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Objective:To observe any effects of contralateral repeated transcranial magnetic stimulation (rTMS) of the swallowing motor cortex on the swallowing and brainstem auditory evoked potentials (BAEPs) of stroke survivors with dysphagia.Methods:A total of 83 stroke survivors with dysphagia were randomly divided into an ipsilesional stimulation group ( n=22), a contralesional stimulation group ( n=21), a bilateral stimulation group ( n=20), and a control group ( n=20). In addition to their conventional dysphagia training, those in the three stimulation groups received 3Hz rTMS while the control group was given fake stimulation. The treatment was administered daily for 20 minutes, 6 days a week, for 5 consecutive weeks. Before and after the treatment, swallowing function was assessed videofluoroscopically and using the Dysphagia Outcome and Severity Scale (DOSS). The oral and pharyngeal stages of swallowing were evaluated using the videofluoroscopic dysphagia scale (VDS). Brain stem conduction was assessed using BAEPs. Results:After treatment the average DOSS scores of all 4 groups were significantly better than before the treatment. The average DOSS scores of the contralesional and bilateral sti-mulation groups were then significantly better than those of the other two groups. The sub-item and total VDS scores of all 4 groups had decreased significantly, but the average score of the bilateral stimulation group was significantly lower than the control group′s average. Ipsilesional stimulation significantly improved the VDS sub-item scores for the triggering of pharyngeal swallowing, laryngeal elevation, and pharyngeal transit time compared with the control group. In the contralesional stimulation group the average total score and the VDS sub-item scores for apraxia, premature bolus loss, oral transit times, the triggering of pharyngeal swallowing, vallecular residue, laryngeal elevation, coating on the pharyngeal wall, and pharyngeal transit time were significantly lower than those of the control group, on average. After the treatment the latencies of BAEP waves I, III and V and the I-III, III-V and I-V interpeak intervals had decreased significantly in all four groups, but the average latencies and intervals of the bilateral and contralesional groups were significantly shorter than those of the control group. The latencies and intervals of the bilateral stimulation group were then significantly shorter than those in the ipsilesional stimulation group on average. The average latency of wave V in the bilateral stimulation group (6.53±0.73ms) was significantly shorter than that in the contralesional stimulation group after the treatment.Conclusion:Bilateral rTMS over the swallowing motor cortex combined with conventional dysphagia training can significantly improve the swallowing of dysphagic stroke survivors.
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Objective:To explore any effect of blood flow restriction during exercise on knee proprioception and motor coordination after anterior cruciate ligament (ACL) reconstruction.Methods:Thirty patients recovering from ACL reconstruction were randomly divided into an experimental group and a control group, each of 15. Both groups were given routine rehabilitation training, while the experimental group was additionally provided with 45 minutes of training with blood flow restriction, 3 times a week for 8 weeks. The blood flow restriction training involved constant pressure in the groin while the patient performed knee flexion and extension resistance training, squats, alternate knee flexion and extension and ergometer cycling. Before and after the intervention, both groups′ knee function, proprioception and lower limb motor coordination were evaluated using the Lysholm knee scale, the Humac isokinetic measurement system and surface electromyography.Results:Before the experiment there were no significant differences between the two groups in any of the measurements. After the intervention, both groups′ average Lysholm score had improved significantly, and errors in reproducing a knee angle had decreased significantly. Significantly better improvement was observed in the observation group than in the control group. That group′s average coordinated contraction rate on the affected side in extension and flexion was also significantly better than the control group′s ave-rage. Indeed, there were no significant differences in the contraction rates between the healthy and affected sides.Conclusions:Training with restricted blood flow can significantly improve knee function, proprioception and motor coordination after anterior cruciate ligament reconstruction.
