Technology-enabled telerehabilitation for Parkinson’s disease: a scoping review of digital rehabilitation systems, delivery architectures, and implementation challenges

 After you get Parkinsons post stroke will your competent? doctor be ready with these interventions? Sorry; you DON'T have a competent doctor, do you!

Parkinson’s Disease May Have Link to Stroke March 2017 

The latest here:

Technology-enabled telerehabilitation for Parkinson’s disease: a scoping review of digital rehabilitation systems, delivery architectures, and implementation challenges

• Chiara Longo,
• Lorenzo Gios,
• Susanna Pardini,
• Raffaello Ferrari,
• Anita Daves,
• Giuseppe Jurman &
• Maria Chiara Malaguti 

We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

Abstract

Introduction

Digital technologies are increasingly integrated into neurorehabilitation programs for Parkinson’s Disease (PD), enabling remote delivery of therapy, continuous monitoring of motor performance, and adaptive feedback during rehabilitation training. Telerehabilitation systems incorporating wearable sensors, virtual reality platforms, mobile applications, and artificial intelligence (AI) have expanded rapidly in recent years. However, the evidence base remains fragmented across heterogeneous technological configurations, clinical contexts, and delivery models, limiting a comprehensive understanding of how digital rehabilitation systems are implemented in PD care.

Methods

This scoping review maps the current literature on telerehabilitation for PD with a focus on the technological architectures, care settings, and delivery models used in digital rehabilitation programs. Peer-reviewed studies published between 2020 and 2025 were identified through searches in PubMed with reference to Scopus and Web of Science. Eligible studies investigated remote rehabilitation interventions for PD using digital technologies such as wearable sensors, mobile health applications, virtual reality systems, and AI-supported monitoring tools. Evidence was analyzed across three domains: (i) technological components and digital rehabilitation systems, (ii) rehabilitation setting, and (iii) delivery model.

Results

Fifty-three studies met the inclusion criteria. Most interventions were home-based and implemented multi-component digital architectures combining teleconferencing platforms, wearable sensors, and mobile applications. Wearable sensing technologies were used in nearly half of the studies to quantify gait, balance, or tremor, while video platforms and mobile applications supported remote supervision and exercise delivery. Virtual reality systems and serious games were used to enhance engagement and taskspecific training, whereas AI techniques were increasingly integrated to support movement detection, monitoring, and adaptive feedback. Despite generally high usability and acceptability, substantial heterogeneity was observed in outcome measures, terminology, and safety reporting. Few studies explicitly described care pathways, delivery architectures, or long-term clinical outcomes.

Disscussion

Telerehabilitation for Parkinson’s disease is evolving toward integrated digital rehabilitation ecosystems combining wearable sensing, software platforms, and AI-enabled monitoring. Although feasibility and patient acceptance are consistently reported, current evidence remains limited by heterogeneous reporting standards and insufficient integration between technological systems and clinical workflows. Future research should focus on standardized outcome frameworks, scalable hybrid care models, and the development of interoperable, explainable digital rehabilitation systems capable of supporting long-term neurorehabilitation in real-world settings.

A clinically applicable nomogram predicting non-return to work in young and middle-aged patients with acute large vessel occlusion stroke: integrating neurological function and psychosocial factors for personalized rehabilitation

 Oh my God; you don't realize this IS ABSOLUTELY FUCKING USELESS FOR SURVIVORS! No recovery protocols that get them back to work. You really don't know that stroke research is to get survivors recovered?  You're going to have a good time with disability when you are the 1 in 4 per WHO that has a stroke!

A clinically applicable nomogram predicting non-return to work in young and middle-aged patients with acute large vessel occlusion stroke: integrating neurological function and psychosocial factors for personalized rehabilitation

• 

  Yu Ding 1†

• 

  Jingling Zhu 1†

• 
  

• 
  

• Y

   Yiling He 1

Xiuling Yang 1

Wenfei Liang 1

K

Kangqiang Yang 1

X

Xiaoling Wu 1

G

Guoshun Li 1

Weimin Ning 1,2,3*

• 1. Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China

• 2. Dongguan Key Laboratory of Intractable Brain Diseases, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
  

  Abstract

  Objective:
  

  This study was designed to identify key predictors of non-return to work (non-RTW) in young and middle-aged patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO) after endovascular therapy (EVT). Based on these predictors, we developed and validated an individualized nomogram for non-RTW risk stratification to facilitate early identification of high-risk patients and guide personalized rehabilitation for better functional recovery and less occupational loss.
  

