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Structure, content and psychometric properties of physical activity measurement/reporting tools applicable to children and adolecents with disabilities: a systematic review
SHI Xiaoyu, YANG Jian
《Chinese Journal of Rehabilitation Theory and Practice》    2023, 29 (6): 621-629.   DOI: 10.3969/j.issn.1006-9771.2023.06.001
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Objective To synthesize the structure, content and psychometric properties of physical activity measurement/reporting tools applied in children and adolescents with disabilities.
Methods Literature on physical activity measurement/reporting tools for children with disabilities were retrieved from PubMed, Medline, EBSCO, Web of Science and CNKI, from establishment to June, 2023. The main structure and content characteristics of the tools were analyzed using the International Classification of Functioning, Disability and Health-Children and Youth Version (ICF-CY). The psychometric properties of the tools was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN).
Results Six tools were selected, and nine papers were finally included. Two tools were globalized standard tools, namely Global Matrix 4.0 Physical Activity Report Card for Children and Youth (Global Matrix 4.0) and the Global Matrix of Para Report Card on Physical Activity of Children and Adolescents with Disabilities (Para Report Card), measuring b455 functions of motor tolerance function, b7 neuromusculoskeletal and motor-related functions; d4 mobility, d450 walking, d470 using transportation, d820 school education, d910 community life, d920 recreation and leisure; e310 immediate family, e320 friends, e460 societal attitudes, and e575general social support services, systems and policies, etc. These tools showed a complete structure, high reliability, validity and feasibility, and could be performed in a self-reported manner or completed by the custodian or school teacher. The International Physical Activity Questionnaire (IPAQ) might measure d4 mobility, d450 walking, d640 doing housework, d820 school education, d920 recreation and leisure. IPAQ was good in terms of internal consistency, content and construct validity, and cross-cultural validity, with different test-retest reliability and hypothesis testing results reported in different applied studies. Children and Adolescents Physical Activity and Sedentary-Questionnaire (CAPAS-Q) might measure the d4 mobility, d450 walking, d470 using transportation, d820 school education, and d920 recreation and leisure. CAPAS-Q was good in internal consistency, retest reliability, content and construct validity, but hypothesis testing results and cross-cultural validity were unknown. Physical Activity Questionnaire for Older Children (PAQ-C) and Physical Activity Questionnaire for Adolescents (PAQ-A) might measure d4 mobility, d450 walking, d470 using transportation, d820 school education, and d920 recreation and leisure. PAQ-C and PAQ-A were strong in internal consistency, retest reliability, content and construct validity, and cross-cultural validity, without hypothesis testing results.
Conclusion In terms of content, Para Report Card is the most comprehensive and extended physical activity measurement/reporting tool for children and adolescents with disabilities. In terms of the psychometric properties of the instruments, the multidimensional, structured physical activity measures show high internal consistency, retest reliability, and content and construct validity, with varying retest reliability and correlational validity with objective measures across studies.

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Effect of repetitive facilitative exercise on hand function of stroke patients with hemiplegic during recovery period
GU Bin, ZHANG Jinqin, XIA Yuanhao, HU Jingran, NAOKI Morohashi, HUANG Fubiao
《Chinese Journal of Rehabilitation Theory and Practice》    2023, 29 (6): 697-702.   DOI: 10.3969/j.issn.1006-9771.2023.06.010
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Objective To observe the effect of repetitive facilitative exercise (RFE) on the hand function of stroke patients with hemiplegia during recovery period.
Methods From January to December, 2022, 80 stroke patients with hemiplegia following hand dysfunction during recovery period in Beijing Bo'ai Hospital were randomly divided into control group (n = 40) and experimental group (n = 40). Both groups received routine rehabilitation, the control group added functional occupational therapy, and the experimental group added RFE, for four weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Simple Test for Evaluating Hand Function (STEF) and modified Barthel Index (MBI) before and after treatment.
Results One case dropped down in the experimental group. After treatment, all the scores increased in both groups (|t| > 12.698, P < 0.001), and were better in the experimental group than in the control group (|t| > 2.302, P < 0.05).
Conclusion RFE could promote the recovery of hand function and activities of daily living in patients with hemiplegia during stroke recovery period.

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《Chinese Journal of Rehabilitation Theory and Practice》    2023, 29 (12): 0-0.  
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Effect of music therapy on post-stroke cognitive impairment
LIN Yufan, WEI Tianyuan, ZHANG Xiaoying, LI Chaojinzi, HE Jingjie, DU Xiaoxia
《Chinese Journal of Rehabilitation Theory and Practice》    2023, 29 (6): 714-719.   DOI: 10.3969/j.issn.1006-9771.2023.06.013
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Objective To observe the effect of music therapy on cognitive function, motor function, and activities of daily living (ADL) of patients with post-stroke cognitive impairment.
Methods From December, 2020 to July, 2022, 48 patients with post-stroke cognitive impairment in Beijing Bo'ai Hospital were enrolled and randomly divided into control group (n = 24) and experimental group (n = 24). Both groups received conventional medication, nursing, and conventional rehabilitation, while the experimental group received music therapy additionally, for eight weeks. Before and after intervention, the cognitive function was assessed by Loewenstein Occupational Therapy Cognitive Assessment (LOTCA), and motor function and ADL were assessed with Fugl-Meyer Assessment (FMA) and modified Barthel Index (MBI), respectively.
Results Six cases in the control group dropped down. The increase in the scores of LOTCA and FMA was more in the experimental group than in the control group (t > 2.665, P < 0.05), however, no significant difference was found in the increase of MBI score between two groups.
Conclusion Music therapy could improve the cognitive function and motor function of patients with post-stroke cognitive impairment.

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Effects of different intensity of wearable lower limb rehabilitation robot-assisted training on lower limb function after stroke
ZHAO Yaxian, TANG Zhiqing, SUN Xinting, WANG Rongrong, LIU Tianhao, ZHANG Hao
《Chinese Journal of Rehabilitation Theory and Practice》    2023, 29 (5): 497-503.   DOI: 10.3969/j.issn.1006-9771.2023.05.001
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Objective To explore the effects of different intensity of wearable lower limb rehabilitation robot-assisted training on walking function, lower limb motor function, balance function and functional independence of stroke patients.