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Objective:To observe any effect of dynamic motor instability training on the balance and postural control of stroke survivors.Methods:Forty stroke survivors with poor balance were randomly divided into a control group and an observation group, each of 20. In addition to routine rehabilitation, the observation group was given 20 minutes of dynamic motor instability training, 5 days a week for 8 weeks, while the control group underwent routine rehabilitation for the same length of time. Before and after the intervention, surface electromyogram of the rectus femoris, biceps femoris, and erector spinae were recorded during perturbation. Activation time and the intensity of the anticipatory and complementary postural adjustments (APAs and CPAs) were also observed. Balance and lower limb motor functioning were assessed using the Berg balance scale (BBS), the Fugl-Meyer lower extremity assessment (FMA-LE), and GaitWatch analysis.Results:After the treatment the average activation time of the rectus femoris, biceps femoris in the affected side and those of the biceps femoris [(-84.31±5.74)s] and erector spinae in the intact side in APAs were all significantly shorter in the observation group than in the control group, while the average activation intensity of the rectus femoris and erector spinae was significantly greater. There was no significant difference in the activation intensity of each muscle group in CPAs after the treatment. After the intervention the average BBS score, FMA-LE score, stride length and walking speed of the observation group all were significantly better than the control group′s averages.Conclusions:Supplementing traditional rehabilitation training with dynamic motor instability training can further improve the posture control of stroke survivors and promote recovery of their balance and walking ability.
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Balance impairment is a common complication after stroke, which often leads to difficulty in walking function recovery and high risk of fall, seriously affecting the independent activity ability and quality of life of stroke patients. Accurate assessment of balance is conducive to better formulation of rehabilitation plans, evaluation of rehabilitation effects, and guidance of safer daily living activities of stroke patients. This article reviews the research progress of various methods for accurate assessment of balance function in patients with stroke.
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Objective:To observe any effect of body-weight-supported treadmill training (BWSTT) combined with functional electrical stimulation (FES) on lower limb motor function and the walking ability of hemiplegic stroke survivors.Methods:Fifty-eight stroke survivors with hemiplegia were randomly divided into an FES group of 19, a BWSTT group of 19 and a combination group of 20. In addition to their early routine rehabilitation therapy, the FES and BWSTT groups were provided with the respective therapies, while the combination group received both. The three groups received 30 minutes of treatment a day, 5 days a week for 8 weeks. The Berg Balance Scale (BBS), the simplified version of the Fugl-Meyer assessment scale for the lower extremities (FMA-LE), the 10-metre walk test (10MWT) and functional ambulation classification (FAC) were used to evaluate the subjects′ balance, lower-limb motor function, walking speed and walking function before and after the 8 weeks of treatment.Results:After the treatment, the average BBS, FMA-LE, 10MWT and FAC scores of all three groups had improved significantly, but the combination group′s averages were then significantly better than those of the other two groups.Conclusions:BWSTT combined with FES can best improve the balance, lower-limb motor functioning and walking of hemiplegic stroke survivors.
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Objective:To explore any effect of training assisted by a pelvic rehabilitation robot on trunk control and walking after cerebral infarction.Methods:Forty cerebral infarction survivors with hemiplegia were randomly divided into an experimental group and a control group, each of 20. Both groups were given routine neurological medication and rehabilitation training, while the experimental group was additionally provided with 20 minutes of robot-assisted gait training daily, five times a week, for 4 weeks. Before and after the intervention, the motor function, walking function, trunk control and pelvic movement were assessed using a simplified version of the Fugl-Meyer assessment (FMA-LL), functional ambulation categories (FAC) and the trunk control test (TCT).Results:After the treatment, significant improvement was observed in all of the above measurements in both groups. The average FMA-LL, FAC and TCT results of the experimental group as well as their average pelvic lateral displacement, height displacement, rotation angle and roll angle were all significantly superior to the control group′s averages.Conclusions:Robot-assisted training can effectively improve lower limb motor functioning, trunk control, walking and pelvic motion after cerebral infarction, with better curative effect than routine rehabilitation training alone.
