Objectives: The aim of this study was to investigate the effects of inspiratory muscle training in post-stroke patients and to explore the effective training protocol. Data sources: PubMed/Medline, Web of Science, Scopus, Embase, Cochrane database, China National Knowledge Infrastructure, and China Science Periodical Database were searched through April 2020. Review methods: Trials examining effects of inspiratory muscle training on pulmonary function, cardiopulmonary endurance, pulmonary infection incidence, and quality of life in post-stroke patients were included. Subgroup analysis was performed to compare different training programs. Mean differences and risk ratios with 95% confidence intervals were presented. Risk of bias was assessed with the Cochrane tool. Results: Thirteen randomized controlled trials involving a total of 373 participants were identified. Meta-analysis conducted in 8 out of 13 trials revealed evidence for beneficial effects of inspiratory muscle training on forced vital capacity (MD: 0.47, 95% CI: 0.28–0.66), forced expired volume in 1 second (MD: 0.26, 95% CI: 0.18–0.35), 6-minute walk test (MD: 52.61, 95% CI: 25.22–80.01), maximum inspiratory pressure (MD: 18.18, 95% CI: 5.58–30.78), inspiratory muscle endurance (MD: 19.99, 95% CI: 13.58–26.40), and pulmonary infection incidence (RR: 0.11, 95% CI: 0.03–0.40). Omitting individual trials from the meta-analysis did not significantly change the results. The effective inspiratory muscle training protocol was suggested by subgroup analysis with three repetitions per week and more than 20 minutes per day for three weeks. Conclusion: Inspiratory muscle training can be considered as an effective intervention for improving pulmonary function and cardiopulmonary endurance, and reducing pulmonary infection incidence in patients after stroke.

Objectives. There is mounting evidence to suggest that the pathophysiology of stroke is greatly influenced by the microbiota of the gut and its metabolites, in particular short-chain fatty acids (SCFAs). The primary purpose of the study was to evaluate whether the levels of SCFAs and the gut microbiota are altered in poststroke patients and to examine the relationship between these alterations and the physical condition, intestinal health, pain, or nutritional status of patients. Methods. Twenty stroke patients and twenty healthy controls were enrolled in the current study, and their demographics were matched. Gas chromatography was used to determine the fecal SCFAs, and 16S rRNA gene sequencing was used to evaluate their fecal microbiota. Microbial diversity and richness were examined using the diversity indices alpha and beta, and taxonomic analysis was utilized to determine group differences. The relationships between the gut microbiome and fecal SCFAs, discriminant bacteria, and poststroke clinical outcomes were analyzed. Results. Less community richness (ACE and Chao) was observed in the poststroke patients ( P < 0.05 ), but the differences between the poststroke group and the healthy control group in terms of species diversity (Shannon and Simpson) were not statistically significant. The makeup of the poststroke gut microbiota was distinct from that of the control group, as evidenced by beta diversity. Then, the relative abundances of the taxa in the poststroke and control groups were compared in order to identify the specific microbiota changes. At the level of phylum, the poststroke subjects showed a significant increase in the relative abundances of Akkermansiaceae, Fusobacteriota, Desulfobacterota, Ruminococcaceae, and Oscillospirales and a particularly noticeable decrease in the relative abundance of Acidobacteriota compared to the control subjects ( P < 0.05 ). In regard to SCFA concentrations, lower levels of fecal acetic acid ( P = 0.001 ) and propionic acid ( P = 0.049 ) were found in poststroke subjects. Agathobacter was highly correlated with acetic acid level ( r = 0.473 , P = 0.002 ), whereas Fusobacteria ( r = − 0.371 , P = 0.018 ), Flavonifractor ( r = − 0.334 , P = 0.034 ), Desulfovibrio ( r = − 0.362 , P = 0.018 ), and Akkermansia ( r = − 0.321 , P = 0.043 ) were negatively related to acetic acid levels. Additionally, the findings of the correlation analysis revealed that Akkermansia ( r = − 0.356 , P = 0.024 ), Desulfovibrio ( r = − 0.316 , P = 0.047 ), and Alloprevotella ( r = − 0.366 , P = 0.020 ) were significantly negatively correlated with high-density lipoprotein cholesterol. In addition, the Neurogenic Bowel Dysfunction score ( r = 0.495 , P = 0.026 ), Barthel index ( r = − 0.531 , P = 0.015 ), Fugl-Meyer Assessment score ( r = − 0.565 , P = 0.009 ), Visual Analogue Scale score ( r = 0.605 , P = 0.005 ), and Brief Pain Inventory score ( r = 0.507 , P = 0.023 ) were significantly associated with alterations of distinctive gut microbiota. Conclusions. Stroke generates extensive and substantial alterations in the gut microbiota and SCFAs, according to our findings. The differences of intestinal flora and lower fecal SCFA levels are closely related to the physical function, intestinal function, pain, or nutritional status of poststroke patients. Treatment strategies aimed at modulating the gut microbiota and SCFAs may have the potential to enhance the clinical results of patients.

