This study was supported by the Fundamental Research Funds for Central Public Welfare Research Institutes (2019CZ-11) and the Project of China Rehabilitation Research Center (number: 2021zx-Q5).

This study was a single-blind randomized controlled trial and was approved by the Ethics Committee of the China Rehabilitation Research Center (CRRC-IEC-RF-SC-005-01) and registered with the Chinese Clinical Trials Registry (MR-11-23-023832).
1. Participants
<ol>
	<li>Based on existing literature21, use the reported Fugl-Meyer Assessment upper extremity (FMA-UE) scores of the experimental group and the control group after 4 weeks of treatment as the standard to calculate the sample size. For an estimated effect size of 0.28, a test level (&#945;) of 0.05, a two-sided distribution for the Z value, and a power of 0.8, the calculated sample size is 28. Assuming a dropout rate of 10%, the final necessary sample size is 32.</li>
	<li>Recruit patients from the Occupational Therapy Department of the China Rehabilitation Research Center. Select patients according to the following inclusion criteria: diagnosis of first-onset right hemispheric injury (RHD); onset time within 3 months; age between 18 and 75 years; Mini-Mental State Examination (MMSE) score22&#62; 20; Brunnstrom stage I or II23 for the upper limb and hand; and right-handedness.</li>
	<li>Exclude patients with obvious depression, anxiety or concurrent serious physical diseases and those who did not cooperate with the training were excluded.</li>
	<li>Include only participants who sign an informed consent form before the study. The recruitment flow chart is shown in Figure 1.</li>
</ol>
2. Randomization and allocation
<ol>
	<li>Randomly allocate the patients meeting the experimental criteria into the Experimental group (EG) and Control group (CG). Assign a therapist not involved in subject assessment or selection to perform the randomization procedure with a random data generator on a computer (https://www.randomizer.org/).</li>
</ol>
3. Intervention
<ol>
	<li>Give both groups conventional drug therapy and conventional rehabilitation. Give all patients 20 min of functional occupational therapy (FOT) and 10 min of different types of upper limb exercise (EG performed active assisted movement and the CG performed passive movement) daily for a total of 30 min per day, 5 days per week for 4 weeks. To ensure the consistency of the intervention, select one therapist to perform all interventions and offer pre-research training to that therapist.</li>
	<li>Functional occupational therapy (FOT): 
	NOTE: The patient uses the metacarpophalangeal and interphalangeal joints of the affected finger to perform finger grasping movements driven by the glove on the healthy side.
	<ol>
		<li>Have the therapist passively move the shoulder, elbow, wrist, thumb, and fingers of the affected limb for approximately 1 min.</li>
		<li>After the passive movements, instruct the patient to use the unaffected limb and hand to actuate the affected limb and hand to perform activities such as pushing a foam roller, lifting a wooden peg, lifting small wooden sticks, and holding a ball. Choose two to three activities for each training session according to the patient&#39;s condition.</li>
	</ol>
	</li>
	<li>Assisted active movement (AAM)
	<ol>
		<li>Select a rehabilitation training device for the hand that will be trained. The device is designed to help the patient perform either passive or active movements. Select Smart Mirror Mode and set the Time to 10 min. Ask the patient about their feelings and choose from levels 1-10 according to the patient&#39;s experience and tolerance. Then click the Start button.</li>
		<li>As the unaffected hand performs voluntary grasping, instruct the patient to observe the movement and to try to grasp with the affected hand with the assistance of the glove (Figure 2A).</li>
		<li>As the unaffected hand is opened voluntarily, instruct the patient to observe the movement and to try to open the fingers of the affected hand with the assistance of the glove (Figure 2B) 
		NOTE: When the unaffected hand grasps, the sensors on the unaffected glove cannot detect the blocked light signal, and the glove on the unaffected side will be triggered to grasp. When the unaffected hand opens, the sensors on the unaffected glove detect a light signal and trigger the glove on the unaffected hand to open.</li>
		<li>Repeat the above process cyclically for 10 min, after which the equipment will end the training process automatically.</li>
	</ol>
	</li>
	<li>Passive movement (PM)
	<ol>
		<li>Have the patient use the same device to perform passive grasping and hand opening. Place the corresponding glove on the affected hand. Select Passive Mode, set the Time to 10 min, adjust the intensity from levels 1-10 according to the patient&#39;s sensations, and then click the Start button.</li>
		<li>Instruct the patient to remain relaxed and to close and open the affected hand with the aid of the glove (Figure 2C). Have the patient continue for 10 min, after which the device will end the training automatically.</li>
	</ol>
	</li>
</ol>
4. Assessment
<ol>
	<li>Have the clinical assessments performed by another therapist not blinded to group assignments. Have this therapist assess each patient twice: once before the intervention and once immediately after the 4 weeks of intervention.
	<ol>
		<li>Collect basic patient information, including age, sex, and type of injury.</li>
		<li>Assess upper extremity motor function before and after intervention using the Fugl-Meyer Assessment for the upper extremity (FMA-UE)24. Additionally, use the wrist-hand component of the FMA (FMA-WH) to assess the hand function of patients.</li>
