Safety and neuromodulation effect of transcranial focused ultrasound for motor recovery in patients with subacute stroke

 Didn't your competent? doctor and hospital figure a protocol on ultrasound years ago? NO? So, they were completely fucking incompetent!

Combined therapy of focused ultrasound and aducanumab induces neurogenesis and decreases of beta-amyloid plaques in a mouse model of Alzheimer’s disease August 2022 

And this from July 2018:

Ultrasound Could Help Improve Dementia Symptoms July 2018 

And this from December 2021:

Using Micro-Ultrasound to Investigate the Effectiveness of Short-Term Rehabilitation following Focal Ischemic Stroke December 2021 

Alzheimer’s breakthrough uses ultrasound technology March 2015

• ultrasound (69 posts to March 2012)

The latest here:

Safety and neuromodulation effect of transcranial focused ultrasound for motor recovery in patients with subacute stroke

• Research
• Open access
• Published: 17 March 2026

• article number , (2026)
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Journal of NeuroEngineering and Rehabilitation Aims and scope Submit manuscript

Safety and neuromodulation effect of transcranial focused ultrasound for motor recovery in patients with subacute stroke

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• Meng-Ting Lin,
• Shao-Yu Chen,
• Pin-Hua Lai,
• Yan-Ci Liu,
• Wen-Shiang Chen,
• Po-Chun Chu,
• Hao-Li Liu,
• Bo-Ching Lee,
• Shu-Mei Yang,
• Chueh-Hung Wu,
• Ting-Ju Lai,
• Abel Po-Hao Huang &
• Ming-Yen Hsiao 

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

Transcranial focused ultrasound (tFUS), a non-invasive brain neuromodulation, can target deeper and more precise brain regions compared to transcranial magnetic stimulation. However, its safety, neuromodulation and therapeutic effects in subacute stroke patients remain unclear. Therefore, the aim of this project is to demonstrate the safety and preliminary efficacy of tFUS for upper limb motor recovery in subacute stroke patients.

Methods

In this phase I single-arm study, we recruited 10 patients with subacute (≤ 3 months) unilateral stroke. tFUS was applied to the contralesional M1 by neuronavigation once daily for five sessions, using I_SPTA 2.8 W/cm² in free field (estimated in situ < 0.3 W/cm²), MI 0.75, PRF 100 Hz, and duty cycle 30%, with 10-minute exposure per session. The primary outcome was safety over 12 weeks. Secondary outcomes included cortical excitability (evaluated by transcranial magnetic stimulation and functional near-infrared spectroscopy) and functional measures assessed pre-treatment and at 1 day, 1 week, 4 weeks, and 12 weeks.)

Results

Ten patients completed the trial, and the safety analysis revealed no severe adverse events (AEs), new imaging abnormalities, or neuropsychological decline; only minor transient AEs occurred in 5 of 10 patients. tFUS showed preliminary therapeutic efficacy, with improvements in hemiplegic upper limb motor recovery and functional performance. Greater FMA improvement was observed in the tFUS group compared with age-, sex-, and baseline FMA-matched patients who received rTMS. Exploratory analyses of cortical excitability measures showed bilateral trends toward facilitation; however, these changes did not reach statistical significance.

Conclusion

tFUS was safe and well tolerated in subacute stroke patients, with only minor transient AEs and no evidence of structural or neuropsychological harm. tFUS demonstrated potential to enhance(Survivors want 100%  recovery! What the fuck are you doing to get there? NOTHING? Like good incompetent 'professionals'!) upper limb motor recovery and functional outcomes. Although exploratory analyses suggested trends toward cortical excitability changes, these findings were not statistically significant and require confirmation in larger controlled trials.

Efficacy of digital health technologies as adjunctive functional training in occupational therapy for stroke rehabilitation: a meta-analysis

 NO efficacy percentages, so completely failed at your research!

