To investigate the value of the predict recovery potential (PREP) 2 algorithm for prognostic stratification in the acute phase of stroke and to longitudinally analyze functional recovery trajectories across different prognostic subgroups in a Chinese stroke population.

In this prospective longitudinal study, 65 stroke patients admitted to the First Affiliated Hospital of Wenzhou Medical University within 3 days of onset between March 2023 and January 2024 were enrolled. The Shoulder Abduction and Finger Extension (SAFE) score was assessed within 3 days post-stroke, and transcranial magnetic stimulation-motor evoked potential (TMS-MEP) assessment was performed within 10 days (T1) for prognostic stratification. Prognostic stratification was subsequently conducted using the PREP2 algorithm. Functional assessments, including the upper limb Fugl-Meyer assessment (UE-FMA), national institutes of health stroke scale (NIHSS), and modified Barthel index (MBI), were conducted at T1, 1 month (T2), and 3 months (T3) post-stroke. All patients received standardized comprehensive rehabilitation therapy.

The PREP2-predicted stratification showed agreement with the 3-month outcome levels defined by UE-FMA recovery rate (weighted Kappa=0.785, P<0.001). Repeated-measures ANOVA revealed significant main effects of time and significant time-by-stratification interaction effects for both UE-FMA and MBI scores (P<0.001), indicating distinct functional recovery trajectories among the prognostic subgroups. Multiple linear regression identified the SAFE score (β=0.407, P<0.001) and MEP status (β=0.304, P<0.001) as independent positive predictors of UE-FMA scores at T3, whereas age (β=-0.181, P<0.001) and NIHSS score at T1 (β=-0.205, P<0.001) were negative predictors.

Under real-world clinical conditions in China, the application of the PREP2 algorithm in the early post-stroke phase (within 10 days) enables effective stratification to distinguish patient subgroups with different recovery trends.

To investigate the effects of blood flow restriction combined with low intensity resistance training on upper limb function and activities of daily living (ADL) in patients with high-level spinal cord injury.

Thirty- four patients with cervical spinal cord injury admitted to Beijing Boai hospital from March 2023 to October 2023 were randomly divided into an experimental group and a control group, with 17 patients in each group. The control group received low intensity resistance training for both upper limbs, while the experimental group added blood flow restriction conditions on top of the control group. Comparing five aspects of muscle thickness, muscle strength, capabolities of upper extremity questionnaire (CUE-Q), spinal cord independence measure- Ⅲ (SCIM- Ⅲ) and spinal cord injury of dysfunction quality of life rating scale (SCIDOLRS) between the two groups before and after intervention.

①Upper limb function:After 6 weeks of treatment, the muscle thickness of each muscle in the experimental group significantly increased compared to before treatment (P<0.05), while the control group only partially improved (P<0.05). The difference in muscle thickness between the experimental group and the control group was significantly different (P<0.05); After treatment, the muscle strength of most muscle groups in the experimental and control groups increased compared to before treatment. In addition, the muscle strength of bilateral elbow flexion and extension muscle groups in the experimental group were better than that in the control group (P<0.05); After 6 weeks of treatment, the CUE-Q scores of both groups significantly increased (P<0.05), and the scores of the experimental group were higher than control group (P<0.05).②Changes in daily activity ability:After 6 weeks of treatment, both groups of patients showed improvements in SCIM- Ⅲ and SCIDOLRS scores (P<0.05), and the experimental group scored better than the control group (P<0.05).

Compared to low intensity resistance training, blood flow restriction combined with low intensity resistance training can more effectively improve upper limb function and daily activity ability in patients with high level spinal cord injury.