Systematic review and meta-analysis of randomized controlled trials assessing the impact of Baduanjin exercise on cognition and memory in patients with mild cognitive impairment.

OBJECTIVE: To determine the effectiveness of Baduanjin exercise in improving cognition and memory in patients with mild cognitive impairment. DATA SOURCES: Relevant English- and Chinese-language studies published until 15th September 2020 were retrieved from the PubMed, Web of Science, Cochrane Library, Embase, EBSCOhost, OVID, National Knowledge Infrastructure, WANFANG DATA, VIP Information, and SinoMed databases. REVIEW METHODS: Randomized controlled trials assessing Baduanjin exercise in patients with mild cognitive impairment were included. Two researchers independently identified eligible studies and extracted data. Risk-of-bias assessment was performed using the Cochrane Risk of Bias Tool. RESULTS: This study included 16 randomized controlled trials (1054 participants) from China that used Chinese versions of standardized tests. Most studies had no significant bias, and only one study had a high risk of bias in the random allocation category. Compared with conventional therapy alone, Baduanjin plus conventional therapy significantly improved the Montreal Cognitive Assessment and Mini-Mental State Examination scores after 6 months of treatment (P < 0.00001 for both), significantly decreased the tau/Aß1-42 ratio in the cerebrospinal fluid (P < 0.00001), and significantly improved some dimensional scores on the Wechsler Memory Scale and the auditory verbal learning test scores at 6 months (P < 0.05 for all). CONCLUSION: Compared with conventional therapy, Baduanjin plus conventional therapy significantly improved cognitive and memory function in patients with mild cognitive impairment.

Effects of MOTOmed movement therapy on the mobility and activities of daily living of stroke patients with hemiplegia: a systematic review and meta-analysis.

OBJECTIVE:: To estimate the effectiveness of MOTOmed® movement therapy in increasing mobility and activities of daily living in stroke patients with hemiplegia. DESIGN:: Systematic review. DATA SOURCES:: English- and Chinese-language articles published from the start of database coverage through 20 June 2018 were retrieved from the Embase, Web of Science, PubMed, OVID, Cochrane Central Register of Controlled Trials, Cochrane Systematic Reviews, Wanfang, Chinese National Knowledge Infrastructure, VIP, and Chinese Biomedicine databases. Articles were also retrieved by manual searches of Rehabilitation Medicine and Chinese journals. METHODS:: Randomized control trials examining MOTOmed movement therapy interventions for patients with post-stroke hemiplegia were included in this review. The risk of bias assessment tool was utilized in accordance with Cochrane Handbook 5.1.0. All included studies reported mobility effects as primary outcomes. Standardized mean differences or mean differences with the corresponding 95% confidence intervals (CIs) were calculated. Review Manager 5.3 was utilized for meta-analysis. RESULTS:: In total, 19 trials involving a total of 1099 patients were included in the analysis. All studies were of moderate quality, based on the Cochrane Handbook for Systematic Reviews of Intervention: Part 2:8.5. MOTOmed movement therapy resulted in a merged mean difference in the Fugl-Meyer Assessment score of 5.51 (95% CI: 4.03 to 6.98). Comparison of groups treated with and without MOTOmed movement therapy yielded the following mean differences: Modified Ashworth Scale, -1.13 (95% CI: -1.37 to -0.89); Berg Balance Scale, 13.66 (95% CI: 10.47-16.85); Functional Ambulation Category Scale, 0.85 (95% CI: 0.68-1.03); 10-m walk test, 10.15 (95% CI: 5.72-14.58); Barthel Index, 14.82 (95% CI: 12.96-16.68); and Modified Barthel Index, 11.49 (95% CI: 8.96-14.03). CONCLUSION:: MOTOmed movement therapy combined with standard rehabilitation improves mobility and activities of daily living in stroke patients with hemiplegia.

A 4-Week Straw Phonation in Water Exercise Program for Aging-Related Vocal Fold Atrophy.

PURPOSE: This study evaluated the efficacy of a 4-week straw phonation in water (SPW) exercise program on aging-related vocal fold atrophy (VFA), with a secondary objective to examine the immediate effects of SPW exercises. METHOD: Thirty-eight older adults aged 60 years and above formally diagnosed with aging-related VFA were randomly assigned into an experimental group undergoing SPW exercises with an 8-cm depth of straw submersion into water for 4 weeks plus vocal hygiene practice (n = 20), and a control group with only vocal hygiene practice (n = 18). Outcome measures included laryngeal endoscopic measures of glottal gap, auditory-perceptual ratings of voice quality, acoustic measures, aerodynamic measures, and standardized self-assessment questionnaire scores. An additional round of acoustic and aerodynamic assessment following 20 min of SPW exercises was conducted to examine the immediate effects. RESULTS: Significant improvements in normalized glottal gap area, perceptual rating of breathiness, smoothed cepstral peak prominence, harmonics-to-noise ratio (HNR), mean oral airflow, subglottal pressure and laryngeal airway resistance at comfortable loudness, Voice-related Quality of Life scores, and Chinese Vocal Fatigue Index Factor 3 scores were observed in the experimental group relative to the control group. There were also significant immediate effects for HNR, mean oral airflow, subglottal pressure, and laryngeal airway resistance. CONCLUSIONS: These findings suggested significant immediate improvements in vocal function following SPW exercises, with additional significant improvements in vocal function as well as significant improvements in quality of life following the 4-week SPW exercise program. Further studies with more long-term follow-up are recommended to better understand the efficacy of SPW exercises with deep levels of straw submersion into water as an effective clinical option for the management of hypofunctional dysphonia associated with aging-related VFA.