Methods From November, 2021 to December, 2022, 60 stroke patients hospitalized in Beijing Bo'ai Hospital were randomly divided into control group (n = 20), observation group 1 (n = 20) and observation group 2 (n = 20). All the groups received routine rehabilitation, while the control group received routine walking training 30 minutes a day, the observation group 1 received wearable lower limb rehabilitation robot-assisted training 30 minutes a day, and the observation group 2 received wearable lower limb rehabilitation robot-assisted training 60 minutes a day, for four weeks. They were assessed with Functional Ambulation Category scale (FAC), Fugl-Meyer Assessment-Lower Extremities (FMA-LE), Berg Balance Scale (BBS) and Rivermead Mobility Index (RMI) before and after treatment.

Results One case in the observation group 1 and three cases in the observation group 2 dropped down. The FAC, FMA-LE, BBS and RMI scores improved in all the three groups after treatment (|Z| > 3.448, |t| > 8.102, P < 0.001), and there was no significant difference in all the indexes among the three groups (|H| < 4.643, F = 1.454, P > 0.05); however, the improvement of BBS score was more in the observation group 1 than in the control group (P < 0.05), and the improvement of all the indexes was more in the observation group 2 than in the control group (P < 0.05).

Conclusion The wearable lower limb rehabilitation robot-assisted training may promote the recovery of walking function, lower limb motor function, balance function and functional independence of stroke patients, and high-intensity training seems to be more effective.

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Effect of transcutaneous auricular vagus nerve stimulation combined with robot-assisted therapy on upper limb function of stroke patients
ZHENG Li, BAO Zhicheng, ZHANG Qi, REN Xuyan, SU Min
《Chinese Journal of Rehabilitation Theory and Practice》    2023, 29 (6): 691-696.   DOI: 10.3969/j.issn.1006-9771.2023.06.009
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Objective To investigate the effect of transcutaneous auricular vagus nerve stimulation (taVNS) combined with robot-assisted therapy on upper limb function of subacute stroke patients.
Methods From March, 2022 to March, 2023, 60 subacute stroke patients from Dushu Lake Hospital and the First People's Hospital of Kunshan were randomly divided into control group (n = 20), robot group (n = 20) and combined group (n = 20). All the groups received conventional treatments including medication, physical therapy and occupational therapy; the robot group received sham taVNS combined with hand robot-assisted therapy; while the combined group received taVNS combined with hand robot-assisted therapy, for four weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and hand part, the root mean square (RMS) electromyography of the extensor carpi radialis and extensor digitorum muscles during contraction, and the latency and amplitude of transcranial magnetic stimulation motor-evoked potential (TMS-MEP) before and after treatment.
Results After treatment, the scores of FMA-UE and hand part, RMS of the extensor carpi radialis and extensor digitorum muscles, and latency and amplitude of TMS-MEP improved in all the groups (t > 2.099, P < 0.05); and they were the best in all indicators in the combined group (F > 9.106, P < 0.001).
Conclusion taVNS combined with robot-assisted therapy can promote central nervous system remodeling and further improve upper limb function in stroke patients.

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Effect of intervention based on theory of planned behavior on muscle attenuation and balance of the elderly with sarcopenia
YANG Ya'nan, MU Liping, XING Fengmei, XUE Xinhong, WANG Xiaoguang, TAO Yangyu, SUN Zhumei, ZHANG Xiaoli
《Chinese Journal of Rehabilitation Theory and Practice》    2023, 29 (8): 869-874.   DOI: 10.3969/j.issn.1006-9771.2023.08.001
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Objective To explore the effect of intervention based on theory of planned behavior on muscle attenuation and balance of the elderly with sarcopenia.
Methods From September, 2022 to February, 2023, 124 elderly people with sarcopenia were conveniently sampled from Lishuiwan Community and Shuxiangyuan Community in Shijiazhuang City, Hebei Province. According to the coin toss, 62 elderly people from Shuxiangyuan Community were designated as control group, and 62 elderly people from Lishuiwan Community were as intervention group. The intervention group implemented the intervention based on the theory of planned behavior, including behavior attitude, behavior, subjective norms, perceived behavior control and behavior awareness; the control group maintained their original lifestyle, for twelve weeks. Before and after intervention, the grip strength, time of Five-Times-Sit-to-Stand Test, relative appendicular skeletal muscle index (RASM), 6-minute walking speed and the score of Berg Balance Scale (BBS) were compared.
Results After intervention, the grip strength, RASM, 6-minute walking speed, and the score of BBS significantly increased, and the time of Five-Times-Sit-to-Stand Test shortened in the intervention group (|Z| > 6.257, |t| > 28.643, P < 0.001), and they were better in the intervention group than in the control group (|Z| > 2.288, |t| > 3.177, P < 0.05).
Conclusion The intervention based on theory of planned behavior can effectively relieve the muscle attenuation of the elderly with sarcopenia, and improve their balance ability.

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《Chinese Journal of Rehabilitation Theory and Practice》    2023, 29 (9): 0-0.  
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Effect of proprioceptive neuromuscular facilitation combined with neuromuscular electrical stimulation on chronic ankle instability
REN Yi, WANG Rui, ZHANG Yaohua
《Chinese Journal of Rehabilitation Theory and Practice》    2023, 29 (7): 750-755.   DOI: 10.3969/j.issn.1006-9771.2023.07.002
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Objective To observe the effect of proprioceptive neuromuscular facilitation combined with neuromuscular electrical stimulation on chronic ankle instability (CAI).

Methods From April, 2016 to December, 2021, 48 patients with CAI were randomly divided into control group (n = 24) and observation group (n = 24). Both groups accepted routine rehabilitation, and the observation group accepted proprioceptive neuromuscular facilitation combined with neuromuscular electrical stimulation additionally, for eight weeks. They were assessed with Visual Analogue Scale (VAS), peak torque to body weight of ankle dorsiflexors and plantarflexors (AD/W, AP/W), Y Balance Test (YBT) and Foot and Ankle Disability Index (FADI) before and after treatment.

