Effects of home-based neurostimulation on outcomes after stroke: a systematic review and meta-analysis.

BACKGROUND: Home-based rehabilitation is a cost-effective means of making services available for patients. The aim of this study is to determine the evidence in the literature on the effects of home-based neurostimulation in patients with stroke. METHOD: We searched PubMED, Embase, Web of Science, Scopus, and CENTRAL for randomized controlled trials on the subject matter using keywords such as stroke, electrical stimulation and transcranial direct current stimulation. Information on participants' characteristics and mean scores on the outcomes of interest were extracted. Risks of bias and methodological quality of the included studies were assessed using Cochrane Risks of bias tool and PEDro scale respectively. The data was analyzed using both narrative and quantitative syntheses. In the quantitative synthesis, meta-analysis was carried out using random effect model analysis. RESULT: The results showed that, home-based neurostimulation is superior to the control at improving upper limb muscle strength (SMD = 0.72, 95% CI = 0.08 to 1.32, p = 0.03), functional mobility (SMD = -0.39, 95% CI = -0.65 to 0.14, p = 0.003) and walking endurance (SMD = 0.33, 95% CI = 0.08 to 0.59, p = 0.01) post intervention; and upper limb motor function (SMD = 0.9, 95% CI = 0.10 to 1.70, p = 0.03), functional mobility (SMD = -0.30, 95% CI = -0.56 to -0.05, p = 0.02) and walking endurance (SMD = 0.33, 95% CI = 0.08 to 0.59, p = 0.01) at follow-up. CONCLUSIONS: Home-based neurostimulation can be used to improve upper and lower limb function after stroke.

Effect of transcutaneous spinal direct current stimulation on spasticity in upper motor neuron conditions: a systematic review and meta-analysis.

STUDY DESIGN: A systematic review and meta-analysis of clinical trials. OBJECTIVES: To determine the effect of non-invasive transcutaneous spinal direct current stimulation (tsDCS) on spasticity, activity limitations and participation restrictions in various upper motor neuron diseases. METHODS: Six databases including CINAHL plus, Cochrane CENTRAL, Embase, MEDLINE, SCOPUS and Web of Science were searched for the relevant records from January 2008 to December 2022. Two reviewers independently selected and extracted data on spasticity, activity limitations and participation restrictions. The risk of bias was evaluated using the PEDro scale while the GRADE approach established the certainty of the evidence. RESULTS: Eleven studies were identified of which 5 (45.5%) were rated as having a low risk of bias and 8 (72.7%) were meta-analyzed. The meta-analyses did not show any significant differences between cathodal (SMD = -0.67, 95% CI = -1.50 to 0.15, P = 0.11, I2 = 75%, 6 RCTs) or anodal (SMD = 0.11, 95% CI = -0.43 to -0.64, p = 0.69, I2 = 0%, 2 RCTs) and sham tsDCS for spasticity. There was also no significant difference between active and sham tsDCS for activity limitations (SMD = -0.42, 95% CI = -0.04 to 0.21, p = 0.2, I2 = 0%, 2 RCTs) and participation restrictions (MD = -8.10, 95% CI = -18.02 to 1.82, p = 0.11, 1 RCT). CONCLUSIONS: The meta-analysis of the available evidence provides an uncertain estimate of the effect of cathodal tsDCS on spasticity, activity limitation and participation restriction. It might be very helpful, or it may make no difference at all. However, considering the level of the evidence and the limitation in the quality of the majority of the included studies, further well-designed research may likely change the estimate of effect. TRIAL REGISTRATION: PROSPERO CRD42021245601.

Prevalence, associated factors and predictors of post stroke pneumonia in a Nigerian population: A retrospective study.

OBJECTIVES: Stroke can trigger an immune response that can raise the risk of infection, alter tracheal epithelium, reduce pulmonary clearance and impair secretions drainage capacity. Infection, altered tracheal epithelium, reduced pulmonary clearance, impaired secretions drainage capacity and aspiration can cause pneumonia after stroke. The aim of this study is to find out the prevalence of post stroke pneumonia in a Nigerian population and factors that are associated with it. MATERIALS AND METHOD: Study data was extracted from the case files of patients with stroke who were managed between 1st January, 2011 and 1st February, 2021 in the study setting. RESULTS: The result showed that, there was a record of only 591 patients with stroke (mean age, 62.78 ± 14.86 years) who were managed in the two hospitals during the period of the study. Out of this number, only 102 (17.3 %) had pneumonia. Presence of the pneumonia was only significantly (p < 0.05) associated with sex, type of stroke, lower limb muscle power, and outcome (died or alive). However, only those with ischaemic stroke are less likely to have pneumonia (Odds ratio=  0.467; CI: 0.275 to 0.791, p=  0.005), and patients who survived the stroke and are alive are less likely to develop pneumonia (Odds ratio=  0.150; CI: 0.092 to 0.245, p < 0.001). CONCLUSIONS: Pneumonia occurs to a large extent after stroke. Therefore, it is important measures are taken to prevent it or complications arising from it especially in those with a hemorrhagic stroke.

