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ObjectiveTo explore the diagnostic value of fiberoptic endoscopic examination of swallowing (FEES) combined with dye test in patients with post-stroke dysphagia and silent aspiration. MethodsFrom December, 2021 to June, 2022, 50 stroke patients in the Rehabilitation Department of Xuzhou Central Hospital were selected. They were assessed with FEES and videofluoroscopic swallowing study (VFSS), and compared. ResultsThe detection rate of aspiration was higher with FEES than with VFSS (χ2 = 7.000, P < 0.05), and especially for liquid food (χ2 = 4.000, P < 0.05). There was a good consistency when consuming paste food (κ = 0.941, P < 0.001) and solid food (κ = 0.779, P < 0.001). There was a good consistency in the food residue site between two methods (κ = 0.818, P < 0.001), as well as for all the three food types (κ ≥ 0.862, P < 0.001). There was no significant difference in the scores of Penetration Aspiration Scale of three food types between two methods (Z < 0.667, P > 0.05). ConclusionFEES combined with dye test can be used for evaluating silent aspiration after stroke.
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@#Objective To explore the effect of high-frequency repetitive transcranial magnetic stimulation (rTMS) on central facial paralysis after ischemic stroke. Methods From June, 2020 to June, 2021, 54 patients with central facial palsy after ischemic stroke who were hospitalized in the Rehabilitation Department of Xuzhou Central Hospital were randomly divided into control group (n = 27) and experimental group (n = 27). Both groups were given conventional rehabilitation treatment, including medication and facial muscle rehabilitation training. The experimental group was treated with 5 Hz rTMS on the affected primary motor cortex, and the control group was treated with the same parameters of sham stimulation at the same site. Before treatment and four weeks after treatment, the House-Brackmann Grading System 2.0 (HBGS-2), the Sunnybrook Facial Grading System, the horizontal distance difference between the bilateral mouth corners to the lower center of the philtrum at rest, the horizontal distance difference between the bilateral mouth corners to the intersection of the mandibular central incisor when showing the teeth at the best effort and the angle of the tongue midline deviating from the facial midline when the tongue was stretched out were used to evaluate the facial nerve function of the patient. Results One case dropped down in each group. Before treatment, there was no significant difference in the scores of HBGS-2 and Sunnybrook Facial Grading System, the horizontal distance difference between the bilateral mouth corners to the lower center of the philtrum at rest, the horizontal distance difference between the bilateral mouth corners to the intersection of the mandibular central incisor when showing the teeth at the best effort, and the angle of the tongue midline deviating from the facial midline when the tongue was stretched out between two groups (P > 0.05). After treatment, all the indexes significantly improved in both groups (|t| > 8.987, P < 0.001), and were better in the experimental group than in the control group (t > 2.939, P < 0.01). Conclusion 5 Hz rTMS on the affected primary motor cortex is effective on the facial nerve function of patients with central facial palsy after ischemic stroke.
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Objective To explore the cognitive impairment of stroke survivors using magnetic resonance spectra (MRS) and the Loewenstein occupational therapy cognitive assessment (LOTCA),and to analyze their correlation and their clinical significance.Methods Thirty stroke survivors diagnosed with cognitive impairment using the mini-mental state examination formed a cognitive impairment group.Another 30 stroke survivors without cognitive impairment served as stroke controls,while a third group of 30 healthy counterparts were the normal controls.All were assessed using magnetic resonance imaging and the LOTCA and the results were correlated.Results The average LOTCA total score and sub-scores of the impaired group were significantly lower than those of the other two groups.The average LOTCA total scores and the orientation and spatial perception,apparent motion and thinking operation sub-scores of the stroke control group were also significantly lower than those of the normal control group,though their average visual perception and motor praxis scores were not.The average levels of N-acetyl aspartate and creatine (NAA and Cr) in the bilateral hippocampus of the cognitively impaired group were significantly lower than among the controls,while their choline and creatine (Cho/Cr) levels were significantly higher.The average NAA/Cr and Cho/Cr levels in the bilateral hippocampus of the stroke control group were similarly significantly lower and higher than among the healthy controls.The average NAA/Cr levels in the left and right hippocampus were weakly to moderately correlated with the total LOTCA scores and the LOTCA sub-score for attention (r=0.376-0.661 and r=0.396-0.691 respectively).The average value of Cho/Cr in the left hippocampus showed weak to moderate negative correlation with the LOTCA total scores (r=-0.368-0.619),but not with the attention scores.The value of Cho/Cr in the right hippocampus had weak to moderate negative correlation with the LOTCA total score and with the orientation,visual perception,visuo-motor organization and thinking operations sub-scores (r=-0.391-0.632),but no obvious correlation with the scores for spatial perception,motor praxis or attention.Conclusion MRS can be used to assess the cognitive impairment of stroke survivors.MRS and LOTCA scores are closely correlated.MRS combined with LOTCA can evaluate cognitive dysfunction more comprehensively and objectively.