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Objective:To explore the effect of a pelvis-assisting rehabilitation robot on lower limb function and knee proprioception after cerebral infarction.Methods:Forty hemiplegic cerebral infarction survivors were randomly divided into an experimental group and a control group, each of 20. Both groups were given routine neurological medication and rehabilitation training, while the experimental group was additionally provided with 20 minutes of robot-assisted gait training daily, five times a week for four weeks. Before and after the intervention, motor function, balance, walking function and knee joint proprioception were assessed using the simplified Fugl-Meyer lower limb assessment, the Berg balance scale, functional ambulation categorization and the Humac Norm isokinetic tester.Results:After the treatment, significant improvement was observed in all of the above measurements in both groups, but the improvements were significantly greater in the experimental group.Conclusions:Robotic pelvic assistance can effectively improve lower limb motor function, balance, knee proprioception and walking after cerebral infarction.
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Objective:To explore the effect of robot-assisted training and repetitive transcranial magnetic stimulation (rTMS) on the lower limb function of hemiplegic stroke survivors.Methods:Forty hemiplegic stroke patients were randomly divided into a treatment group ( n=20) and a control group ( n=20). Both groups were given routine rehabilitation training and robot-assisted walking training, but the treatment group was additionally treated with rTMS at 1Hz applied to the primary motor cortex M1 area at an intensity of 80% of the resting motor threshold. The stimulation time was 5 seconds at 5-second intervals, 600 pulses each time, five times a week for 8 weeks. Lower limb motor function, balance and walking function were assessed before and after the intervention using the Fugl-Meyer assessment for the lower extremities, the Berg balance scale and the Holden walking function scale. Results:There was no significant difference between the two groups in any measurement before the training, but after the intervention all of the measurements had improved significantly in both groups, with the average Fugl-Meyer score, Berg score and Holden grading significantly better in the treatment group.Conclusion:Repetitive transcranial magnetic stimulation can improve the effectiveness of robot-assisted walking training in improving lower limb motor function, balance and walking after a stroke.
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Objective:To observe any effect of repeated unilateral high frequency transcranial magnetic stimulation (rTMS) on the swallowing function and functional magnetic resonance images of dysphagic stroke survivors.Methods:Twenty stroke survivors with dysphagia were randomly divided into a treatment group ( n=10) and a control group ( n=10). Both groups received traditional swallowing rehabilitation training, while the treatment group was additionally provided with high frequency rTMS over the cortical area of the suprahyoid muscle group of the healthy contralateral cerebral hemisphere. The stimulation frequency was 5Hz and the stimulation intensity was 80% of the resting movement threshold. During the 20-minute treatment, there was a 20-second interval between each 2-second dose of stimulation. Before and after the treatment, both groups were evaluated using the Eating Assessment Tool-10 (EAT-10), a swallowing functional communication measurement (FCM) and the modified Mann Assessment of Swallowing Ability (MMASA). In addition, functional magnetic resonance imaging was used to observe any changes in the relevant brain regions. Results:After the treatment the average EAT-10, FCM and MMASA scores of both groups were significantly better than those before the treatment, with the treatment group′s averages significantly superior to those of the control group. After the treatment, the activation range of the parietal lobe, the superior parietal lobule, the BA7 region and the BA40 area in the treatment group was significantly larger than before the treatment and larger than the control group′s ranges.Conclusions:Repeated high-frequency transcranial magnetic stimulation of the cortical area of the suprahyoid muscles in the contralateral cerebral hemisphere can improve dysphagia and promote the activation of brain areas related to swallowing after a stroke.
