{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T05:18:38Z","timestamp":1787635118161,"version":"build-2736575974"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the efficacy of Tuina combined with pulsed dry cupping for constipation management and gastrointestinal (GI) function recovery in severe traumatic brain injury (sTBI), and its associations with nutritional status, neurological function, and patient satisfaction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study was a prospective real-world observational cohort study. A total of 120 patients with severe traumatic brain injury (sTBI) were consecutively enrolled between March 2023 and March 2024. Patients were classified into routine care or combined intervention groups according to routine clinical care pathways without randomization or investigator-driven assignment. Participants in the combined intervention group received Tuina combined with pulsed dry cupping once daily, five times per week for 4 consecutive weeks. Outcomes included constipation-related measures, gastrointestinal function, nutritional indicators, neurological function, and patient-reported outcomes. Appropriate statistical methods were applied for comparisons.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Post-intervention, the combined intervention group showed increased completely spontaneous bowel movements, reduced defecation effort, higher BSS scores, and lower PAC-SYM and GSRS scores versus the routine care group (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05). Serum Hb, ALB, and PA levels and GCS scores were higher in the combined intervention group (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05), while GFAP and NSE levels showed non-significant decreasing trends. PGIC scores were lower in the combined intervention group (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this prospective real-world observational cohort study, Tuina combined with pulsed dry cupping was associated with improvements in constipation-related symptoms, gastrointestinal function, nutritional indicators, and patient-reported outcomes in patients with severe traumatic brain injury. However, given the observational design, causal inferences regarding efficacy cannot be established.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1828783","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T04:22:52Z","timestamp":1787631772000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Tuina combined with pulsed dry cupping for constipation and gastrointestinal recovery in severe traumatic brain injury: a multidimensional rehabilitation study"],"prefix":"10.3389","volume":"17","author":[{"given":"Wenjuan","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Taizhou Affiliated Hospital of Nanjing University of Chinese Medicine","place":["Taizhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongyi","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Nursing, The Affiliated Taizhou Hospital of Nanjing University of Chinese Medicine","place":["Taizhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuexiang","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Nursing, The Affiliated Taizhou Hospital of Nanjing University of Chinese Medicine","place":["Taizhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuxia","family":"Pan","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, The Affiliated Taizhou Hospital of Nanjing University of Chinese Medicine","place":["Taizhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"638","DOI":"10.1016\/s2468-1253(21)00111-4","article-title":"Global prevalence of functional constipation according to the Rome criteria: a systematic review and meta-analysis","volume":"6","author":"Barberio","year":"2021","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e14050","DOI":"10.1111\/nmo.14050","article-title":"Chronic constipation in adults: contemporary perspectives and clinical challenges. 1: epidemiology, diagnosis, clinical associations, pathophysiology and investigation","volume":"33","author":"Scott","year":"2021","journal-title":"Neurogastroenterol Motil"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"106667","DOI":"10.1016\/j.micpath.2024.106667","article-title":"The gut microbiota-constipation connection: insights from a two sample bidirectional mendelian randomization study","volume":"192","author":"Zhou","year":"2024","journal-title":"Microb Pathog"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"975","DOI":"10.1080\/17474124.2023.2267441","article-title":"Recommendations for the management of opioid-induced constipation \u2013 how to improve usability in clinical practice","volume":"17","author":"Okdahl","year":"2023","journal-title":"Expert Rev Gastroenterol Hepatol"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1172\/jci143771","article-title":"Gastrointestinal motility disorders in neurologic disease","volume":"131","author":"Camilleri","year":"2021","journal-title":"J Clin Invest"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"423","DOI":"10.5152\/tjg.2024.24029","article-title":"Functional bowel disorder Management in Routine Practice with tips for hot topics: expert opinion review","volume":"35","author":"Aky\u00fcz","year":"2024","journal-title":"Turk J Gastroenterol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1146054","DOI":"10.3389\/fnhum.2023.1146054","article-title":"Bowel dysfunctions after acquired brain injury: a scoping review","volume":"17","author":"Zandalasini","year":"2023","journal-title":"Front Hum