Results After treatment, VAS score, AD/W, AP/W, YBT and FADI improved in the observation group (|t| > 2.208, P < 0.05), while VAS score and AP/W improved in the control group (|t| > 2.156, P < 0.05); and all the VAS score, AD/W, AP/W, YBT and FADI were better in the observation group than in the control group (|t| > 2.067, P < 0.05).

Conclusion Proprioceptive neuromuscular facilitation combined with neuromuscular electrical stimulation can effectively relieve the pain of patients with CAI, and increase the muscle strength around the ankle, to improve the stability and balance.

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Effect of motor imagery on knee function after unicompartmental knee arthroplasty
LI Ziyi, SONG Weiqun, DU Jubao, CAO Guanglei, ZHANG Yanming, LI Ran
《Chinese Journal of Rehabilitation Theory and Practice》    2023, 29 (7): 745-749.   DOI: 10.3969/j.issn.1006-9771.2023.07.001
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Objective To explore the effect of motor imagery (MI) on knee function after unicompartmental knee arthroplasty (UKA).

Methods From January to September, 2022, 32 patients underwent UKA for the first time in Xuanwu Hospital were randomly divided into control group (n = 16) and experimental group (n = 16). All the patients accepted routine rehabilitation, and the experimental group accepted MI in addition, until four weeks after discharge. They were assessed with Oxford Knee Score (OKS), Visual Analogue Scale for pain (VAS), range of motion (ROM) of knee, and Timed Up and Go Test (TUGT) before and after treatment.

Results All the indexes improved after treatment (|t| > 2.517, P < 0.05), except ROM in the control group; and they improved more in the experimental group than in the control group (F > 7.999, P < 0.01), except the VAS score.

Conclusion MI can further improve the knee function after UKA, but do less for pain.

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Effect of acute physical activity on cognitive function in children: a systematic review
JIANG Changhao, GAO Xiaoyan
《Chinese Journal of Rehabilitation Theory and Practice》    2023, 29 (6): 667-672.   DOI: 10.3969/j.issn.1006-9771.2023.06.006
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Objective To evaluate the effects of physical activity on children's cognitive function based on International Classification of Functioning, Disability and Health (ICF).
Methods The PICO framework was constructed. Trials on the effects of physical activity on children's cognition were searched in Web of Science, PubMed, ProQuest and CNKI from inception to June 1st, 2023. The included literature was evaluated for methodological quality using the Physiotherapy Evidence Database (PEDro) scale.
Results Ten papers from six countries with a total of 550 subjects were involved, including both healthy children and children with attention deficit and hyperactivity disorders. Physical activity involved running, cycling, high jumping, jumping rope and soccer, and the type of physical activity was acute aerobic exercise, ranging from twelve to 30 minutes, mostly at moderate intensity. Health outcomes were focused on cognitive aspects.
Conclusion A theoretical framework for the benefits of physical activity on children's cognitive function has been constructed based on ICF. Acute physical activity shortens reaction time, improves various subcomponents of executive function, increases selective attention, and consolidates long-term memory.

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Application of constraint-induced movement therapy in the field of rehabilitation: a visualized analysis
MA Tiantian, YU Zifu, QIN Fang, LENG Xiaoxuan, LIU Xihua
《Chinese Journal of Rehabilitation Theory and Practice》    2023, 29 (7): 822-832.   DOI: 10.3969/j.issn.1006-9771.2023.07.012
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Objective To understand the current research status, research hotspots and development trends of constraint-induced movement therapy (CIMT) in the field of rehabilitation.

Methods The relevant articles of CIMT in rehabilitation from January, 2000 to October, 2022 in CNKI and Web of Science were retrieved. The authors, institutions, countries, keywords and burst words were extracted with CiteSpace 6.1.R3 to draw knowledge mapping.

Results A total of 1 165 articles were included, 359 articles in Chinese and 806 in English. The trend of annual publications was generally consistent, and after a period of rapid growth, the current annual publications showed a fluctuating trend. There was more cooperation among the institutions in English articles, with geographical limitation. The institutions in Chinese articles had the problem of insufficient cooperation. The researches mainly focused on the application of CIMT in different diseases, the improvement of motor function by CIMT, the application of CIMT in combination with other therapies, and the study of the related mechanisms of CIMT. In recent years, Chinese burst keywords included modified constraint-induced movement therapy, stroke hemiparesis, clinical efficacy and repetitive transcranial magnetic stimulation; English burst keywords included transcranial direct current stimulation, non-invasive brain stimulation, and unilateral cerebral palsy.

Conclusion Research on CIMT in the field of rehabilitation is in a period of steady development, and CIMT combined with non-invasive brain stimulation is likely to be a hotspot in future research.

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Effect of core stability training on dynamic balance and surface electromyography after anterior cruciate ligament reconstruction
MA Shengnan, KE Jingyue, DONG Hongming, LI Jianping, ZHANG Honghao, LIU Chao, SHEN Shuang, LI Guqiang
《Chinese Journal of Rehabilitation Theory and Practice》    2023, 29 (8): 882-889.   DOI: 10.3969/j.issn.1006-9771.2023.08.003
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Objective To explore the effect of core stability training on dynamic balance and surface electromyography (sEMG) after anterior cruciate ligament reconstruction (ACLR), and to analyze the correlation between balance index and sEMG.
Methods From March to December, 2022, 32 patients with ACLR in Yantai Affiliated Hospital of Binzhou Medical University were randomly divided into control group (n = 16) and experimental group (n = 16). The control group accepted routine rehabilitation treatment, and the experimental group added core stability training, for six weeks. They were evaluated with American Hospital for Special Surgery Knee Score (HSS) and International Knee Documentation Committee Knee Score (IKDC), and the dynamic balance function and sEMG were measured before and after treatment, and the correlation between dynamic balance index and root mean square (RMS) of sEMG was analyzed.
Results After treatment, the scores of HSS and IKDC increased significantly in both groups (|Z| > 3.526, |t| > 63.544, P < 0.001), and were better in the experimental group than in the control group (Z = -2.392, t = 2.650, P < 0.05); the length of gait line and single support line increased significantly, the medial-lateral displacement displacement decreased (|t| > 2.368, Z = -3.516, P < 0.05), and they were better in the experimental group than in the control group (|t| > 2.497, Z = -3.091, P < 0.05); the RMS of gluteus maximus and gluteus medius increased in the experimental group (t = -5.900, Z = -2.741, P < 0.01), and were better than those in the control group (t = 3.930, Z = -3.260, P < 0.01). After treatment, the RMS of gluteus maximus and gluteus medius in both groups were positively correlated with gait line length and single support line length, and were negatively correlated with medial-lateral displacement (|r| > 0.502, P < 0.01).
Conclusion Core stability training could significantly improve knee joint function and dynamic balance, and enhance the activation of gluteus maximus and gluteus medius. Dynamic balance is highly correlated with sEMG.