Efficacy of digital health technologies as adjunctive functional training in occupational therapy for stroke rehabilitation: a meta-analysis

Review Article Published:14 March 2026Volume 47344 2026Cite this article Save articleNeurological SciencesAims and scopeSubmit manuscript

• Yangzi Zhang, 
• Chenshu Ge, 
• Congwei Li & 
• Fang Liu 

• 11 Accesses

• Explore all metrics 

Abstract

Background

Post-stroke rehabilitation is essential for achieving functional recovery. Using digital health technologies as adjunctive functional training within occupational therapy offers a promising approach to improve training outcomes. However, a comprehensive and updated synthesis of the efficacy of this adjunctive approach is needed.

Methods

Utilizing a systematic search strategy, we identified pertinent randomized controlled trials (RCTs) from eight databases. The emphasis was placed on stroke rehabilitation studies that incorporated both digital health technologies and occupational therapy (search date: May 27, 2025). The primary outcomes assessed included upper limb motor function and activities of daily living, while secondary outcomes encompassed hand function, balance, and cognitive function. Data were synthesized using Stata 18.0, accompanied by subgroup analyses to investigate heterogeneity.

Results

This meta-analysis included 822 stroke survivors from 18 studies. The mean difference (MD) and its 95% confidence interval (CI) were used to assess the between-group comparison at post-intervention. The results showed that adjunctive DHT intervention led to significant improvements compared to controls in upper limb motor function (MD: 6.46; 95%CI [5.29, 7.63]; P < 0.001) and activities of daily living (MD: 9.52; 95%CI [5.63, 13.41]; P < 0.001). Additionally, benefits were noted in hand function and cognitive performance. However, no statistically significant difference was found between the groups for balance function.

Conclusion

Current evidence indicates that digital health technologies, when used as an adjunctive functional training tool alongside occupational therapy, enhance upper limb motor function(NOT GOOD ENOUGH! You incompetently don't know that survivors want 100% recovery? Or you do know and are OK with failure of your survivor requirements! Take your pick: FAILURE OR INCOMPETENCE! No other options exist!)  and activities of daily living for stroke survivors.Additionally, benefits have been noted in hand function and cognitive performance. However, the impact of these technologies on balance function remains inconclusive.

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Innovative control strategy enhances stroke rehabilitation with CASIA-EXO exoskeleton

 'Enhances' is NOT GOOD ENOUGH! Survivors want full recovery! When the hell will you GET THERE? Why is failure to get to 100% recovery not being treated as career ending in stroke research?

Innovative control strategy enhances stroke rehabilitation with CASIA-EXO exoskeleton

Stroke is one of the leading causes of non-traumatic disability worldwide, affecting more than 15 million people each year, with about three-quarters experiencing long-term functional impairments. This makes it crucial to develop long-term rehabilitation programs that can promote motor relearning, enhance neural plasticity, and restore daily motor function. Robot-assisted rehabilitation, which combines neuroscience, biomechanics, and advanced control systems, is emerging as a highly promising approach.

In recent years, exoskeleton-type rehabilitation robots that enable distributed interaction across multiple joints have gained popularity due to additional improvements in upper-limb motor abilities. Some prominent examples of such robots include ArmeoPower, ANYexo, and EXO-UL8. They employ control strategies that optimize robotic intervention and maximize active patient participation. However, few existing systems simultaneously incorporate motion intention detection, desired trajectory generation, and assistance level personalization for effective and efficient neurorehabilitation.

In an innovation, a team of researchers from China, led by Professor Zeng-Guang Hou from the State Key Laboratory of Multimodal Artificial Intelligence Systems (MAIS), Institute of Automation, Chinese Academy of Sciences, have developed CASIA-EXO, an upper-limb exoskeleton, and proposed an exciting control strategy for motor learning in post-stroke patient-in-the-loop neurorehabilitation. Their novel findings were published in Volume 12, Issue 8 of the IEEE/CAA Journal of Automatica Sinica on 20 August 2025. The team includes researchers Chen Wang and Liang Peng from MAIS.