Neurosci"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"102944","DOI":"10.1016\/j.clnesp.2026.102944","article-title":"Gastrointestinal dysfunction in critically ill patients: a prospective observational study of frequency, severity, risk factors, and outcomes","volume":"73","author":"Asrani","year":"2026","journal-title":"Clin Nutr ESPEN"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"26323524231222496","DOI":"10.1177\/26323524231222496","article-title":"Non-pharmacological interventions feasible in the nursing scope of practice for pain relief in palliative care patients: a systematic review","volume":"18","author":"van Veen","year":"2024","journal-title":"Palliat Care Soc Pract"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"S19","DOI":"10.1097\/sap.0000000000003891","article-title":"Negative pressure wound therapy for chronic wounds","volume":"93","author":"Li","year":"2024","journal-title":"Ann Plast Surg"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"815","DOI":"10.1093\/bja\/aeg275","article-title":"Constipation and its implications in the critically ill patient","volume":"91","author":"Mostafa","year":"2003","journal-title":"Br J Anaesth"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1111\/nmo.12738","article-title":"Bristol stool form scale reliability and agreement decreases when determining Rome III stool form designations","volume":"28","author":"Chumpitazi","year":"2016","journal-title":"Neurogastroenterol Motil"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"005","DOI":"10.1055\/s-0040-1714245","article-title":"Metrics used to quantify Fecal incontinence and constipation","volume":"34","author":"Hunt","year":"2021","journal-title":"Clin Colon Rectal Surg"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"101976","DOI":"10.1016\/j.cdnut.2023.101976","article-title":"Assessing gastrointestinal tolerance in healthy adults: reliability and validity of a weekly questionnaire","volume":"7","author":"Alvarez","year":"2023","journal-title":"Curr Dev Nutr"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1016\/s0140-6736(74)91639-0","article-title":"Assessment of coma and impaired consciousness. A practical scale","volume":"2","author":"Teasdale","year":"1974","journal-title":"Lancet"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1117","DOI":"10.1002\/ejp.1378","article-title":"Patients' global impression of change in the management of peripheral neuropathic pain: clinical relevance and correlations in daily practice","volume":"23","author":"Perrot","year":"2019","journal-title":"Eur J Pain"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"2021","DOI":"10.1080\/13854046.2021.1967452","article-title":"Anosognosia in moderate-to-severe traumatic brain injury: a review of prevalence, clinical correlates, and diversity considerations","volume":"36","author":"Steward","year":"2022","journal-title":"Clin Neuropsychol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1877","DOI":"10.1152\/physrev.00018.2018","article-title":"The microbiota-gut-brain Axis","volume":"99","author":"Cryan","year":"2019","journal-title":"Physiol Rev"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1007\/s00134-016-4665-0","article-title":"Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines","volume":"43","author":"Reintam Blaser","year":"2017","journal-title":"Intensive Care Med"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"104936","DOI":"10.1016\/j.ijnurstu.2024.104936","article-title":"Effectiveness of abdominal massage on chronic constipation in adults: a systematic review and meta-analysis","volume":"161","author":"Huang","year":"2025","journal-title":"Int J Nurs Stud"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/pzac058","article-title":"Abdominal massage in functional chronic constipation: a randomized placebo-controlled trial","volume":"102","author":"Do\u011fan","year":"2022","journal-title":"Phys Ther"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"177","DOI":"10.3831\/kpi.2024.27.3.177","article-title":"Cupping therapy for the treatment of migraine headache: a systematic review and meta-analysis of clinical trials","volume":"27","author":"Mohandes","year":"2024","journal-title":"J Pharmacopunct"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.3390\/microorganisms10102082","article-title":"Translocation and dissemination of gut bacteria after severe traumatic brain injury","volume":"10","author":"Yang","year":"2022","journal-title":"Microorganisms"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2022\/8331439","article-title":"Abdominal massage improves the symptoms of irritable bowel syndrome by regulating mast cells via the Trypase-PAR2-PKC\u03b5 pathway in rats","volume":"2022","author":"Li","year":"2022","journal-title":"Pain Res Manag"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"47","DOI":"10.21873\/invivo.13053","article-title":"Non-pharmacological interventions on pain and quality of life in chemotherapy induced polyneuropathy: systematic review and meta-analysis","volume":"37","author":"Papadopoulou","year":"2023","journal-title":"In Vivo"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1828783\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T04:22:53Z","timestamp":1787631773000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1828783\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,25]]},"references-count":25,"alternative-id":["10.3389\/fneur.2026.1828783"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1828783","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,25]]},"article-number":"1828783"}}