Objective：We aimed to examine the effects of a transcranial direct current stimulation (tDCS) performed prior to occupational therapy and combined with an Integrated Volitional control Electrical Stimulation (IVES) therapy on the upper extremity function for patients with chronic stroke. We also aimed to detect the longitudinal changes of hemodynamic responses in the sensorimotor cortex area (SMC) following successive tDCS prior to IVES therapy.Methods：Seven subjects with moderate upper extremity (UE) paresis in chronic stroke were enrolled in this study. The patients received coupled tDCS and IVES therapy five times a week. UE function was estimated by Simple Test for Evaluating Hand Function (STEF). Functional near-infrared spectroscopy (fNIRS) was used to detect the long-term changes of hemodynamic responses in bilateral SMC during opening and closing of the affected fingers, assisted by IVES. Lastly, the SMC responses after the first tDCS were compared with those obtained after the fifth tDCS.Results：Coupled tDCS and IVES therapy was effective for improving the UE paresis. fNIRS demonstrated a significantly increased hemodynamic responses in bilateral SMC, following IVES therapy with the fifth tDCS relative to those with the first tDCS.Conclusion：The findings suggested that tDCS prior to IVES therapy might improve UE function of the patients with chronic stroke, presumably by augmenting hemodynamic responses in bilateral SMC.

Objective：We aimed to examine the effects of a transcranial direct current stimulation (tDCS) performed prior to occupational therapy and combined with an Integrated Volitional control Electrical Stimulation (IVES) therapy on the upper extremity function for patients with chronic stroke. We also aimed to detect the longitudinal changes of hemodynamic responses in the sensorimotor cortex area (SMC) following successive tDCS prior to IVES therapy.Methods：Seven subjects with moderate upper extremity (UE) paresis in chronic stroke were enrolled in this study. The patients received coupled tDCS and IVES therapy five times a week. UE function was estimated by Simple Test for Evaluating Hand Function (STEF). Functional near-infrared spectroscopy (fNIRS) was used to detect the long-term changes of hemodynamic responses in bilateral SMC during opening and closing of the affected fingers, assisted by IVES. Lastly, the SMC responses after the first tDCS were compared with those obtained after the fifth tDCS.Results：Coupled tDCS and IVES therapy was effective for improving the UE paresis. fNIRS demonstrated a significantly increased hemodynamic responses in bilateral SMC, following IVES therapy with the fifth tDCS relative to those with the first tDCS.Conclusion：The findings suggested that tDCS prior to IVES therapy might improve UE function of the patients with chronic stroke, presumably by augmenting hemodynamic responses in bilateral SMC.

Objective: To clarify whether early mobilization is a predictive factor for ambulation recovery in elderly patients and/or patients with severe subarachnoid hemorrhage (SAH).Methods: This multicenter retrospective observational study included 471 patients with treated SAH (Group 1). We focused on SAH patients with a poor prognosis, including a subgroup of elderly SAH patients (age>65 years: n=203) (Group 2) and patients with severe SAH (World Federation of Neurological Societies [WFNS] grade IV or V: n=117) (Group 3). The chi-square test and Mann-Whitney U test were used to compare the differences between the ambulation recovery group and the non-recovery group. Multivariable logistic regression analysis modeling was used to estimate odds ratios and 95% confidence intervals of early mobilization for the ambulation-recovered group within 30 days of onset compared with the unrecovered group. Other covariates examined as possible confounders of the outcome were age, sex, location of the ruptured aneurysm, modified Fisher scale score, WFNS grade, mode of treatment (surgical vs. endovascular), duration of cerebrospinal fluid drainage, days on mechanical ventilation, intracerebral hemorrhage, symptomatic cerebral vasospasm, complications, shunt placement for hydrocephalus, and time to start mobilization.Results: Early mobilization was an independent predictive factor for gait recovery in all groups. Furthermore, location of the ruptured aneurysm (anterior circulation), absence of complications, and absence of shunt placement were independent factors for ambulation recovery in all groups.Conclusion: Early mobilization in elder or/and sever patients with SAH may be a predictive factor for ambulation recovery within 30 days of onset.

Objective: To clarify whether early mobilization is a predictive factor for ambulation recovery in elderly patients and/or patients with severe subarachnoid hemorrhage (SAH).Methods: This multicenter retrospective observational study included 471 patients with treated SAH (Group 1). We focused on SAH patients with a poor prognosis, including a subgroup of elderly SAH patients (age>65 years:n=203) (Group 2) and patients with severe SAH (World Federation of Neurological Societies [WFNS] grade IV or V:n=117) (Group 3). The chi-square test and Mann-Whitney U test were used to compare the differences between the ambulation recovery group and the non-recovery group. Multivariable logistic regression analysis modeling was used to estimate odds ratios and 95% confidence intervals of early mobilization for the ambulation-recovered group within 30 days of onset compared with the unrecovered group. Other covariates examined as possible confounders of the outcome were age, sex, location of the ruptured aneurysm, modified Fisher scale score, WFNS grade, mode of treatment (surgical vs. endovascular), duration of cerebrospinal fluid drainage, days on mechanical ventilation, intracerebral hemorrhage, symptomatic cerebral vasospasm, complications, shunt placement for hydrocephalus, and time to start mobilization.Results: Early mobilization was an independent predictive factor for gait recovery in all groups. Furthermore, location of the ruptured aneurysm (anterior circulation), absence of complications, and absence of shunt placement were independent factors for ambulation recovery in all groups.Conclusion: Early mobilization in elder or/and sever patients with SAH may be a predictive factor for ambulation recovery within 30 days of onset.