  Methods:
  

  In this retrospective cohort study, 350 consecutive AIS-LVO patients who underwent EVT at Dongguan Hospital of Traditional Chinese Medicine (July 2018–July 2025) were included. Potential predictors were selected using least absolute shrinkage and selection operator (LASSO) regression, and independent predictors were identified via multivariable logistic regression. A nomogram was constructed and assessed for discrimination using the area under the receiver operating characteristic curve (AUC), for calibration using calibration curves and the Hosmer–Lemeshow test, and for clinical utility via decision curve analysis (DCA).
  

  Results:
  

  Six independent predictors of non-RTW were identified: instrumental activities of daily living (IADL), admission NIHSS score, Nutritional Risk Screening 2002 (NRS-2002) score, balance impairment (as measured by the Berg Balance Scale, BBS), post-stroke rehabilitation (Rehab), and anxiety-depressive state (ADS). The nomogram demonstrated robust discriminative performance (AUC = 0.858, 95% CI: 0.812–0.903). Calibration curves confirmed favorable calibration between predicted and observed probabilities. Decision curve and clinical impact analyses revealed clinically meaningful net benefit across most threshold probabilities.
  

  Conclusion:
  

  We developed and validated a clinically actionable nomogram to predict non-RTW in young and middle-aged AIS-LVO patients after EVT. This tool enables early risk stratification and personalized rehabilitation planning, promoting long-term functional and vocational recovery.

Exploring occupational therapists’ perceptions of the use of functional electrical stimulation in adult stroke rehabilitation

Who cares what therapists think? Survivors are the client; you ask them how well you as a therapist are providing EXACT recovery protocols! If you're willing to listen, they'll tell you you have NOTHING concrete for recovery!

 Exploring occupational therapists’ perceptions of the use of functional electrical stimulation in adult stroke rehabilitation

Sarah Frew

 &

Fiona Breytenbach

, Accepted 29 May 2026, Published online: 09 Jun 2026

Abstract

Purpose: Stroke is one of the leading global causes of disability, with motor deficits, particularly in the upper limb, being among the most common and debilitating consequences. Occupational therapists are crucial members of the multidisciplinary team, working to enhance patients’ participation in daily activities by addressing motor impairments through interventions such as Functional Electrical Stimulation (FES). However, an evidence-practice gap exists in the application of FES. This study aimed to explore occupational therapists’ perceptions of using FES in adult stroke rehabilitation in Gauteng, South Africa. This study employed a descriptive qualitative research design. Twelve occupational therapists participated in semi-structured interviews conducted via an online platform. The research population included clinicians working in the neurorehabilitation field in Gauteng, South Africa from both public and private healthcare sectors. An inductive thematic analysis was used to analyse the data.  Three themes emerged from this qualitative study, namely, ‘A Tug of War’, ‘The Lost Leading the Lost’ and ‘A Puzzle of Practicality’. These themes unravel the perceptions of occupational therapists and explore the factors that influence the use of FES in stroke rehabilitation. Conclusion: Many identified perceptions and factors challenge the use of FES in adult stroke rehabilitation. Addressing these challenges is essential for improving evidence-based practices in occupational therapy, especially for motor impairments after stroke.

IMPLICATIONS FOR REHABILITATION

Training on FES needs to be enhanced at an undergraduate and postgraduate level for improved application of the technology.Open-loop FES currently does not align with the complex movement patterns required for occupation-based intervention and is therefore best suited as a preparatory modality. Policy, protocol, and guideline development is needed for a unified approach to FES use in stroke rehabilitation. The commercial availability and access to closed-loop FES systems should be explored by rehabilitation technology manufacturers and sales representatives.

Is Creatine Supplementation for Brain Health Worth a Try?

 Not until your competent? doctor approves it.

Is Creatine Supplementation for Brain Health Worth a Try?

Creatine supplements have been recently examined for their potential to improve brain health and prevent dementia. Given the lack of effective therapies for dementia, it is worth considering whether these supplements are safe and effective.

What Role Does Creatine Play in the Body? 

