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ObjectiveTo investigate the effect of high-definition transcranial direct current stimulation (HD-tDCS) combined with rehabilitation robot on upper limb and hand dysfunction in patients with subacute stroke. MethodsFrom December, 2019 to December, 2021, 50 inpatients with subacute stroke in Zhejiang Provincial People's Hospital were randomly divided into control group (n = 25) and experimental group (n = 25). Both groups received routine rehabilitation therapy, while the control group added sham HD-tDCS combined with rehabilitation robot, and the experimental group added HD-tDCS combined with rehabilitation robot, for four weeks. The upper limb and hand function was assessed with Action Research Arm Test (ARAT), Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and Motor Assessment Scale (MAS) before and after treatment. ResultsAfter treatment, the scores of ARAT, FMA-UE and MAS increased in the two groups (∣Z∣ > 3.320, t > 6.379, P < 0.01), while the scores of FMA-UE and MAS were higher in the experimental group than in the control group (Z = -2.379, t = 3.181, P < 0.05), as well as the scores of grasping and gross motor of ARAT (∣Z∣ > 2.033, P < 0.05). ConclusionThe combination of HD-tDCS and rehabilitation robot can be more effective on upper limb and hand function in patients with subacute stroke than rehabilitation robot alone.
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ObjectiveTo evaluate the effects of transcranial direct current stimulation (tDCS) on post-stroke aphasia (PSA). MethodsLiteratures about tDCS for PSA were retrieved from PubMed, Web of Science, Cochrane library, Embase CNKI and Wanfang Data, until December, 2021. The contents of the author, publication time, subjects, intervention methods and time, main outcome indicators and conclusions were extracted. ResultsA total of 1 026 articles were returned and 45 articles were finally included. The publication time was from 2010 to 2021. The subjects of the study were patients with PSA. The main outcome indicators were the various speech scales and their sub-items. For most of the trials, scores of the scales were better in the experimental groups than in the control groups after treatment, and a few found little improvement in Boston Diagnostic Aphasia Examination, or only improved in complex language tasks. tDCS can improve the repetition, naming, spelling and verbal fluency of PSA patients, which might relate with electrode placement, current magnitude, duration, intensity and left cortical integrity. ConclusiontDCS is effective on different language sub-items of PSA, and various with the program of tDCS.
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@#Objective To systematicly evaluate the constituent factors and accuracy of prediction models of outcome for patients with prolonged disorders of consciousness. Methods Articles about prediction models of outcome for patients with prolonged disorders of consciousness were retrieved from PubMed, Web of Science, CNKI and Wanfang Data until September 30th, 2021. The authors, publishing times, subjects, predictive indicators, outcomes and conclusions were extracted. Results A total of 4 313 articles were returned and 37 included, comprising randomized controlled trials and cohort studies, which published mainly from 2012 to 2021. The subjects were patients with prolonged disorders of consciousness, and their predictions consisted of clinical assessment scales, neuroimaging, neuroelectrophysiology and laboratory indicators. Conclusion Prediction models may be valuable for the long-term outcomes of patients with prolonged disorders of consciousness. Most of the current prediction models are composed of only a limited number of technical means, and the accuracy is uneven. Coma Recovery Scale-revised, default mode network and multiple evoked potentials-related prediction models are accurate, but lack a unified adaptation standard.
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Brain functional network changes over time along with the process of brain development, disease, and aging. However, most of the available measurements for evaluation of the difference (or similarity) between the individual brain functional networks are for charactering static networks, which do not work with the dynamic characteristics of the brain networks that typically involve a long-span and large-scale evolution over the time. The current study proposes an index for measuring the similarity of dynamic brain networks, named as dynamic network similarity (DNS). It measures the similarity by combining the "evolutional" and "structural" properties of the dynamic network. Four sets of simulated dynamic networks with different evolutional and structural properties (varying amplitude of changes, trend of changes, distribution of connectivity strength, range of connectivity strength) were generated to validate the performance of DNS. In addition, real world imaging datasets, acquired from 13 stroke patients who were treated by transcranial direct current stimulation (tDCS), were used to further validate the proposed method and compared with the traditional similarity measurements that were developed for static network similarity. The results showed that DNS was significantly correlated with the varying amplitude of changes, trend of changes, distribution of connectivity strength and range of connectivity strength of the dynamic networks. DNS was able to appropriately measure the significant similarity of the dynamics of network changes over the time for the patients before and after the tDCS treatments. However, the traditional methods failed, which showed significantly differences between the data before and after the tDCS treatments. The experiment results demonstrate that DNS may robustly measure the similarity of evolutional and structural properties of dynamic networks. The new method appears to be superior to the traditional methods in that the new one is capable of assessing the temporal similarity of dynamic functional imaging data.
