Chirurgie des accidents vasculaires cérébraux hémorragiques au Centre Hospitalier Universitaire Joseph Ravoahangy Andrianavalona, Antananarivo, Madagascar / Surgery of intracerebral haemorrhage at the Joseph Ravoahangy Andrianavalona teaching hospital, Antananarivo, Madagascar

L'accident vasculaire cérébral hémorragique (AVCH) est une interruption de la circulation sanguine par la rupture d'une artère cérébrale qui va provoquer une perte soudaine d'une ou plusieurs fonctions cérébrales. L'objectif de notre étude était de déterminer l'aspect épidemio-clinique et radiologique et de décrire la prise en charge chirurgicale d'un AVCH au Centre Hospitalier Universitaire Joseph Ravoahangy Andrianavalona (CHU JRA), Antananarivo Madagascar. Méthodes : Il s'agit d'une étude rétrospective et descriptive de 125 cas d'AVCH opérés sur des patients hospitalisés du Janvier 2017 au 31 Décembre 2019. Résultats : Nous avons noté une prédominance masculine de 55% avec un Sex ratio de 0,82 ; dont l'âge moyen était de 52,8 ans. Le facteur de risque le plus rencontré était l'hypertension artérielle (HTA) avec 58,4% des cas. Les motifs d'admission étaient les troubles de la conscience (63,2%) et les déficits moteurs (44,8%). Les signes à l'examen étaient surtout l'hémiplégie (55,2%), la dysarthrie (22,4%). Les hématomes étaient lobaires dans 80,8% des cas et 19,2% au niveau de la fosse postérieure. La technique chirurgicale la plus utilisée était l'évacuation de l'hématome par craniotomie. Les séquelles étaient dominées par l'hémiparésie et l'aphasie respectivement 53.6% et 10.4%. Le taux de mortalité a été de 8%. Conclusion : La chirurgie tient une place primordiale dans la prise en charge des AVCH au CHU JRA.

Effects of whole body vibration combined with extracorporeal shock wave therapy on spasticity and balance gait parameters in hemiplegic patients with stroke / 中南大学学报(医学版)

OBJECTIVES@#Stroke patients may have various sensory-motor disorders, such as spasticity, muscle weakness or sensory damage. Spasticity affects 20% to 40% of stroke patients. Patients with spasticity may have problems such as pain, motor function damage, and the decreased range of motion, which leads to decline of activity and quality of daily life. Extracorporeal shock wave therapy (ESWT) is a technique that can improve post-stroke spasticity. Whole body vibration (WBV), as a passive neuromuscular muscle stimulation technique, can improve the posture control, muscle strength, and muscle work of different people. At present, there are still few studies using WBV combined with ESWT for the treatment of hemiplegic patients with stroke. This study aims to explore the effects of WBV combined with ESWT on spasticity of the affected lower limb and gait function in stroke patients.@*METHODS@#From March 2020 to March 2021, 50 hemiplegic patients with stroke were treated in the Department of Rehabilitation Medicine of the First Hospital of Changsha and they were assigned into a control group and a combined group, 25 cases per group. Both groups carried out conventional treatment, while the control group undertook the ESWT and fake WBV based on conventional treatment, and the combined group undertook ESWT after WBV and conventional treatment. Modified Ashworth Scale (MAS), Lower Extremity portion of the Fugl-Meyer Motor Assessment (FMA-LE), Berg Balance Scale (BBS), and parameters of three-dimensional gait analysis including kinematic parameters (peak value of hip flexion and knee flexion) and spatiotemporal parameters (velocity, cadence and stride length) were assessed before and after 4-week treatment between the 2 groups.@*RESULTS@#After 4 weeks of treatment, MAS scores in 2 groups were lower than before (both P<0.05), and the combined group was lower than the control group (P<0.001); BBS and FMA-LE scores were higher than those before treatment (both P<0.05), and the combined group was higher than the control group (both P<0.001); in the control group, the walking speed, stride frequency, and stride length were higher than those before treatment (all P<0.05), and there was no significant difference between the peak value of flexion hip and peak value of flexion knee (both P<0.05); the peak value of hip flexion, peak value of knee flexion, step speed, step frequency, and stride length in the combined group were higher than those before treatment (all P<0.05), and were higher than those in control group (P<0.05 or P<0.001).@*CONCLUSIONS@#WBV combined with ESWT can improve the spasticity and motor function of the affected lower extremity, balance, and gait in hemiplegic patients with stroke.