Objective. Muscle weakness and spasticity are common consequences of stroke, leading to a decrease in physical activity. The effective implementation of precision rehabilitation requires detailed rehabilitation evaluation. We aimed to analyze the surface electromyography (sEMG) signal features of elbow flexor muscle (biceps brachii and brachioradialis) spasticity in maximum voluntary isometric contraction (MVIC) and fast passive extension (FPE) in stroke patients and to explore the main muscle groups that affect the active movement and spasticity of the elbow flexor muscles to provide an objective reference for optimizing stroke rehabilitation. Methods. Fifteen patients with elbow flexor spasticity after stroke were enrolled in this study. sEMG signals of the paretic and nonparetic elbow flexor muscles (biceps and brachioradialis) were detected during MVIC and FPE, and root mean square (RMS) values were calculated. The RMS values (mean and peak) of the biceps and brachioradialis were compared between the paretic and nonparetic sides. Additionally, the correlation between the manual muscle test (MMT) score and the RMS values (mean and peak) of the paretic elbow flexors during MVIC was analyzed, and the correlation between the modified Ashworth scale (MAS) score and the RMS values (mean and peak) of the paretic elbow flexors during FPE was analyzed. Results. During MVIC exercise, the RMS values (mean and peak) of the biceps and brachioradialis on the paretic side were significantly lower than those on the nonparetic side ( p < 0.01 ), and the RMS values (mean and peak) of the bilateral biceps were significantly higher than those of the brachioradialis ( p < 0.01 ). The MMT score was positively correlated with the mean and peak RMS values of the paretic biceps and brachioradialis ( r = 0.89 , r = 0.91 , r = 0.82 , r = 0.85 ; p < 0.001 ). During FPE exercise, the RMS values (mean and peak) of the biceps and brachioradialis on the paretic side were significantly higher than those on the nonparetic side ( p < 0.01 ), and the RMS values (mean and peak) of the brachioradialis on the paretic side were significantly higher than those of the biceps ( p < 0.01 ). TheMAS score was positively correlated with the mean RMS of the paretic biceps and brachioradialis ( r = 0.62 , p = 0.021 ; r = 0.74 , p = 0.004 ), and the MAS score was positively correlated with the peak RMS of the paretic brachioradialis ( r = 0.59 , p = 0.029 ) but had no significant correlation with the peak RMS of the paretic biceps ( r = 0.49 , p > 0.05 ). Conclusions. The results confirm that the biceps is a vital muscle in active elbow flexion and that the brachioradialis plays an important role in elbow flexor spasticity, suggesting that the biceps should be the focus of muscle strength training of the elbow flexors and that the role of the brachioradialis should not be ignored in the treatment of elbow flexor spasticity. This study also confirmed the application value of sEMG in the objective assessment of individual muscle strength and spasticity in stroke patients.