Objective: To evaluate individual finger synchronized robot-assisted hand rehabilitation in stroke patients. Design: Prospective parallel group randomized controlled clinical trial. Subjects: The study recruited patients who were ≥18 years old, more than three months post stroke, showed limited index finger movement and had weakened and impaired hand function. Patients with severe sensory loss, spasticity, apraxia, aphasia, disabling hand disease, impaired consciousness or depression were excluded. Interventions: Patients received either four weeks (20 sessions) of active robot-assisted intervention (the FTI (full-term intervention) group, 9 patients) or two weeks (10 sessions) of early passive therapy followed by two weeks (10 sessions) of active robot-assisted intervention (the HTI (half-term intervention) group, 8 patients). Patients underwent arm function assessments prior to therapy (baseline), and at 2, 4 and 8 weeks after starting therapy. Results: Compared to baseline, both the FTI and HTI groups showed improved results for the Jebsen Taylor test, the wrist and hand subportion of the Fugl-Meyer arm motor scale, active movement of the 2nd metacarpophalangeal joint, grasping, and pinching power ( P < 0.05 for all) at each time point (2, 4 and 8 weeks), with a greater degree of improvement for the FTI compared to the HTI group ( P < 0.05); for example, in Jebsen Taylor test (65.9 ± 36.5 vs. 46.4 ± 37.4) and wrist and hand subportion of the Fugl-Meyer arm motor scale (4.3 ± 1.9 vs. 3.4 ± 2.5) after eight weeks. Conclusions: A four-week rehabilitation using a novel robot that provides individual finger synchronization resulted in a dose-dependent improvement in hand function in subacute to chronic stroke patients.

Objective: To investigate the effects of Morning Walk^®–assisted gait training for patients with stroke. Design: Prospective randomized controlled trial. Setting: Three hospital rehabilitation departments (two tertiary and one secondary). Patients: We enrolled 58 patients with hemiparesis following a first-time stroke within the preceding year and with Functional Ambulation Category scores ⩾2. Intervention: The patients were randomly assigned to one of two treatment groups: 30 minutes of training with Morning Walk^®, a lower limb rehabilitation robot, plus 1 hour of conventional physiotherapy (Morning Walk^® group; n = 28); or 1.5 hour of conventional physiotherapy (control group; n = 30). All received treatment five times per week for three weeks. Main outcome measurements: The primary outcomes were walking ability, assessed using the Functional Ambulation Category scale, and lower limb function, assessed using the Motricity Index-Lower. Secondary outcomes included the 10 Meter Walk Test, Modified Barthel Index, Rivermead Mobility Index, and Berg Balance Scale scores. Results: A total of 10 patients were lost to follow-up, leaving a cohort of 48 for the final analyses. After training, all outcome measures significantly improved in both groups. In Motricity Index-Lower of the affected limb, the Morning Walk^® group (∆mean ± SD; 19.68 ± 14.06) showed greater improvement ( p = .034) than the control group (∆mean ± SD; 11.70 ± 10.65). And Berg Balance Scale scores improved more ( p = .047) in the Morning Walk^® group (∆mean ± SD; 14.36 ± 9.01) than the control group (∆mean ± SD; 9.65 ± 8.14). Conclusion: Compared with conventional physiotherapy alone, our results suggest that voluntary strength and balance of stroke patients with hemiparesis might be improved with Morning Walk^®–assisted gait training combined with conventional physiotherapy.