		<li>Assess the ability to perform daily activities using the modified Barthel index (MBI)25.</li>
		<li>Monitor the activation of primary motor areas during passive motor tasks using fNIRS.</li>
		<li>Functional near-infrared spectroscopy data acquisition
		<ol>
			<li>Obtain a research-type near-infrared brain functional imaging system with which to collect the fNIRS data. Such a system uses three wavelengths of near-infrared light (780, 805, and 830 nm) to monitor changes in the concentration of oxyhemoglobin (&#916;[Oxy-Hb]) and deoxyhemoglobin (&#916;[Deoxy-Hb]) and the total hemoglobin concentration (&#916;[Hb]); its sampling rate is 13 Hz.</li>
			<li>According to the international 10-20 system, place 4 light source emitters and 4 detectors on the bilateral primary motor cortex (M1), with a total of 20 channels. See Figure 3 for the specific positions.</li>
		</ol>
		</li>
		<li>Task procedure
		<ol>
			<li>Conduct the fNIRS evaluation in 5 consecutive trials in a modular paradigm (rest [15 s]-task [30 s]-rest [15 s]), as described in steps 4.1.6.2-4.1.6.9 (see Figure 4).</li>
			<li>Open the fNIRS computer interface and enter the patient&#39;s basic information. Then, choose the optode arrangement 2X4(R), 2X4(L). Choose the 15-30-15 task paradigm, and set the assessment time to 5.</li>
			<li>Place the near-infrared system device on the patient according to the layout of the optodes. Adjust the positions of the emitters and detectors, and carefully remove the hair so that the optodes are in close contact with the scalp. After the adjustment is complete, click the OK button.</li>
			<li>Go to the system&#39;s automatic signal adjustment interface, click Standby, and adjust all channels to display green (good signal).</li>
			<li>Place the glove on the affected hand of the patient. Select the Passive Exercise mode. Since the training frequency will change with the strength, select the average strength, that is, 5 gears, for each subject during the test.</li>
			<li>Click the Start button on the fNIRS computer interface. Perform the task in 3 phases. Measure an initial resting phase of 15 s, counting down from 15 s until 0 s. During this process, instruct the patient to sit quietly in the chair, keep still, and try not to think about other things so that the brain is in a relaxed state.</li>
			<li>When the time counts down to 0 s, click the Start button of the hand device. The patient&#39;s affected hand will begin passive grasping and opening movements with the aid of the glove. At this time, the computer will start to count down from 30 s, which is the duration of the passive movement. When the countdown reaches 0 s, click the Stop button of the hand device to end the exercise. The frequency of grasping and opening is set by the device; 3 cycles of grasping and opening will be completed 3 times during the 30 s task.</li>
			<li>Begin another 15 s rest period as described before. When this interval has passed, the first rest-task-rest test is over.</li>
			<li>Repeat the above rest-task-rest test 5 times, and then end the fNIRS test.</li>
		</ol>
		</li>
		<li>Near-infrared data analysis:
		<ol>
			<li>For this analysis, use the data analysis software installed in the fNIRS system, as described below.</li>
			<li>Eliminate the outlier data caused by severe motion artifacts in all channels and the dropped data. 
			NOTE: When this protocol was performed, 1 outlier in the EG, 1 outlier in the CG, and 2 cases of dropped data in the CG were eliminated.</li>
			<li>Discard any channels with obvious motion artifacts.</li>
			<li>Conduct overlay averaging of the left and right channels (10 channels per side) separately.</li>
			<li>Use a bandpass filter (0.01-0.08 Hz) to remove noise components with obvious periodic fluctuations in the signal, including mechanical noise and physiological noise. Types of physiological noise that must be eliminated include heart rate (approximately 1 Hz), respiration (approximately 0.2-0.3 Hz), Mayer waves (approximately 0.1 Hz), and extremely low-frequency physiological fluctuations (&#60;0.01 Hz).</li>
			<li>Take the 15 s before and after the start of the experimental task as the baseline, and take a block (rest [15 s]-task [30 s]-rest [15 s]) as the test unit. Superimpose the five blocks and take the average.</li>
			<li>Use the Savitzky-Golay method for smoothing. Set the number of smoothing points to 5 and the number of smoothing times to 126.</li>
			<li>After preprocessing, calculate the integral and centroid values.</li>
			<li>Use the Shapiro-Wilk test (Shapiro-Wilk, SW) to test the normality of the centroid values, the integral values, and their differences before and after intervention in the two groups; consider the data normally distributed if the resulting P value is &#62;0.05.</li>
			<li>Use the independent-sample t-test to compare the data between the two groups before and after the intervention. Use the paired-sample t-test to compare the centroid values and integral values within the two groups before and after the intervention.</li>
		</ol>
		</li>
	</ol>
	</li>
</ol>
5. Statistics
<ol>
	<li>Use SPSS for the statistical analysis.</li>
	<li>Test the normality of the data using the SW test.</li>
	<li>Compare the general data of the patients in each group using Fisher&#39;s exact test or an independent-sample t-test.</li>
	<li>Behavioral data were compared between groups and within groups using repeated ANOVA and described as mean &#177; standard deviation.</li>
</ol>