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Difference of cervical and shoulder muscle performance and its correlation with pain and body mass index in patients with chronic neck pain
SHEN Xingxing, XIONG Yuling, CHEN Weijian, LI Congcong, LI Junyi, WANG Shuai, ZHANG Jiahao, XIANG Ruian, CHEN Jiahao, LIU Wengang, XU Xuemeng
《Chinese Journal of Rehabilitation Theory and Practice》    2023, 29 (12): 1420-1428.   DOI: 10.3969/j.issn.1006-9771.2023.12.006
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Objective To test the inter-tester reliability and test-retest reliability of MyotonPRO for evaluating neck and shoulder muscle performance parameters in patients with unilateral chronic neck pain, observe the difference of muscle performance between the healthy and affected sides of patients with chronic neck pain, and analyze the factors that cause the imbalance of muscle performance in patients with chronic neck pain.

Methods From January to June, 2023, 32 patients with unilateral chronic neck pain in Guangdong Second Traditional Chinese Medicine Hospital were selected. Two testers used the same MyotonPRO equipment to measure the muscle tone, muscle hardness and muscle elasticity on both sides of the sternocleidomastoid muscle and the upper trapezius muscle in the relaxed position. Tester 1 repeated the measurement after an interval of 30 minutes, and Tester 2 was measured within the time interval between the two measurements of Tester 1. The intraclass correlation coefficient (ICC), standard error of mean (SEM) and minimum detectable change (MDC) were calculated simultaneously. The measurement results were plotted into Bland-Altman diagram and systematic bias analysis was performed. The difference in muscle characteristics between the affected side and the healthy side was compared. At the same time, the Visual Analogue Scale (VAS) score and body mass index (BMI) of the subjects were collected for correlation analysis.

Results Except the sternocleidomastoid muscle elasticity of the affected side (ICC = 0.697), the inter-tester reliability of all other parameters was high to very high (ICC = 0.719 to 0.952, SEM = 0.04 to 6.53, MDC = 0.12 to 18.11). The test-retest reliability of all parameters was high (ICC = 0.883 to 0.981, SEM = 0.03 to 5.72, MDC = 0.09 to 15.84). Bland-Altman plot analysis showed that the scatter distribution was consistent. The muscle tone, muscle hardness and muscle elasticity of sternocleidomastoid muscle and upper trapezius muscle were higher on the affected side than on the healthy side (t > 2.846, P< 0.05). The asymmetry index of tension, hardness and elasticity of upper trapezius muscle and sternocleidomastoid muscle was significantly positively correlated with VAS score and BMI (r> 0.385, P< 0.05).

Conclusion MyotonPRO has good inter-tester reliability and retest reliability in evaluating the muscle performance of both sides of patients with chronic neck pain. The muscle tone, muscle hardness and muscle elasticity of sternocleidomastoid muscle and upper trapezius muscle on the affected side were higher than on the healthy side, and the difference of muscle performance was positively correlated with pain and BMI.

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Effect of short-foot exercise on adult flatfoot: a systematic review
YU Zhongqi, WANG Chao, HE Gang, ZHANG Liang, WANG Ruiyan
《Chinese Journal of Rehabilitation Theory and Practice》    2023, 29 (5): 551-557.   DOI: 10.3969/j.issn.1006-9771.2023.05.009
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Objective To systematically review the effects of short-foot exercise on adult flatfoot.

Methods Articles related to short-foot exercise for flatfoot were searched from PubMed, Web of Science, Cochrane, Embase, Scopus, CNKI, Wanfang Data and CBM, from January, 2010 to December, 2022. The methodological quality was evaluated with the Physiotherapy Evidence Database (PEDro) scale, and the relevant data were extracted.

Results Ten randomized controlled trials were included, involved 335 individuals. The mean score of the PEDro scale was 7.1. Short-foot exercise improved the navicular drop, posture index score, balance and cross-sectional area of abductor hallucis muscle for patients with flatfoot, but plantar pressure.

Conclusion Short-foot exercise can improve the foot structure, balance and adductor hallucis muscle in adult flatfoot, but plantar pressure.

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Pelvic floor rehabilitation domestic and abroad in the last decade: a visualized analysis
WU Qianhao, HOU Rongjie, FU Liyuan
《Chinese Journal of Rehabilitation Theory and Practice》    2023, 29 (6): 673-685.   DOI: 10.3969/j.issn.1006-9771.2023.06.007
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Objective To perform a visualized analysis on the relevant literature about rehabilitation in pelvic floor dysfunction (PFD) domestic and abroad, and summarize the current hot spots and frontiers in this field.
Methods The literature related to PFD rehabilitation from January, 2012 to June, 2022 was searched and screened from the databases of CNKI and Web of Science, and the CiteSpace software was used to analyze the trends of publications, authors, institutions and key words.
Results A total of 2 448 articles were included. Relatively few high-quality domestic researches were published. In terms of research hotspots, both domestic and international researches focused on causes, mechanisms, rehabilitation techniques and evaluation indicators of PFD, but domestic researches had not paid enough attention to evaluation indicators and prevention of PFD. The key words constantly appeared in 2022 were mechanisms of PFD due to pregnancy, treatment of postoperative complications in prostate cancer patients, the role of pelvic floor muscle training, and quality of life studies in women.
Conclusion Research related to the field of PFD rehabilitation is increasing. There is still a large gap for future development in China.