Creatine is endogenously synthesized in the liver and kidneys, and its amino acid precursors are also provided by a variety of foods, including meat and vegetables. Most of the body’s creatine is stored in muscle cells as phosphocreatine; creatine serves to help replenish adenosine triphosphate during physical activity, which is why we have seen creatine supplements increasingly used in the setting of weight training and exercise over the past decade. 

With the emerging understanding of its role in the brain, research on creatine supplementation has moved from the gym to the brain lab. 

How Creatine May Affect Brain Health 

Creatine is produced in the brain and retina through a process that involves the enzyme guanidinoacetate methyltransferase, which is highly expressed in glial cells. In addition to information on markers of creatine synthesis and activity, evidence is accumulating regarding the action of creatine in the brain. 

Interest in creatine for brain health grew out of the knowledge that creatine deficiency or dysfunction may adversely affect cognition. Defects in the creatine transporter (CRT) gene (SLC6A8) result in low brain creatine levels, along with severe neurologic symptoms, defined as CRT deficiency syndrome. The mechanism of neurologic dysfunction is still unclear, and currently there is no treatment for CRT deficiency syndrome.

There are different creatine formulations. The most common one used in studies is powder mixed with water, which has a more established bioavailability. Other commercial forms include pills, capsules, and gummies. 

The first step is to verify that creatine supplementation affects brain creatine levels. This is supported by a few small-scale human studies, but the increase is less than that seen in skeletal muscle. 

Authors of a review noted that creatine supplementation may help improve mood, cognition, and sleep in healthy adults. The observed improvements were generally more notable among women than men, which the authors attributed to lower baseline endogenous creatine stores in women. 

In a 2026 study in 29 sleep-deprived but otherwise healthy adults, 0.2 g/kg creatine monohydrate supplementation was associated with up to a 12% improvement of sleep deprivation-induced deterioration in cognitive skills. For a 150-lb adult, this dosage would be about 14 g of creatine per day. 

Creatine Supplementation for Treating Brain Disorders 

While experimental evidence suggesting that creatine supplementation may help healthy people does not automatically imply that extra creatine would be beneficial in the context of brain disease, there appears to be promise in the use of creatine supplements as an adjunctive treatment in some brain disorders.

According to a 2022 review in Nutrients, creatine supplementation may help reduce some symptoms of traumatic brain injury and concussion.

Creatine also has been explored as a possible treatment for Alzheimer’s disease symptoms or as a disease-modifying therapy. A single-arm pilot trial in 20 patients with Alzheimer’s disease found that 20 g/d creatine monohydrate for 8 weeks was associated with increased total brain creatine and modest improvements on cognitive tests. 

Is There a Place for Creatine Supplementation for Healthy Adults? 

The evidence is still not solid regarding potential benefits of creatine supplements for healthy individuals or for people who have dementia. And while creatine appears to be safe when used as a supplement for exercise and for building muscle, safety concerns have not been entirely ruled out. Furthermore, established dosing and dietary references are lacking. 

Despite these shortcomings, it may be worthwhile for healthy adults or those with cognitive symptoms to try creatine supplements. So far, this supplement shows promise (albeit inconsistent) for short-term cognitive benefits, rather than a lasting impact on brain health. It is the short-lived nature of the effects that makes it worth trying. Many people use other supplements for brain health, like ginkgo biloba or ginseng, and can judge for themselves whether they see any benefits. The same principle applies to creatine – anyone taking it can assess if it improves their cognition or mood, without bearing the burden of deciphering whether a clinically undetectable effect is taking place. 

Heidi Moawad, MD, is a neurologist and medical editor. She is on the teaching faculty at Case Western Reserve University. Dr Moawad resides in Cleveland, Ohio, and enjoys traveling, cooking, and taking exercise classes. 

Exoskeleton Reads Faint Muscle Signals to Overcome Hand Paralysis

 Won't work for me dead motor cortex doesn't send any signals at all.

Exoskeleton Reads Faint Muscle Signals to Overcome Hand Paralysis

Summary: Researchers created an intelligent, low-cost pneumatic glove that successfully restores grasping capabilities to paralyzed hands. By combining inexpensive fabric and smart air cushions with advanced machine learning, the system intercepts weak electromyogram (EMG) signals straight from the forearm.

This allows the glove to read a user’s biological intent with up to 97% reliability, inflating targeted chambers to close fingers safely around glasses, forks, and everyday objects.

