ABSTRACT
Stroke is a disease with a high disability rate， and often leads to limb dysfunction， especially upper limb motor dysfunction， which significantly affects the patients’ abilities and quality of life. With patients' increasing demand for functional recovery， various therapeutic techniques of rehabilitation medicine have been rapidly developed. As an important active central intervention technology， motor imagery training can be initiated by the patient's brain and activate the sensorimotor network to accelerate the repair of limb functions. The development of preventive medicine has promoted the continuous evolution of the concept of rehabilitation. The strategies of full cycle functional protection and disability prevention have been improved and developed in the clinical and scientific research practice of upper limb rehabilitation after stroke. The motor imagery training can activate the upper limb motor neural network in the early stage of stroke to prevent functional loss； In the recovery period， it can accelerate the neural function remodeling and reduce the upper limb disability； In the later stage after stroke， it can improve the performance of upper limb function in daily life， thus helping patients return to family life and society. This article reviews the research progress in recent years in China and abroad in the application of motor imagery training for the full cycle function protection and disability prevention of stroke.
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Objective:To explore the mechanism of motor imagery training (MIT) combined with conventional rehabilitation to promote the functional recovery of upper limbs in stroke survivors. To explore the brain network reorganization resulting when motor imagery training (MIT) is combined with conventional rehabilitation to promote the motor recovery of stroke survivors.Methods:Fourteen hemiplegic patients were recruited as the MIT group. They underwent 4 weeks of MIT (30 min/day, 5 days/week) along with conventional rehabilitation treatment. The upper limb section of the Fugl-Meyer assessment (FMA-UE) and the modified Barthel Index (MBI) were used to assess all of the patients, and resting-state fMRI was performed before and after the treatment. Twenty-eight age- and sex-matched healthy subjects also received one-time resting-state fMRI scanning. Granger causal analysis was performed in the MIT group to calculate the changes in effective connection between the ipsilesional primary motor cortex and the whole brain before and after the treatment, and the results were compared with the healthy control group.Results:After the treatment, the average FMA-UE and MBI of the MIT group had increased significantly. Before the intervention, the effective connection mode of the ipsilesional M1 area in the MIT group was significantly different from that of the healthy controls. The causal flow from the ipsilesional M1 area to the bilateral prefrontal cortex had increased abnormally and the causal flow from the contralesional primary motor cortex, the inferior parietal lobule and the cerebellum to the ipsilesional M1 area had decreased significantly. After the treatment, the effective connection pattern of the stroke survivors was nearly normal, and the causal influence from contralesional motor imagery-related brain areas (the superior parietal lobule, inferior parietal lobule, thalamus and the fusiform gyrus) to the ipsilesional M1 area was enhanced. Effective connection from the ipsilesional M1 area to the contralesional cerebellum before the intervention was positively correlated with the improvement in FMA-UE scores, and the effective connection from the contralesional middle frontal gyrus to the ipsilesional M1 area was correlated negatively.Conclusions:The neural mechanism of MIT's effectiveness when it is combined with conventional rehabilitation might be related to the reorganization of effective connections. That would include enhanced causal flow between motor imagery-related brain areas and the contralesional cerebellum and ipsilesional M1 area. Down-regulation of the effective connection from the contralesional middle frontal gyrus to the ipsilesional M1 area also occurs.
