Correlation between recovery of motor function and regional glucose metabolism induced by CIMT in rats with cerebral ischemia / 复旦学报（医学版）

Objective To study the correlation between regional cerebral glucose metabolism and behavioral scores in middle cerebral artery occlusion(MCAO)model rats before and after the intervention of constraint induced movement therapy(CIMT),and the correlation between the natural recovery processand motor function recovery in MCAO model rats and the brain activation after CIMT intervention,and to further explore the mechanism of CIMT. Methods Twenty-two adult male Sprague-Dawley(SD)rats were randomly divided into an ischemic group treated with CIMT (CIMT,n=6),an ischemic group (Control,n=6),a sham-operated group(Sham,n=6),and a blank control group(Normal,n=4). The MCAO models of rats in the CIMT group and Control group were established by thread embolism method. The middle cerebral artery was not blocked during the operation for the Sham group,and the Normal group was not given any special treatment. After operation,rats in the CIMT group and Sham group were treated with CIMT. On the 7th day(d7)and the 22nd day(d22)after surgery,foot-fault test(FFT)and the beam balance and walking (BBW) test were used to evaluate the forelimb motor;micro positron emission tomography-computed tomography (micro PET/CT) imaging with fluorodeoxyglucose (18F-FDG) was used to scan the glucose metabolism in different brain regions of rats;Pearson correlation analysis was used to analyze the correlation between behavioral scores and glucose metabolism level in the CIMT group and Control group. Results On d7,the BBW score in the CIMT group and Control group was negatively correlated with glucose metabolism in the left insular cortex and the auditory cortex,and positively correlated with glucose metabolism in the right posterior hippocampus,superior colliculus,and inferior colliculus,with statistically significant differences;the FFT score was negatively correlated with glucose metabolism in the left somatosensory cortex, insular cortex and orbitofrontal cortex, and positively correlated with glucose metabolism in the right midbrain,with statistically significant differences. On d22, the BBW score in the CIMT group and Control group was positively correlated with glucose metabolism in the amygdala,caudate putamen,insular cortex and entorhinal cortex,and negatively correlated with glucose metabolism in the nucleus accumbens (Acb) core shell and caudate putamen in the right brain region,with statistically significant differences;the FFT score was negatively correlated with the entorhinal cortex in the right hemisphere and the difference was statistically significant. Conclusion The recovery of motor function promoted by CIMT was associated with the activation of both cerebral hemispheres in rats. The improvement of balance function promoted by CIMT in rats with cerebral ischemia was mainly related to the activation of Acb core shell in the right hemisphere. The recovery of fine grasping function promoted by CIMT may be related to the activation of the right entorhinal cortex.

Chronic inflammatory diseases, subclinical atherosclerosis, and cardiovascular diseases: Design, objectives, and baseline characteristics of a prospective case-cohort study ‒ ELSA-Brasil

Abstract Objectives This analysis describes the protocol of a study with a case-cohort to design to prospectively evaluate the incidence of subclinical atherosclerosis and Cardiovascular Disease (CVD) in Chronic Inflammatory Disease (CID) participants compared to non-diseased ones. Methods A high-risk group for CID was defined based on data collected in all visits on self-reported medical diagnosis, use of medicines, and levels of high-sensitivity C-Reactive Protein >10 mg/L. The comparison group is the Aleatory Cohort Sample (ACS): a group with 10% of participants selected at baseline who represent the entire cohort. In both groups, specific biomarkers for DIC, markers of subclinical atherosclerosis, and CVD morbimortality will be tested using weighted Cox. Results The high-risk group (n = 2,949; aged 53.6 ± 9.2; 65.5% women) and the ACS (n=1543; 52.2±8.8; 54.1% women) were identified. Beyond being older and mostly women, participants in the high-risk group present low average income (29.1% vs. 24.8%, p < 0.0001), higher BMI (Kg/m2) (28.1 vs. 26.9, p < 0.0001), higher waist circumference (cm) (93.3 vs. 91, p < 0.0001), higher frequencies of hypertension (40.2% vs. 34.5%, p < 0.0001), diabetes (20.7% vs. 17%, p = 0.003) depression (5.8% vs. 3.9%, p = 0.007) and higher levels of GlycA a new inflammatory marker (p < 0.0001) compared to the ACS. Conclusions The high-risk group selected mostly women, older, lower-income/education, higher BMI, waist circumference, and of hypertension, diabetes, depression, and higher levels of GlycA when compared to the ACS. The strategy chosen to define the high-risk group seems adequate given that multiple sociodemographic and clinical characteristics are compatible with CID.