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Humans , Aging/physiology , Brain/physiology , Brain Mapping , Magnetic Resonance Imaging/methods , Nerve Net/physiology , Transcranial Direct Current Stimulation/methodsABSTRACT
Objective:To explore the research and teaching ability of rehabilitation in medical institutions at different levels in Zhejiang province, for better guiding and promoting of rehabilitation medicine.Methods:90 public hospitals in Zhejiang province were surveyed by Zhejiang Rehabilitation Center from May to August during 2019, to collect information of the research papers, research project applications, patents and monographs of each rehabilitation medicine department in the past five years, as well as the teaching and training activities in 2018.Results:Among the 90 hospitals surveyed, 86 hospitals had rehabilitation medicine departments. In the past five years, 86 hospitals published 636 papers in core journals, 120 SCI/EI papers, and applied for 19 national projects, 40 provincial projects, and 204 bureau level projects, and applied for 25 invention patents and 40 utility model patents, and edited 19 monographs. The average research capacity of rehabilitation including research paper, research project application, patent invention and monograph preparation in tertiary hospitals was significantly better than that of secondary general hospitals in recent 5 years. No SCI/EI papers have been published in the secondary hospital in the past 5 years, and no national project has been awarded. The proportion of SCI/EI papers published by tertiary hospitals was 92.5% (111/120). More teaching work was conducted by tertiary hospitals.Conclusions:The research and teaching ability of rehabilitation in public hospitals of Zhejiang province has reached a certain scale, but there is still a long way to go with other subjects. It is suggested that we should take the opportunity of development of great health and great rehabilitation, different levels of rehabilitation institutions should take their advantages to carry out scientific research and teaching training at different levels. Combined with the three-level rehabilitation network, a number of rehabilitation development measures such as linkage between the upper and the lower levels, mutual assistance in scientific research and integration in teaching should be implemented.
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Objective:To evaluate and quantify the degree of language impairment by obtaining the cerebral blood flow in the main language functional areas of aphasia patients after stroke with arterial spin labeling sequence, so as to make aphasia evaluation more objectively, accurately and effectively.Methods:From May 2016 to October 2019, 22 patients with aphasia after stroke and 22 healthy controls were collected from the Department of Neurology, the First Affiliated Hospital of Zhejiang University, for multimode MR scanning, and the patients were evaluated by aphasia scale during hospitalization. The classic language related brain area and potential language related brain area were selected as the regions of interest to extract the local mean cerebral blood flow. The differences of cerebral blood flow between the two groups were compared, and the correlation between the cerebral blood flow of each region of interest and the sub items of multiple language scales was analyzed.Results:Compared with the control group, the cerebral blood flow of the inferior parietal gyrus （AAL-11，(39.18±3.85) ml·100 g -1·min -1vs (50.41±1.93) ml·100 g -1·min -1， t=2.605）, angular gyrus （AAL-13，(39.90±3.29) ml·100 g -1·min -1vs (47.86±1.93) ml·100 g -1·min -1, t=2.087） in the patients was obviously decreased; In the relevant brain areas of listening comprehension, the cerebral blood flow of the inferior parietal gyrus (AAL-61, (33.86±4.15) ml·100 g -1·min -1vs (44.31±2.39) ml·100 g -1·min -1, t=2.179), superior marginal gyrus (AAL-63, (36.49±4.40) ml·100 g -1·min -1vs（50.17±2.26） ml·100 g -1·min -1, t=2.765), and angular gyrus (AAL-65, (35.56±4.24) ml·100 g -1·min -1vs(48.98±2.32) ml·100 g -1·min -1, t=2.777), Heschl gyrus (AAL-79, (47.30±5.11) ml·100 g -1·min -1vs（62.54±2.45） ml·100 g -1·min -1, t=2.689) and superior temporal gyrus (AAL-81, (43.56±4.82) ml·100 g -1·min -1vs (56.29±2.06) ml·100 