ABSTRACT
<p><b>OBJECTIVE</b>To explore the effects of electroacupuncture (EA) combined with motor imagery therapy on motor function and activity of daily living in patients with hemiplegic cerebral infarction.</p><p><b>METHODS</b>Ninety patients with hemiplegic cerebral infarction were randomly divided into a rehabilitation group, an EA group and a comprehensive group, 30 patients in each one. The patients in the rehabilitation group were treated with regular care, medication and rehabilitation training; based on the rehabilitation group, the patients in the EA group were treated mainly with electroacupuncture at Baihui (GV 20), Dingnieqianxiexian (MS 6), Dingniehouxiexian (MS 7), Jianyu (LI 15), Waiguan (TE 5), Fengshi (GB 31) and Sanyinjiao (SP 6); with the arrival of. EA device was connected for 30 min. The patients in the comprehensive group were treated with EA as the EA group and motor imagery therapy, 20 min per treatment. The treatment was given once a day, five treatments per week, and totally 4-week treatment was performed. The Barthel index and Brunnstrom score before and after treatment were observed in the three groups.</p><p><b>RESULTS</b>Three cases did not finish the trial and finally 87 cases were included into analysis, including 30 cases in the rehabilitation group, 29 cases in the EA group and 28 cases in the comprehensive group. Compared before treatment, the Barthel index and Brunnstrom score were significantly improved after treatment in the three groups (all<0.01); after treatment, the Barthel index in the EA group and comprehensive group was significantly higher than that in the rehabilitation group (both<0.01); the lower extremity score of Brunnstrom score in the comprehensive group was better than those in the EA group and rehabilitation group (both<0.05).</p><p><b>CONCLUSION</b>EA combined with motor imagery therapy and rehabilitation can significantly improve the motor function and activity of daily living in patients with hemiplegic cerebral infarction, which is superior to rehabilitation alone or EA alone.</p>
ABSTRACT
Objective To study the effect of repetitive peripheral magnetic stimulation combined with exercise on spasticity in the ankle plantar flexors among stroke survivors.Methods Sixty stroke survivors with spasticity in their ankle plantar flexors were randomly divided into a treatment group and a control group,each of 30.Both groups were given conventional kinesitherapy,while the treatment group were additionally provided with repeti-tive peripheral magnetic stimulation for 4 weeks.The myoelectric activity of the agonist and antagonist muscles was recorded using surface electromyography during maximum isometric voluntary contractions of the ankle dorsiflexors and co-contraction ratios (CRs) were calculated.The motor function,walking ability and ankle plantar flexor spasticity were evaluated using the Fugl-Meyer lower extremity assessment (FMA-LE),functional ambulation categories (FACs) and a composite spasticity scale (CSS).Results Before the intervention there was no signification difference between the two groups in terms of any of the assessments.After 4 weeks of treatment,the average integrated EMG of the anterior tibialis in the treatment group was significantly better than in the control group.That group's average FMA-LE and FAC scores were also significantly better.The experimental group's average spasticity score and co-contraction ratio during maximum isometric voluntary contractions of the ankle dorsiflexors had both decreased significantly.All of the improvements in the treatment group were significantly better than those in the control group.Conclusion Repetitive peripheral magnetic stimulation combined with the exercise therapy can effectively reduce ankle plantar flexior spasticity while improving motor function and walking ability.It is more effective than exercise alone.
ABSTRACT
Objective To investigate the early risk factors for stroke-associated pneumonia (SAP) in acute stroke patients with dysphagia.Methods The modified Mann assessment of swallowing ability (MMASA) was used to screen dysphagia in patients with acute stroke admitted to hospital within 24 hours after symptom onset.The patients with dysphagia were used as research subjects.They were divided into either a SAP group or a non-SAP group according to whether they had SAP or not within one week of symptom onset.Univariate and multivariate logistic recession analyses were used to analyze the data of demography,past history,clinical practice,and laboratory.The early risk factors for the occurrence of SAP in patients with dysphagia were identified.The independent risk factors were analyzed with receiver operating characteristic (ROC) curves in order to assess their predictive value for SAP.Results Of the 113 patients with acute stroke,55 had dysphagia,and 30 of them (54.54％ ) had SAP.Univariate analysis showed that the National Institutes of Health Stroke Scale (NIHSS) score (median,[ interquartile range] 16,[ 13 - 21 ] vs.3,[ 1 - 7 ] ; P =0.000),neut rophil counts ([ 8.22 ± 3.75 ] × 109/L vs.[ 5.39 ± 2.56 ] × 109/L; t =3.198; P =0.002),proportion of hemorrhagic stroke (96.00％ vs.4.00％ ;x2 =7.333; P =0.007),and proportion of mechanical ventilation (20.00％ vs. 0.00％;x2=5.612; P=0.018) in the SAP group (n=30) were significantly higher than those in the non-SAP group (n =25),while the MMASA score (median,[ interquartile range ] 53,[ 27 - 84 ] vs.88,[ 66 - 92 ] ; P =0.002),Glasgow Coma sCale (GCS) score (median,[ interquartile range] 10,[7-13] vs.15,[11-15];P=0.001),lymphocytecounts([1.17±0.54] ×109/L vs.[1.75±0.81 ] × 109/L; t =-3.563,P =0.001),CD3+ T lymphocyte counts ([0.73 ± 0.42] × 109/L vs.[ 1.14 ±0.85] × 109/L; t=-2.307; P=0.025),and CD4+ T lymphocyte counts ([0.38± 0.22] × 109/L vs.[ 0.69 ±0.57] × 109/L; t =-2.761; P =0.008) were significantly lower than those in the non-SAP group.Multivariate logistic regression analysis showed that the NIHSS score was higher at admission (odds ratio [ OR ],1.206,95％ confidence interval [ CI ] 1.076- 1.351; P=0.001) and the CD4+ T lymphocyte counts decreased ( OR,0.974,95％ CI 0.952 - 0.997; P =0.025) were the independent risk factors for SAP in stroke patients with dysphagia.The NIHSS score ≥ 10.5 had good predictive value for SAP,and its sensitivity and specificity were 86.7％ and 72.0％ respectively (P =0.000).Conclusions More than half of the acute stroke patients with dysphagia occurred SAP.The NIHSS score at admission,neutrophil counts,stroke types,mechanical ventilation,MMASA score,GCS score,lymphocyte counts,CD3+ T lymphocyte counts,CD4+ Tlymphocyte counts,and other factors were associated with occurrenee of SAP in patients with dysphagia,in which a higher NIHSS score and a decreased CD4+ T lymphocyte counts were independent risk factors for the occurrence of SAP in stroke patients with dysphagia.The NIHSS score ≥ 10.5 at admission had higher predictive value.