Functional OT and Near-IR Spectroscopy to Study Brain Function Remodeling

The authors declare that the research was conducted in the absence of any commercial or financial relationship that could be construed as a potential conflict of interest.

In this study, by using near-infrared spectroscopy, we explored the effect of FOT combined with upper limb functional training in different exercise modes on the early rehabilitation of RHD patients. FOT helps the patient passively move the stiff upper limbs to facilitate subsequent training. The key is that the healthy hand leads the affected hand to perform purposeful, important, and practical functional tasks, use real-life objects, and simulate real scenarios as much as possible28. This can stimulate the patient&#39;s enthusiasm for treatment and maximize the patient&#39;s active movement. The most crucial point of AAM is that the patient&#39;s movement is driven by the unaffected limb and hand, while the affected limb and hand make a spontaneous active attempt, which is the most important feature that distinguishes it from passive movement. The rehabilitation devices give patients real-time visual and tactile feedback and complete a closed loop between the central nervous system and the periphery in rehabilitation training29.
There are no complex techniques involved in training for the rehabilitation task, but there are numerous caveats to consider when evaluating patients with fNIRS. To ensure a good fNIRS signal and prevent motion artifacts from interfering with test results, we usually place a head holder on the table in front of the subject. We adjust the height of the table so that the subject&#39;s chin rests on the head holder without causing discomfort. This helps to reduce head sway during movement. In addition, skin oil on the scalp will affect the optical signal; accordingly, we wipe the oil from the patient&#39;s head with oil-absorbing paper before the experiment to ensure the signal quality. Based on previous experience, we have also found that reducing the influence of natural light and sound improves the collection of fNIRS signals; therefore, we collect all data in a dark and quiet environment30.
Previous studies have shown that MT can effectively improve finger flexibility after stroke 31, especially for the upper limb rehabilitation of subacute patients32, and therefore shows great promise in restoring motor function and improving the ability to perform daily activities after cerebral hemisphere damage33,34,35,36. When a patient moves their unaffected arm, an optical illusion formed by a mirror is considered by the patient to be the movement of their affected hand, which increases the activity of their visual and somatosensory cortical areas, thereby enhancing the patient&#39;s attention and reducing the possibility of unilateral neglect37,38. In this way, the patient can consciously choose to use the affected limbs more often39. On the basis of traditional MT, we directly provide somatosensory stimulation and visual feedback to the affected limb through the AAM device, which reduces the unpleasant feeling caused by the asynchrony of proprioception of the affected hand and vision40, thus demonstrating broader therapeutic potential than conventional MT. Our training equipment has a simple operating procedure and a strong safety profile, with the option to stop the training immediately by clicking the close button to avoid emergency situations that may occur during the test. In addition, some studies have demonstrated that MT can promote the normalization of hemisphere balance after stroke by regulating the excitability of M1. In follow-up studies, we will use fNIRS to evaluate the resting-state functional connectivity of the cerebral cortex to verify the cerebral hemisphere changes in RHD patients further after treatment41.
This study has several limitations. First, the task paradigm chosen for the near-infrared spectroscopy test is passive, whereas brain activation may occur more in active movements. Thus, the task paradigm of active attempts may be more suitable than passive movement. Second, we monitored only the M1 area, but MT also increases neural activity in areas involved in attention allocation and cognitive control, which can promote the recovery of motor function by increasing the cognitive role in motor control42; therefore, monitoring prefrontal hemodynamics may also be necessary. In addition, due to the large number of treatment plans for the inpatients, only 10 min of hand rehabilitation training was performed every day. In the future, the training time should be extended to better explore the rehabilitative effect. Follow-up studies are needed to observe the long-term effect of this training. In the future, large-sample multicenter studies are expected to provide the most suitable rehabilitation strategies for early RHD patients.

Cerebral hemispheric damage can lead to sensory and motor dysfunction of the contralateral limbs1,2,3, negatively affecting patients&#39; motor control, mobility, and functional learning to various degrees4 and therefore imposing heavy burdens on families and society5. For patients with right hemisphere damage (RHD), the speed of recovery is less than satisfactory. However, in most RHD cases, the affected left limbs, being on the non-dominant side of the body, have received insufficient attention from the patient and the caregivers. Given that dysfunction of the upper limbs and hands seriously affects the ability to perform daily activities and quality of life, a more suitable method to improve the rehabilitation effect of upper limb function in RHD patients is needed6,7,8,9,10.
Exercise therapy is an important method to help patients recover their limb function. For the early rehabilitation of patients with brain injury, passive movement (PM) and assisted active movement (AAM) training methods are usually used. AAM entails the activity of specific joints completed through a combination of their own muscle strength and outside assistance11. The key is for the patient to actively participate in assisted rehabilitation. The readiness of the human brain to activate can help stimulate and integrate the motor system in the cycle of motor control. Many studies have shown that AAM can induce neuroplastic changes, thereby leading to increased functional recovery in patients12,13.
Functional near-infrared spectroscopy (fNIRS) is an imaging technique based on optical principles. According to the correlation between the attenuation of light in the tissue and the different concentrations of light-absorbing substances, fNIRS can quantitatively analyze concentration changes in oxygenated hemoglobin and deoxygenated hemoglobin in brain tissue, thereby monitoring the functional activity of the cerebral cortex14. Many studies have shown that fNIRS is an important means of monitoring brain oxygenation and energy metabolism after cerebral hemisphere injury15,16,17. Therefore, fNIRS might be a suitable monitoring method for studying cerebral cortex changes related to upper limb motor function recovery after cerebral hemisphere injury.
The motor signals produced by different sensory input methods and the adjustment states of the sensory cortex are different18,19. The sensory stimuli produced by passive and active movements are closely related to the stability of perception and the ability to build accurate representations of one&#39;s environment, which then guide one&#39;s behavior20. This study was designed to explore the effects of different modes of exercise on early upper limb rehabilitation and brain activation in patients with cerebral hemispheric injuries by analyzing fNIRS data and to provide scientific strategies for the comprehensive rehabilitation of patients in the future.
The purpose of this study was to investigate the effects of FOT combined with different types of exercise on upper limb function and brain remodeling in RHD patients. We hypothesized that FOT-AAM is more effective than FOT-PM in improving upper limb function and brain activation in RHD patients.

<table><tbody><tr><td>Hand Active Passive Rehabilitation Trainer</td><td>Soft Robot Technology Co., Ltd.</td><td>H1000</td><td>FOT-AAM group training/FOT-PM group training</td></tr><tr><td>Near-Infrared Brain Functional Imaging System</td><td>Shimadzu (China) Co.,Ltd.</td><td>LIGHTNIRS</td><td>Assessment</td></tr></tbody></table>

investigating the effect of different types of exercise on upper limb functional recovery in patients with right hemisphere damage based on fnirs

To investigate the effects of functional occupational therapy (FOT) combined with different types of exercise on upper limb motor function recovery and brain function remodeling in patients with right hemisphere damage (RHD) by analyzing functional near-infrared spectroscopy (fNIRS). Patients (n = 32) with RHD at Beijing Bo'ai Hospital were recruited and randomly allocated to receive either FOT combined with passive motion (N=16) or FOT combined with assisted active movement (N=16). The passive motion group (FOT-PM) received functional occupational therapy for 20 min and passive exercise for 10 min in each session, while the assisted active movement group (FOT-AAM) received functional occupational therapy for 20 min and assisted active exercise for 10 min. Both groups received conventional drug therapy and other rehabilitation therapy. Treatment was performed once a day, 5 times a week for 4 weeks. The recovery of motor function and activities of daily living (ADL) was assessed using Fugl-Meyer Assessment upper extremity (FMA-UE) and modified Barthel index (MBI) before and after treatment, and brain activation of the bilateral motor area was analyzed with fNIRS. The findings suggested that FOT combined with AAM was more effective than FOT combined with PM in improving the motor function of RHD patients' upper limbs and fingers, improving their ability to perform activities of daily living, and facilitating brain function remodeling of the motor area.