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Relationship between lower limb muscle strength and walk speed in community dwelling older adults: the chain mediating role of flexibility and dynamic balance
TAN Xiaohuan, JIANG Guiping, HUANG Xinyi, WANG Dandan, ZHANG Lei, BU Qingguo, WU Xueping
《Chinese Journal of Rehabilitation Theory and Practice》    2023, 29 (6): 646-653.   DOI: 10.3969/j.issn.1006-9771.2023.06.004
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Objective To investigate the relationship between lower limb muscle strength and walking speed in older adults, and to analyze the mediating role of flexibility and dynamic balance.
Methods From November to December, 2021, a total of 155 older adults at the Shanghai Senior Sports and Health Home were included. Their basic health information was collected, and the lower limb muscle strength, flexibility, dynamic balance and walking speed were tested. A mediated effects analysis was conducted.
Results There was a pairwise correlation among lower limb muscle strength, flexibility, dynamic balance and walking speed in older adults (r > 0.210, P < 0.01). In the mediated effects model, after controlling for age and gender, lower limb muscle strength did not directly predict walking speed in older adults (β = 0.029, P = 0.699), however, lower limb muscle strength could influence walking speed through the partial mediation of dynamic balance (effect = 0.0130, 95% CI 0.0073~0.0197) and the chain mediation of lower flexibility and dynamic balance (effect = 0.0019, 95% CI 0.0003~0.0043).
Conclusion Lower limb muscle strength can indirectly affect walking speed in older adults through the mediators of flexibility and dynamic balance, or the dynamic balance alone.

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Construction of basic rehabilitation training course for family doctor teams serving for people with disabilities based on WHO rehabilitation competency framework
YANG Xiulian, QIN Jian, XIAN Yuantao, LIU Hongliang, YANG Yaru, XIANG Youyu, LUO Jie, ZHONG Shixun, ZHONG Yu, ZHOU Sujun, SU Hong, XIAO Hongmei, ZHOU Xinjian
《Chinese Journal of Rehabilitation Theory and Practice》    2023, 29 (11): 1249-1260.   DOI: 10.3969/j.issn.1006-9771.2023.11.002
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Objective To develop basic training courses for family doctor teams for people with disabilities.

Methods Utilizing the methods and theories of the World Health Organization (WHO) rehabilitation competency framework (RCF), and referring to the WHO universal health coverage global competency framework, the rehabilitation competency characteristics of family doctor teams for people with disabilities in community settings were analyzed, and a basic training course system for these teams based on the RCF was developed.

Results and Conclusion Based on RCF, a competency framework for family doctor teams serving people with disabilities has been constructed. The objectives, content and training course system for basic rehabilitation training has been established.

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Effect of robot-assisted bilateral task-oriented upper limb training on upper limb function of patients with stroke
SUN Ya, LI Yan, FU Jianming, LU Jingjing, JIN Xin, LIN Zailong
《Chinese Journal of Rehabilitation Theory and Practice》    2023, 29 (10): 1195-1200.   DOI: 10.3969/j.issn.1006-9771.2023.10.011
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Objective To investigate the effect of robot-assisted bilateral task-oriented upper limb training on upper limb function of patients with stroke.
Methods From January, 2021 to June, 2022, 52 patients with stroke in the Second Hospital of Jiaxing were enrolled and randomized into control group (n = 26) and experimental group (n = 26). Both groups received routine treatment. The control group added conventional bilateral upper limb training, while the experimental group added robot-assisted bilateral task-oriented upper limb training, for six weeks. Before and after treatment, the upper limb motor function and activities of daily living were assessed with Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and modified Barthel Index (MBI). The upper limb proprioception test system was used to measure the average trace error (ATE) and test execution time of the upper limb.
Results Before treatment, there was no significant difference in the scores of FMA-UE and MBI, and ATE and test execution time between two groups (P > 0.05). After treatment, all the indexes improved significantly in both groups (|t| > 5.400, P < 0.001), and were better in the experimental group than in the control group (|t| > 2.123, P < 0.05).
Conclusion Robot-assisted bilateral task-oriented upper limb training could facilitate to improve the upper limb motor function and activities of daily living of stroke patients.

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Application of functional near-infrared spectroscopy in rehabilitation: a visualized analysis
ZHANG Ning, YANG Yuanbin, TIAN Haolin, WAN Mengying
《Chinese Journal of Rehabilitation Theory and Practice》    2023, 29 (10): 1171-1178.   DOI: 10.3969/j.issn.1006-9771.2023.10.008
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Objective To summarize the current situation, hot spots and frontiers of the application of functional near-infrared spectroscopy (fNIRS) in rehabilitation in recent ten years.
Methods Literature related to the application of fNIRS in rehabilitation was retrieved from the core collection of Web of Science from January, 2003 to December, 2022, and the visualized analysis was performed by CiteSpace 6.1.R6 software.
Results A total of 828 literatures were included. The annual publication volume was on the rise. The most prolific author was LI Zengyong. The most published country was the United States. And the most published institution was Karolinska Institute. Hot keywords included children, stroke, activation, quality of life, cerebral palsy, etc. The hot keywords of bursting intensity included early intervention, speech perception, cerebral palsy, plasticity, spinal cord injury, physical therapy, visual feedback, Parkinson's disease, etc. Cluster analysis suggested that in the past decade, the application of fNIRS in rehabilitation involved physical therapy, speech therapy, occupational therapy, pre-rehabilitation and early rehabilitation of surgery, mainly focusing on six themes: the rehabilitation of motor dysfunction after stroke, cognitive impairment, hearing and speech dysfunction, children with cerebral palsy, cardiopulmonary function monitoring in severe diseases and long-term nursing of chronic diseases. Among them, the application of fNIRS in neurological rehabilitation of stroke patients occupied a large proportion, which might be the current research hot spot and trend.
Conclusion The application of fNIRS in rehabilitation is on the rise. In the future, more attention should be paid to the application of fNIRS in the study of the injury and recovery mechanism of neurological disorders, especially the effects of various rehabilitation interventions on cortical plasticity and the etiology of neurological disorders.