g -1·min -1, t=2.429) of the patients was also decreased to different degrees ( P<0.05). In addition, the cerebral blood flow of the left insula (AAL-29, (46.59±3.76) ml·100 g -1·min -1vs (55.74±2.12) ml·100 g -1·min -1, t=2.120) and the rolandic island (AAL-17, (39.71±3.81) ml·100 g -1·min -1vs (52.48±2.01) ml·100 g -1·min -1, t=2.968)cover in the patients was also lower than that in the control group significantly ( P<0.05). The results of correlation analysis showed that there was a significant positive correlation ( P<0.05) between the brain blood flow of the left inferior frontal gyrus, the triangle of inferior frontal gyrus, the insular lobe, the inferior parietal lobe, the bilateral superior marginal gyrus and the sub item scores of the language scale in the patients. Conclusions:The decrease of cerebral blood flow is the potential cause of the decrease of language function in aphasia patients after stroke. The decrease of cerebral blood flow in six brain regions, including the frontal inferior gyrus, the frontal inferior gyrus triangle, the insular lobe, the left and right superior marginal gyrus and the inferior parietal lobe, can be used as an objective quantitative index to reflect the level of naming function.
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Arterial spin labeling (ASL) technology is a popular technique for evaluating and studying cerebral perfusion in recent years. It can sensitively detect the abnormal cerebral perfusion and effectively avoid the potential risks caused by exogenous contrast agents in other tests. Detection of the abnormal cerebral blood flow perfusion by ASL technology can early predict cognitive decline in normal elderly, explore the pathogeneses of mild cognitive dysfunction and Alzheimer's disease, and evaluate the cerebral blood flow around the ischemic focus and the establishment of collateral circulation in patients with aphasia after stroke. At the same time, it is verified that the decrease of cerebral blood flow perfusion is another precipitating factor of primary progressive aphasia except cortex atrophy. Although there are still some limitations, the ASL technology has a good prospect in the application of cognitive disorders.
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Objective To elucidate the mechanism underlying eletroacupuncture's (EA's) amply-documented analgesic effect.To observe its effect on the pain threshold and on the expression of P2X4 receptor and microglia activation in the spinal cords of rats with neuropathic pain.To demonstrate whether or not interfering with A1 receptors and P2X4 receptors at the same time could enhance the analgesic effect.Methods A total of 40 SpragueDawley rats weighing 150 to 180 g were randomly divided into a sham group,a CCI group,an EA group,a 2-chloroN(6)-cyclopentyladenosine (CCPA) group and a CCPA+EA group,each of 8.Chronic constriction injury (CCI)was induced successfully in the rats of all groups except the sham group.Five days later,EA and 20 μL injections of 0.1 mm/L CCPA were applied to the rat analogues of the Zusanli (ST36) and Yanglingquan (GB34) acupoints once a day for 15 days for the rats in the appropriate groups.The mechanical withdrawal threshold (MWT) and the thermal withdrawal latency (TWL) were measured before the CCI operation and 20 days afterward.L4-L6 spinal cord tissue was then resected and the fluorescence intensity of P2X4 and OX42 receptors was detected using double label immunohistochemical staining.The correlation between the mean fluorescence intensity and the pain threshold gap was analyzed.Results The average MWT and TWL of the CCI group were significantly lower than in the other four groups.The expression of P2X4 receptor and OX42 in the spinal cord increased significantly in the CCI group compared to the other four groups.There was significant correlation between the mean fluorescence intensity of P2X4 and OX42 receptors and the gap in pain threshold,with correlation coefficients of 0.907 and 0.717 respectively.Conclusion P2X4 receptor and microglia activation might be involved in the development of neuropathic pain.CCPA and EA can inhibit the activation of microglia and reduce the activity of P2X4 receptors.The interaction between A1 receptors and P2X4 receptors can strengthen the analgesic effect of EA.