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Objective To measure the efficacy of combining motor imagery training ( MIT) with convention-al therapy in improving stroke patients′upper-extremity function. And to seek a cortical reorganization mechanism as-sociated with the improvement using resting-state functional magnetic resonance imaging ( rs-fMRI) . Methods Ten stroke survivors were selected as an experimental group. They were given motor imagery training for four weeks ( 30 minutes a day, 5 days a week) and conventional rehabilitation therapy ( 40 minutes a day, 5 days a week) . Another 10 healthy counterparts were the control group. Before and after the four weeks of treatment, both groups were as-sessed using the upper extremity Fugl-Meyer assessment ( FMA-UE) and the modified Barthel index ( MBI) . Moreo-ver, rs-fMRI was conducted to assess functional connectivity between cortical regions and the ipsilesional primary mo-tor cortex ( M1) before and after the intervention. The laterality index ( LI) of the primary motor or sensory cortex was also calculated. Results After the intervention, the average FMA-UE and MBI scores of the experimental group had increased significantly. After MIT and conventional therapy there was increased functional connectivity between the ip-silesional and contralesional M1 areas, and between the ipsilesional M1 and contralesional primary sensory cortex ( S1) and frontal lobe, the functional connection between the ipsilesional M1 and the ipsilesional paracentral lobule and the anterior cingutate was also increased. More specifically, the LI relating M1 and S1 decreased after the inter-vention, tending toward the normal level. LIMI decreased significantly. Conclusion The 4-week regimen of motor imagery training and conventional therapy resulted in functional improvement in the upper limbs and greater ability in the activities of daily living. The observed improvements may be due to cortical reorganization, including better func-tional connectivity between the bilateral M1 areas and increased connectivity between the ipsilesional M1 area and some non-motor areas. There is some recovery of symmetry in the bilateral primary motor cortex.
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@# Objective To explore the effects of transcutaneous electrical acupoint stimulation (TEAS) on upper limbs function in chronic stroke patients. Methods From March, 2016 to May, 2018, 53 patients were randomly divided into control group (n = 27) and research group (n = 26). All the patients received conventional rehabilitation, and the research group received additional intervention of TEAS, for six weeks. They were assessed with Manual Muscle Test (MMT) on upper limbs, modified Ashworth Scale (MAS), Fugl-Meyer Assessment-upper extremities (FMA-UE), Hand Motor Status Scale and modified Barthel Index (MBI) before, at the end of 6-week treatment and twelve weeks after treatment. Results There was no significant difference in all the scores between two groups at the end of 6-week treatment (t < 1.511, P > 0.05). The scores of MMT of wrist dorsal extension, FMA-UE and MBI were better in the research group than in the control group twelve weeks after end of treatment (t > 2.312, P < 0.05). Conclusion TEAS may promote the recovery of hands and upper limbs function in chronic stroke patients.
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Upper limb lymphedema is one of the most common complications secondary to breast cancer surgery. Detailed medical his-tory inquiry, careful physical examination, and precise and objective measurement are indispensable to accurately diagnose and evaluate up-per limb lymphedema. The mostly widely used objective assessments include circumference and volume measurement, bioimpedance for de-tection of fluid state and all kinds of lymphatic system imaging techniques.
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ObjectiveTo investigate the correlation between femoral distal medial torsion and patellofemoral joint malalignment and analyze the causes of patellofemoral joint disorders,which provide the new theory with clinical treatment.MethodsFrom May 2007 to June 2009,124 knees(95 cases) with patellofemoral joint disorders were enrolled in this study randomly.Each knee was scanned with CT in dynamic 20° -30° knee flax position.Femoral distal medial torsion angle (FMTA),patellar congruence angle (CA) and patellar tilt angle(PTA) were measured.The correlation between FMTA and CA or PTA was analyzed.Results FMTA ＜ 5° in 25 knees,≥5° in 99 knees,6 knees with trochlear dysplasia who were excluded.FMTA in 93 knees was 16.06° ± 5.68°,CA was 16.40° ± 5.48° and PTA was 19.59° ± 3.32°.The positive correlation was found between FMTA and CA when FMTA ＞ 10°through scatter diagram analysis (r =0.709,P ＜ 0.05 ).The positive correlation was found between FMTA and PTA when FMTA ＞10°( r =0.652,P ＜ 0.05),the positive trend declined when FMTA ＞ 27°.ConclusionsFemoral distal medial torsion is an important risk factor of patellofemoral joint malalignment.When FMTA ＞ 10°,FMTA and CA,PTA has positive correlation,but the positive tend between FMTA and PTA declines when FMTA ＞ 27°.