Study of Carotid Intima Media Thickness (CIMT) In Type 2 Diabetes Mellitus and Its Correlation with Glycaemic Control and Inflammatory Marker HsCRP

Background: Carotid Intima Media Thickness (CIMT) andCRP (C Reactive Protein) are have been used for measuringAtherosclerotic Risk in Diabetics. However there is paucity ofdata regarding their importance in Statin Naïve Diabetics.Aim: To study Correlation of CIMT with glycaemic control andhsCRP in Statin Naïve Diabetics.Materials and Methods: 80 Cases (Patient suffering from type2 Diabetes Mellitus) and 20 controls (non- diabetic healthpatients) presenting in outpatient department of a tertiaryHospital were included in this observational cross sectionalobservational study. Complete Blood Count, urine Routine andMicroscopy, urine for microalbuminuria, fasting plasma glucose(FPG), postprandial plasma glucose (PPPG), glycatedhaemoglobin (HbA1C), lipid profile, renal function test, hs-CRPand CIMT were evaluated in each individual. Independentsamples T-test was used to compare CIMT and hs-CRP bothcases and controls. Test of proportion and chi-square test wasused for association between categorical variables.Spearman’s method was used to assess correlation betweenhsCRP and CIMT.Results: 80 cases (Statin naïve and Non-smoker Diabeticpatients and 20 healthy controls were included in this study.Average CIMT in cases was significantly higher in Diabeticcases than Control (0.66 + 0.14 vs 0.56±0.05, difference= 0.10 mm, 95% C.I. (0.1 - 0.17), p < 0.0001). HsCRP wassignificantly correlated with average CIMT in Diabetic cases.(r=0.512, 95% C.I. 0.33-0.658, p<0.0001). Fasting Blood Sugarwas correlated with average CIMT in Diabetic cases. (r=0.234,95% C.I. 0.015-0.432, p=0.0366). Post Prandial Blood Sugarwas also correlated with average CIMT (r=0.300, 95% C.I.0.086-0.488, p=0.00677).Conclusion: Cardiovascular risk factors like glycaemic controland inflammatory markers like hsCRP are significantlyassociated with CIMT even in non-smoking and statin naïveDiabetics.

Factors affecting carotid intimal medial thickness in patients with rheumatoid arthritis, an analytical cross-sectional study

Background: IMT assessment as a non-invasive imaging test is quite widely used especially among RA patients, the clinical applications of using such knowledge is scarce, hence study was conducted to compare the carotid artery intima-media thickness (CIMT) in patients with rheumatoid arthritis (RA) with healthy controls also to study the correlation between duration of rheumatoid arthritis, the activity of rheumatoid arthritis and other factors influencing (CIMT).Methods: In analytical cross-sectional study, of 80 participants of RA and 40 healthy controls, “DAS28” was used to assess disease activity. Carotid intima-media thickness assessed using carotid ultrasonography.Results: Mean age of the cases and controls was 43.9 and 44.38 years. Subjects with duration of disease <2 years, to 5 years and >5 years were 35%, 45% and 20%. The mean carotid intima-media thickness was 5.61mm in controls, and CIMT was 6.11mm in people below 2 years and 7.08 mm in people between 2 to 5 years and 8.00mm in people above 5 years which was statistically significant. The mean carotid intima-media thickness was 5.61mm controls and 6.86mm in people with low, 7.00mm in people with moderate and 6.95mm in people with high disease activity, which was statistically significant.Conclusions: Study findings revealed risk of increase in carotid intima-media thickness higher among RA patients in the later stages and can increase the patients’ susceptibility to cardiovascular events. The factors showing strong association with intimal medial thickness were the age and symptoms duration.

