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      Using brain functional magnetic resonance imaging to evaluate the effectiveness of acupuncture combined with mirror therapy on upper limb function in patients with cerebral ischemic stroke: a study protocol for a randomized, controlled trial

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          Abstract

          Background

          Upper limb and hand motor dysfunction is one of the challenges in rehabilitation after cerebral ischemic stroke (CIS), and the clinical efficacy of rehabilitation needs to be improved. This study aims to combine Jin’s three-needle acupuncture (JTN) therapy with mirror therapy (MT) for hemiplegia after CIS, objectively evaluate the clinical effects and safety of JTN to treat upper limb dysfunction, and use functional magnetic resonance imaging (fMRI) of the brain to investigate the central mechanisms of the effects, which would provide a powerful evidence-based medical basis for further supporting the application of JTN combined with MT.

          Methods/design

          This trial will be a single-blind, randomized controlled study. Patients who meet the study criteria will be recruited and randomly assigned to either the combined treatment group (JTN+MT) or the JTN group. Both interventions will be conducted for 6 days per week and last for 4 weeks. The primary outcome will be the effective rate based on the Fugl–Meyer Assessment for Upper Extremity (FMA-UE). Other outcome measures will include scores on the motor assessment scale (MAS), action research arm test (ARAT), activities of daily living (ADL) scale, and fMRI analyses. For safety evaluation, adverse events will be observed and recorded.

          Discussion

          This study may help to identify the efficacy and safety of acupuncture combined with MT for upper limb dysfunction after CIS and explore the central mechanisms with brain fMRI.

          Trial registration

          Chinese Clinical Trial Registry ChiCTR-IOR-17012174. Registered on 5 April 2017.

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          Most cited references35

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          Motor recovery after stroke: a systematic review.

          Loss of functional movement is a common consequence of stroke for which a wide range of interventions has been developed. In this Review, we aimed to provide an overview of the available evidence on interventions for motor recovery after stroke through the evaluation of systematic reviews, supplemented by recent randomised controlled trials. Most trials were small and had some design limitations. Improvements in recovery of arm function were seen for constraint-induced movement therapy, electromyographic biofeedback, mental practice with motor imagery, and robotics. Improvements in transfer ability or balance were seen with repetitive task training, biofeedback, and training with a moving platform. Physical fitness training, high-intensity therapy (usually physiotherapy), and repetitive task training improved walking speed. Although the existing evidence is limited by poor trial designs, some treatments do show promise for improving motor recovery, particularly those that have focused on high-intensity and repetitive task-specific practice.
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            Current advances in ischemic stroke research and therapies

            With more than 795,000 cases occurring every year, stroke has become a major problem in the United States across all demographics. Stroke is the leading cause of long-term disability and is the fifth leading cause of death in the US. Ischemic stroke represents 87% of total strokes in the US, and is currently the main focus of stroke research. This literature review examines the risk factors associated with ischemic stroke, changes in cell morphology and signaling in the brain after stroke, and the advantages and disadvantages of in vivo and in vitro ischemic stroke models. Classification systems for stroke etiology are also discussed briefly, as well as current ischemic stroke therapies and new therapeutic strategies that focus on the potential of stem cells to promote stroke recovery.
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              The Kinesthetic and Visual Imagery Questionnaire (KVIQ) for assessing motor imagery in persons with physical disabilities: a reliability and construct validity study.