Low-Frequency Repetitive Transcranial Magnetic Stimulation in Patients With Poststroke Aphasia: Systematic Review and Meta-Analysis of Its Effect Upon Communication.

Objective The aim of the study was to investigate the effectiveness and safety of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) in patients with poststroke aphasia. Method We comprehensively searched for eligible studies from 11 electronic medical databases from their inception to February 20, 2019. Randomized controlled trials reporting the effectiveness of LF-rTMS for patients with poststroke aphasia were included. The primary outcome was language ability. The secondary outcomes were functional communication and adverse events. The methodological quality of the randomized controlled trials was evaluated by the Cochrane Back Review Group Risk of Bias Assessment Criteria. Results Of the 567 records retrieved, 18 studies with a total of 536 participants were included. All the included studies were of relatively acceptable methodological quality. All studies but one used LF-rTMS + speech and language therapy (SLT), not LF-rTMS alone. The meta-analysis showed that LF-rTMS had beneficial effects for patients with aphasia after a stroke in terms of naming, repetition, comprehension, written language, and functional communication. The subgroup analyses of language performance showed positive effects of LF-rTMS among stroke patients with chronic aphasia and acute aphasia. LF-rTMS + SLT had effects on language performance that were superior to the sham rTMS + SLT and SLT alone. A shorter LF-rTMS duration benefited language performance more than a longer duration. Additionally, 20 min of LF-rTMS per session produced a positive effect on language ability for patients with aphasia after a stroke. No adverse events were reported. Conclusions LF-rTMS + SLT is an effective and safe method for patients with poststroke aphasia to improve their language performance. Additionally, the most commonly used LF-rTMS protocol for patients with aphasia after a stroke was 90% of the resting motor threshold 20 min per day, 5 days per week, for 2 weeks.

Acupoint Massage for Managing Cognitive Alterations in Older Adults: A Systematic Review and Meta-Analysis.

BACKGROUND: Cognitive disorders pose a major problem in the aging population across the globe. Acupoint massage has been used to improve cognitive functions in older adults. In this study, the authors performed a meta-analysis to evaluate the usefulness of acupoint massage in preventing cognitive declines in older adults. DESIGN: The authors searched for randomized controlled trials (RCTs) reporting on the effectiveness of acupoint massage on cognition in older adults in the following literature databases: PubMed, MEDLINE, Embase, CINAHL, ScienceDirect, Foreign Medical Journal Service, Cochrane Library, VIP Information, Chinese National Knowledge Infrastructure, WANFANG, and Chinese Biomedical. Two reviewers independently extracted the data related to the study and participants' characteristics and the cognitive impairment outcomes. Only RCTs meeting the inclusion criteria were used in the present meta-analysis. RESULTS: Eight RCTs with 657 participants in total (age ≥60 years) were included. It is actually 8 for synthetic and 6 in the meta-analysis. The authors calculated the pooled estimates of the random effects of changes in the Mini-Mental State Examination to compare the groups with and without acupoint massage. The merged mean difference (MD) was 1.94 (95% confidence interval, C.I., [1.41-2.47], p < 0.00001) after 3 months of acupoint massage treatment and 3.04 (95% C.I. [2.43-3.64], p < 0.00001) after 6 months of treatment. They also calculated the merged MD of the Wechsler Memory Scale-Revised Chinese version after 6 months of acupoint massage. Visual Reproduction was 2.95 (95% C.I. [1.30-4.60], p = 0.0005), Associate Learning was 1.89 (95% C.I. [1.41-2.37], p < 0.00001), Logical Memory was 2.85 (95% C.I. [2.06-3.63], p < 0.00001), and Digit Span was 3.16 (95% C.I. [2.59-3.73], p < 0.00001). The Cochrane Handbook for Systematic Reviews of Interventions was used to rate the quality of the studies, which was moderate overall. CONCLUSION: The findings suggested that acupoint massage is an effective intervention for maintaining cognitive functions in older adults.