Baseline 
From October 2021 to June 2023, we recruited 35 patients, 32 of whom ultimately completed the study; no patients experienced any adverse events during the trial.
Regarding the clinical symptoms of the two groups of patients (Table 1), the average ages of the EG and the CG were 53.19 &#177; 10.72 and 55.88 &#177; 12.32 years (P = 0.515), respectively. There were no significant differences in gender, disease type, FMA-UL scores, or MBI scores (P &#62; 0.05). Before the intervention, the FMA-WH scores of all patients in both groups were 0 points.
FMA-UL has high clinical significance and can effectively and reliably assess upper limb involvement in patients with brain injury. The FMA-UL has a total of 33 upper limb assessment items, and each unidirectional score is assigned as 2 points for full completion, 1 point for partial completion, and 0 points for no completion. The total possible upper limb movement score is 66 points. As a subcategory of the FMA-UL, the wrist-hand scale (FMA-WH) has 12 items, with a total possible score of 24 points.
The results of repeated measures analysis of variance showed that the main effect of the group on FMA-UL score was significant, F = 5.564, p = 0.030, &#627;2p = 0.214; the main effect of time was significant, F = 34.716, p &#60; 0.001, &#627;2p = 0.831; the interaction effect of group and time was significant, F = 5.554, p = 0.030, &#627;2p = 0.256. (Table 2)
The main effect of the group on the FMA-WH score was significant, F = 8.817, p = 0.006, &#627;2p = 0.227; the main effect of time was significant, F =13.357, p = 0.001, &#627;2p = 0.308; The interaction effect between time and group was significant, F = 8.817, p = 0.006, &#627;2p = 0.227. (Table 2).
The modified Barthel index is widely used to assess the ability to perform daily activities and measures a person&#39;s ability to perform ten such basic activities. The total possible score on the Barthel index is 100 points, and the higher the score is, the stronger the patient&#39;s ability to perform activities of daily living.
The main effect of the group on the MBI score was significant, F = 8.512, p = 0.007, &#627;2p = 0.221; the main effect of time was significant, F = 588.559, p &#60; 0.001, &#627;2p = 0.952; the interaction effect between group and time was significant, F = 10.425, p = 0.003, &#627;2p = 0.258. (Table 2).
The integral value is the integral of the blood oxygen signal during the execution of the task and reflects the magnitude of the hemodynamic response during the task. The centroid value is the time (s) shown by the vertical line of the center of the blood oxygen signal change area during the entire task period and is an indicator of time-course changes throughout the task, representing the speed of the hemodynamic response27.
There was no significant difference in the integral or centroid values between the two groups before (Figure 5A) the intervention (P &#62; 0.05). After the intervention, the integral value of the right hemisphere of the subjects in the CG was 0.20 &#177; 0.32, the integral value of the right hemisphere of the subjects in the EG was -0.06 &#177; 0.24, and there was a significant difference in the overall means of the two groups (t=-2.489, d=0.92, P = 0.020, P &#60; 0.025 is considered statistically significant) (Table 3). After the intervention, the integral value of the left hemisphere of the subjects in the CG was 0.18 &#177; 0.32, the integral value of the left hemisphere of the subjects in the EG group was -0.04&#177;0.26, and there was no significant difference in the overall means of the two groups (t=-1.975, P=0.059, d=0.75). There were no significant differences in the centroid values between the two groups after the intervention (P &#62; 0.025) (Figure 5B).
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/65996/65996fig01.jpg" /> 
Figure 1: Recruitment flow chart. A total of 35 subjects were recruited, of which 2 subjects did not meet the requirements and 1 subject dropped out due to the epidemic, and 32 subjects were finally included. <a href="https://www.jove.com/files/ftp_upload/65996/65996fig01large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/65996/65996fig02.jpg" /> 
Figure 2: Upper limb rehabilitation training with different movement modes. (A,B) EG performing active hand rehabilitation training. (C) CG performing passive hand rehabilitation training. <a href="https://www.jove.com/files/ftp_upload/65996/65996fig02large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/65996/65996fig03.jpg" /> 
Figure 3: Arrangement and location of light beams. A red circle represents a light source, a blue circle represents a detector, and the path of the beam is shown between them. <a href="https://www.jove.com/files/ftp_upload/65996/65996fig03large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 4" class="xfigimg" src="/files/ftp_upload/65996/65996fig04.jpg" /> 
Figure 4: Task paradigm. A rest (15 s)-task (30 s)-rest (15 s) was used as a test unit and repeated 5 times in total. <a href="https://www.jove.com/files/ftp_upload/65996/65996fig04large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 5" class="xfigimg" src="/files/ftp_upload/65996/65996fig05.jpg" /> 
Figure 5: Scatter plots showing the distributions of the centroid values and integral values of the right hemisphere in the two groups of patients. (A) Before the intervention. (B) After the intervention. <a href="https://www.jove.com/files/ftp_upload/65996/65996fig05large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Variable</td>
			<td>PM (n = 16)</td>
			<td>AAM (n = 16)</td>
			<td>&#160;p value</td>
		</tr>
		<tr>
			<td>Gender (male/female)</td>
			<td>9/7</td>
			<td>8/8</td>
			<td>1</td>
		</tr>
		<tr>
			<td>Age in years (mean &#177; SD)</td>
			<td>53.19 &#177; 10.72</td>
			<td>55.88&#160; &#177; 12.32</td>
			<td>0.515</td>
		</tr>
		<tr>
			<td>Type (hemorrhagic/ischemic)</td>
			<td>9/7</td>
			<td>6/10</td>
			<td>0.479</td>
		</tr>
	</tbody>
</table>
Table 1: Subject characteristics. FMA: Fugl-Meyer Assessment; MBI: Modified Barthel Index; PM: passive motion; AAM: assisted active movement; FOT: functional occupational therapy.
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td rowspan="2">Assessment Indicators</td>
			<td colspan="3">Main Effect (Group)</td>
			<td colspan="3">Main Effect (Time)</td>
			<td colspan="3">Interaction Effect (Group x Time)</td>
		</tr>
		<tr>
			<td>F</td>
			<td>P-values</td>
			<td>&#951;&#178;p</td>
			<td>F</td>
			<td>P-values</td>
			<td>&#951;&#178;p</td>
			<td>F</td>
			<td>P-values</td>
			<td>&#951;&#178;p</td>
		</tr>
		<tr>
			<td>FMA-UL</td>
			<td>5.564</td>
			<td>0.03</td>
			<td>0.214</td>
			<td>34.716</td>
			<td>&#60;0.001</td>
			<td>0.831</td>
			<td>5.554</td>
			<td>0.03</td>
			<td>0.256</td>
		</tr>
		<tr>
			<td>FMA-WH</td>
			<td>8.817</td>
			<td>0.006</td>
			<td>0.227</td>
			<td>13.357</td>
			<td>0.001</td>
			<td>0.308</td>
			<td>8.817</td>
			<td>0.006</td>
			<td>0.227</td>
		</tr>
		<tr>
			<td>MBI</td>
			<td>8.512</td>
			<td>0.007</td>
			<td>0.221</td>
			<td>588.559</td>
			<td>&#60;0.001</td>
			<td>0.952</td>
			<td>10.425</td>
			<td>0.003</td>
			<td>0.258</td>
		</tr>
	</tbody>
</table>
Table 2: Results of analysis of repeated two-way ANOVA conducted on GROUP, TIME, and interaction effect on FMA-UL, FMA-WH, and MBI.
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td></td>
			<td></td>
			<td>Assisted Active Movement Group</td>
			<td>Passive Movement Group&#160;</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td></td>
			<td></td>
			<td>mean &#177; SD</td>
			<td>mean &#177; SD</td>
			<td>t value</td>
			<td>P value</td>
			<td>Cohen&#8217;s d</td>
		</tr>
		<tr>
			<td rowspan="2">Integral value</td>
			<td>Left</td>
			<td>-0.04 &#177; 0.26</td>
			<td>0.18 &#177; 0.32</td>
			<td>-1.975</td>
			<td>0.059</td>
			<td>0.75</td>
		</tr>
		<tr>
			<td>Right</td>
			<td>-0.06 &#177; 0.24</td>
			<td>0.20 &#177; 0.32</td>
			<td>-2.489</td>
			<td>0.02</td>
			<td>0.92</td>
		</tr>
		<tr>
			<td rowspan="2">Centoid value</td>
			<td>Left</td>
			<td>13.03 &#177; 10.45</td>
			<td>11.54 &#177; 9.13</td>
			<td>0.396</td>
			<td>0.695</td>
			<td>0.15</td>
		</tr>
		<tr>
			<td>Right</td>
			<td>11.04 &#177; 12.00</td>
			<td>12.58 &#177; 10.98</td>
			<td>-0.351</td>
			<td>0.728</td>
			<td>0.13</td>
		</tr>
	</tbody>
</table>
Table 3: Comparison of fNIRS data between the two groups after the intervention.