Carotid and femoral intima-media thickness in adults with sickle cell disease

Background: This study was conducted to evaluate Carotid Intima Media Thickness (CIMT) and Femoral Intima Media Thickness (FIMT) in adults with SCD.Methods: The present prospective cross-sectional study with control group was carried out in Department of Medicine at Acharya Vinoba Bhave rural hospital over a period of 6months from January to June 2018. A total of 100 (50 cases of SCD, 50 normal subjects) were studied. In the SCD group, 35 cases were patients regular follow up cases and 15 patients were in sickle cell crisis. CIMT of both left and right carotids were taken and the mean of the two values were recorded. The IMT was also measured in the right common femoral artery (RCFA) and left common femoral artery.Results: SCD patients in steady state had significantly decreased Hb%, increased WBC counts and platelet counts as compared to healthy controls. The mean right FIMT, left FIMT, right CIMT and left CIMT the patients with SCD with crisis were significantly higher than that of the patients without SCD (P<0.001). One way showed that there were significant differences in duration of disease in mean level of Hb%, WBC count, platelet count of the patients in the three groups (p<0.01).Conclusions: CIMT and FIMT can pick up the macrovascular involvement early and can be utilized as screening tools to predict vascular injury so that at risk individuals would be subjected to proper treatment protocols, especially hydroxyurea therapy early on.

Effect Of Constraint Induced Movement Therpy In Storke Rehbilitation

INTRODUCTION: Stroke is most common in hypertensive patients in old age. This definition of stroke is the reversibility of tissue damage and was devised for the purpose, with the time frame of 24 hours being chosen arbitrarily. The 24–hour limit divides stroke from transient ischemic attack, which is a related syndrome of stroke symptoms that resolve completely within 24 hours. Various physiotherapy techniques used for the rehabilitation after stroke. Constraint induced movement therapy is from one of the technique used for stoke rehabilitation. Constraint Induced Movement Therapy is a new treatment technique that claims to improve the arm motor ability and the functional use of a paretic arm – hand. Constraint Induced Movement Therapy focus the use of the affected side by restraining the unaffected side. It is observed that patients with hemiparesis did not use their affected extremity (hemi –neglecting). The application of the method is the patients wear a mitt on the unaffected arm 90% of their waking hours and perform repetitive exercises with the more affected arm six to seven hours per day during two to three weeks OBEJECTIVE: The objective of this project is to determine the effects of constraint induced movement therapy in stoke rehabilitation. CONCLUSION: It can be concluded from the present study that Constraint Induced Movement Therapy might be beneficial than traditional rehabilitation therapy in stroke. These findings from the articles which are included in the study have clinical significance for the rehabilitation of patient within stroke. These articles shows significant effects of constraint induced movement therapy in Stroke Rehabilitation.

The Study of Relationship of Glycated Haemoglobin with Carotid Artery Intimal Thickness in Patients with Ischaemic Stroke

Background:Long term uncontrolled hyperglycemia, which is indicated by HbA1c levels, is strongly suspected of promoting atheogensis.An accurate marker for assessing the risk of stroke is the carotid artery intima-media thickening (IMT), assessed by Doppler ultrasound. Increased common carotid artery IMT is correlated with silent cerebral infarcts.This study aimed to show the association between marker of uncontrolled long term hyperglycemia (HbA1C) and marker of atherosclerosis (Carotid intima media thickness [CIMT]) in ischemic stroke patients. Methods: This study was conducted In Deptt. of Medicine, Rajindra hospital Patiala in collabroration with Deptt. Of Radiology and Deptt. of Biochemistry. Results: This study included a total number of 75 patients admitted in various ward of Medicine Deptt. Rajindra Hospital Patiala.CIMT was found to be significantly increased in the patients having diabetics mellitus than non diabetic patients.Conclusion:There is seen a positive correlation of HbA1C with CIMT in our study which included only the ischemic stroke patients.