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@#Objective To observe the effects of Pilates on balance, walking and lower limbs motor function in older patients after stroke. Methods From November, 2016 to December, 2017, 60 older patients after stroke were divided into control group (n=30) and Pilates group (n=30). The control group received routine medicine and rehabilitation, the Pilates group accepted Pilates training in addition, for ten weeks. They were evaluated with Berg Balance Scale (BBS), 10-metre Maximum Walking Speed (MWS), Timed 'Up and Go' Test (TUGT) and Fugl-Meyer Assessment-Lower Extremity (FMA-LE) before, and five weeks and ten weeks after training.Results The BBS score, MWS, TUGT and FMA-LE score all improved ten weeks after training in both groups (t>2.122, P<0.05), and improved more in the Pilates group than in the control group (t>2.264, P<0.05).Conclusion Pilates can improve the balance, walking and lower limbs motor function in older patients after stroke.
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<p><b>OBJECTIVE</b>To observe the differences of affected-side ankle plantar flexors function and clinical efficacy between contralateral acupuncture combined with rehabilitation training and rehabilitation training alone for patients with acute closed achilles tendon rupture.</p><p><b>METHODS</b>Seventy-four patients with acute closed achilles tendon rupture were randomly assigned to an observation group and a control group, 37 cases in each group. Patients in the both groups were treated with routine rehabilitation training after the operation for 12 weeks; besides, patients in the observation group were treated with contralateral acupuncture at Zusanli (ST 36), Yanglingquan (GB 34), Chengshan (BL 57), Taixi (KI 3) before rehabilitation training in the first 6 weeks. The treatment were given once a day, 5 times as 1 course with 2 d at the interval. The Biodex System 4 multi-joint dynamometers system was applied to test and compare affected-side plantar flexion peak torque (PFPT), peak torque/body weight (PT/BW) and total work (TW) after 6 weeks, 8 weeks and 12 weeks. The efficacy evaluation was conducted after 6 weeks and 12 weeks, and the follow-up visit was conducted 12 weeks after end of treatment.</p><p><b>RESULTS</b>The PFPT, PT/BW, TW in the observation group were significantly superior to those in the control group after 8 weeks and 12 weeks of treatment (all<0.05); compared with those after 6 weeks, the PFPT, PT/BW, TW were significantly increased after 8 weeks of treatment (all<0.05); compared with those after 6 weeks and 8 weeks, the PFPT, PT/BW, TW were significantly increased after 12 weeks of treatment (all<0.05). After 12 weeks of treatment and at follow-up visit, the clinical excellent and effective rates in the observation group were higher than those in the control group[89.2% (33/37) vs 70.3% (26/37), 94.6% (35/37) vs 75.7% (28/37), both<0.05].</p><p><b>CONCLUSIONS</b>During the postoperative rehabilitation of acute closed achilles tendon rupture, the contralateral acupuncture combined with rehabilitation training could improve ankle plantar flexors function and clinical efficacy better than rehabilitation training only.</p>
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Objective To explore the effect of music therapy on post-stroke depression (PSD) with left basal ganglia aphasia. Methods From April, 2013 to July, 2016, 60 patients with PSD and left basal ganglia aphasia were selected as control group (n=30) and research group (n=30). Both groups accepted routine medicine and rehabilitation, and the research group accepted music therapy in addition, for three months. They were assessed with modified Stroke Aphasic Depression Questionnaire Hospital Version (SADQ-H) and China Rehabilitation Research Center Aphasia Examination (CRRCAE) before and after treatment. Results The incidence of serious depression was less in the re-search group than in the control group after treatment, according to the score of SADQ-H (χ2=8.926, P5.707, P<0.001). Conclusion Music therapy helps to relief depression and improve speech in patients with PSD and basal ganglia aphasia.