Key Facts

• The 13-Tube Pneumatic Matrix: The soft-hand exoskeleton is constructed using basic, low-cost fabric embedded with specialized air cushions across its outer surface. These cushions are fed by 13 independent micro-tubes, allowing the glove to bend or straighten individual fingers and smoothly rotate the wrist.
• Deep Intent Prediction: Forearm sensors capture faint electrical muscle impulses (EMG data). The team’s machine learning algorithms process these signals, inferring the user’s intended grasping gesture with an incredible 97% accuracy rate before the hand even attempts to move.
• The Anti-Drop Safety Shield: To prevent the heartbreak of dropping an item mid-reach, researcher Nicolas Berberich integrated supplementary motion sensors. These sensors detect active transport movements as the arm swings, keeping the exoskeleton’s pneumatic grip firmly locked until the object is safely set down.
• The ALS Patient Milestone: The system was co-developed and validated in close collaboration with an ALS patient who had lost almost all hand movement, retaining control over only his first thumb joint. By targeting the flexor pollicis longus muscle in the forearm, the system successfully amplified his remaining muscle pulses.
• A Fork in Four Years: Using the TUM glove, the ALS patient was able to pick up and hold a fork for the first time in four years, manipulate small blocks, and successfully feed himself. Remarkably, just five minutes of training using a specialized thumb-controlled video game was enough to dramatically optimize his operational control.
• Affordable Democratic Design: Unlike elite, six-figure lab exoskeletons, Dr. John Nassour hand-sewed the fabric glove using highly affordable materials. This low-cost, high-yield engineering design guarantees that the high-tech solution can remain financially accessible to low-income families and everyday stroke survivors.
• Broad Clinical Horizons: Following the success of the ALS pilot, Professor Gordon Cheng and neurologist Tobias Wächter are expanding the soft glove concept to assist stroke survivors, motorcycle accident victims with peripheral nerve damage, and individuals living with flaccid paralysis or polyneuropathy.

Source: TUM

The Technical University of Munich (TUM) has developed a soft, pneumatic glove that restores the ability of people with paralyzed hands to grasp objects.

New Global Movement Aims to Rewrite Stroke Care with Survivor-Led Solutions

 Hopefully they will drop the 'care' idea  and change it to 100% recovery. I know of no survivor who demands 'care'. Unless they are bamboozled by staff they will always want recovery.

I suggest everyone of you reading this sends an email to Stacy Quinn stacy@shinecollaboration.org asking them to focus on 100% recovery rather than 'care'. I got no reply to my email.

New Global Movement Aims to Rewrite Stroke Care with Survivor-Led Solutions

ZURICH, SWITZERLAND, June 26, 2026 /EINPresswire.com/ — SHINE (Survivors Honouring Inclusion, Networking and Empowerment) launched at the World Stroke Congress in October 2025 as the first global movement led entirely by stroke survivors. Today, the founders share the story behind that moment. It’s how three women, each changed by stroke, chose to build an organization that treats lived experience as expertise and turns survivor insight into system change.

“Stories should do more than sit in a room. They should shape the room,” says Stacie Broek, Co-Founder & Executive Director. “SHINE ensures survivor voices are integrated upstream into care, research and policy.”

Stacie met Stacy Quinn in 2023 through a mutual colleague, and from the start it felt as though they were two peas from the same pod. “I deeply respected Stacy’s hopeful, fully charged spirit, and I cherished the close connection we maintained,” says Stacie. “I truly believe we were destined to do something wonderful together.” She later connected with Melinda B. Roaldsen through a committee and interviewed her for a speech. “Melinda’s story was full of hope and positivity,” Stacie says. “I brought Melinda and Stacy into the same conversation because their passion and their deep desire to drive change were undeniable. SHINE was born as a call to action to put lived experience at the forefront.”

According to a 2024 National Institutes of Health report, cervical artery dissection affects about 3 in 100,000 people each year. An arterial dissection is when a tear forms in the artery wall, allowing blood to separate its layers, disrupting the blood flow and potentially causing a blood clot, that can lead to a stroke. Although dissections account for approximately 2% of all strokes, they cause 10% of strokes in younger people (Yaghi et al., Stroke, 2024). All three SHINE founders experienced a carotid artery dissection, a type of cervical artery dissection.