Hepatocyte growth factor and carotid intima-media thickness in relation to circulating CD34-positive cell levels

BACKGROUND@#Hepatocyte growth factor (HGF) may act as a possible biochemical index for vascular damage, although evidence for the association between HGF and carotid intima-media thickness (CIMT) is limited. Since both HGF and circulating CD34-positive cells play an important role in endothelial repair, circulating CD34-positive cell levels may influence the association between HGF and CIMT.@*METHODS@#We conducted a cross-sectional study of 269 elderly Japanese men aged 60-69 years who had undertaken an annual medical checkup from 2014 to 2015.@*RESULTS@#The median value for circulating CD34-positive cells was 0.93 cells/μL. Among the study population, 135 men showed low circulating CD34-positive cell levels (≤ 0.93 cells/μL). By multivariable linear regression analysis, HGF was found to be significantly positively associated with CIMT only to participants with low circulating CD34-positive cell levels, with a multi-adjusted β of 0.26 (p = 0.005) and 0.002 (0.986) for low and high circulating CD34-positive cell levels, respectively. In addition, a significant interaction was observed between HGF and circulating CD34-positive cell levels (low and high) on CIMT (multivariable p value of 0.049). A positive association exists between HGF and CIMT in elderly Japanese men, limited to participants with low circulating CD34-positive cell levels.@*CONCLUSION@#A positive association exists between HGF and CIMT in community-dwelling elderly Japanese men, which is limited to participants with low numbers of circulating CD34-positive cells. Our findings indicate that circulating CD34-positive cell levels could determine the influence of HGF on CIMT in elderly Japanese men.

Correlation between serum 25-hydroxyvitamin D levels and carotid intima-media thickness in a Brazilian population descended from African slaves

Hypovitaminosis D has been identified as a possible new cardiovascular risk factor. However, the results of studies correlating serum vitamin D levels with markers of subclinical atherosclerosis have been conflicting. The aim of this study was to correlate serum levels of 25-hydroxyvitamin D [25(OH)D] with carotid intima-media thickness (C-IMT) and conventional cardiovascular risk factors in Afro-descendants. A cross-sectional analysis was performed on a sample of 382 individuals from a cohort of descendants of African slaves, inhabitants of "Quilombola" communities, with a mean age of 57.79 ±15.3 years, 54.5% of whom were women. Socio-demographic and clinical data were collected and biochemical tests were performed, including serum levels of 25(OH)D by electrochemiluminescence and urinary albumin excretion, evaluated by the albumin/creatinine ratio (ACR) in a spot urine sample. All participants underwent high-resolution ultrasonography for C-IMT measurement. Hypovitaminosis D was defined as serum 25(OH)D levels <30 ng/mL. The mean serum 25(OH)D levels were 50.4±13.5 ng/mL, with a low prevalence of hypovitaminosis D (4.86%). By simple linear correlation, a significant inverse association between 25(OH)D levels and C-IMT (r=-0.174, P=0.001) was observed. However, after multiple linear regression analysis, the significance of the association between serum levels of 25(OH)D and C-IMT measurement was lost (β=-0.039, P=0.318) and only male gender, age, smoking, systolic blood pressure, glucose and low density lipoprotein (LDL)-cholesterol remained significantly associated with C-IMT. Levels of 25(OH)D were independently and positively associated with HDL-cholesterol and inversely associated with age and ACR. In conclusion, no independent association between 25(OH)D levels and C-IMT was observed in this population. On the other hand, there was an inverse association with albuminuria, a marker of endothelial lesion.

Circulating E-selectin levels and insulin resistance are associated with early stages of atherosclerosis in nonfunctional adrenal incidentaloma