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Objective To explore the impact of low frequency repetitive transcranial magnetic stimula tion (rTMS) on executive dysfunction after stroke by magnetic resonance spectroscopy (MRS) and neuropsychological scale.Methods 60 stroke patients with executive dysfunction were recruited and randomly divided into a study group and a control group,with 30 in each.The study group was treated with rTMS in addition to routine treatment,while the control group received routine treatment only.Before and after treatment,the neuropsychological scale and MRS were measured in both groups.Results After treatment,the scores on the LOTCA and FAB of neuropsychological scale in the treatment group were (87.10 ± 3.16) and (11.97 ± 0.48),significantly better than before the baselines.NAA/Cr was (1.64 ± 0.08) and Cho/Cr was (1.17 ± 0.07),which were significantly better than the baselines.In the control group,significant differences were also observed in the scores of the neuropsychological scale and in the indicators of MRS before and after treatment.Conclusions rTMS can effectively improve executive function in patients with cerebral apoplexy by influencing the metabolites related with cognitive function in the brain.Magnetic resonance spectroscopy can show the therapeutic effect at molecular level.
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Objective To quantify any therapeutic effect of cyclic movement training combined with functional electrical stimulation for improving lower limb motor function and ability in the activities of daily life after stroke.Methods Seventy stroke survivors were randomly divided into a control group and an experimental group,each of 35.Both groups were given conventional rehabilitation,including cyclic training,but the experimental group was additionally provided with functional electrical stimulation of the quadriceps,hamstrings,anterior tibialis and gastrocnemius at the affected side.Before and after four weeks of treatment the Fugl-Meyer lower limb (FMA-L) and balance (FMA-B) assessments were performed and a modified Barthel index (MBI) was assigned to each subject to quantify functioning.Results Before the treatment,no significant differences were observed between the two groups in any of the measurements.But after four weeks of treatment the average FMA-L,FMA-B and MBI scores of the experimental group were all significantly better than before the treatment and significantly better than the control group's averages.Conclusion Cyclic movement training combined with functional electrical stimulation can improve the lower limb motor function of stroke survivors and their ability in the activities of daily life.
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Objective To quantify any therapeutic effect of cyclic movement training combined with functional electrical stimulation for improving lower limb motor function and ability in the activities of daily life after stroke.Methods Seventy stroke survivors were randomly divided into a control group and an experimental group,each of 35.Both groups were given conventional rehabilitation,including cyclic training,but the experimental group was additionally provided with functional electrical stimulation of the quadriceps,hamstrings,anterior tibialis and gastrocnemius at the affected side.Before and after four weeks of treatment the Fugl-Meyer lower limb (FMA-L) and balance (FMA-B) assessments were performed and a modified Barthel index (MBI) was assigned to each subject to quantify functioning.Results Before the treatment,no significant differences were observed between the two groups in any of the measurements.But after four weeks of treatment the average FMA-L,FMA-B and MBI scores of the experimental group were all significantly better than before the treatment and significantly better than the control group's averages.Conclusion Cyclic movement training combined with functional electrical stimulation can improve the lower limb motor function of stroke survivors and their ability in the activities of daily life.