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Objective:To observe the effect of observing good swallowing on the swallowing action of stroke survivors with dysphagia.Methods:Eighteen stroke survivors with dysphagia were randomly divided into a treatment group ( n=9) and a control group ( n=9). In addition to routine swallowing rehabilitation therapy, the treatment group was asked to simulate swallowing after watching a video of normal people′s swallowing action. They did so 5 times a week for 10 minutes, while the control group just watched landscape videos at the same time. The treatment lasted 8 weeks. Before and after the treatment, both groups were assessed using the eating assessment tool (EAT-10), the functional oral intake scale (FOIS) and the penetration and aspiration scale (PAS). Functional magnetic resonance imaging (fMRI) was also used to observe their swallowing action. Results:There was no significant difference between the two groups in any of the measurements before the treatment. After the 8 weeks of treatment the average EAT-10, FOIS and PAS scores of the treatment group were all significantly better than before the treatment and better than the control group′s averages at the time. fMRI showed significantly more areas activated in the precuneus, parietal lobe, posterior central gyrus, BA7, BA5, frontal lobe and paracentral lobule in the treatment group compared with before the intervention and also more than in the control group.Conclusions:Observing proper swallowing action can improve dysphagia and activation of the swallowing-related brain areas of stroke survivors.
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Objective:To observe the effect of applying repetitive transcranial magnetic stimulation (rTMS) on swallowing function and auditory evoked potentials in the brain-stems of stroke survivors with dysphagia.Methods:Sixty stroke survivors with dysphagia were randomly assigned to an observation group and a control group, each of 30. Both groups were given 30 minutes of routine swallowing training 6 times a week for 5 weeks, while the observation group was additionally provided with two-second bursts of rTMS on the left and right brain hemispheres alternately for 20 minutes daily. The frequency was 3.0Hz and the strength was 80% of the resting motor threshold (RMT), with an interval of 10 seconds between bursts. Before and after the treatment, both groups′ swallowing was assessed using the functional communication measure (FCM) and the modified Mann swallowing capacity evaluation scale (MMASA). Brainstem auditory evoked potentials (BAEP) were recorded to detect any changes in the peak latency (PL) and inter-peak latency (IPL). The clinical efficacy was also observed.Results:After the treatment, the average FCM results of both groups had improved significantly, but the observation group had improved significantly more. The average MMASA total scores and the average scores on all the sub-items had improved significantly more in the observation group except for the expressive speech disorder and anarthria scores. After the treatment, improvement was observed in respiration, anarthria, range of motion of the tongue muscles, strength of the tongue muscles, gag reflex and soft palate movement compared with before the intervention. Peak and inter-peak latencies had also improved significantly more in the observation than in the control group, on average.Conclusions:rTMS combined with conventional swallowing training can significantly improve the swallowing of dysphagic stroke survivors, and shorten the PL of the BAEP so as to better regulate deglutition.
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Objective To explore the effect of robot assistance on the gait kinematics of hemiplegic persons after a stroke.Methods Forty hemiplegic stroke patients were randomly divided into an experimental group and a control group,each of 20.Both groups were given routine neurological medication and rehabilitation training,while the experimental group was additionally provided with 20 minutes of robot-assisted gait training daily,six times a week,for 8 weeks.Before and after the intervention,both groups' motor function,balance,step length and pace were evaluated,as well as their pelvic rotation angles,side inclination,vertical displacement and lateral displacement.The Fugl-Meyer assessment for the lower extremities (FMA-LE) was used along with the Berg balance scale (BBS),the gait analysis system of Biodex Gait Trainer-2 equipment.Results After the treatment,the average FMA-LE score,BBS score,pace and step length of the experimental group were all significantly better than the before the treatment and significantly better than the control group's averages after the treatment.The improvements observed in the pelvic rotation angle,side inclination,vertical displacement and lateral displacement were all significant.Conclusion Robot assistance can usefully supplement routine rehabilitation training after stroke.It can improve control of the pelvis,enhance walking and balance and generally improve the motor function of the lower extremities.
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Objective To explore the effect of robot-assisted gait training on pelvis kinematics and the walking function of hemiplegic stroke survivors.Methods Thirty stroke survivors with hemiplegia were randomly divided into a treatment group and a control group,each of 15.Both groups were given routine clinical medication and rehabilitation training,while the treatment group was additionally provided with 20 minutes of robot-assisted gait training a day,6 d/wk for 8 weeks.Before and after the treatment,all of the patients' pelvis kinematics were assessed using 10 m walking speed (MWS),the timed up and go test (TUGT) and functional ambulation categorization (FAC).Results Before the treatment there were no significant differences between the two group in any of the measurements.After the treatment,significant improvement was observed in both groups in the vertical displacement and rotation and tilt angles of the pelvis while walking,with significantly more improvement in the treatment group than in the control group.There was also significant improvement in the average walking speed,TUGT time and FAC score of both groups,with significantly more improvement in the treatment group.Conclusion Robot-assisted gait training can significantly improve the pelvis control and walking ability of hemiplegic stroke survivors.