Effects of Interactive Dynamic Scalp Acupuncture on Motor Function and Gait of Lower Limbs after Stroke: A Multicenter, Randomized, Controlled Clinical Trial / 中国结合医学杂志

OBJECTIVE@#To evaluate the effects of interactive dynamic scalp acupuncture (IDSA), simple combination therapy (SCT), and traditional scalp acupuncture (TSA) on motor function and gait of the lower limbs in post-stroke hemiplegia patients.@*METHODS@#A total of 231 patients with post-stroke hemiplegia was randomly divided into IDSA (78 cases), SCT (78 cases), and TSA (75 cases) groups by a random number table. Scalp acupuncture (SA) and lower-limb robot training (LLRT) were both performed in the IDSA and SCT groups. The patients in the TSA group underwent SA and did not receive LLRT. The treatment was administered once daily and 6 times weekly for 8 continuous weeks, each session lasted for 30 min. The primary outcome measures included Fugl-Meyer assessment of the lower extremity (FMA-LE), berg balance scale (BBS), modified barthel index (MBI), and 6-min walking test (6MWT). The secondary outcome measures included stride frequency (SF), stride length (SL), stride width (SW), affected side foot angle (ASFA), passive range of motion (PROM) of the affected hip (PROM-H), knee (PROM-K) and ankle (PROM-A) joints. The patients were evaluated before treatment, at 1- and 2-month treatment, and 1-, and 2-month follow-up visits, respectively. Adverse events during 2-month treatment were observed.@*RESULTS@#Nineteen patients withdrew from the trial, with 8 in the IDSA and 5 in the SCT groups, 6 in the TSA group. The FMA-LE, BBS, 6MWT and MBI scores in the IDSA group were significantly increased after 8-week treatment and 2 follow-up visits compared with the SCT and TSA groups (P<0.05 or P<0.01). Compared with pre-treatment, the grade distribution of BBS and MBI scores in the 3 groups were significantly improved at 1, 2-month treatment and 2 follow-up visits (P<0.05 or P<0.01). The SF, PROM-H, PROM-K and PROM-A in the IDSA group was significantly increased compared with the SCT and TSA groups after 8-week of treatment (P<0.05 or P<0.01). Compared with the SCT group, ASFA of the IDSA group was significantly reduced after 8-week of treatment (P<0.05). SF, SL, PROM-K and PROM-A were significantly increased at the 2nd follow-up visit whereas the ASFA was significantly reduced in the IDSA group compared with the SCT groups at 1st follow-up visit (P<0.05 or P<0.01). The SF was significantly increased in the SCT group compared with the TSA group after 8-week treatment (P<0.05). Compared with the TSA group, PROM-K, PROM-A were significantly increased at the 2nd follow-up visit (P<0.05).@*CONCLUSIONS@#The effects of IDSA on lower-limb motor function and walking ability of post-stroke patients were superior to SCT and TSA. The SCT was comparable to TSA treatment, and appeared to be superior in improving the motion range of the lower extremities. (Registration No. ChiCTR1900027206).

A pelvic support weight rehabilitation system tracing the human center of mass height / 生物医学工程学杂志