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Author Spotlight: Advancing Upper Limb Rehabilitation in Patients with Right Hemisphere Damage Using Assisted Active Exercise

Here, we investigate the effect of functional occupational therapy combined with assisted active or passive motion on the upper limb function of patients with right hemisphere damage and explore the effect of functional near-infrared spectroscopy on brain function remodeling.

Investigating the Effect of Different Types of Exercise on Upper Limb Functional Recovery in Patients with Right Hemisphere Damage Based on fNIRS

To investigate the effects of functional occupational therapy (FOT) combined with different types of exercise on upper limb motor function recovery and ...

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Research

JoVE Journal

Medicine

1.0K Views.  China Rehabilitation Research Center. We proberen de revalidatie van de bovenste ledematen voor patiënten met ruggenmergletsel aan te pakken, en we hebben de effectiviteit van geassisteerde actieve lichaamsbeweging in functionele ergotherapie bestudeerd voor patiënten met schade aan de rechterhersenhelft. Voor ons onderzoek gebruiken we momenteel robotica voor hoofdrevalidatie en de nabij-infrarood functionele hersenverbeeldingstechnologie. Uitdagingen die zich tot nu toe hebben voorgedaan, zijn onder meer de noodzaak voor de p...

Video: Auteur in de schijnwerpers: Bevordering van de revalidatie van de bovenste ledematen bij patiënten met schade aan de rechterhersenhelft met behulp van geassisteerde actieve oefeningen

Measuring Frailty in HIV-infected Individuals. Identification of Frail Patients is the First Step to Amelioration and Reversal of Frailty

A simple, validated protocol consisting of a battery of tests is available to identify elderly patients with frailty syndrome. This syndrome of decreased reserve and resistance to stressors increases in incidence with increasing age. In the elderly, frailty may pursue a step-wise loss of function from non-frail to pre-frail to frail. We studied frailty in HIV-infected patients and found that ~20% are frail using the Fried phenotype using stringent criteria developed for the elderly1,2. In HIV infection the syndrome occurs at a younger age.
HIV patients were checked for 1) unintentional weight loss; 2) slowness as determined by walking speed; 3) weakness as measured by a grip dynamometer; 4) exhaustion by responses to a depression scale; and 5) low physical activity was determined by assessing kilocalories expended in a week's time. Pre-frailty was present with any two of five criteria and frailty was present if any three of the five criteria were abnormal.
The tests take approximately 10-15 min to complete and they can be performed by medical assistants during routine clinic visits. Test results are scored by referring to standard tables. Understanding which of the five components contribute to frailty in an individual patient can allow the clinician to address relevant underlying problems, many of which are not evident in routine HIV clinic visits.