According to Prof. Hou, "CASIA-EXO is a five degree-of-freedom biomimetic exoskeleton that comprises three rotational joints adopting an oblique arrangement and two rotational joints co-locating in a serial chain. Its dynamics is modelled and linearized to identify unknown parameters embedded in the shoulder, elbow and wrist mechanisms."

Following the modelling, the researchers propose a novel patient-in-the-loop control strategy for rehabilitation training for post-stroke motor recovery.

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"It consists of the intention-based trajectory planning and performance-based intervention adaptation. While an oscillator-based intention estimator quantifies the time-varying training requirement and integrates the invariant laws in normal motion patterns into the multi-joint trajectory generation, the performance-based adaptive algorithm alters the assistance and resistance levels during the robot-aided rehabilitation, which can enhance active participation of subjects with various impairment levels," explains Dr. Wang.

The research team conducted various experiments to demonstrate the efficacy of their proposed system, wherein 10 healthy subjects sat in a chair with their dominant arm coupled with CASIA-EXO and passed the wooden boxes over and then brought them back using a virtual reality display. They found that their novel control strategy steadily individualized the training trajectory and intervention level as per the subject's changing requirements and motor abilities, facilitating closed-loop robot-aided rehabilitation. Consequently, the close cooperation between trajectory planning and intervention adaptation can aid motor relearning and functional recovery in patients with motor impairments as naturally as possible.

This breakthrough underscores the potential of CASIA-EXO to deliver safer, smarter, and more personalized rehabilitation for stroke survivors.

Source:

IEEE Chinese Association of Automation

Journal reference:

Wang, C., et al., (2025) Development and Control of an Upper-Limb Exoskeleton CASIA-EXO for Motor Learning in Post-Stroke Rehabilitation. IEEE/CAA Journal of Automatica Sinica. doi: 10.1109/JAS.2024.124662. https://ieeexplore.ieee.org/document/10916678

Comparison of the effects of different physical stimulation therapies on reducing upper limb spastic paralysis and motor dysfunction in stroke survivors after stroke: a network meta-analysis of randomized controlled trials

 'Enhances' is NOT GOOD ENOUGH! Survivors want spasticity cured! When the hell will you GET THERE? Why is failure to cure spasticity not being treated as career ending in stroke research?

Comparison of the effects of different physical stimulation therapies on reducing upper limb spastic paralysis and motor dysfunction in stroke survivors after stroke: a network meta-analysis of randomized controlled trials

Mingtong Bian^1,2Fuyan Chen^1,2,3*Huizhen Su³Zhiying Li^1,2Xiaowei Sun^1,2Yang Liu^1,2Jinyuan Shi^1,2Shuo Liu^1,2Ru Rong^1,2

• ¹Department of Acupuncture, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
• ²National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
• ³Qinghai Provincial Hospital of Traditional Chinese Medicine, Xining, Qinghai, China

Background: Upper limb spasticity is a common and disabling sequela of stroke, which significantly impairing motor function and the capacity to perform activities of daily living (ADL). The relative efficacy of different physical therapies and their combinations compared to monotherapies remains unclear.

Methods: A comprehensive database search was conducted to identify randomized controlled trials (RCTs) published from database inception to 2024 that evaluated physical therapies for post-stroke upper limb spasticity. Data were analyzed using RevMan and STATA/R software with a Bayesian framework for network meta-analysis. Evidence consistency was assessed via node-splitting approaches, and intervention efficacy was ranked using the surface under the cumulative ranking curve (SUCRA). Effect sizes were expressed as mean differences (MD) with 95% confidence intervals (CI), and study quality was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system.

Results: Forty-nine RCTs involving 3,219 patients were included. The combination of physical rehabilitation (PR) with repetitive transcranial magnetic stimulation (rTMS) and electro-acupuncture (EA) demonstrated the highest improvement in Fugl-Meyer Assessment for Upper Extremity (FMA-UE) scores (91.1%), outperforming PR alone (13.2%) or EA monotherapy (30.3%). PR combined with rTMS and body acupuncture (BA) shows the most significant improvement in the Modified Barthel Index (MBI) (83.1%), superior to PR (20.8%) or BA (23.8%) alone. Adverse events (e.g., minor bruising from EA) were infrequent and self-resolving.