After her stroke at 46, Stacie relearned how to speak and write through intensive daily therapy despite being told she never would. “I don’t share my story for its own sake,” she says. “It must frame problems and drive solutions.” Too often she saw survivors invited to speak after decisions were made. “Voices were present, but they weren’t shaping agendas or research. SHINE integrates survivor leadership, not just celebrates it.”

“I was a stroke expert before my stroke,” says Melinda B. Roaldsen, Co-Founder & Scientific Director. “After my carotid artery dissection in 2023, my horizon expanded. I saw the need for more implementation of stroke services along the entire treatment chain and advancement of survivor leadership as a concept.” Invitations to share stories were increasing, she notes, but survivor expertise rarely influenced decisions. “Survivors have first-hand knowledge across the whole treatment journey pathway. Systematically including lived experience makes healthcare more relevant and grounded.”

Melinda adds: “One-in-four people will have a stroke, and two-in-three survivors live with permanent disabilities. Research, awareness and policy can change this and improve outcomes.

After misdiagnosis and frustration, Co-Founder & Communications Director Stacy Quinn created My Stroke of Hope to support carotid artery dissection and stroke survivors, especially young women. “My misdiagnoses showed me how easily the patient and survivor voice gets lost,” says Stacy. “Through SHINE, we’re turning our experiences into change by embedding lived experience, so that care, research and policy are informed by the people they serve.”

From Lived Experience to Leadership
At SHINE’s World Stroke Congress launch, the founders felt a shift. “Clinicians, stakeholders and scientists came up afterward and asked, ‘How can we embed lived experience meaningfully,’” says Melinda. “That mindset, that appreciation of seeing survivor leadership as an integral part, was the most important reaction.”

Survivors consistently report gaps after discharge: support for fatigue management and emotional regulation, better continuity across specialists, and stronger social support. If hospitals added one survivor-informed change tomorrow, Stacie says, it would be a standardized, survivor-led discharge plan that puts the survivor’s own goals and vision at the center. “Personal goal setting is huge for me, and it’s far too often overshadowed,” explains, Stacie. “Everyone on the care team should be working toward the survivor’s plans, vision and goals.”

The biggest gaps in secondary prevention and long-term support fall on people with fewer resources. They also affect women and younger adults, whose symptoms are often under-recognized, and rural or underserved communities with limited access to rehabilitation. The effects of stroke on mobility, speech and cognition can make getting help even harder. “Equity means meeting people where they are with culturally and contextually relevant support and measuring what matters to them,” Stacy says.

At the recent European Stroke Organisation Congress (ESOC), SHINE presented its abstract, From Voice to Value: A Framework for Survivor-led System Design in Stroke. The work has since been published in the European Stroke Journal, further advancing the conversation on survivor-led stroke care.

About SHINE
SHINE places survivor expertise and lived experience at the center of stroke care, research, and policy. Through global collaboration, advocacy, research, and innovation, SHINE works alongside survivors, healthcare providers, researchers, organizations, and policymakers to ensure that lived experience helps shape the decisions, services, and systems that affect life after stroke. By connecting voices, sharing expertise, and fostering meaningful partnership, SHINE supports a global network of survivors working to influence change and improve outcomes for people affected by stroke.

Stacy Quinn
SHINE Global Stroke Collaboration
stacy@shinecollaboration.org
Visit us on social media:
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Scientists uncover how exercise reverses muscle ageing by switching off key gene

 You want this because of this: Muscle fitness is strongly associated with improved rate of ageing in the brain July 2018

Your doctor's requirement is: EXACT 100% RECOVERY PROTOCOLS! Not having them IS PURE INCOMPETENCE! Known of the need since medical school, so plenty of time to get that done!

Scientists uncover how exercise reverses muscle ageing by switching off key gene

Scientists have identified the gene DEAF1 as a key driver of muscle ageing, showing how exercise restores muscle repair by lowering its activity, potentially paving the way for future anti-ageing therapies

Researchers have identified a molecular mechanism that explains why exercise helps ageing muscles stay healthy. A new study has found that physical activity lowers levels of a gene called DEAF1, restoring muscles' ability to remove damaged proteins, repair themselves and maintain strength. The findings could open new avenues for therapies targeting age-related muscle loss and impaired recovery.