Objective To evaluate circulating E-selectin levels in patients with nonfunctional adrenal incidentaloma (NFA) in relation to insulin resistance and early atherosclerosis.Subjects and methods A total of 40 patients with NFA (mean [SD] age: 55.6 [10.7] years; 70% were females) and 35 controls (mean [SD] age: 51.5 [8.1] years; 71.4% were females) selected from age-, gender- and body mass index (BMI)- matched healthy subjects were enrolled. Serum hsCRP, lipid profile, insulin levels and the homeostasis model assessment of insulin resistance (HOMA-IR) were evaluated. High-resolution B-mode ultrasonography was performed. Serum levels of E-selectin were evaluated by enzyme-linked immunosorbent assay.Results Patients with NFA had significantly higher values for E-selectin (14.9 (4.8) vs. 12.2 (4.1) ng/mL, p < 0.01) and CIMT (0.6 (0.1) vs. 0.5 (0.1) mm, p < 0.05) than controls. Serum E-selectin levels showed a statistically significant association with hsCRP (r = 0.751, p < 0.001), HOMA-IR (r = 0.575, p < 0.001) and CIMT (r = 0.762, p < 0.001). CIMT (Carotid intima media thickness) was increased in patients with NFA patients with NFA were more insulin resistant than controls and statistically significant relationship was found between size of tumor and HOMA-IR (r = 0.361, p < 0.001).Conclusion In conclusion, based on significantly higher values for E-selectin, CIMT and HOMA-IR in patients with NFA than controls along with significant correlation of E-selectin levels to CIMT, HOMA-IR and hs-CRP, our findings seems to indicate an increased risk of early atherosclerosis and impaired endothelial function in NFA patients, particularly in case of insulin resistance.

Effects of Methotrexate on Carotid Intima-media Thickness in Patients with Rheumatoid Arthritis

The purpose of this study was to evaluate the effects of rheumatoid arthritis (RA) and antirheumatic drugs on atherosclerosis by comparing carotid intima-media thickness (CIMT) as an indicator for cardiovascular diseases (CVD). This study included 44 female RA patients who met the 2010 ACR/EULAR criteria and age-matched 22 healthy females. CIMT was measured on both carotid arteries using a B-mode ultrasound scan. The mean value of both sides was taken as the CIMT of the subject. The CIMT was evaluated according to the use of drugs, disease activity and CVD risk factors in RA patients as a case-control study. Higher CIMT was observed in RA patients as compared with healthy subjects (0.705 +/- 0.198 mm, 0.611 +/- 0.093 mm, respectively, P < 0.05). With adjustment for the CVD risk factors, disease activity and the use of anti-rheumatic drugs, methotrexate (MTX) only showed a favorable effect on CIMT in RA. A significantly lower CIMT was observed in RA with MTX as compared with RA without MTX (0.644 +/- 0.136 mm, 0.767 +/- 0.233 mm, respectively, P < 0.05). The effects were correlated with MTX dosage (beta = -0.029, P < 0.01). The use of MTX should be considered in high priority not only to control arthritis but also to reduce the RA-related CVD risk to mortality.

Effectiveness of distributed form of constraint induced movement therapy to improve functional outcome in chronic hemiparesis patients.

Background: Upper limb hemiparesis is among the most common deficits after stroke that leads to disability. Learned nonuse develops due to over-reliance on the less affected limb for the functional activities. However for many stroke patients, participation in a traditional, more intense CIMT may be problematic, given the required practice intensity and the duration of the restraint schedule. So it is necessary to evaluate the effects of distributed form of Constraint Induced Movement Therapy (dCIMT) in improving functional outcome and quality of life in patients with chronic hemiparesis. Methods: 36 hemiplegic patients following stroke were included. The experimental group was given dCIMT for 5sessions/week for 4 consecutive weeks in addition to conventional therapy while the control group received only conventional therapy. The outcome measures were motor activity log, wolf motor functional test and nine hole peg test. Results: The results of within group analysis for both the experimental group (Group-A) and control group B showed highly significant improvement on all the 3 outcome measures with P <0.0001.But the difference in the improvement of group-A compared to group-B was highly significant on the MAL and NHPT (P <0.0001) whereas it was not significant for WMFT performance score but highly significant for WMFT duration (U=23). Conclusion: dCIMT is an effective measure in improving the upper extremity motor function in terms of the quality and amount of use & speed and co- ordination. Thus improves the functional level and the quality of life of the patients with chronic stroke.

Correlation of Coronary Angiographic Severity with Carotid intima Media Thickness and Flow mediated dilatation of brachial Artery in Patients with Ischemic Heart Disease.