The body weight support rehabilitation training system has now become an important treatment method for the rehabilitation of lower limb motor dysfunction. In this paper, a pelvic brace body weight support rehabilitation system is proposed, which follows the center of mass height (CoMH) of the human body. It aims to address the problems that the existing pelvic brace body weight support rehabilitation system with constant impedance provides a fixed motion trajectory for the pelvic mechanism during the rehabilitation training and that the patients have low participation in rehabilitation training. The system collectes human lower limb motion information through inertial measurement unit and predicts CoMH through artificial neural network to realize the tracking control of pelvic brace height. The proposed CoMH model was tested through rehabilitation training of hemiplegic patients. The results showed that the range of motion of the hip and knee joints on the affected side of the patient was improved by 25.0% and 31.4%, respectively, and the ratio of swing phase to support phase on the affected side was closer to that of the gait phase on the healthy side, as opposed to the traditional body weight support rehabilitation training model with fixed motion trajectory of pelvic brace. The motion trajectory of the pelvic brace in CoMH mode depends on the current state of the trainer so as to realize the walking training guided by active movement on the healthy side of hemiplegia patients. The strategy of dynamically adjustment of body weight support is more helpful to improve the efficiency of walking rehabilitation training.

Mutação missense de novo patogênica c. 2415C G (p. Asp805Glu) no gene ATP1A3 em paciente com hemiplegia alternante da infância com resposta favorável ao cloridrato de biperideno / A de novo missense pathogenic mutation c.2415C> G (p.Asp805Glu) in ATP1A3 gene in a patient with alternating hemiplegia of childhood with favorable response to biperiden hydrochloride

A Hemiplegia Alternante da Infância é um distúrbio neurológico grave e uma doença rara (1 em cada 100.000 recém-nascidos), caracterizado por ataques repetidos transitórios de hemiplegia episódica ou tetraplegia que podem durar minutos a horas, acompanhados por outros sintomas paroxísticos como anormalidades oculomotoras e autonômicas, distúrbios do movimento como ataxia, comprometimento cognitivo progressivo, convulsões, distonia e coreia. Os tratamentos atuais são amplamente sintomáticos. Neste relato de caso, apresentamos paciente do sexo feminino, 18 anos, na qual aos 10 meses apresentou o primeiro episódio aparente de crise convulsiva com versão ocular. O eletroencefalograma e tomografia computadorizada não revelaram anormalidades e foram administradas diversas medicações como fenobarbital, carbamazepina, valproato de sódio, topiramato, dicloridrato de flunarizina, clonazepam, cipro-heptadina e pizotifeno, todos sem resultado. Devidos aos sintomas extrapiramidais, paciente passou a utilizar biperideno, apresentando não só melhora da distonia, mas também no número de crises hemiplégicas. Aos 13 anos, ela foi diagnosticada com Hemiplegia Alternante da Infância na mutação patogênica missense de novo c.2415C G (p.Asp805Glu) no gene ATP1A3 apresentando boa resposta ao tratamento com cloridrato de biperideno. (AU)

Alternating hemiplegia of childhood is a severe neurological disorder and a rare disease (1 in 100,000 newborns), characterized by repeated transient attacks of episodic hemiplegia or tetraplegia that can last minutes to hours, accompanied by other paroxysmal symptoms such as oculomotor and autonomic abnormalities, movement disorders such as ataxia, progressive cognitive impairment, seizures, dystonia, and chorea. Current treatments are largely symptomatic. In this case report, we present a female patient, 18 years old, who presented the first apparent episode of seizure with ocular version at ten months of age. The electroencephalogram and CT scan revealed no abnormalities, and several medications such as phenobarbital, carbamazepine, sodium valproate, topiramate, flunarizine dihydrochloride, clonazepam, cyproheptadine and pizotifen were administered, all without result. Due to the extrapyramidal symptoms, the patient started using biperidene, showing improvement in dystonia and the number of hemiplegic seizures. At age 13, she was diagnosed with Alternating hemiplegia of Childhood in the pathogenic missense de novo mutation c.2415C>G (p.Asp805Glu) in the ATP1A3 gene showing a good response to treatment with biperidene hydrochloride. (AU)

Effectiveness of physical exercise on the recovery of limb function in stroke patients / Eficácia do exercício físico na recuperação da função dos membros em pacientes com avc / Efectividad del ejercicio físico en la recuperación de la función de las extremidades en pacientes con acv