Frailty syndrome is commonly seen in the aged and reflects multi-system physiological change. However, with reduced functional reserve and resilience frailty is also known to be common in the HIV infected population. This study outlined an easily administered screening test to identify HIV patients with frailty. When significant components of frailty are identified, clinicians will be able to focus on amelioration of the problem and promote reversion to the pre-frail state.

A simple, validated protocol consisting of a battery of tests is available to identify elderly patients with frailty syndrome. This syndrome of decreased ...

Computerized Dynamic Posturography for Postural Control Assessment in Patients with Intermittent Claudication

Computerized dynamic posturography with the EquiTest is an objective technique for measuring postural strategies under challenging static and dynamic conditions. As part of a diagnostic assessment, the early detection of postural deficits is important so that appropriate and targeted interventions can be prescribed. The Sensory Organization Test (SOT) on the EquiTest determines an individual&#39;s use of the sensory systems (somatosensory, visual, and vestibular) that are responsible for postural control. Somatosensory and visual input are altered by the calibrated sway-referenced support surface and visual surround, which move in the anterior-posterior direction in response to the individual&#39;s postural sway. This creates a conflicting sensory experience. The Motor Control Test (MCT) challenges postural control by creating unexpected postural disturbances in the form of backwards and forwards translations. The translations are graded in magnitude and the time to recover from the perturbation is computed.
Intermittent claudication, the most common symptom of peripheral arterial disease, is characterized by a cramping pain in the lower limbs and caused by muscle ischemia secondary to reduced blood flow to working muscles during physical exertion. Claudicants often display poor balance, making them susceptible to falls and activity avoidance. The Ankle Brachial Pressure Index (ABPI) is a noninvasive method for indicating the presence of peripheral arterial disease and intermittent claudication, a common symptom in the lower extremities. ABPI is measured as the highest systolic pressure from either the dorsalis pedis or posterior tibial artery divided by the highest brachial artery systolic pressure from either arm. This paper will focus on the use of computerized dynamic posturography in the assessment of balance in claudicants.

Individuals with intermittent claudication exhibit poor balance compared to healthy controls. Computerized dynamic posturography is an objective method for measuring an individual's postural responses to balance disturbances. This provides an objective reflection of the person&#x2019;s ability to respond to situations under which sensory stimuli are altered and unexpected perturbations occur.

Computerized dynamic posturography with the EquiTest is an objective technique for measuring postural strategies under challenging static and dynamic ...

Induction and Assessment of Exertional Skeletal Muscle Damage in Humans

Contraction-induced muscle damage via voluntary eccentric (lengthening) contractions offers an excellent model for studying muscle adaptation and recovery in humans. Herein we discuss the design of an eccentric exercise protocol to induce damage in the quadriceps muscles, marked by changes in strength, soreness, and plasma creatine kinase levels. This method is simple, ethical, and widely applicable since it is performed in human participants and eliminates the interspecies translation of the results. Subjects perform 300 maximal eccentric contractions of the knee extensor muscles at a speed of 120&#176;/sec on an isokinetic dynamometer. The extent of the damage is measurable using relatively non-invasive isokinetic and isometric measures of strength loss, soreness, and plasma creatine kinase levels over several days following the exercise. Therefore, its application can be directed to specific populations in an attempt to identify mechanisms for muscle adaptation and regeneration.

This article describes a safe and reliable method to induce and quantify exertional skeletal muscle damage in human subjects.

Contraction-induced muscle damage via voluntary eccentric (lengthening) contractions offers an excellent model for studying muscle adaptation and recovery ...

Turbidimetry on Human Washed Platelets: The Effect of the Pannexin1-inhibitor Brilliant Blue FCF on Collagen-induced Aggregation

Turbidimetry is a laboratory technique that is applied to measure the aggregation of platelets suspended in either plasma (platelet-rich plasma, PRP) or in buffer (washed platelets), by the use of one or a combination of agonists. The use of washed platelets separated from their plasma environment and in the absence of anticoagulants allows for studying intrinsic platelet properties. Among the large panel of agonists, arachidonic acid (AA), adenosine di-phosphate (ADP), thrombin and collagen are the most frequently used. The aggregation response is quantified by measuring the relative optical density (OD) over time of platelet suspension under continuous stirring. Platelets in homogeneous suspension limit the passage of light after the addition of an agonist, platelet shape change occurs producing a small transitory increase in OD. Following this initial activation step, platelet clots form gradually, allowing the passage of light through the suspension as a result of decreased OD. The aggregation process is ultimately expressed as a percentage, compared to the OD of platelet-poor plasma or buffer. Rigorous calibration is thus essential at the beginning of each experiment. As a general rule: calibration to 0% is set by measuring the OD of a non-stimulated platelet suspension while measuring the OD of the suspension medium containing no platelets represents a value of 100%. Platelet aggregation is generally visualized as a real-time aggregation curve. Turbidimetry is one of the most commonly used laboratory techniques for the investigation of platelet function and is considered as the historical gold standard and used for the development of new pharmaceutical agents aimed at inhibiting platelet aggregation. Here, we describe detailed protocols for 1) preparation of human washed platelets and 2) turbidimetric analysis of collagen-induced aggregation of human washed platelets pretreated with the food dye Brilliant Blue FCF that was recently identified as an inhibitor of Pannexin1 (Panx1) channels.