Effect of home-based virtual reality training and telerehabilitation on balance in individuals with Parkinson disease, multiple sclerosis, and stroke: a systematic review and meta-analysis.

OBJECTIVE: In the last decade, there is a growing interest in the use of virtual reality for rehabilitation in clinical and home settings. The aim of this systematic review is to do a summary of the current evidence on the effect of home-based virtual reality training and telerehabilitation on postural balance in individuals with central neurological disorders. METHODS: Literature was searched in PubMed, Web of Science, PEDro, ScienceDirect, and MEDLINE. Randomized controlled trials (RCTs) evaluating the effect of home-based virtual reality (VR) training and telerehabilitation (TR) on postural balance in patients with Parkinson's disease, Multiple sclerosis or stroke. Studies were imported to EndNote and Excel to perform two screening phases by four reviewers. Risk of bias was assessed using PEDro scale and Cochrane assessment tool for risk of bias. Synthesis of the data on comparative outcomes was performed using RevMan software. RESULTS: Seven RCTs were included, with all three pathologies represented. VR and TR consisted of a training device (e.g., Nintendo Wii or Xbox 360) and a monitoring device (e.g., Skype or Microsoft Kinect). Five studies used the Berg Balance Scale (BBS) for measuring postural balance. Across studies, there was an improvement in BBS scores over time in both experimental and control groups, and the effect remained at follow-up for both groups. However, there was no significant difference between  groups post-intervention (MD = 0.74, p = 0.45). CONCLUSION: Home-based VR and TR can be used as prolongation to conventional therapy.

Vagus nerve stimulation for the treatment of epilepsy: things to note on the protocols, the effects and the mechanisms of action.

Epilepsy is a chronic brain disorder that is characterized by repetitive un-triggered seizures that occur severally within 24 h or more. Non-pharmacological methods for the management of epilepsy were discussed. The non-pharmacological methods include the vagus nerve stimulation (VNS) which is subdivided into invasive and non-invasive techniques. For the non-invasive techniques, the auricular VNS, stimulation of the cervical branch of vagus nerve in the neck, manual massage of the neck, and respiratory vagal nerve stimulation were discussed. Similarly, the stimulation parameters used and the mechanisms of actions through which VNS improves seizures were also discussed. Use of VNS to reduce seizure frequency has come a long way. However, considering the cost and side effects of the invasive method, non-invasive techniques should be given a renewed attention. In particular, respiratory vagal nerve stimulation should be considered. In doing this, the patients should for instance carry out slow-deep breathing exercise 6 to 8 times every 3 h during the waking hours. Slow-deep breathing can be carried out by the patients on their own; therefore this can serve as a form of self-management.HIGHLIGHTSEpilepsy can interfere with the patients' ability to carry out their daily activities and ultimately affect their quality of life.Medications are used to manage epilepsy; but they often have their serious side effects.Vagus nerve stimulation (VNS) is gaining ground especially in the management of refractory epilepsy.The VNS is administered through either the invasive or the non-invasive methodsThe invasive method of VNS like the medication has potential side effects, and can be costly.The non-invasive method includes auricular VNS, stimulation of the neck muscles and skin and respiratory vagal nerve stimulation via slow-deep breathing exercises.The respiratory vagal nerve stimulation via slow-deep breathing exercises seems easy to administer even by the patients themselves.Consequently, it is our opinion that patients with epilepsy be made to carry out slow-deep breathing exercise 6-8 times every 3 h during the waking hours.

Determination of hand grip strength and its correlates during pregnancy: a cross-sectional study.