ABSTRACT Introduction Patients with cerebrovascular accident and hemiplegia need to perform physical exercise and aerobic training, but physical dysfunction restricts the performance of these activities. Objective The article aims to develop physical strength sports for stroke patients with hemiplegia to explore the efficacy of sports to regain limb function in these patients. Methods We randomly selected 30 patients with stroke sequelae and divided them into control and exercise groups. While undergoing rehab, the exercise group performed a certain amount of aerobic exercise. During this period, we compared the relevant physiological indicators of the patients, and, at the same time, we used the Fugle-Meyer motor function scoring method to assess limb function. Results The two groups of patients are significantly different regarding the recovery of physical function and the capacity for daily life. Physiological indicators of patients are also different. Conclusion Low-intensity aerobic exercise can help stroke and hemiplegia patients regain their basic ability to live and exercise. Level of evidence II; Therapeutic studies: investigation of treatment results.

RESUMO Introdução É muito importante que pacientes com acidente vascular encefálico e hemiplegia realizem exercícios físicos e treinamento aeróbio, mas a disfunção física restringe a realização dessas atividades. Objetivo o artigo tem como objetivo desenvolver esportes de força física para pacientes com AVC com hemiplegia para explorar a eficácia dos esportes para recuperar a função dos membros nesses pacientes. Métodos Selecionamos aleatoriamente 30 pacientes com sequela de AVC e os dividimos em grupos controle e exercício. Durante a reabilitação, o grupo de exercícios realmente executou uma certa quantidade de exercícios aeróbicos. Durante esse período, comparamos os indicadores fisiológicos relevantes dos pacientes e, ao mesmo tempo, usamos o método de pontuação da função motora de Fugle-Meyer para avaliar a função dos membros. Resultados Os dois grupos de pacientes são significativamente diferentes em termos de recuperação da função física e capacidade para a vida diária. Os indicadores fisiológicos dos pacientes também são diferentes. Conclusão O exercício aeróbico de baixa intensidade pode ajudar os pacientes com derrame e hemiplegia a recuperar sua capacidade básica de viver e se exercitar. Nível de evidência II; Estudos terapêuticos: investigação dos resultados do tratamento.

RESUMEN Introducción Es muy importante para los pacientes con accidente cerebrovascular y hemiplejía realizar ejercicio físico y entrenamiento aeróbico, pero la disfunción física restringe la realización estas actividades.Objeto: El artículo tiene como objetivo desarrollar deportes de fuerza física para pacientes con accidente cerebrovascular con hemiplejía para explorar la eficacia de los deportes para recuperar la función de las extremidades de estos pacientes. Métodos Seleccionamos aleatoriamente a 30 pacientes con secuelas por accidente cerebrovascular y los dividimos en grupos de control y de ejercicio. Mientras se sometía a rehabilitación, el grupo de ejercicio llegó a realizar una cierta cantidad de ejercicio aeróbico. Durante este período, comparamos los indicadores fisiológicos relevantes de los pacientes y, al mismo tiempo, utilizamos el método de puntuación de la función motora de Fugle-Meyer para evaluar la función de las extremidades. Resultados Los dos grupos de pacientes son significativamente diferentes en cuanto a la recuperación de la función física y la capacidad para la vida diaria. Los indicadores fisiológicos de los pacientes también son diferentes. Conclusión El ejercicio aeróbico de baja intensidad puede ayudar a los pacientes con accidente cerebrovascular y hemiplejía a recuperar su capacidad básica de vida y ejercicio. Nivel de evidencia II; Estudios terapéuticos: investigación de los resultados del tratamiento.

Relação entre função motora e cognitiva na paralisia cerebral hemiplégica / Relationship between motor and cognitive function in hemiplegic cerebral palsy