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Objective To observe the effect of hyperbaric oxygen (HBO) therapy combined with repeated transcranial magnetic stimulation (rTMS) on patients with cognitive dysfunction after cerebral infarction.Methods A total of 81 patients with cognitive dysfunction after cerebral infarction were randomly divided into a control group,an HBO group and a combined treatment group,each of 27.In addition to basic medication and traditional rehabilitation therapy,the HBO group was also treated with hyperbaric oxygen,while the combined treatment group received both HBO and rTMS.The mini-mental state examination (MMSE) and the Montreal cognitive assessment (MoCA) were administered before and after the four weeks of treatment.Results The average MMSE scores of the HBO and combined treatment groups were both significantly higher than that of the control group,with the former significantly higher than the latter.Moreover,the average MoCA score of the HBO group was also significantly higher than that of the combined treatment group,and both were significantly higher than that of the control group.Conclusion Hyperbaric oxygen therapy can more effectively improve the cognitive function of patients with cognitive dysfunction after the cerebral infarction when it is combined with repeated transcranial magnetic stimulation.
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Objective To investigate the safety of training using a lower-limb rehabilitation robot and its effectiveness in terms of stroke survivors' cardiopulmonary function.Methods Thirty-two hemiplegic stroke survivors were randomly divided into a robot group and a control group,each of 16.Both groups received conventional rehabilitation medication and training,120 min/d,5 d/week for 8 weeks.The robot group was additionally trained with a Flexbot robotic gait training apparatus for 30 min/d,5 d/week for the same 8 weeks.The subjects' maximum oxygen consumption (VO2max),heart rate,blood pressure,ventilation (VE) and rate of perceived exertion (RPE) were quantified before and after the training.Results After the 8 weeks there was no significant difference in average heart rate,blood pressure,VE or RPE between the two groups.The average VO2max of the robot group was,however,significantly higher than that of the control group.Conclusion Robotic gait training is safe and can improve the cardiopulmonary function of stroke survivors.
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Objective To explore the effect of progressive strength training with TheraBand on lower limb motor function and gait after stroke.Methods Forty-eight hemiplegic stroke survivors were randomly divided into a treatment group and a control group,each of 24.The patients of both groups were provided with the routine rehabilitation training,while the treatment group additionally trained the muscles of the paretic side progressively using Thera-Band elastic belts.Before and after 8 weeks of treatment,both groups were evaluated using the Fugl-Meyer movement assessment (FMA),the Berg balance scale (BBS),and the walking and stair negotiation components of the functional independence measure (FIM).GaitWatch gait analysis was also performed.Results After the treatment,significant improvement was observed with both groups' average FMA scores,BBS ratings,FIM scores,stride frequency,stride length and walking speed,but the treatment group showed significantly greater improvement than the control group,on average.Conclusion Using Thera-Band elastic belts to provide resistance can supplement routine rehabilitation training in improving motor function and walking ability after a stroke.