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Objective To investigate the association between chronotropic incompetence (CI)and motor ability in type 2 diabetic mellitus (T2DM) patients complicated with metabolic syndrome (MS).Methods One hundred and twenty patients with T2DM were enrolled in the study,including 66 cases with MS (MS group) and 54 without MS (non-MS group).The electrocardiographic exercise test was performed,the CI indexes including ratio of heart rate (rHR),heart rate reserve (HRR)were measured and the max metabolic equivalents(maxMETs) were calculated.Result The rHR(0.77 ±0.04 vs.0.81 ±0.06,t =3.41,P ＜ 0.05),HRR (0.62 ± 0.05 vs.0.70 ± 0.07,t =5.96,P ＜ 0.05) and maxMETs (8.8 ± 1.1 vs.9.7 ± 1.2,t =0.16,P ＜ 0.05) in patients of MS group all lower than those in non-MS group.The maxMETs were positively correlated with rHR (r =0.81,P ＜ 0.05) and HRR (r =0.78,P ＜ 0.05).Conclusion The results indicate that CI as well as maxMETs and rating of perceived exertion can be used as monitoring index in type 2 diabetic patients complicated with metabolic syndrome.
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Objective To explore the applicability of the Loewenstein occupational therapy cognitive assessment (LOTCA) in evaluating cognitive function and observing the curative effect of stroke treatment.Methods Thirty stroke patients with cognitive impairment (the cognitive impairment group) and thirty stroke patients without marked cognitive impairment (the stroke control group) were screened using the mini-mental status examination (MMSE),and thirty healthy subjects served as a normal control group.The gender distributions,ages and levels of education of the three groups were matched.All cases were examined with the LOTCA.After two months of treatment,the three groups were assessed again.Results The average total scores and the scores on the LOTCA subitems were significantly lower in the cognitive impairment group than in the stroke control group and were even lower than those in the normal control group.Particularly conspicuous were their lower scores on the thinking operations and orientation and visuo-motor organization LOTCA sub-items,In the stroke control group the average scores on the thinking operations,visuo-motor organization,attention,orientation and spatial perception sub-items were all significantly lower than those in the normal control group,especially on the thinking operations and visuo-motor organization sub-items.After treatment,the LOTCA scores in all three groups had improved significantly compared with before treatment.Conclusion The LOTCA can assess the severity and characteristics of cognitive impairment in stroke patients.It offers an effective method for identifying cognitive impairment and tracking any improvements.The scores reflect patients' cognitive levels,and so have clinical value.
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Objective To compare the assessment results of Loewenstein occupational therapy cognitive assessment (LOTCA) and mini-mental state examination(MMSE) in stroke patients,and to analyze the correlation between the two assessments and to explore the applicable values of LOTCA in assessing vascular cognitive function impairment (VCI).Methods According to the diagnostic standard of cognitive impairment with MMSE,thirty stroke patients with cognitive impairment were selected as cognitive impairment group,thirty stroke patients without markedly cognitive impairment as stroke control group,and thirty normal subjects served as normal control group.All the subjects' age,gender and level of education were matched in the three groups. All the subjects were assessed with LOTCA and MMSE.ResultsThe total scores of LOTCA had high positive correlation with the total scores of MMSE in cognitive impairment group ( r =0.934,P ＜ 0.01 ),the correlations were also found between every sub-items of LOTCA and those of MMSE (P ＜ 0.01 ).The total scores and the scores of sub-items of LOTCA in cognitive impairment group were significantly lower than those in stroke control group and were those in normal control group(P ＜ 0.01 ),particularly lower scores in LOTCA sub-items of thinking operations,orientation,visuomotor organization.The scores of sub-items of LOTCA,including thinking operations,visuo-motor organization,attention,orientation,spatial perception were all significantly lower in stroke control group than those in normal control group(P ＜0.01 ),especially in thinking operations and visuo-motor organization sub-items.Conclusions Correlations were found between LOTCA and MMSE.Compared to MMSE,LOTCA could detect vascular cognitive function impairment earlier and is much more comprehensive,so it is suitable to assess vascular cognitive impairment patients with no dementia.