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Effect of repetitive transcranial magnetic stimulation combined with mirror therapy on upper limb motor function and neuroelectrophysiology in stroke patients with hemiplegia
CHEN Benmei, JIANG Lixiang, QIU Mulei, WANG Chuanjie, TAO Feng
《Chinese Journal of Rehabilitation Theory and Practice》    2023, 29 (10): 1201-1207.   DOI: 10.3969/j.issn.1006-9771.2023.10.012
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Objective To investigate the effect of 1 Hz repetitive transcranial magnetic stimulation (rTMS) combined with mirror therapy on upper limb motor function and cortical neurophysiological indicators in stroke patients with hemiplegia.
Methods Sixty stroke patients who were admitted to Jinshan Hospital of Fudan University, from October, 2022 to March, 2023 were randomly assigned to control group (n = 15), rTMS group (n = 15), mirror therapy group (n = 15) and combined group (n = 15). All groups received routine medicine and rehabilitation. In addition, the control group received sham rTMS and sham mirror therapy, rTMS group received 1 Hz rTMS and sham mirror therapy, the mirror therapy group received sham rTMS and mirror therapy, and the combined group received 1Hz rTMS combined with mirror therapy, for four weeks. Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and Action Research Arm Test (ARAT) were used to evaluate the motor function of the affected upper limb. The motor-evoked potential (MEP) amplitude and central motor conduction time (CMCT) of the affected cortex were measured using a transcranial magnetic stimulation device.
Results After treatment, the scores of FMA-UE and ARAT, and the amplitude of MEP significantly improved in all groups (|t| > 3.854, P < 0.001), while the CMCT significantly shortened (t > 5.967, P < 0.001). Compared to the control group, rTMS group, the mirror therapy group and the combined group showed more significant improvement in the scores of FMA-UE and ARAT, and the amplitude of MEP, and shorter CMCT (P < 0.05). When compared to rTMS group and the mirror therapy group, the combined group showed more significant improvement the scores of FMA-UE and ARAT, and the amplitude of MEP, and shorter CMCT (P < 0.05). There was significant positive correlation of the scores of FMA-UE and ARAT with the amplitude of MEP, and negative correlation with the CMCT in all groups (R2 > 0.804, P < 0.001).
Conclusion The combination of 1 Hz rTMS and mirror therapy contributes to the post-stroke brain functional remodeling and facilitates upper limb motor recovery in stroke patients with hemiplegia.

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Effect of high-intensity interval training on executive function for healthy children and adolescents: a systematic review
WANG Junyu, YANG Yong, YUAN Xun, XIE Ting, ZHUANG Jie
《Chinese Journal of Rehabilitation Theory and Practice》    2023, 29 (9): 1012-1020.   DOI: 10.3969/j.issn.1006-9771.2023.09.003
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Objective To systematically review the effect of high-intensity interval training (HIIT) on executive function for healthy children and adolescents, and delineate the factors related to the intervention outcome.

Methods Literature about the effect of HIIT on executive functions for healthy children and adolescent was retrieved from Web of Science, PubMed, Cochrane, Embase, Google Scholar, and CNKI, up to July 31st, 2023. The methodological quality was evaluated using the Physiotherapy Evidence Database (PEDro) scale, and relevant data were systematically reviewed.

Results Fifteen researches were included, from nine countries, comprising 13 randomized controlled trials with the scores of PEDro scale from five to eight, involving 17 021 participants aged six to 18 years. They were published mainly from 2016 to 2023. The primary factors related to the intervention outcome were the age of participants, HIIT intervention programs, and work-to-rest ratio. HIIT significantly improved working memory and inhibitory control in healthy children, while it was limited for adolescents.

Conclusion HIIT can significantly improve inhibitory control and working memory in healthy children. Key factors related to the intervention outcomes include the age of participants and the specifics of the HIIT program, etc.

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Effect of anodal or cathodal transcranial direct current stimulation on upper limb function of stroke patients
CAI Qian, XU Liang, YANG Xi, LIU Jin, MA Ming
《Chinese Journal of Rehabilitation Theory and Practice》    2023, 29 (5): 521-526.   DOI: 10.3969/j.issn.1006-9771.2023.05.005
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Objective To observe the clinical efficacy of anodal or cathodal transcranial direct current stimulation (atDCS and ctDCS) on upper limb function of stroke patients with moderate to severe upper extremity impairment.

Methods From January to September, 2022, 69 patients in Zhongda Hospital Southeast University were randomly divided into control group (n = 23), atDCS group (n = 23) and ctDCS group (n = 23). All the groups received conventional rehabilitation. Moreover, atDCS group received atDCS over the M1 area of the affected hemisphere, ctDCS group received ctDCS over the M1 area of the unaffected hemisphere, and the control group received placebo stimulation. Before and four weeks after treatment, they were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Wolf Motor Function Test (WMFT) and modified Barthel index (MBI).

Results Before treatment, there was no significant difference in the scores of FMA-UE, WMFT and MBI among groups (F < 1.165, P > 0.05). After treatment, all the scores improved significantly in all the groups (|t| > 6.412, P < 0.001), and were higher in the atDCS group and ctDCS group than in the control group (P < 0.05), however, no significant difference was found between the atDCS group and ctDCS group (P > 0.05).

Conclusion Both atDCS and ctDCS could improve the upper limb motor function and activities of daily living of stroke patients with moderate to severe upper extremity impairment.

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Effect of bilateral sequential repetitive transcranial magnetic stimulation on motor function of upper limbs in stroke patients
CHEN Yiting, WANG Qian, CUI Shenhong, LI Yingcai, ZHANG Siyu, WEI Yanxu, REN Hui, LENG Jun, CHEN Bin
《Chinese Journal of Rehabilitation Theory and Practice》    2023, 29 (8): 926-932.   DOI: 10.3969/j.issn.1006-9771.2023.08.009
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Objective To observe the effect of bilateral sequential repetitive transcranial magnetic stimulation on the motor function of upper limbs in stroke patients.
Methods From December, 2020 to December, 2022, 62 stroke inpatients in the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine were included. They were randomly divided into control group (n = 31) and observation group (n = 31). Both groups accepted conventional medicine and rehabilitation, as well as electroacupuncture antagonistic muscle therapy. Before electroacupuncture, the observation group acceped low-frequency repetitive transcranial magnetic stimulation at primary motor cortex (M1) on the healthy side, followed by intermittent theta burst stimulation at M1 on the affected side, for four weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), modified Barthel Index (MBI) and modified Ashworth Scale (MAS), and motor evoked potential (MEP) latency was compared before and after treatment.
Results One patient dropped down in the observation group, and no adverse event happened. After treatment, the scores of FMA-UE and MBI significantly increased (|t| > 9.953, P < 0.001), and the score of MAS and the latency of MEP significantly decreased (|t| > 5.043, P < 0.001) in both groups; while all of them were better in the observation group than in the control group (|t| > 2.237, P < 0.05).
Conclusion Bilateral sequential repetitive transcranial magnetic stimulation can effectively promote the recovery of upper limb motor function in stroke patients.