Background: Ischemic Heart Disease which encompasses Acute Coronary Syndrome and Chronic Stable Angina is the most common cause of worldwide mortality and morbidity. Carotid intima media thickness (CIMT) is a non-invasive ultrasonographic technique to image the carotid arteries which measures the thickness of the intima and media of these vessels. It is a marker of atherosclerotic process. Flow mediated dilatation (FMD) is a marker of endothelial function of arteries. Ischemic heart disease can be predicted long before its actual occurrence by observing these two phenomenons. Methods: This cross sectional study done in the Department of Cardiology, Dhaka Medical College Hospital during the period of Oct 2010- Sept 2011.We enrolled 102 patients admitted with IHD by purposive sampling. We assessed FMD of brachial artery, CIMT by vascular duplex. Coronary artery disease severity was assessed by vessel score, stenosis score and extent score from angiography. Results:The mean (±SD) age of the patients was 50.9(±11.3) years. The male- female ratio was 5:1. CIMT has significant negative correlation with FMD (r=-.407, p=<.001). Flow mediated dilatation of brachial artery has weak but significant negative co-relation with vessel score(r=-.609, p=<.001), stenosis score(r=- .493, p=<.001) and extent score (r=-.477, p=<.001). However, carotid intima media thickness has weak but positive correlation with vessel score (r=.447, p=<.001), stenosis score (r=.417, p=<.001) and extent score(r=.412, p=<.001). Conclusion: The present study concludes CIMT has significant negative correlation with flow mediated dilatation of brachial artery. FMD has weak but significant negative co-relation and CIMT has weak but positive correlation with vessel score, stenosis score and extent score of coronary arteries.

Tratamento de restrição e indução do movimento na reabilitação funcional de pacientes pós acidente vascular encefálico: uma revisão bibliográfica / A review about the effectiveness of the constraint induced movement therapy in rehabilitation of patients after stroke

INTRODUÇÃO: O Acidente Vascular Encefálico (AVE) é uma das doenças mais incidentes da hipermodernidade, que resulta em múltiplas sequelas. Uma das mais importantes refere-se à função motora do membro superior afetado que, em geral, é mais lenta que a do membro inferior e não acontece de forma adequada. A Terapia de Restrição e Indução do Movimento (TRIM) tem sido considerada uma técnica de reabilitação da função motora da extremidade hemiparética, capaz de promover melhora funcional deste membro. OBJETIVO: O objetivo deste estudo é realizar uma pesquisa bibliográfica para avaliar a eficácia da TRIM em pacientes acometidos por AVE. Material e Método: o presente estudo é uma revisão bibliográfica de artigos indexados na base de dados PubMed, publicados de janeiro de 2000 a dezembro de 2007, em inglês e português. Na estratégia de busca foram utilizados os unitermos: "cerebrovascular accident", "stroke", "CIMT", "constraint induced movement therapy". RESULTADOS E DISCUSSÃO: de modo geral, as pesquisas demonstram que a TRIM é uma técnica alternativa no campo de reabilitação funcional do membro superior parético, promovendo reorganização cortical, superação do "não uso aprendido" e melhora na quantidade e qualidade de movimentos, e que este efeito é transferido para o dia-a-dia do paciente durante suas atividades de rotina. CONCLUSÃO: a TRIM é um produto do advento científico da fisioterapia que traz benefícios funcionais para os pacientes que se submetem a ela. Porém, faz-se necessário investigar mais detalhadamente essa técnica a fim de reduzir as complicações psicológicas advindas deste tratamento, maximizando, assim, a funcionalidade do membro superior acometido.

INTRODUCTION: The cerebrovascular accident is one of the most incident disease of the modernity, that results in multiple sequels. One of the most important sequel is the impairment of the motor function of the affected upper limb and, usually, the rehabilitation is slower than the lower limb and, often, it does not happen in adequate form. The Constraint Induced Movement Therapy (CIMT) have been considered a rehabilitation technique for the affected upper limb and it’s able to promote the functional recovery of the hemiparetic arm. OBJECTIVE: the aim of this study is conducting a literature search to assess the effectiveness of the CIMT in patients after stroke. Materials and Method: this study is a literature review of articles indexed in the database PubMed, published from 2000 to 2007, in English and Portuguese. In the search strategy was used the following key-words: “cerebrovascular accident”, “stroke”, “constraint induced movement therapy” and “CIMT”. RESULTS AND DISCUSSION: in general, the researches shows that the CIMT is an alternative technique in the field of functional rehabilitation of the paretic arm, promoting cortical reorganization, overcoming of the “learned non-use”, improving the quality of movement and increasing amount of use and, these improvements are transferred to the daily life activities of the patient. CONCLUSION: CIMT is a product of the scientific advent of the physiotherapy that brings functional benefits for the patients after stroke. However, it’s necessary more investigation about this technique to reduce the psychological complications resulting from the treatment, thus maximizing the functionality of the affected upper limb.

