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ObjectiveTo explore the effect of low frequency or high frequency repetitive transcranial magnetic stimulation (rTMS) on right Broca's homologue in stroke patients with nonfluent aphasia. MethodsFrom January, 2019 to August, 2022, 80 inpatients in Beijing Bo'ai Hospital were randomly divided into control group (n = 20), sham stimulation group (n = 20), low-frequency (1 Hz) rTMS (LF-rTMS) group (n = 20) and high-frequency (10 Hz) rTMS (HF-rTMS) group (n = 20). All the patients received routine language therapy. LF-rTMS group and HF-rTMS group received ten days of rTMS (1 Hz or 10 Hz), and the sham group received ten days of sham rTMS. The Western Aphasia Battery (WAB) was used to evaluate the language function before, after treatment, and two months after treatment. ResultsBefore treatment, there was no significant difference in the scores of WAB among four groups (P > 0.05). All the scores improved in the four groups immediately after treatment and two months after treatment (P < 0.05). Compared with immediately after treatment, all the scores of WAB improved in LF-rTMS group (P < 0.05), and the scores of recall, name and aphasia quotient (AQ) improved in HF-rTMS group (P < 0.05) two months after treatment. Immediately after treatment, the scores of content and fluency, auditory comprehension and AQ were higher in LF-rTMS group than in HF-rTMS group (P < 0.05). Two months after treatment, the scores of content and fluency were higher in LF-rTMS group than in HF-rTMS group (P < 0.05). ConclusionBoth 1 Hz and 10 Hz rTMS could improve the language function of stroke patients with nonfluent aphasia, especially 1 Hz.
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@#Objective To explore the risk of venous thromboembolism (VTE), especially lower-extremity deep vein thrombosis (DVT) and pulmonary embolism (PE), for stroke patients in rehabilitating, and the functional outcome. Methods A total of 3 557 stroke patients in the neurological rehabilitation center of Beijing Bo'ai Hospital for stroke rehabilitation from January, 2015 to October, 2020 were reviewed through the electronic medical record system. Demographic characteristics, stroke characteristics (type and location), laboratory data (D-dimer polymer and arterial partial pressure of oxygen), motor function (Brunnstrom stage, Fugl-Meyer Assessment of motor and balance, modified Ashworth Scale score of triceps crus, and Holden Walking Ability Classification), activities of daily living (Barthel Index), and anticoagulant/antiplatelet treatment data were collected and analyzed. Results The incidence of DVT and PE was 28.5% and 1.29%, respectively. Most were found 30 days later after onset. The incidence of PE was higher after ischemic stroke (χ2 = 12.49, P < 0.001) rather than hemorrhagic stroke. The patients with hemispheric stroke, severe lower-extremity paralysis, and poor activities of daily living were more prone to complications associated with VTE. After rehabilitation, the function of stroke patients with PE could be improved (|t| > 4.302, P < 0.001). Conclusion The risk of DVT and PE in patients during stroke convalescence may not be negligible, and those with older age, previous history of thrombosis, severe stroke, and severe limb paralysis may be stratified in high-risk. Following anticoagulation treatment, early individualized comprehensive rehabilitation can be done for patients with PE to improve their function and activities of daily living.
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This article showed the work pattern of rehabilitation assessment, and made assessment of a patient who suffered from bilat-eral hemiplegia and pseudobulbar paralysis caused by multiple cerebral apoplexy. Finally, the special characteristics of rehabilitation treat-ment for a patient with bilateral paralysis were summarized.
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@# Objective To explore the effect of low frequency repetitive transranial magnetic stimulation (rTMS) on unilateral spatial neglect (USN). Methods 40 stroke patients with USN were divided into treatment group (n=20) and control group (n=20). Patients in the treatment group were treated with low frequency rTMS for 2 weeks. The USN degree of these groups were evaluated before and after the treatment. Results There was no significant difference of USN degree between these groups before the treatment (P>0.05); Compared with the control group, the treatment group improved significantly after the treatment (P<0.05). The USN degree of patients in the treatment group decreased significantly after the treatment (P<0.05), while patients in the controlled group had no difference (P>0.05). Conclusion USN induced by stroke could be improved obviously through low frequency rTMS.
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@# A 33-year-old male patient with tick-borne encephalitis (TBE) was reviewed, who presented with severe neurological deficits following TBEV infection, and improved in his motor and quality of life after an individualized rehabilitation.
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@#ObjectiveTo analyze the prevalence of urinary incontinence in stroke patients in the convalescent stage, and the characteristics of different type of incontinence. Methods176 stroke patients in the convalescent stage were classified as urinary incontinence and continence, the former were classified as with and without awareness of the need to void. Their features were reviewed. ResultsThe incidence of urinary incontinence was 26.1%. No differences were observed for sex, types, and locations of the focus. There was statistic difference of the single/multiple lesions between the incontinence and the continence （P<0.05）. There was statistic difference in parietal lobe lesions and cognitive dysfunction among the patients with and without awareness of the need to void （P<0.05）. ConclusionThe urinary incontinence in stroke patients in the convalescent stage tend to occur in the patients with multiple lesions, and those without awareness of the need to void is associated with parietal lobe and the cognitive dysfunction.
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@#Objective To investigate the relationship between polymorphism in methylenetetra-hydrofolate reductase (MTHFR ) and acute cerebral infarction (CI), observe the variation regular of fasting plasma homocysteine (Hcy) level.Methods Using Homocysteine Microplate STE Assay to examine the fasting plasma homocysteine level of 28 CI patients during their initial stage (flaring up between 1 to 3 days) and later stage (flaring up 10 to 15 days) of acute period and 27 healthy controls. The presence of the MTHFR genetic type was determined by polymerase chain reaction (PCR) assay and subsequent restriction enzyme digestion.Results There was no significant difference among the three MTHFR genotypes in distributed frequency of the CI group, normal controls and the 677 allelic gene (P>0.05). The discrepancy of Hcy level in various kinds of genotypes: heterozygote mutation and homozygoto mutation were much higher than wild type (P<0.01). Homozygoto mutation was higher than heterozygote mutation, but there was no significant difference between them (P>0.05). The high homocysteine of group CI during the acute early stage were found out more frequent than normal control (P<0.05). There was no significant difference of fasting plasma Hcy level between the initial stage and later stage of CI group which were in acute period (P>0.05), both of the Results were higher than normal control (P<0.01). There was no significant difference among the Hcy level of various genetypes in CI group during the initial stage and later stage of acute period (P<0.05).Conclusion MTHFR gene C677T mutation is one of the cause of high homocystinemia, while it dose not lead to CI directly. High Hcy level is the independent risk factor of CI, but has no concern to the course of acute CI.