              To benefit from mental practice training after stroke, one must be able to engage in motor imagery, and thus reliable motor imagery assessment tools tailored to persons with sensorimotor impairments are needed. The aims of this study were to (1) examine the test-retest reliability of the Kinesthetic and Visual Imagery Questionnaire (KVIQ-20) and its short version (the KVIQ-10) in healthy subjects and subjects with stroke, (2) investigate the internal consistency of both KVIQ versions, and (3) explore the factorial structure of the two KVIQ versions. The KVIQ assesses on a five-point ordinal scale the clarity of the image (visual: V subscale) and the intensity of the sensations (kinesthetic: K subscale) that the subjects are able to imagine from the first-person perspective. Nineteen persons who had sustained a stroke (CVA group) and 46 healthy persons (CTL group) including an age-matched (aCTL: n = 19) control group were assessed twice by the same examiner 10 to 14 days apart. The test-retest reliability was assessed using intraclass correlation coef- ficients (ICCs). The internal consistency (Cronbach alpha) and the factorial structure of both KVIQ versions were studied in a sample of 131 subjects. In the CVA group, the ICCs ranged from 0.81 to 0.90, from 0.73 to 0.86 in the aCTL group, and from 0.72 to 0.81 in the CTL group. When imagining movements of the affected and unaffected limbs (upper and lower limbs combined) ICCs in the CVA group ranged, respectively, from 0.71 to.87 and from 0.86 to 0.94. Likewise, when imagining movement of the dominant and nondominant limbs, ICCs in the aCTL group ranged, respectively, from 0.75 to 0.89 and from 0.81 to.92. Cronbach a values were, respectively, 0.94 (V) and 0.92 (K) for the KVIQ-20 and 0.89 (V) and 0.87(K) for the KVIQ-10. The factorial analyses indicated that two factors explained 63.4% and 67.7% of total variance, respectively. Both versions of the KVIQ present similar psychometric properties that support their use in healthy individuals and in persons post-stroke. Because the KVIQ-10 can be administered in half the time, however, it is a good choice when assessing persons with physical disabilities.
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                Author and article information

                Contributors
                312259917@qq.com
                herb107@126.com
                Journal
                Trials
                Trials
                Trials
                BioMed Central (London )
                1745-6215
                12 January 2021
                12 January 2021
                2021
                : 22
                : 53
                Affiliations
                [1 ]Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, 518034 Guangdong China
                [2 ]GRID grid.284723.8, ISNI 0000 0000 8877 7471, Shenzhen Hospital, , Southern Medical University, ; Shenzhen, 518100 Guangdong China
                [3 ]GRID grid.11135.37, ISNI 0000 0001 2256 9319, Shenzhen Hospital, , Peking University, ; Shenzhen, 518034 Guangdong China
                [4 ]GRID grid.411866.c, ISNI 0000 0000 8848 7685, Guangzhou University of Chinese Medicine, ; Guangzhou, 510405 China
                [5 ]GRID grid.429502.8, ISNI 0000 0000 9955 1726, MGH Institute of Health Professions, ; Boston, MA USA
                [6 ]GRID grid.35030.35, ISNI 0000 0004 1792 6846, Department of Biomedical Engineering, , City University of Hong Kong, ; Kowloon Tong, Hong Kong
                [7 ]GRID grid.9227.e, ISNI 0000000119573309, Shenzhen Institutes of Advanced Technology, , Chinese Academy of Sciences, ; Beijing, China
                [8 ]Shenzhen Prevention and Treatment Center for Occupational Diseases, Shenzhen, 518001 China
                [9 ]GRID grid.259384.1, ISNI 0000 0000 8945 4455, Macau University of Science and Technology, ; Macau, 519020 China
                Author information
                http://orcid.org/0000-0001-6723-7465
                Article
                4955
                10.1186/s13063-020-04955-2
                7805106
                33436053
                bd7acebb-37d3-473e-b5e8-04dcc7def556
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 7 May 2020
                : 8 December 2020
                Funding
                Funded by: Traditional Chinese Medicine Bureau of Guangdong Province
                Award ID: No. 2016A020215139
                Award Recipient :
                Funded by: Shenzhen science and technology innovation committee
                Award ID: JCY20160425151844396
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100012151, Sanming Project of Medicine in Shenzhen;
                Award ID: SZSM201502044
                Award Recipient :
                Categories
                Study Protocol
                Custom metadata
                © The Author(s) 2021

                Medicine
                upper limb and hand motor dysfunction,cerebral ischemia,mirror therapy,jin’s three-needle acupuncture,fmri,randomized controlled trial

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