BACKGROUND: Pregnancy results in many changes, including reduced hand grip strength (HGS). However, good HGS is required for physical functions such as carrying and breastfeeding the baby after birth. The aim of this study was to determine the factors that may predict HGS during pregnancy. METHODS: The study was a cross-sectional study approved by the Research Ethics Committees of Kano State Ministry of Health and Aminu Kano Teaching Hospital in Kano, north-west, Nigeria. Pregnant women at the designated hospitals were included in the study if they had no serious comorbidities or any known neurological condition that affects the hands and the neck. Demographic characteristics and independent (predictor) variables (age, weight, height, BMI, maternity leave status, number of full-term deliveries, number of preterm deliveries, number of live births, number of abortuses, gravidity, trimester, systolic blood pressure, diastolic blood pressure, inter arm systolic BP difference [IASBP], inter arm diastolic BP difference [IADBP], and heart rate) of each of the participants were recorded by experienced therapists. The data were analysed using descriptive statistics, t-test, Pearson correlation coefficient and standard multiple regression. RESULT: One hundred and sixty-one pregnant women with mean age, 25.04 ± 4.83 years participated in the study. In the dominant hand, 120 participants (74.5%) had weak grip strength. In the non-dominant hand, 135 participants (83.9%) had weak grip strength. For the dominant hand, the total variance explained by the whole model was significant, 28.5%, F(11, 161) = 1.187, R2 = 0.081, p = 0.300 . In the final model, none of the variables significantly predicted HGS. However, systolic blood pressure contributed to the model more than any other variable (Beta = -0.155). For the non-dominant hand, the total variance explained by the whole model was not significant, 33.1%, F(11, 161) = 1.675, R2 = 0.111, p = 0.089 . In the final model, only systolic blood pressure (Beta = -0.254, p = 0.023) significantly predicted hand grip strength. CONCLUSION: Cardiovascular events or changes during pregnancy (such as change in systolic blood pressure) may be related to HGS in pregnant women. It is therefore, important for clinicians to pay attention to this, in planning rehabilitation strategies for pregnant women.

Constraint-induced movement therapy protocols using the number of repetitions of task practice: a systematic review of feasibility and effects.

BACKGROUND: High repetitions of task practice is required for the recovery of the motor function during constraint-induced movement therapy (CIMT). This can be achieved into ways: when the task practice is measured in hours of practice or when the number of repetitions is counted. However, it has been argued that using hours of task practice as a measure of practice does not provide a clear instruction on the dose of practice. AIM: The aim of this study is to determine the feasibility and effects of the CIMT protocol that uses the number of repetitions of task practice. MATERIALS/METHOD: The study was a systematic review registered in PROSPERO (CRD42020142140). Five databases, PubMED, CENTRAL, PEDro, OTSeeker and Web of Science, were searched. Studies of any designs in adults with stroke were included if they used the number of repetitions of task practice as a measure of dose. The methodological quality of the included studies was assessed using Modified McMaster critical review form. The results were analysed using qualitative synthesis. RESULTS: Eight studies (n = 205) were included in the study. The number of task repetitions in the studies ranges between 45 and 1280 per day. The results showed that CIMT protocol using the number of repetitions of task practice was feasible and improved outcomes such as motor function, quality of life, functional mobility and spasticity. CONCLUSION: The number of repetitions of task practice as a measure of CIMT dose can be used in place of the existing protocol that uses the number of hours of task practice.

Comparing Two Different Modes of Task Practice during Lower Limb Constraint-Induced Movement Therapy in People with Stroke: A Randomized Clinical Trial.

Background: Constraint-induced movement therapy (CIMT) is used for the rehabilitation of motor function after stroke. Objectives: The aim of this study was to compare the effects of lower limb CIMT that uses number of repetition of tasks with the one that uses number of hours of practice. Method: The study was a randomized clinical trial approved by the Ethics Committee of Kano State Ministry of Health. Fifty-eight people with stroke participated in the study. Groups 1 and 2 performed daily 600 repetitions and 3 hours of task practice, respectively, 5 times weekly for 4 weeks. Motor impairment (primary outcome), balance, functional mobility, knee extensor spasticity, walking speed and endurance, and exertion before and after commencement of activities were assessed at baseline and postintervention. The data was analyzed using Friedmann and Mann-Whitney U tests. Result: The results showed that there was only significant difference (p < 0.05) in knee extensor spasticity (group 1 (median = 0(0), mean rank = 27.50); group 2 (median = 0(0), mean rank = 31.64)), exertion before commencement of activities (group 1 (median = 0(0.5), mean rank = 21.90); group 2 (median = 1(0.5), mean rank = 37.64)), and exertion after commencement of activities (group 1 (median = 1(1), mean rank = 20.07); group 2 (median = 1(0), mean rank = 39.61) postintervention in favour of the experimental group (group 1)). Conclusion: The group 1 protocol is more effective at improving outcomes after stroke.