We describe a straightforward method for the isolation of washed platelets from human blood followed by agonist-induced platelet aggregation measurements by turbidimetry. As an example we apply this method for studying the aggregation response of human platelets to collagen after a pre-incubation with the Pannexin1 channel inhibitor Brilliant Blue FCF.

Turbidimetry is a laboratory technique that is applied to measure the aggregation of platelets suspended in either plasma (platelet-rich plasma, PRP) or ...

Qualitative and Comparative Cortical Activity Data Analyses from a Functional Near-Infrared Spectroscopy Experiment Applying Block Design

Neuroimaging studies play a pivotal role in the evaluation of pre- vs. post-interventional neurological conditions such as in rehabilitation and surgical treatment. Among the many neuroimaging technologies used to measure brain activity, functional near-infrared spectroscopy (fNIRS) enables the evaluation of dynamic cortical activities by measuring the local hemoglobin levels similar to functional magnetic resonance imaging (fMRI). Also, due to lesser physical restriction in fNIRS, multiple variants of sensorimotor tasks can be evaluated. Many laboratories have developed several methods for fNIRS data analysis; however, despite the fact that the general principles are the same, there is no universally standardized method. Here, we present the qualitative and comparative analytic methods of data obtained from a multi-channel fNIRS experiment using a block design. For qualitative analysis, we used a software for NIRS as a mass-univariate approach based on the generalized linear model. The NIRS-SPM analysis shows qualitative results for each session by visualizing the activated area during the task. In addition, the non-invasive three-dimensional digitizer can be used to estimate the fNIRS channel locations relative to the brain. To corroborate the NIRS-SPM findings, the amplitude of the changes in hemoglobin levels induced by the sensorimotor task can be statistically analyzed by comparing the data obtained from two different sessions (before and after intervention) of the same study subject using a multi-channel hierarchical mixed model. Our methods can be used to measure the pre- vs. post-intervention analysis in a variety of neurological disorders such as movement disorders, cerebrovascular diseases, and neuropsychiatric disorders.

We describe the analysis of continuous-wave functional near-infrared spectroscopy experiment using a block design with a sensorimotor task. To increase the reliability of the data analysis, we used the qualitative general linear model-based statistical parametric mapping and the comparative hierarchical mixed models for multi-channels.

Neuroimaging studies play a pivotal role in the evaluation of pre- vs. post-interventional neurological conditions such as in rehabilitation and surgical ...

Neuroscience

Restoring Post-Stroke Motor Function by Motor Imagery Brain-Computer Interface

Motor Imagery Brain-Computer Interface in Rehabilitation of Upper Limb Motor Dysfunction After Stroke

The rehabilitation effect of patients with moderate or severe upper limb motor dysfunction after stroke is poor, which has been the focus of research owing to the difficulties encountered. Brain-computer interface (BCI) represents a hot frontier technology in brain neuroscience research. It refers to the direct conversion of the sensory perception, imagery, cognition, and thinking of users or subjects into actions, without reliance on peripheral nerves or muscles, to establish direct communication and control channels between the brain and external devices. Motor imagery brain-computer interface (MI-BCI) is the most common clinical application of rehabilitation as a non-invasive means of rehabilitation. Previous clinical studies have confirmed that MI-BCI positively improves motor dysfunction in patients after stroke. However, there is a lack of clinical operation demonstration. To that end, this study describes in detail the treatment of MI-BCI for patients with moderate and severe upper limb dysfunction after stroke and shows the intervention effect of MI-BCI through clinical function evaluation and brain function evaluation results, thereby providing ideas and references for clinical rehabilitation application and mechanism research.

Author Spotlight: Using Motor Imagery Brain-Computer Interface to Improve Motor and Cognitive Function in Stroke Patients

The purpose of this study is to provide an important reference for the standard clinical operation of motor imagery brain-computer interface (MI-BCI) for upper limb motor dysfunction after stroke.

The rehabilitation effect of patients with moderate or severe upper limb motor dysfunction after stroke is poor, which has been the focus of research ...

Evaluating Brain Activation by fNIRS During a Lower Limb Robotic Therapy Session

An Experiment Using Functional Near-Infrared Spectroscopy and Robot-Assisted Multi-Joint Pointing Movements of the Lower Limb

Stroke affects approximately 17 million individuals worldwide each year and is a leading cause of long-term disability. Robotic therapy has shown promise in helping stroke patients regain lost motor functions. One potential avenue for increasing the understanding of how motor recovery occurs is to study brain activation during the movements that are targeted by therapy in healthy individuals. Functional Near-Infrared Spectroscopy (fNIRS) has emerged as a promising neuroimaging technique for examining neural underpinnings of motor function. This study aimed to investigate fNIRS neural correlates of complex lower limb movements in healthy subjects. Participants were asked to perform cycles of rest and movement for 6 min using a robotic device for motor rehabilitation. The task required coordinated knee and ankle joint movements to point to targets displayed on a computer screen. Two experimental conditions with different levels of movement assistance provided by the robot were explored. The results showed that the fNIRS protocol effectively detected brain regions associated with motor control during the task. Notably, all subjects exhibited greater activation in the contralateral premotor area during the no-assistance condition compared to the assisted condition. In conclusion, fNIRS appears to be a valuable approach for detecting changes in oxyhemoglobin concentration associated with multi-joint pointing movements of the lower limb. This research might contribute to the understanding of stroke motor recovery mechanisms and might pave the way for improved rehabilitation treatments for stroke patients. However, further research is needed to fully elucidate the potential of fNIRS in studying motor function and its applications in clinical settings.

Author Spotlight: Assessing Brain Activity in Robotic-Assisted Lower Limb Rehabilitation Using fNIRS

It is estimated that 1 in 6 individuals worldwide will have a stroke in their lifetime, causing long-term disability, whose rehabilitation mechanisms are still poorly understood. This study proposes a protocol to evaluate brain activation by functional near-infrared spectroscopy (fNIRS) during a lower limb robotic therapy session.