Augmented reality (AR)-based rehabilitation shows potential to improve upper and lower limb function after stroke. This study aims to review the effect of AR technology in the recovery of the upper and lower limb function in stroke patients. Published randomized controlled trials and observational investigations with adult stroke patients were retrieved from five electronic databases to analyze the effect of the AR systems in improving motor function and balance and gait function for stroke patients. The treatment effect was estimated by standardized mean difference (SMD) and 95% confidence interval (CI) using a random effect model for motor function outcomes at the body structure and function, body activity and participation level of the International Classification of Functioning, and balance and gait outcomes. In total, 13 investigations (9 for the upper limb and 4 for the lower limb) were identified. AR demonstrated a significant influence on the upper limb function (SMD = 0.657; 95% CI, 0.287 to 1.026; p = 0.000) and the lower limb function (SMD = 0.52; 95% CI, 0.039 to 1.001; p = 0.034). The present analysis suggests that AR applications could offer options for increasing treatment intensity and promoting motor recovery after a stroke. This approach can be used with the conventional rehabilitation methods as a new intervention for recovering upper and lower limb function.

To overcome the limitation of short-term efficacy of virtual reality (VR), an enhanced reality (ER) analgesia, (combination of the VR, real-time motion capture, mirror therapy [MT]) involving a high degree of patients’ presence or embodiment was explored. Patients, who underwent unilateral total knee arthroplasty (TKA), received ER analgesia. The duration was 5 times a week, for 2 weeks for one group and 5 times a week, for 1 week in the other. Visual Analogue Scale (VAS) at rest and during movement, active knee range of motion (ROM) for flexion and extension were measured repeatedly. After screening 157 patients, 60 were included. Pre-interventional evaluation was performed at 6.7 days and ER was initiated at 12.4 days after surgery. Evaluation was performed at 5, 12, 33 days after the initiation of ER. Analgesia in the 2 week therapy group was effective until the third evaluation (p = 0.000), whereas in the other group, it was effective only until the second evaluation (p = 0.010). Improvement in ROM in the 2 week group was also maintained until the third evaluation (p = 0.037, p = 0.009). It could lay the foundations for the development of safe and long-lasting analgesic tools.

Human umbilical vein endothelial cells (HUVECs) and human aortic smooth muscle cells (HASMCs) were coaxially and continuously extruded without ultraviolet illumination using a microfluidic-based nozzle. Type I collagen (3 mg ml ⁻¹ ) containing HUVECs and a crosslinking reagent (100 mM CaCl ₂ ) were supplied as the core material. A mixture of 3 mg ml ⁻¹ of type I collagen (25%) and 1.8% weight volume ⁻¹ of sodium alginate (75%) was provided as the shell layer material surrounding the core material. The HUVECs were well proliferated at the core and reshaped into a monolayer formation along the axial direction of the scaffold. The HASMCs showed more than 90% cell viability in the shell layer. Fluorescent beads were passed through the inside channel of the scaffold with the HUVEC core and HASMC shell using an in-house connector. This double-layered scaffold showed higher angiogenesis in growth factor-free medium than the scaffold with only a HUVEC core. The HASMCs in the shell layer affected angiogenesis, extracellular matrix secretion, and outer diameter. The proposed technique could be applied to three-dimensional bioprinting for the production of high-volume vascularised tissue.

Objective: To evaluate the effect of pre-emptive swallowing stimulation on the recovery of swallowing function in long-term intubated patients. Design and subjects: Patients in the intensive care unit intubated for at least 48 hours due to respiratory distress from March to August 2004 were randomly divided into two groups. Fifteen patients of mean age 55.39±17.9 years were stimulated (experimental group) and 18 patients of mean age 61.39±13.5 years were not stimulated (control group). The duration of intubation was 15.59±6.7 days in the experimental group and 15.79±6.5 days in the control group. Duration of stimulation in the experimental group was 7.39±3.6 days. After extubation, we compared the severity of dysphagia via video-fluoroscopic swallow study. Results: There were no statistically significant differences in the percentage of aspiration and the swallowed volume between the two groups. However, oral transit time in the experimental group (0.379±0.07 seconds) was significantly shorter than that of the control group (0.839±0.10 seconds), and the oropharyngeal swallowing efficiency of the experimental group (73.39±17.4%/s) was significantly higher than that of the control group (50.19±13.0%/s). Conclusion: Pre-emptive swallowing stimulation during intubation assists in the recovery of swallowing function in long-term intubated patients.