Knowledge and current practices of physiotherapists on the physical activity and exercise in the rehabilitation of children with epileptic seizures.

BACKGROUND: Physiotherapists play a key role in the rehabilitation of children with epileptic seizures. Regular physical exercise generates psychological and physiological benefits for people with epilepsy. DESIGN: This study was a cross-sectional design. PURPOSE: The purpose of this study was to evaluate the knowledge and current practices of physiotherapists on the physical activity and exercise in the rehabilitation of children with epileptic seizures in Nigeria. METHODS: Physiotherapists with minimum bachelor's degrees were invited to participate in the study using an electronic questionnaire. The subjects (N = 117) answered a questionnaire comprising 33 simple closed-ended questions with three domains: personal information, knowledge, and current practices. RESULTS: Out of the 117 physiotherapists, 77.7% (n = 91) had postgraduate degrees, 16.2% (n = 19) had bachelor's degree in physiotherapy, and only 5.9% (n = 7) had Doctor of Physical Therapy (DPT). The results also indicated that 79.5% (n = 93) of physiotherapists had sufficient knowledge about epilepsy, and 86.3% (n = 101) of physiotherapists were using current skills/physical activity to rehabilitate children with epileptic seizures. CONCLUSIONS: It was concluded that physiotherapists had sufficient knowledge about epilepsy and were using current skills/physical activity in the rehabilitation of children with epileptic seizures.

Caregiver's perspectives on facilitators and barriers of active participation in cerebral palsy rehabilitation in North West Nigeria: a qualitative study.

BACKGROUND: Cerebral Palsy (CP) refers to the permanent disorders involving postural and movement control as a result of injury to the developing brain. As a result of impairment in postural and movement control, children with CP usually have problems in carrying out activities of daily living (ADL). This makes them dependent on help from their caregivers. Thus, for effective rehabilitation of children with CP, active participation of their caregivers is important. This study seeks to explore the facilitators and barriers of active participation of caregivers in the rehabilitation of children with CP in Kano, Nigeria. METHODS: The study design used was qualitative in-depth interview. The participants were caregivers of children with CP at Hasiya Bayero Paediatric Specialists Hospital, Kano. The caregivers were interviewed face-to-face, and their responses were audio-recorded with a tape recorder, supplemented with note taking. The data generated was analyzed using constant comparative analysis. RESULTS: Forty young caregivers (mean age, 27.17 ± 4.46 years) participated in the study. They expressed encouragement from the therapist managing the child, family support, empathy, improvement in the conditions of other children with CP, cooperation of the child during home programs family support and improvement in the child's condition as factors that facilitate their active participation in the rehabilitation of the children. However, they mentioned occupation, financial resources and the number of children the caregiver has are the barriers to their active participation in the rehabilitation of the children. CONCLUSIONS: Both the facilitators and barriers of active participation of caregivers in the rehabilitation of children with CP need to be recognized in order to help caregivers reinforce or overcome them respectively. In addition, economically sustainable and accessible rehabilitation services are needed for all children with CP. Similarly, sharing caregiving rehabilitation tasks amongst family members could facilitate caregiver active participation.

Neurobiology of Recovery of Motor Function after Stroke: The Central Nervous System Biomarker Effects of Constraint-Induced Movement Therapy.

Recovery of motor function after stroke involves many biomarkers. This review attempts to identify the biomarker effects responsible for recovery of motor function following the use of Constraint-Induced Movement Therapy (CIMT) and discuss their implications for research and practice. From the studies reviewed, the biomarker effects identified include improved perfusion of motor areas and brain glucose metabolism; increased expression of proteins, namely, Brain-Derived Neurotrophic Factor (BDNF), Vascular Endothelial Growth Factor (VEGF), and Growth-Associated Protein 43 (GAP-43); and decreased level of Gamma-Aminobutyric Acid (GABA). Others include increased cortical activation, increased motor map size, and decreased interhemispheric inhibition of the ipsilesional hemisphere by the contralesional hemisphere. Interestingly, the biomarker effects correlated well with improved motor function. However, some of the biomarker effects have not yet been investigated in humans, and they require that CIMT starts early on poststroke. In addition, one study seems to suggest the combined use of CIMT with other rehabilitation techniques such as Transcortical Direct Stimulation (tDCs) in patients with chronic stroke to achieve the biomarker effects. Unfortunately, there are few studies in humans that implemented CIMT during early poststroke. Thus, it is important that more studies in humans are carried out to determine the biomarker effects of CIMT especially early on poststroke, when there is a greater opportunity for recovery. Furthermore, it should be noted that these effects are mainly in ischaemic stroke.