Effects of the Constraint-Induced Movement Therapy on Cortical Reorganization in Patients with Hemiplegic Cerebral Palsy

OBJECTIVE: To investigate the effects of modified constraint- induced movement therapy (CIMT) on motor function and cortical activation in children with hemiplegic cerebral palsy (CP). METHOD: Five children with hemiplegic cerebral palsy were studied with Jebsen hand function test and quality of upper extremity skills test (QUEST), dynamic electromyography (EMG), and single photon emission computed tomography (SPECT) at rest before and after the CIMT period. Children were treated with a 4-week protocol of modified CIMT, consisting of twice-weekly 2-hour sessions of structured activities and a home program for non-treatment days. Children wore orthoses on their less affected upper extremities for 6 hours per day, during which time they were engaged in play, functional activities and 2-hour protocol of motor tasks. RESULTS: Improvements in upper-extremity function were found in Jebsen hand function test and QUEST. Increased muscle activities in elbow extensors were observed in dynamic EMG during affected hand grip. In right hemiplegic patients, regional cerebral perfusion increased in right Brodmann area (BA) 3 and lentiform nucleus. In left hemiplegic patients, regional cerebral perfusion increased in right BA 6, 9, 21, left BA 19 and left cerebellum, but decreased in left BA 11. CONCLUSION: Modified CIMT appears to change local cerebral perfusion in areas known to participate in movement planning and execution. These changes might be a sign of cortical activation after CIMT in the children with hemiplegic cerebral palsy. Results of this study suggest that modified CIMT may be an effective way of treating children with hemiplegic CP.

Constraint-induced Movement Therapy for Upper Extremity in Early Cerebral Infarction / 中国康复理论与实践

@#Objective To study the feasibility, safety, tolerance and the effectiveness of constraint-induced movement therapy (CIMT) in early cerebral infarction, and the long-term outcome.Methods 2 weeks after cerebral infarction, 22 patients with upper extremity weakness were divided into treatment group (11 cases, accepted CIMT) and control group (11 cases, accepted routine rehabilitation). They were assessed with Fugl-Meyer Assessment (FMA), Wolf Motor Function Test (WMFT), Motor Activity Log (MAL) and Barthel Index (BI) before and 2 weeks, 3 months after treatment. Results The scores of FMA, WMFT, MAL and BI improved in both group (P<0.05), but more in the treatment group (P<0.05). 3 months after treatment, the score of MAL quality was no different between two group.Conclusion CIMT is safe and effective for early cerebral infarction, and more effective than routine immediately, but it is similar 3 months later.

The Importance of Motivation and Dropping Out from Treatment in Constraint-induced Movement Therapy for Stroke Patients

OBJECTIVE: To assess the effect of motivation for treatment and to find out causes of dropping out from treatment in performing the constraint-induced movement therapy (CIMT). METHOD: Forty six stroke patients were treated with CIMT for 2 weeks. Prior to and after treatment, Fugl-Meyer motor assessment (FMA), Wolf motor function test (WMFT), box and block test (BBT), and 9 hole peg test, motor activity log (MAL) were performed, and for the evaluation of treatment motivation, motivation score (MS) was assessed in 24 patients. RESULTS: After 2 weeks of CIMT treatment, the mean value of FMA increased by 15.1%, WMFT by 19.5%, BBT by 35.8%, the time of 9 hole peg test decreased by 20.2%, and the "How well" sub-score of the increased MAL was 59.6% (p<0.05). Larger improvement of FMA score was observed in patients with high MS (p<0.05). Twelve out of 46 patients were dropped, 5 patients (18.5%) among 27 right side hemiplegic patients and 7 patients (38.9%) of 19 left side hemiplegic patients gave up the treatment in the middle, and the MS score of the quitted patients (35.3 point) was lower than that of patients who did not quit (40.5 point) (p<0.05). CONCLUSION: After 2 weeks of CIMT treatment, larger improvement of movement capacity was observed in patients with high motivation. Among patients with low treatment motivation and old age, many patients were dropped out during CIMT.

