used as criteria for discontinuation of the intervention. A stroke upper limb motor function assessment and virtual reality rehabilitation training system based on the FTHUE scale can achieve a close link between intelligent assessment and treatment of upper limb motor function in poststroke patients while integrating the design concepts of the upper limb and hand assessment and treatment, which can theoretically improve upper limb function in stroke to a greater extent, but further high-quality studies are needed. The results of this trial will determine whether an assessment and training system based on the FTHUE scale can improve upper extremity motor dysfunction after stroke. Chinese Clinical Trial Registration Center, ChiCTR2200060214. Registered May 22, 2022. Manuscript Version: 2.0 Manuscript Date: May 2, 2025.

Post-stroke bimanual coordination dysfunction severely impairs activities of daily living. However, the underlying neurophysiological mechanisms remain incompletely understood, particularly regarding central-peripheral coupling characteristics under different bimanual coordination tasks and their distinction from aging effects. This study included 32 chronic subcortical stroke patients and 29 healthy controls. Functional near-infrared spectroscopy and surface electromyography signals were synchronously acquired during the execution of symmetrical and asymmetrical bimanual coordination tasks. Analyzed indices included cortical activation patterns, functional connectivity, corticomuscular coupling characterized by transfer entropy, intermuscular coupling, and muscle synergies. Correlations between these indices and the Fugl-Meyer Assessment for Upper Extremity and Modified Barthel Index were also evaluated. The results showed that during the symmetrical task, the ascending muscle-to-cortex connectivity was significantly reduced in the patient group, and this index was significantly positively correlated with the Modified Barthel Index. Brain functional connectivity and cortical activation were significantly increased in the patient group, and the connectivity from the ipsilesional prefrontal cortex to the contralesional SAC was significantly negatively correlated with Fugl-Meyer Assessment for Upper Extremity scores. Additionally, intermuscular coupling was significantly weakened, and muscle synergy patterns were abnormal in the patient group. During the asymmetrical task, no significant group differences in corticomuscular coupling were found, but brain functional connectivity and cortical activation were both significantly increased, and the connectivity from the ipsilesional supplementary motor area to the contralesional supplementary motor area was significantly positively correlated with MBI. Intermuscular coupling was significantly weakened, and muscle synergy patterns were abnormal. Attribution analysis suggested that cortical hyperactivation patterns and abnormal muscle synergies mainly reflect stroke effects, while abnormal sensory cortex activation and altered corticomuscular coupling may be influenced by both stroke and aging. This study suggests that post-stroke bimanual coordination impairment is closely related to selective damage to sensory feedback pathways, manifested as task-dependent reductions in ascending (muscle-to-cortex) corticomuscular coupling and compensatory cortical reorganization. Multimodal neurophysiological indicators may serve as potential quantitative tools for assessing upper limb function after stroke, but age-matched control studies are essential to dissociate stroke effects from aging effects.