Stochastic SIS Modelling: Coinfection of Two Pathogens in Two-Host Communities.

A pathogen can infect multiple hosts. For example, zoonotic diseases like rabies often colonize both humans and animals. Meanwhile, a single host can sometimes be infected with many pathogens, such as malaria and meningitis. Therefore, we studied two susceptible classes S 1 ( t ) and S 2 ( t ) , each of which can be infected when interacting with two different infectious groups I 1 ( t ) and I 2 ( t ) . The stochastic models were formulated through the continuous time Markov chain (CTMC) along with their deterministic analogues. The statistics for the developed model were studied using the multi-type branching process. Since each epidemic class was assumed to transmit only its own type of pathogen, two reproduction numbers were obtained, in addition to the probability-generating functions of offspring. Thus, these, together with the mean number of infections, were used to estimate the probability of extinction. The initial population of infectious classes can influence their probability of extinction. Understanding the disease extinctions and outbreaks could result in rapid intervention by the management for effective control measures.

Understanding the mechanisms of disease modifying effects of aerobic exercise in people with Alzheimer's disease.

Alzheimer's disease (AD) is a very disabling disease. Pathologically, it is characterized by the presence of amyloid plaques and neurofibrillary tangles in the brain that results in neurodegeneration. Its clinical manifestations include progressive memory impairment, language decline and difficulty in carrying out activities of daily living (ADL). The disease is managed using interventions such as pharmacological interventions and aerobic exercise. Use of aerobic exercise has shown some promises in reducing the risk of developing AD, and improving cognitive function and the ability to carry out both basic and instrumental ADL. Although, the mechanisms through which aerobic exercise improves AD are poorly understood, improvement in vascular function, brain glucose metabolism and cardiorespiratory fitness, increase in antioxidant capacity and haemoglobin level, amelioration of immune-related and inflammatory responses, modulation of concentration of circulating Neurotrophins and peptides and decrease in concentration of tau protein and cortisol level among others seem to be the possible mechanisms. Therefore, understanding these mechanisms is important to help characterize the dose and the nature of the aerobic exercise to be given. In addition, they may also help in finding ways to optimize other interventions such as the pharmacological interventions. However, more quality studies are needed to verify the mechanisms.

Effects of home-based and telerehabilitation exercise on mental and physical health, and disease cost in people with Alzheimer's disease: A meta-analysis.

BACKGROUND: Alzheimer's disease (AD) is a very disabling long-term disease that requires continuous regular care. A cost-effective and sustainable means of such care may be physical activity or exercise delivered at home or through telerehabilitation. The aim of this study is to determine the effects of home-based or telerehabilitation exercise in people with AD. METHOD: PubMED, Embase, Web of Science (WoS), PEDro, and CENTRAL were searched for randomized controlled trials until January 2024. The data extracted include the characteristics of the participants, the interventions used for both experimental and the control groups, the baseline, post-intervention and follow-up mean and standard deviation values on the outcomes assessed and the findings of the included studies. Cochrane risks of bias assessment tool and PEDro scale were used to assess the risks of bias and methodological quality of the studies. The results were analyzed using narrative and quantitative syntheses. RESULT: Eleven articles from nine studies (n=550) were included in the study. The results showed that, only global cognitive function (SMD = 0.72, 95% CI = 0.19-1.25, p=0.007), neuropsychiatric symptom (MD = -5.28, 95% CI =-6.22 to -4.34, p<0.0001) and ADL (SMD =3.12, 95% CI =0.11-6.13, p=0.04) improved significantly higher in the experimental group post-intervention. At follow-up, the significant difference was maintained only in neuropsychiatric symptoms (MD =-6.20, 95% CI =-7.17 to -5.23, p<0.0001). CONCLUSION: There is a low evidence on the effects of home-based physical activity or exercise on global cognitive function, neuropsychiatric symptoms and ADL.