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Objective To investigate the examination of tumor cells in pleural effusion by body fluid mod-el of Sysmex XN-9000 automated hematology analyzer ,and set the cutoff value of HF-BF# and HB-FB%for screen-ing tumor cells in pleural effusion. Methods One hundred and six pleural effusion specimens were detected by Sysmex XN-9000,and malignant samples were confirmed by TCT(Thinprep Cytology Test)and immunohistochem-istry method. Results Of 106 specimens,44 cases of HF-BF count were positive,and 12 samples were confirmed malignant by TCT and immunohistochemistry method. The cutoff value of HF-BF#(× 106/L)and HF-BF%/100WBC were 3.5 and 1.55 respectively. The detection sensitivity,specificity,positive predictive value,negative predictive value,accuracy of HF-BF# were 66.7%,40.1%,27.3%,91.7% and 63.2% respectively and those of HF-BF%were 83.3%,40.6%,27.3%,91.7%and 63.2%respectively. Conclusions HF-BF# and HF-BF%of body fluid model of Sysmex XN automated hematology analyzer are effective for screening tumor cell in pleural effusion ,and all the screening samples must be confirmed by pathology methods.
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Objective To explore the effects of action observation therapy on upper-extremity motor function and ability in the activities of daily living after cerebral infarction.Methods Forty-one cerebral infarction survivors were randomly assigned to an observation group (n =21) or a control group (n =20).Both groups were given the conventional rehabilitation treatment,while the observation group additionally received action observation therapy 20 mins per day,6 times per week for 8 weeks.Before and after the 8 weeks of treatment,both groups were assessed using the Fugl-Meyer assessment (FMA),Wolf's motor function test (WMFT) and the modified Barthel index (MBI).Results Before the intervention there was no significant difference between the groups in any of the measurements.After the 8 weeks of treatment,all of the results in the treatment group were significantly better,on average,than those of the control group.Conclusions Action observation therapy can improve upper-extremity motor function and ability in the activities of daily living after stroke.
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Objective To explore the effectiveness of a respiratory function training instrument with stable chronic obstructive pulmonary disease (COPD) patients.Methods Sixty-seven COPD patients in the stable period were randomly divided into a treatment group of 36 and a control group of 31 using a random number table.Both groups were given conventional pulmonary rehabilitation,including half-closed lip respiration,abdominal respiration and upper limb training.The treatment group was additionally provided with 30 minutes of respiratory training using a respiration function training instrument 5 times per week for 6 months.Both groups were assessed for their mobility,life quality and pulmonary function using the 6-minute walk test (6 MWT),a COPD assessment test (CAT),the BODE index,forced vital capacity (FVC),forced expiratory volume in one second (FEV1) and surface electromyography (SEMG) of the respiratory muscles before and after the 6-month intervention.Results Before the treatment there were no significant differences between the two groups in terms of any of the measurements.After the treatment,significant improvement was observed in the average 6 MWT,CAT,BODE index and SEMG results in both groups,but with significantly greater improvement in the treatment group.The average FVC and FEV1 results did not improve significantly,so after the intervention there was still no significant difference between the groups.Conclusions Respiratory training using the pulmonary function training instrument can improve the mobility,life quality and the functioning of the respiratory muscles of COPD patients in the stable period.
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Objective To explore the effects of action observation therapy on upper-extremity motor function after ischemic stroke and on the motor cortex using functional magnetic resonance imaging (fMRI).Methods Forty patients with ischemic stroke were randomly assigned to an observational group (n =20) or a control group (n =20).Both groups received conventional rehabilitation,while the observational group was additionally provided with action observation therapy for 8 weeks.Both groups were assessed using the Fugl-Meyer assessment (FMA) and the Barthel index (BI) before and after the 8 weeks of treatment and functional magnetic resonance imaging was performed before treatment.Two months after the treatment,nine patients of the experimental group and 8 of the control group who continued to receive their respective treatments after discharge were again assessed using functional magnetic resonance imaging.Results After the treatment the average FMA score and BI score of both the observational group and the control group had increased significantly.The increase in the average FMA score of the observational group was significantly greater than that of the control group.However,there was no significant difference between the two groups in the increases in BI score after 8 weeks of treatment.The fMRI results showed that there was a significantly greater rise in activity in the bilateral precentral gyrus,parietal lobe and the supplementary motor area of the patients in the observational group after the treatment compared with the control group.Conclusion Action observation therapy can improve upper extremity motor function and performance in the activities of daily living after ischemic stroke and induce changes in the excitability of the cerebral motor cortex.