Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 4 appraisals
Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
Effects of transcranial direct current stimulation on motor function in patients with multiple sclerosis: a systematic review and meta-analysis
OBJECTIVE: To assess the effectiveness of transcranial direct current stimulation (tDCS) in enhancing motor function recovery in the upper and lower extremities of individuals with multiple sclerosis. DATA SOURCES: PubMed, Embase, Web of Science, Cochrane Library, and China Knowledge Network (CNKI) databases from inception until December 28, 2025. STUDY SELECTION: Randomized controlled trials that investigated transcranial direct current stimulation and tDCS combined with physical training on motor function in the upper and lower limbs of individuals with MS. DATA EXTRACTION: Two reviewers extracted the data and assessed the risk of bias. Standardized mean difference (SMD) and 95% confidence intervals (CI) were calculated using a random-effects model based on heterogeneity. The analysis included 10 articles with a total of 299 subjects. DATA SYNTHESIS: The Meta-analysis shows tDCS significantly improves lower limb motor function in MS patients (SMD = 0.31, 95% CI: 0.16 - 0.46, p < 0.0001). Subgroup analyses found significant increases in walking distance (p = 0.0005) and static balance (Berg Balance Score, p = 0.0002), but no significant improvements were observed in walking speed and dynamic balance. For upper limb motor function, no statistically significant difference was found in hand dexterity (9-HPT) (p = 0.11). Notably, subgroup analyses of stimulation parameters showed that high intensity (2.0-2.5 mA, p = 0.007) and a 20-minute duration (p = 0.03) yielded significant effects, whereas low intensity (1.0-1.5 mA) and 15-minute duration showed no significant benefits. CONCLUSIONS: Transcranial direct current stimulation is effective in enhancing lower limb motor function in patients with MS. However, the efficacy of tDCS in improving upper limb fine motor skills remains unclear. Evidence suggests that stimulation at 2.0-2.5 mA for 20 min may be the optimal protocol for clinical intervention.
13 July 2026
Read appraisal →PLoS computational biology
Predictive coding explains asymmetric connectivity in the brain: A neural network study
Seminal frameworks of predictive coding propose a hierarchy of generative modules, each attempting to infer the neural representation of the module one level below; the predictions are carried by top-down feedback projections, while the predictive error is propagated by reciprocal forward pathways. Such symmetric feedback connections support visual processing of noisy stimuli in computational models. However, neurophysiological studies have yielded evidence of asymmetric cortical feedback connections. We investigated the contribution of neural feedback in visual processing for computing grasp parameters, by utilizing convolutional neural network models that had been augmented with predictive feedback and were trained to compute grasp positions for real-world objects. After establishing an ameliorative effect of symmetric feedback on grasp detection performance when evaluated on noisy stimuli, we characterized the performance effects of asymmetric feedback, similar to that observed in the cortex. Specifically, we tested model variants extended with short-, medium-, long- and longer-range feedback connections (i) originating at the same source layer or (ii) terminating at the same target layer. We found that the performance-enhancing effect of predictive coding under adverse conditions was optimal for medium-range asymmetric feedback. Moreover, this effect was most prominent when medium-range feedback originated at a level of representational abstraction that was proximal to the input layer, in contrast to more distal layers. To conclude, our simulations show that introducing biologically realistic asymmetric predictive feedback improves model robustness to noisy visual stimuli in a neural network model optimized for grasp detection.
8 July 2026
Read appraisal →Journal of bodywork and movement therapies
Wearable technologies in neurorehabilitation and cardiac rehabilitation: A narrative review
BACKGROUND/OBJECTIVE: Wearable devices are sensor-based technologies capable of continuous physiological and movement monitoring, improving health tracking and clinical care. They can play a crucial role in clinical practice including cardiac and neurological rehabilitation, aiding in conditions as stroke, Parkinson and heart failure. These tools enhance treatment adherence and outcomes through remote, continuous, and personalized monitoring. By overcoming barriers of traditional rehabilitation, wearable devices offer cost-effective, accessible, and patient-centered solutions for chronic care. The purpose of this study is to evaluate the state of the art of the use of wearable devices in cardiology and neurology clinical rehabilitation practice. METHODS: A structured literature search was performed in PubMed, Embase, Web of Science, Scopus and Cochrane Library databases, for original studies published between 2014 and 2024 involving adult patients and clinical data. Only original studies with patient intervention or observation were included. RESULTS: Of the 25 studies included, 19 focused on neurology and 6 on cardiology, all exploring wearable devices in adult rehabilitation from 2014 to 2024. Neurological studies targeted conditions like stroke and Parkinson's disease, using robotic aids and virtual reality, while cardiac studies focused on activity monitoring and recovery support. Devices ranged from IMUs and sensor-equipped gloves to wrist-worn ECG monitors, with outcomes assessing motor function, heart rate, and rehabilitation adherence. Patient acceptance was generally positive, particularly in tele-rehabilitation contexts, although usability and long-term adherence were inconsistently reported. CONCLUSIONS: Wearable devices effectively improve neurological and cardiac rehabilitation by supporting personalized, data-driven therapies and remote monitoring, helping to monitor activity and therapeutic adherence. Overall, they promote better outcomes, patient autonomy, and access to care, although there is less evidence. Future studies should further investigate the utility of these devices in different rehabilitation settings.
1 July 2026
Read appraisal →Journal of robotic surgery
Progress and perspectives in soft robotics for surgery and rehabilitation
Soft robotic systems have become a promising technology in the biomedical field due to their higher safety, dexterity and adaptability compared to traditional rigid robotic systems. This review focuses on recent advances in soft robotic systems applied to surgical assistance and rehabilitation. In surgery, soft grippers and flexible endoscopes show better adaptability, dexterity, and miniaturization, enabling safer and more precise manipulation of delicate tissues. In rehabilitation, wearable soft devices show great potential to help patients with neurological injuries to regain movement. Key innovations in actuation technology are examined, along with recent advances in multifunctional, self-healing, and environmentally responsive materials. Meanwhile, sensing systems are evolving from unimodal sensing to multimodal fusion, self-perception, and sense-drive integration, enabling robots to sense the body state and external environment with higher accuracy and realize closed-loop control. Finally, this paper points out that soft robots still face key challenges such as material durability, biosafety, and stability during clinical translation. In the future, the focus should be on the construction of systems with self-diagnosis, self-adaptive adjustment and closed-loop control, and promote the efficient landing and personalized application of soft robots from experimental research to real medical scenarios.
21 June 2026
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