Conclusion: Current evidence indicates that synergistic application of PR with rTMS and acupuncture (EA/BA) significantly enhances upper limb motor function and ADL capacity. However, GRADE evaluations rated most evidence as moderate quality, limited by implementation bias, insufficient subgroup analyses, and lack of long-term follow-up data. Future studies should adopt standardized protocols and investigate efficacy variations across stroke subtypes.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42025633289, identifier [CRD42025633289].

1 Introduction

Upper limb dysfunction following a stroke represents a significant cause of long-term disability in patients, frequently occurring in conjunction with a range of injuries, including upper limb weakness and spasticity. The principal manifestation of upper limb spastic paralysis is an increase in muscle tone on the affected side, which is characterized by symptoms such as shoulder adduction and internal rotation, elbow flexion and pronation, wrist flexion and ulnar deviation, and finger clenching (1). This can result in a number of adverse effects, including pain, muscle contraction, changes in soft tissue structure, weakness, associated reactions, loss of passive function, limited active function, and a decrease in quality of life. This has a significant impact on the patient’s activities of daily living (2). The pathological mechanism of upper limb spasticity is complex, involving damage to the corticospinal tract, peripheral mechanisms, extensor mechanisms, and potential spastic dystonia, among other factors (3). Furthermore, because the upper limb’s role in more refined and diverse functions, the recovery of its dysfunction is more complex and slow, posing significant challenges to the patient’s daily life and social participation.

Nevertheless, research has demonstrated that spasticity can be effectively managed in the chronic phase of stroke through appropriate intervention, thereby enhancing motor function and facilitating the restoration of limb function (4). It is therefore imperative to identify and investigate efficacious rehabilitation techniques to facilitate enhanced recovery of upper limb function in patients. At present, there is a general consensus on the rehabilitation treatment for this condition, both domestically and internationally. The aforementioned treatments are primarily comprised of physical exercise and occupational therapy. In recent years, the advancement of medical technology and the intensification of clinical research have given rise to a multitude of novel rehabilitation therapies, including acupuncture, massage, proprioceptive neuromuscular facilitation (PNF), repetitive transcranial magnetic stimulation (rTMS), and theta-burst stimulation (TBS). A number of studies (5–8) have demonstrated that these physical therapies can facilitate the improvement of post-stroke spastic paralysis to a certain extent. However, existing research has predominantly focused on monotherapies, with insufficient comparative investigations of multimodal therapeutic regimens, leaving the optimal therapeutic combinations poorly defined.

Network meta-analysis (NMA) overcomes the limitations of traditional pairwise meta-analyses, which are restricted to comparing two interventions at a time, by integrating direct and indirect evidence to systematically evaluate the synergistic effects of complex multimodal rehabilitation strategies within a unified framework (9). This study applied NMA to compare the efficacy of 21 intervention modalities for post-stroke upper limb spasticity, aiming to provide evidence-based insights for personalized, multimodal rehabilitation protocols. A total of 49 randomized controlled trials (RCTs) involving 3,219 participants, published between 2009 and 2024, were included. Outcomes were quantified using the Fugl-Meyer Assessment for Upper Extremity (FMA-UE) for motor function and the Modified Barthel Index (MBI) for activities of daily living (ADL). A Bayesian network meta-analysis (implemented in STATA/R) was conducted to comprehensively assess efficacy differences among rehabilitation therapies, neuromodulation techniques, and integrative traditional Chinese medicine (TCM) regimens. Interventions were ranked via the surface under the cumulative ranking curve (SUCRA). The results elucidated effectiveness hierarchies through probabilistic estimates and established indirect efficacy comparison pathways for interventions lacking direct comparative data. This framework provides clinicians and patients with a scientific foundation for optimizing combined strategies of rehabilitation, neuromodulation, and TCM therapies, while bridging critical evidence gaps in the current literature on post-stroke spasticity management.

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