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Functional magnetic resonance imaging (fMRI) is a technology combined with function, anatomy and images to evaluate the brain function in real-time, dynamic, non-invasive ways. fMRI has been applied in the rehabilitation after stroke for the assessment and prog-nosis of motor, speech, cognition and sense function, etc.
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Objective To investigate the therapeutic effects of acupuncture on pelvic floor muscles and urinary function in patients with spinal cord injury. Methods From March, 2012 to March, 2015, 23 patients with spinal cord injury were divided into control group (n=8), early intervention group (n=8) and later intervention group (n=7). The control group received routine rehabilitation, the intervention groups received acupuncture at Baliao (BL-31, BL-32, BL-33 BL-34), Yanglingquan (GB-34), Sanyinjiao (SP-6) and Taichong (LR-3) acupoints in addition. The early intervention group was acupunctured one week before removal of catheter, and the later intervention group adopted inter-mittent catheterization after removal of catheter, and then received acupuncture. The pelvic floor muscles strength, the urine function and quality of life were recorded before and six weeks after intervention. Results There was no significant difference in all the indices before in-tervention (P>0.05). After intervention, the pelvic floor muscles strength improved in the intervention groups compared with the control group (P0.05). The quality of life improved in all the groups after inter-vention (F>0.864, P<0.05), however, no significant difference was found among three groups (F=1.558, P<0.05). Conclusion Acupuncture, especially early acupuncture, could improve the pelvic floor muscle strength and bladder function in spinal cord injury patients.
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Objective To observe the effect of acupuncture penetrated from Tiaokou (ST38) to Chenshan (BL57) combined with exer-cise on affected limbs of shoulder-hand syndrome (SHS) at stage I after stroke. Methods 40 inpatients with SHS at stage I after stroke from January, 2013 to December, 2014 were randomly divided into treatment group (n=20) and control group (n=20). The treatment group accept-ed acupuncture from Tiaokou to Chenshan on unaffected sides and exercise of affected upper limbs, and the control group accetpted routine acupuncture on Triple Shoulder Acupoints on affected sides. They were assessed with Pain Rating Index (PRI), Fugl-Meyer Assessment (FMA) and modified Barthel Index (MBI) before and 4 weeks after intervention. Results The incidence of improvement was 90% in the treatment group, and 80%in the control group (χ2=0.784, P=0.376). The scores of PRI decreased (t>5.37, P4.66, P2.25, P<0.05). Conclusion Acupuncture from Tiaokou to Chenshan combined with exercise is more effective on SHS at stage I after stroke than conventional Triple Shoulder Acupoints.
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@#Objective To explore the therapeutic effects of electroacupuncture on regional cerebral blood flow (rCBF) in patients with post-stroke depression. Methods 21 patients with post-stroke depression were randomly divided into electroacupuncture group (n=11) and drug group (n=10). The electroacupuncture group received electroacupuncture on double Hegu (LI4) and Taichong (LR3) once a day for 8 weeks, while the drug group took fluoxetine hydrochloride dispersible tablets 20 mg a day for 8 weeks. They were evaluated with Hamilton Self-rating Scale for Depression (HAMD) before, and 2 weeks, 4 weeks and 8 weeks after treatment respectively. The rCBF were measured with single positron emission computerized tomography (SPECT) before and 8 weeks after treatment. Results The score of HAMD decreased more in the electroacupuncture group than in the drug group 2 weeks after treatment (P<0.05), and there was no significant difference between the two groups 4 and 8 weeks after treatment (P>0.05). The rCBF was significantly greater in the electroacupuncture group than in the drug group. Conclusion That electroacupuncture is effective on post-stroke depression, which may be related with the increase of the rCBF levels.