A Qualitative Study of HIV Testing Experiences and HIV Self-Testing Perspectives among Men in Northern Nigeria.

HIV self-testing (HIVST) holds promise for accessing hard-to-reach populations by overcoming sociocultural and structural barriers to awareness of HIV status. This phenomenological qualitative study explored the experiences and perspectives of married men in Kano, northern Nigeria, regarding HIV testing and counseling (HTC) and HIVST. Twenty married men from diverse socioeconomic backgrounds participated in in-depth interviews conducted in the local language. Thematic analysis was employed to analyze the data, yielding key themes related to prior test experiences, knowledge of self-testing, and perceived ease of use, in addition to motivation for self-testing and concerns about reliability and counseling support. The findings shed light on the impact of facility-based HIV testing experiences on the perspectives of participants. Concerns related to delays, overcrowding, discomfort, fear, and unsupportive attitudes from healthcare providers influenced their perceptions. Among persons with previous self-testing experience, initial uneasiness was overcome with repeated use, highlighting the ease of use associated with HIVST. Motivations for self-testing included privacy, convenience, personal empowerment, improved infection detection, and efficiency. Concerns were raised regarding the reliability of self-testing results compared to hospital-based testing, and the absence of counseling support during self-testing. Our findings underscore the need to address infrastructural limitations, enhance counseling support, and promote awareness and knowledge of HIVST.

Prevalence and risks factors of caregiving-related low back pain among caregivers of stroke survivors: a systematic review and meta-analysis.

INTRODUCTION: Stroke causes disability that makes its survivors depend on caregivers for help. The caregivers offer help during lifting and transferring patients from one place to another. However, such activities result in the caregivers sustaining musculoskeletal injuries such as the low back pain (LBP). The aim of this study was to carry out a systematic review and meta-analysis to determine the prevalence of LBP and its risk factors among these caregivers. EVIDENCE ACQUISITION: PubMED, Embase, Web of Science (WoS) and CINAHL were searched until January 2023, and cross-sectional studies were included. Data on prevalence of LBP due to caregiving activities and participants' characteristics such as sex and nature of caregiving were extracted. EVIDENCE SYNTHESIS: Risks of bias of the included studies were assessed using Agency for healthcare Research and Quality (AHRQ) tool. The data were analyzed using both narrative and quantitative syntheses. In the quantitative synthesis, random effect model meta-analysis of the prevalence and odd of developing LBP between men and women; and between partial and complete caregivers was used. Fives studies (N.=644) were included. The results showed that the prevalence of LBP was 53.9%, with 96% CI from 50.0% to 57.8%. In addition, there was no statistically significant difference in the risk of developing LBP between men and women (OR=1.58, 95% CI=0.27 to 9.27, P=0.61); and between partial and complete caregivers (OR=1.33, 95% CI=0.32 to 5.61, P=0.70). CONCLUSIONS: About half of caregivers of stroke survivors may experience LBP. Therefore, this should be considered during rehabilitation.

Efficacy of diaphragmatic breathing exercise on respiratory, cognitive, and motor function outcomes in patients with stroke: a systematic review and meta-analysis.

Background: Stroke disrupts the functions carried out by the brain such as the control of movement, sensation, and cognition. Disruption of movement control results in hemiparesis that affects the function of the diaphragm. Impaired function of the diaphragm can in turn affect many outcomes such as respiratory, cognitive, and motor function. The aim of this study is to carry out a systematic review and meta-analysis to determine the efficacy of diaphragmatic breathing exercise on respiratory, cognitive, and motor outcomes after stroke. Method: The study was registered in PROSPERO (CRD42023422293). PubMED, Embase, Web of Science (WoS), PEDro, Scopus, and CENTRAL databases were searched until September 2023. Only randomized controlled trials comparing diaphragmatic breathing exercise with a control were included. Information on the study authors, time since stroke, mean age, height, weight, sex, and the protocols of the experimental and control interventions including intensity, mean scores on the outcomes such as respiratory, cognitive, and motor functions were extracted. Cochrane risks of bias assessment tool and PEDro scale were used to assess the risks of bias and methodological quality of the studies. Narrative synthesis and meta-analysis were used to summarize the results, which were then presented in tables, risk-of-bias graph, and forest plots. The meta-analysis was carried out on respiratory function [forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC, peak expiratory flow (PEF)] and motor function (trunk impairment, and internal and external oblique muscles activity). Results: Six studies consisting of 151 participants were included. The results of the meta-analyses showed that diaphragmatic breathing exercise is only superior to the control at improving respiratory function, FVC (MD = 0.90, 95% CI = 0.76 to 1.04, P < 0.00001), FEV1 (MD = 0.32, 95% CI = 0.11 to 0.52, P = 0.002), and PEF (MD = 1.48, 95% CI = 1.15 to 1.81, P < 0.00001). Conclusion: There is limited evidence suggesting that diaphragmatic breathing exercise may help enhance respiratory function, which may help enhance recovery of function post stroke. Systematic Review Registration: PROSPERO, identifier CRD42023422293.