DEAF1 identified as key driver of muscle ageing

The study, led by researchers at Duke-NUS Medical School in collaboration with Singapore General Hospital and Cardiff University, found that ageing muscles accumulate damage because of an imbalance in the way they produce and remove proteins. The findings were published in the Proceedings of the National Academy of Sciences (PNAS).

Muscles play a crucial role in movement, metabolism, blood sugar regulation and overall health. However, muscle strength naturally declines with age, increasing the risk of falls, fractures and slower recovery from illness or injury.

Researchers found that a growth pathway known as mTORC1 becomes overactive in ageing muscles, causing cells to prioritise protein production over the removal of damaged proteins. As these damaged proteins accumulate, muscle cells become stressed and gradually lose strength.

The study identified the gene DEAF1 as a major contributor to this process. Normally regulated by proteins known as FOXOs, DEAF1 levels rise as FOXO activity declines with age. This, in turn, drives excessive mTORC1 activity and accelerates muscle deterioration.

Exercise restores muscles' natural repair system

The researchers found that exercise can reverse this imbalance by lowering DEAF1 levels, allowing ageing muscles to resume their natural repair process.

Assistant Professor Tang Hong-Wen, from the Cancer and Stem Cell Biology Program at Duke-NUS and the study's lead author, said: "Exercise can reverse this process, correcting the imbalance. Physical activity activates certain proteins which lower DEAF1 levels, bringing the growth pathway back into balance. This allows aging muscles to clear out damaged proteins, rebuild themselves properly, and help them stay stronger and more resilient."

The study also found that exercise may not fully restore muscle repair in cases where DEAF1 levels become extremely high or FOXO activity declines significantly. This may explain why some older adults benefit more from exercise than others.

Blood–brain barrier permeating dendrimers for alleviation of cerebral ischemia–reperfusion injury

 We've known of blood brain barrier problems post stroke a long time ago! Where ARE THE EXACT PROTOCOLS TO PREVENT THAT?

Inflammatory action leaking through the blood brain barrier.  May 2013

Why is no one solving the problems identified? I know we have fucking failures of stroke associations doing nothing but there must be some leadership out there. 

Blood–brain barrier permeating dendrimers for alleviation of cerebral ischemia–reperfusion injury

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Highlights

• •
  Controlled synthesis yields monodisperse dendrimers with tailored MW and size.
• •
  RONS-triggered deshielding and oxidation enable targeted brain delivery.
• •
  PEG deshielding facilitates BBB penetration into cerebral I/R injury lesions.
• •
  G4-PB-PEG dendrimer reduces infarct volume and improves neurological outcomes.
• •
  Biodegradable components of G4-PB-PEG dendrimer ensure high biocompatibility.

Abstract

Ischemia–reperfusion injury (IRI) is a major contributor to incomplete neurological recovery after ischemic stroke, particularly after reperfusion therapies such as thrombolysis or mechanical thrombectomy. Reperfusion can trigger excessive generation of reactive oxygen and nitrogen species (RONS) and amplify inflammatory cell recruitment, thereby driving secondary brain injury. Although numerous neuroprotective and immunomodulatory agents have been explored for mitigating IRI, their brain penetration capacity and therapeutic efficacy are limited in part by the blood–brain barrier (BBB), which restricts drug accumulation within the brain parenchyma. To overcome this challenge, we developed a RONS-scavenging dendrimer, G4-PB-PEG, with prolonged systemic circulation and a RONS-responsive PEG shell. In the ischemic microenvironment with excessive RONS, stimulus-responsive PEG deshielding facilitates BBB penetration and lesion-selective accumulation, thereby enabling efficient scavenging of pathological RONS. In a mouse model of transient middle cerebral artery occlusion, intravenously administered G4-PB-PEG exhibited preferential accumulation at the cerebral lesion. By effectively scavenging RONS and attenuating neuroinflammatory responses, G4-PB-PEG significantly decreased infarct volume and the levels of neuroinflammation markers. Neurological outcomes also improved markedly, as quantified using the modified neurological severity score. These results indicate that G4-PB-PEG effectively alleviates cerebral IRI by facilitating BBB penetration and lesion-selective accumulation, with potent neuroprotective effects. Therefore, G4-PB-PEG warrants further evaluation for clinical translation.

Graphical Abstract

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