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Objective To explore the correlation between P300 and Loewenstein occupational therapy cognitive assessment (LOTCA) results, and to analyze its clinical significance. Also to explore whether P300 might represent specific cognitive functions. Methods Sixty stroke patients were matched with 30 healthy persons serving as a control group. All were examined with auditory evoked potential P300 and the LOTCA, and the correlation between the results was analyzed.Results The stroke patients had significantly longer P200,N200 and P300 latencies and significantly lower P300 amplitude compared with the controls. The LOTCA total scores and each sub-item score in the patient group were all significantly lower than those in the control group. In the patient group, there was strong negative correlation between P300 latency and the total LOTCA score, weak positive correlation between P300 amplitude and the total LOTCA score, and medium to high negative correlation between P300 latency and LOTCA sub-item scores. Stepwise regression and multivariate analysis revealed that sub-items of LOTCA, followed by thinking operations, motor praxis and spatial perception, were strongly correlated with P300 latencies.Conclusions Significant correlation were found between P300 and LOTCA. The combination of P300 and LOTCA can enable earlier, more objective and more comprehensive assessment of vascular cognitive impairment. The latency of P300 has no obvious specificity in reflecting cognitive function, and it is affected by thinking operations most.
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@#ObjectiveTo observe the therapeutic effect of proprioception strengthening training on knee osteoarthritis.MethodsBased on clinical diagnostic criteria, 80 patients with knee osteoarthritis were randomly divided into a treatment group(41 cases) and a control group(39 cases). The patients in the treatment group were administered proprioception strengthening training, muscle strengthening exercise and treatment with sodium hyaluronate injection of knee joint, while the patients in the control group were administered muscle strengthening exercise and treatment with sodium hyaluronate injection of knee joint. Before and after the treatment, knee function were assessed with Lysholm Assessment Standard on knee function.ResultsThe patients in both groups scored significantly higher on Lysholm on knee function than the patients before the treatment (P<0.01). The patients in the treatment group are better than the patients in the control group(P<0.01).ConclusionProprioception strengthening training can improve the knee function and it is a valid method to treat knee osteoarthritis.
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@#Objective To explore the effect of early rehabilitation on function recovery in stroke patients.Methods 70 patients were divided into two groups, rehabilitation group (38 cases) and control group (32 cases). Rehabilitation group was given clinical treatment and early rehabilitatio therapy, while control group was given clinical treatment and unguided self-training, and the evaluation was done in pre-treatment and eight weeks after the treatment respectively. Motor function of limbs was assessed in Brunnstrom grade and Fugl-Meyer Assessment (FMA), Neurological Function would be assessed with the scale of Clinical Neurological Function Defects (CNFD), and Activities of Daily Living was assessed in Modified Barthel Index(MBI). Results All scores in the rehabilitation group were superior to that in the control group (P< 0.05). Conclusion Early rehabilitation training on stroke patients may obviously improve motor function, promote neurological function and increasing the activities of daily living.
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@#Objective To explore the effect of early rehabilitation on function recovery in stroke patients.Methods 70 patients were divided into two groups, rehabilitation group (38 cases) and control group (32 cases). Rehabilitation group was given clinical treatment and early rehabilitatio therapy, while control group was given clinical treatment and unguided self-training, and the evaluation was done in pre-treatment and eight weeks after the treatment respectively. Motor function of limbs was assessed in Brunnstrom grade and Fugl-Meyer Assessment (FMA), Neurological Function would be assessed with the scale of Clinical Neurological Function Defects (CNFD), and Activities of Daily Living was assessed in Modified Barthel Index(MBI). Results All scores in the rehabilitation group were superior to that in the control group (P< 0.05). Conclusion Early rehabilitation training on stroke patients may obviously improve motor function, promote neurological function and increasing the activities of daily living.