Stroke affects approximately 17 million individuals worldwide each year and is a leading cause of long-term disability. Robotic therapy has shown promise ...

Enhancing Stroke Rehabilitation with Virtual Reality-Based Occupational Training

Cognitive Function and Upper Limb Rehabilitation Training Post-Stroke Using a Digital Occupational Training System

Stroke rehabilitation often requires frequent and intensive therapy to improve functional recovery. Virtual reality (VR) technology has shown the potential to meet these demands by providing engaging and motivating therapy options. The digital occupational training system is a VR application that utilizes cutting-edge technologies, including multi-touch screens, virtual reality, and human-computer interaction, to offer diverse training techniques for advanced cognitive capacity and hand-eye coordination abilities. The objective of this study was to assess the effectiveness of this program in enhancing cognitive function and upper extremity rehabilitation in stroke patients. The training and assessment consist of five cognitive modules covering perception, attention, memory, logical reasoning, and calculation, along with hand-eye coordination training. This research indicates that after eight weeks of training, the digital occupational training system can significantly improve cognitive function, daily living skills, attention, and self-care abilities in stroke patients. This software can be employed as a time-saving and clinically effective rehabilitation aid to complement traditional one-on-one occupational therapy sessions. In summary, the digital occupational training system shows promise and offers potential financial benefits as a tool to support the functional recovery of stroke patients.

Author Spotlight: Rehabilitation of Stroke Patients With a Digital Occupational Training System

The current protocol outlines how the VR-based digital occupational training system enhances the rehabilitation of patients with cognitive impairment and upper limb dysfunction following a stroke.

Stroke rehabilitation often requires frequent and intensive therapy to improve functional recovery. Virtual reality (VR) technology has shown the ...

Integrated Robotic and Conventional Therapy for Post-Stroke Upper Limb Recovery

Enhancing Upper Limb Function and Motor Skills Post-Stroke Through an Upper Limb Rehabilitation Robot

Cerebrovascular accidents, commonly known as strokes, represent a prevalent neurological event leading to significant upper limb disabilities, thereby profoundly affecting individuals' activities of daily living and diminishing their quality of life. Traditional rehabilitation methods for upper limb recovery post-stroke are often hindered by limitations, including therapist and patient fatigue, reliance on singular training methodologies, and lack of sustained motivation. Addressing these challenges, this study introduces an upper limb rehabilitation robot, which uses intelligent feedback motion control to improve therapeutic outcomes. The system is distinguished by its capability to adjust the direction and magnitude of force feedback dynamically, based on the detection of spastic movements during exercises, thereby offering a tailored therapeutic experience. This system is equipped with four distinct training modes, intelligent assessment of joint range of motion, and the ability to personalize training programs. Moreover, it provides an immersive interactive gaming experience coupled with comprehensive safety measures. This multifaceted approach not only elevates the engagement and interest of participants beyond traditional rehabilitation protocols but also demonstrates significant improvements in upper limb functionality and the activities of daily living among hemiplegic patients. The system exemplifies an advanced tool in upper limb rehabilitation, offering a synergistic blend of precision, personalization, and interactive engagement, thereby broadening the therapeutic options available to stroke survivors.

Author Spotlight: Enhancing Post-Stroke Upper Limb Rehabilitation with Robotic Technologies for Improved Motor Recovery and Functional Outcomes

This protocol describes an upper limb rehabilitation robot that provides intelligent feedback through four modes. These modes enhance upper limb function and flexibility, thereby improving patients' quality of life.

Cerebrovascular accidents, commonly known as strokes, represent a prevalent neurological event leading to significant upper limb disabilities, thereby ...

Dual Upper Limb Robotic Training in Stroke Rehabilitation

Application of a Dual Upper Limb Task-Oriented Robotic System for the Functional Recovery of the Upper Limb in Stroke Patients

Highly repetitive and task-oriented training has been shown to promote the recovery of limb function in stroke patients. Additionally, bilateral arm training can help stroke survivors regain their upper limb function and improve their daily activities. The dual upper limb task-oriented robotic system is designed to assist the healthy side of the stroke patient in driving the affected side to perform bilateral arm training through the use of a robotic device. It can also guide the patient in carrying out dual upper limb coordinated movements and engage them in a task-oriented virtual game using force feedback and human-computer interaction technology. This study aimed to assess the efficacy of the system in enhancing upper limb function and activities of daily living in stroke patients. The assessment methods used included motor evoked potential (MEP), functional test for the hemiplegic upper extremity-Hong Kong (FTHUE-HK), Fugl-Meyer Assessment Upper Extremity Scale (FMA-UE), and modified Barthel index (MBI). The results of the study indicate that the dual upper limb task-oriented robotic system can significantly improve the corticospinal pathway, upper limb function, and activities of daily living in stroke patients after 6 weeks of treatment. This system can serve as an effective adjunct to upper limb functional rehabilitation in stroke survivors, reducing the dependence on rehabilitation therapists. In conclusion, the dual upper limb task-oriented robotic system provides a new strategy for post-stroke limb functional rehabilitation and holds great potential for application, as it offers certain social and financial benefits.

Author Spotlight: Enhancing Upper Limb Rehabilitation in Stroke Patients Through Advanced Robotic and Neuromodulation Technologies

This experimental protocol outlines the use of a dual upper limb task-oriented robotic system for stroke patients with upper limb dysfunction. The findings indicate that this system can significantly improve stroke patients' upper limb function and daily living activities.

Highly repetitive and task-oriented training has been shown to promote the recovery of limb function in stroke patients. Additionally, bilateral arm ...

Investigating the Effect of Different Types of Exercise on Upper Limb Functional Recovery in Patients with Right Hemisphere Damage Based on fNIRS

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