Intima-Media Thickness and Pulse Wave Velocity in Hypertensive Adolescents

Increased intima-media thickness (IMT) and pulse wave velocity (PWV) are noninvasive markers of early arterial wall alteration and are more widely used in adult clinical research. We investigated whether IMT and PWV are useful predictors of cardiovascular risk in hypertensive adolescents. Fifteen hypertensive adolescents (13-18 yr old, systolic BP > or = 140 mmHg, diastolic BP > or = 90 mmHg) and seventeen normotensive subjects were included. Height, weight, obesity index, body mass index (BMI), and fat distribution were obtained from each group. Serum lipid, insulin, vitamine B12, folate, renin, aldosterone, angiotensin-converting enzyme (ACE), and homocysteine levels were compared. The carotid IMT and PWV were measured. Arterial wall compliance and distensibility were calculated with the equation. High systolic blood pressure significantly correlated with height, weight, BMI, obesity index, arm circumference, fat mass, and fat distribution. Hypertensive adolescents had significantly greater cIMT (carotid intima-media thickness) and lower elastic properties such as cross-sectional compliance and distensibility of the carotid artery. The carotid IMT significantly correlated with brachial-ankle PWV. In conclusion, the measurement of carotid IMT and brachial-ankle PWV might be useful to predict the development of atherosclerosis in hypertensive adolescents.

Effects of Constraint-induced Movement Training on Neurological Medullary Sheath in Rats after Middle Cerebral Artery Occlusion / 中国康复理论与实践

@#Objective To study the effects of constraint-induced movement train (CIMT) on the neurological medullary sheath in the rats after middle cerebral artery occlusion (MCAO). Methods 55 SD rats were randomly divided into CIMT group and nature recovery (NR) group after MCAO. The CIMT group were trained with balance beam and rolling cage everyday, with restrictting the movement of the intact upper limbs. The NR group lived in the same condition. The rats in CIMT group were assessed with ethology 5 d, 10 d, 15 d, 30 d and 60 d after operation respectively. At last, 5 rats of each group were checked with MRI, then they were immolated for myelin staining. Results The balance and muscle strength of CIMT group improved better compared with the NR ones (P<0.05), as well as the diameter and the demyelination of neurofibril in the infarcted area. Conclusion CIMT can collect more functional neurofibra and decrease myelinolysis.

Effect of Constraint-Induced Movement Therapy on Improving the Flexibilty of Upper Extremities and the Ability of Daily Living of Patients With Hemiplegia / 中国康复理论与实践

@#ObjectiveTo investigate the effect of constraint-induced movement therapy(CIMT) on improving the flexibilty of upper extremities and the ability of daily living(ADL) of patients with hemiplegia.Methods36 patients with hemiparesis were randomized to two groups: CIMT and traditional rehabilitation(TR).In CIMT group,18 patients received intensive shaping training of 5 h/d,lasting 3 weeks, with the constraint of unaffected arms.In TR group,patients received traditional rehabilitation in the same times,without the constraint of unaffected arms. They were evaluated with Action Research Arm(ARA) Test and Barthel Index(BI) before intervention,immediate after intervention,4 and 12 weeks after intervention respectively.Patients in CIMT group were also evaluated with ARA tests 2 and 3 weeks after training.ResultsSignificant difference was found between CIMT and TR group on the improvement of ARA test(P<0.05).There was no significant difference between 2 and 3 weeks after training in CIMT group.Significant difference in BI was also found in CIMT group(P<0.01),but has not been found between CIMT and TR group.ConclusionCIMT significantly improved the flexibilty of upper extremities and ADL of patients with hemiplegia,which is superior to the traditional rehabilitation.