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Relationship between symmetry of lower limb function and gait symmetry in patients with incomplete spinal cord injury
WANG Yiji, ZHOU Hongjun, HE Zejia, LIU Genlin, ZHENG Ying, HAO Chunxia, WEI Bo, KANG Haiqiong, ZHANG Ying, LU Xiaolei, YUAN Yuan, MENG Qianru
《Chinese Journal of Rehabilitation Theory and Practice》    2023, 29 (6): 639-645.   DOI: 10.3969/j.issn.1006-9771.2023.06.003
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Objective To observe the characteristics of gait symmetry and its influencing factors in patients with incomplete spinal cord injury (ISCI).
Methods From May, 2018 to November, 2021, 34 patients with ISCI in Beijing Bo'ai Hospital were divided into symmetrical injury of lower limb (SI) group and asymmetrical injury of lower limb (ASI) group according to the lower extremities motor score (LEMS). Three dimensional motion acquisition system and plantar pressure acquisition system were used for gait test. The symmetry indexes of step length, stance time and swing time were caculated.
Results The symmetry indexes of step length, stance time and swing time were significant lower in SI group than in ASI group (|t| > 2.619, P < 0.01). Stance time and swing time significantly correlated to the difference of bilateral LEMS in ASI group (r > 0.468, P < 0.01). Discriminant analysis showed that gait parameter equations were different for patients with different symmetry of lower limb injuries.
Conclusion The symmetry of lower limb motor function impacts gait symmetry for patients with ISCI, especially the difference value of bilateral total LEMS. Gait parameters can be used to determine the symmetry of lower limb injury in patients with ISCI.

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Surface electromyography of lower limb muscles in healthy middle-aged and old women during stair ascent and descent
LI Dan, WANG Jianxiong, HUANG Maomao, XU Fangyuan, ZENG Qiu, LI Jiyang, LI Yang, XIA Cuihong, ZHENG Yadan, XU Zhangyu, FANG Wenfeng, WAN Tenggang
《Chinese Journal of Rehabilitation Theory and Practice》    2023, 29 (6): 731-737.   DOI: 10.3969/j.issn.1006-9771.2023.06.016
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Objective To observe the lower limb muscle activation strategy of healthy middle-aged and old women during stair ascent and descent with surface electromyography.
Methods From August, 2021 to February, 2022, 20 healthy middle-aged and old women were measured the surface electromyography root mean square (RMS) and integrated electromyography (iEMG) of bilateral vastus lateral, rectus femoris, vastus medialis, biceps femoris and semitendinosus during stair ascent and descent, and co-contraction ratio was calculated.
Results During stair ascent, the RMS of bilateral vastus lateral, rectus femoris and vastus medialis was higher at starting stage than at following stage (|t| > 6.650, P < 0.001), while the RMS of biceps femoris and semitendinosus was lower (t > 3.559, P < 0.01); and the co-contraction ratio of hamstrings/quadriceps was lower at starting stage than at following stage (t > 8.185, P < 0.001). During stair descent, the RMS of bilateral vastus lateral, vastus medialis, biceps femoris and semitendinosus was higher at following stage than at starting stage (t > 2.345, P < 0.05), as well as the co-contraction ratio of hamstrings/quadriceps (t > 2.405, P < 0.05).
Conclusion The activities of the muscles around the knees are almost symmetrical during stair ascent and descent for healthy middle-aged and old women. The activation and co-contraction ratio of quadriceps and hamstring are various at starting/following stages.

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School health services and effectiveness based on World Health Organization health-promoting school framework: a scoping review
ZHANG Yuan, YANG Jian
《Chinese Journal of Rehabilitation Theory and Practice》    2023, 29 (7): 791-799.   DOI: 10.3969/j.issn.1006-9771.2023.07.008
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Objective To review the studies related to school health services and their outcomes based on the World Health Organization health-promoting school framework, to synthesize and analyze the main research scopes and related evidence in this field.

Methods Literature about the interventions and outcomes of implementing health-promoting school health services were retrieved from PubMed, Web of Science, EBSCO and CNKI, from the establishment to June, 2023, and a scoping review was conducted.

Results Seven papers were eventually included, involving 76 researches, more than 20 interventions, from five countries, published mainly from 2014 to 2021. The interventions included asthma education training curriculum, oral health education, menstrual management interventions, cognitive anxiety prevention programs, physical activity curriculum, cooking and nutrition curriculum, exercise and fitness interventions, mental health education programs, health-promoting diets curriculum and health education curriculum, and health skills training curriculum. The school health services programs included health screening and monitoring, disease prevention and control, and safety and first aid training for teachers and students. The health benefits of health-promoting school for students included improving health education outcomes and grades in health services elective courses; improving health condition and qualities of learning and life at school, reducing prevalence of chronic diseases and frequency of visiting the emergency room, and alleviating asthma; improving self-esteem, communication skills and social cohesion of the group, alleviating the influence of anxiety and other negative emotion, and increasing awareness of autonomy; improving activities related to healthy living, and positively affecting behaviors, attitudes and action. The health benefits of health-promoting school for teachers included improving pedagogical abilities and skills in teaching physical activity-related curriculum content, and increasing professional support for staff such as knowledge of first aid and participation in the school health service. The health benefits of health-promoting school for schools included promoting the incorporation of health education courses into regular teaching activities and increasing the school's financial investment in the construction of health-related psychosocial environments; promoting the plan and implementation of the health service in the schools.

Conclusion The school-based health services in health-promoting school consisted of two main categories: school curriculum and school health services. The health-promoting school may improve the health conditions, health behaviors and health services for the students, teachers and schools.