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Objective To explore the therapeutic effects of electroacupuncture on regional cerebral blood flow (rCBF) in patients with post-stroke depression. Methods 21 patients with post-stroke depression were randomly divided into electroacupuncture group (n=11) and drug group (n=10). The electroacupuncture group received electroacupuncture on double Hegu (LI4) and Taichong (LR3) once a day for 8 weeks, while the drug group took fluoxetine hydrochloride dispersible tablets 20 mg a day for 8 weeks. They were evaluated with Hamilton Self-rating Scale for Depression (HAMD) before, and 2 weeks, 4 weeks and 8 weeks after treatment respectively. The rCBF were measured with single positron emission computerized tomography (SPECT) before and 8 weeks after treatment. Results The score of HAMD de-creased more in the electroacupuncture group than in the drug group 2 weeks after treatment (P0.05). The rCBF was significantly greater in the electroacupuncture group than in the drug group. Conclusion That electroacupuncture is effective on post-stroke depression, which may be related with the increase of the rCBF levels.
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@#Objective To explore the therapeutic effects of electroacupuncture on regional cerebral blood flow (rCBF) in patients with post-stroke depression. Methods 21 patients with post-stroke depression were randomly divided into electroacupuncture group (n=11) and drug group (n=10). The electroacupuncture group received electroacupuncture on double Hegu (LI4) and Taichong (LR3) once a day for 8 weeks, while the drug group took fluoxetine hydrochloride dispersible tablets 20 mg a day for 8 weeks. They were evaluated with Hamilton Self-rating Scale for Depression (HAMD) before, and 2 weeks, 4 weeks and 8 weeks after treatment respectively. The rCBF were measured with single positron emission computerized tomography (SPECT) before and 8 weeks after treatment. Results The score of HAMD decreased more in the electroacupuncture group than in the drug group 2 weeks after treatment (P<0.05), and there was no significant difference between the two groups 4 and 8 weeks after treatment (P>0.05). The rCBF was significantly greater in the electroacupuncture group than in the drug group. Conclusion That electroacupuncture is effective on post-stroke depression, which may be related with the increase of the rCBF levels.
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Objective To observe the effect of cognition training on the motor and executive functioning of patients after a basal ganglia stroke.Methods Thirty patients with basal ganglia stroke were randomly divided into a treatment group and a control group.The control group received standard stroke rehabilitation training,while the treatment group received in addition 2 months of cognitive function training.The executive and motor functions of all of the subjects and their facility in the activities of daily living (ADL) were tested using the Tower of Hanoi,the Wisconsin card sorting test,a Stroop-3 test and the Fugl-Meyer assessment,the Berg balance scale and the modified Barthel index before and at the end of treatment.Results After two months of training,both within-group and between group comparisons showed that the treatment group had improved significantly more in executive function,cognition and motor function.Conclusion Cognition training can improve executive function,motor function and ADL performance after a basal ganglia stroke.
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Objective To investigate the feature of event-related potential N400 before and after speech therapy in Chinese aphasia pa-tients. Methods 20 Chinese aphasia patients received speech therapy for 12 weeks. Language function was evaluated with Western Aphasia Battery (WAB), and the latency and amplitude of N400 were monitored before and after treatment. Results Spontaneous speech, retelling, and nomination in WAB and aphasia quotient (AQ) of WAB significantly increased after treatment (P<0.05). N400 latency was shorter and N400 amplitude was lower after treatment (P<0.05). The latency and amplitude of N400 were negatively correlated to the score of AQ in the difference before and after treatment (P<0.001). Conclusion Event-related potential N400 could reflect the improvement of speech function before and after treatment, and it is a valuable index for evaluating the recovery of language function in Chinese aphasia patients.
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Objective To explore the effect of wrist extensor energy on humeral epicondylitis. Methods 48 humeral epicondylitis pa-tients were divided into muscular energy group and block therapy group with 24 cases in each group. The muscular energy group was treat-ed with muscle energy technique, and the other group received block therapy. They were assessed with Visual Analogue Scale (VAS) and muscle strength. They were followed up 3 months, 6 months and 1 year after discharge. Results The score of VAS was lower in the block therapy group than in the muscular energy group (P0.05);6 months after discharge, the muscular energy group (75.0%) was better than the block therapy group (46.1%) (P<0.01); 1 year after dis-charge, the muscular energy group (54.2%) was better than the block therapy group (16.7%) (P<0.01). Conclusion The block therapy is bet-ter in short-term effect on humeral epicondylitis, and the muscle energy technique was better in long-term effect.