Effects of constraint induced movement therapy in patients with multiple sclerosis: A systematic review.

BACKGROUND: Multiple sclerosis (MS) is a chronic neurodegenerative disorder of the central nervous system (CNS) that commonly affects young and middle-aged adults. Neurodegeneration of the CNS affects its functions such as sensorimotor, autonomic and cognitive functions. Affectation of motor function can result in disability in performance of daily life activities. Thus, effective rehabilitation interventions are needed to help prevent disability in patients with MS. One of these interventions is the constraint induced movement therapy (CIMT). The CIMT is used to improve motor function in patients with stroke and other neurological conditions. Recently, its use in patients with MS is gaining ground. The aim of this study is to carry out a systematic review and meta-analysis to determine from the literature, the effects of CIMT on upper limb function in patients with MS. METHODS: PubMED, Embase, Web of Science (WoS), PEDro, and CENTRAL were searched until October 2022. Randomized controlled trials in patients with MS who were 18 years and above were included. Data on the characteristics of the study participants such as disease duration, type of MS, the mean scores of the outcomes of interest such as motor function and use of the arm in daily activities, and white matter integrity were extracted. Methodological quality and risks of bias of the included studies were assessed using PEDro scale and Cochrane risks of bias tool. The data was analysed using both narrative and quantitative syntheses. In the quantitative synthesis, random effect model meta-analysis of the mean and standard deviation of the scores on the outcomes of interest and the study sample size (for both the CIMT and the control group) post intervention was carried out. In addition, percentage of variation across the studies due to heterogeneity (I2) was considered significant when it is between 50% and 90% at p < 0.05. RESULTS: Two studies comprising of 4 published articles with good methodological quality were included in the study. The results showed that, CIMT is safe and improved white matter integrity, motor function, muscle strength, dexterity, real-world arm use and biomechanical parameters post intervention. However, although there was a trend towards better improvement in the CIMT group in all the outcomes, there was no statistically significant difference between groups in motor function (SMD=0.44, 95% CI=-0.20 to 1.07, p = 0.18) and quality of movement (SMD=0.96, -1.15 to 3.07, p = 0.37). CONCLUSION: CIMT can be used in patients with MS since it is safe as well as effective at improving functional outcomes. However, more studies are required to confirm its safety and effectiveness.

Combination of noninvasive brain stimulation and constraint-induced movement therapy in patients with stroke: a systematic review and meta-analysis.

INTRODUCTION: Constraint-induced movement therapy (CIMT) and noninvasive brain stimulation (NIBS) are used to counteract learned nonuse phenomenon and imbalance in interhemispheric inhibition following stroke. The aim of this study is to summarize the available evidence on the effects of combining NIBS with CIMT in patients with stroke. METHOD: PubMed, Embase, Web of Science (WoS), PEDro, OTSeeker, and CENTRAL were searched for randomized controlled trials comparing the use of NIBS+CIMT with sham NIBS+CIMT. Data on variables such as time since stroke and mean scores and standard deviations on outcomes assessed such as motor function were extracted. Cochrane risks of bias assessment tool and PEDro scale were used to assess the risk of bias and methodological quality of the included studies. RESULTS: The results showed that both NIBS+CIMT and sham NIBS+CIMT improved all outcomes post-intervention and at follow-up. However, NIBS+CIMT is superior to sham NIBS+CIMT at improving level of motor impairment (SMD = 1.75, 95% CI = 0.49 to 3.01, P = 0.007) post-intervention and hand function (SMD = 1.21, 95% CI = 0.07 to 2.35, P = 0.04) at follow-up. CONCLUSIONS: The addition of NIBS to CIMT seems to provide additional benefits to the recovery of function following stroke.