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Application of functional near-infrared spectroscopy in stroke: a visualized analysis
WANG Haifang, XU Minjie, LI Ying, LEI Xiaojing, CHANG Jingling
《Chinese Journal of Rehabilitation Theory and Practice》    2023, 29 (12): 1405-1419.   DOI: 10.3969/j.issn.1006-9771.2023.12.005
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Objective To explore the current status and frontier hotspots of functional near-infrared spectroscopy (fNIRS) in the field of stroke.

Methods Relevant literature on stroke and fNIRS from the Web of Science Core Collection (WoSCC) database was searched from its inception to July, 2023. VOSviewer, CiteSpace and Scimago were utilized for analysis of publication output, countries (regions) and institutions, international collaboration, co-cited references, co-occurring keywords and burst keywords.

Results A total of 379 articles were included. The research activity in this field showed an overall upward trend with slight fluctuations in the early stage. Among the top five institutions by publication output, four were from China. Co-occurrence analysis revealed that Beihang University and Boston Children's Hospital were central in collaboration networks. This study involved 1 787 authors, with 120 core authors, in which the top five most cited authors were Li Zengyong, Li Wenhao, Huo Congcong, Dou Zulin and Song Ying. The publications in this field were primarily concentrated in disciplines such as neurology, psychiatry, ophthalmology and clinical medicine. Overlay visualization of journal co-citation networks demonstrated associations between medical, clinical, and neurology disciplines with psychology, education, and sociology. Co-occurrence and clustering analysis of keywords indicated research emphasis on stroke rehabilitation, integration of multiple technical modalities, and exploration of innovative training strategies and brain activation connectivity. The research evolution of fNIRS in the stroke domain revealed initial use of photodiode devices for cerebral ischemia reperfusion monitoring. Subsequent studies refined cortical activation through improved laser sources, avalanche photodiodes, single-task experimental designs and transcranial direct current stimulation. Later, research extended to whole-brain detection, multimodal stimulation and the combination of virtual reality technology with audiovisual stimulation, resulting in significantly enhanced brain activation. The application of brain-computer interface technology further facilitated direct restoration of motor function.

Conclusion Researches in the field of stroke using fNIRS technology overall demonstrat a continuous upward trend. The researches focuse on post-stroke rehabilitation, integrating multimodal fusion, brain-computer interfaces, virtual reality, and sensory stimulation for real-time monitoring and personalized neurorehabilitation training strategies. It emphasizes interdisciplinary collaboration, expanding innovative research and the application of new technologies.

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Effect of transcranial direct current stimulation combined with acupuncture on central and upper limb function in stroke patients based on central-peripheral-central theory
WANG Haiyun, WANG Yin, ZHOU Xinjie, HE Aiqun
《Chinese Journal of Rehabilitation Theory and Practice》    2023, 29 (8): 919-925.   DOI: 10.3969/j.issn.1006-9771.2023.08.008
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Objective To explore the effect of transcranial direct current stimulation (tDCS) combined with acupuncture on central and upper limb function in stroke patients at flaccid stage based on central-peripheral-central theory.
Methods From September, 2018 to December, 2021, 120 patients with upper limb dysfunction after stroke in Guangdong Work Injury Rehabilitation Hospital were selected and randomly divided into control group 1 (n = 40), control group 2 (n = 40) and experimental group (n = 40). All the groups received conventional rehabilitation treatment. In addition, the control group 1 received acupuncture treatment, the control group 2 received anodal tDCS, and the experimental group received combined treatment of both, for four weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and modified Barthel Index (MBI) before and after treatment. Electroencephalograph (EEG) was used to detect brain symmetry index (BSI), and electromyography (EMG) was used to detect root mean square values (RMS) of triceps brachii, biceps brachii, extensor wrist and flexor wrist of the affected upper limbs.
Results Two cases in the control group 1, one in the control group 2 and one in the experimental group dropped off, respectively. After treatment, the scores of FMA-UE and MBI significantly increased in all the groups (t > 11.757, P < 0.001), and they were higer in the experimental group than in the control groups (P < 0.001); the BSI decreased in the control group 2 and the experimental group (t > 2.324, P < 0.05), and it was less in the experimental group than in the control group 2 (P < 0.05); the RMS of biceps increased in all the groups (t > 2.953, P < 0.01), and was higer in the experimental group than in the control groups (P < 0.05); the RMS of flexor wrist and triceps increased in the control group 1 and the experimental group (t > 2.230, P < 0.05), and were higher in the experimental group than in the control group 1 (P < 0.05); the RMS of wrist extensor muscle increased only in the experimental group (t = 3.350, P < 0.01).
Conclusion tDCS combined with acupuncture based on central-peripheral-central theory could effectively improve the upper limb function of stroke patients at flaccid stage, with advantages in improving hemispheric asymmetry and enhancing the activation level of affected muscles.

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Non-drug rehabilitation for gait abnormality of Parkinson's disease: a review based on ClinicalTrials.gov
WANG Jingxuan, LÜ Diyang, FANG Boyan
《Chinese Journal of Rehabilitation Theory and Practice》    2023, 29 (7): 816-821.   DOI: 10.3969/j.issn.1006-9771.2023.07.011
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Objective To investigate the current trend of non-drug therapy for gait abnormality of Parkinson's disease.

Methods The clinical trials about non-drug therapy for gait abnormality of Parkinson's disease were retrieved from the clinical trial registration platform ClinicalTrials.gov, from inception to October 25th, 2022. The records were screened by two researchers independently, and the registration time, registration count, sample sizes, interventions, primary outcome measurements and study design, etc., were summarized and analyzed, according to the PICOS principle.

Results A total of 218 eligible records were included. The registration count increased in recently years. Almost all of the trials (93.6%) were with a relatively small sample size less than 100, mainly 21 to 30 cases. The major intervention approach was the neuromodulation technique, however, virtual reality and robot-assisted gait training were coming to use in recent years. The primary outcome measurements were the clinical scales, the questionnaires and the exercise examinations. Randomized parallel controlled trials were the most (111, 50.9%).

Conclusion The number of non-drug therapy for gait abnormality of Parkinson's disease increased year by year. The new technologies such as virtual reality and robot-assisted gait training may be used more in the future.

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