Introdução: Crianças com paralisia cerebral hemiplégica (PCH) exibem dificuldades funcionais na utilização do membro superior hemiparético, repercutindo negativamente no desempenho em realizar atividades de vida diária. Atualmente, os déficits motores nessa população são acompanhados por distúrbios sensoriais, dificuldades na aprendizagem, alterações de comportamento e comunicação e défices cognitivos gerais. Objetivo: Investigar a possível associação entre os déficits motores e cognitivos de crianças com PCH, verificando ainda a influência da lateralidade da hemiplegia. Métodos: Participaram do estudo 30 crianças com PCH (idade média = 10,48 ± 2,46 anos). Os participantes foram submetidos aos seguintes testes: Assisting Hand Assessment (AHA), Matrizes Progressivas Coloridas de Raven, o Subteste cubos do Wechsler Intelligence Scale for Children fourth Edition - WISC IV e a fluência verbal semântica de animais. Resultados: Os grupos foram homogêneos em relação ao sexo e idade (p > 0.05). Os grupos não diferiram em relação ao nível de desempenho motor, memória de trabalho, inteligência e fluência verbal (p > 0,05). O desempenho motor correlacionou com todas as variáveis cognitivas. Conclusão: Em crianças com PCH o desempenho motor correlacionou fortemente com funções cognitivas. Além disso, a lateralidade da lesão cerebral não influenciou o desempenho em tarefas motoras e cognitivas. (AU)

Introduction: Children with hemiplegic cerebral palsy (HCP) exhibit functional difficulties in using the hemiparetic upper limb, negatively impacting their performance in carrying out activities of daily living. Currently, motor deficits in this population are accompanied by sensory disorders, learning difficulties, changes in behavior and communication and general cognitive deficits. Objective: To investigate the possible association between motor and cognitive deficits in children with PCH, also verifying the influence of laterality in hemiplegia. Methods: Thirty children with PCH participated in the study (mean age = 10.48 ± 2.46 years). Participants were subjected to the following tests: Assisting Hand Assessment (AHA), Raven's Colorful Progressive Matrices, the Wechsler Intelligence Scale for Children fourth Edition - WISC IV Subtest and the semantic verbal fluency of animals. Results: The groups were homogeneous in relation to sex and age (p > 0.05). The groups did not differ in relation to the level of motor performance, working memory, intelligence and verbal fluency (p> 0.05). Motor performance correlated with all cognitive variables. Conclusion: In children with PCH, motor performance correlated strongly with cognitive functions. In addition, the laterality of the brain injury did not influence performance in motor and cognitive tasks. (AU)

Efectividad del tratamiento intensivo de rehabilitación en pacientes hemipléjicos posterior a un accidente cerebrovascular / Effectiveness of intensive rehabilitation treatment in hemiplegic patients following stroke

Introducción. Los accidentes cerebrovasculares (ACV) son considerados la segunda causa de muerte y la tercera causa de discapacidad a nivel mundial. En Ecuador constituyen la primera causa de mortalidad y son una amenaza para la salud debido al grado de discapacidad que pueden ocasionar, lo que genera un gran impacto socioeconómico, familiar y en la calidad de vida de la población que los sufre. Objetivo. Determinar la efectividad del tratamiento intensivo y no intensivo de rehabilitación en pacientes hemipléjicos posterior a un ACV atendidos en el servicio de medicina física y rehabilitación de un hospital de Guayaquil, Ecuador, entre 2015 y 2018. Materiales y métodos. Estudio transversal no experimental realizado en 99 pacientes ambulatorios con diagnóstico de ACV. Se aplicó el índice de Barthel, correlacionando la respuesta al tratamiento rehabilitador intensivo y no intensivo en el periodo de tiempo ya definido para establecer la mejoría en la calidad de vida de los pacientes. Resultados. El diagnóstico de ACV fue más prevalente en el sexo masculino (67,7%), además se encontró que el 67,7% de los casos fueron de tipo isquémico y que se presentaron compli- caciones en el 17,2%, y comorbilidades en el 73,7%. Se estableció asociación estadísticamente significativa (p=0,010) al iniciar precozmente el tratamiento rehabilitador con el grado de discapacidad y la calidad de vida. Un Chi cuadrado de 62,878 y un valor alfa de 0,0001 indicaron asociación estadística entre la rehabilitación intensiva y resultados favorables según el índice de Barthel. Conclusiones. El tratamiento de alto nivel de intensidad produce una mejor recuperación funcional en los pacientes hemipléjicos posterior a un ACV.

Introduction. Cerebrovascular accidents (CVA) are considered the second leading cause of death and the third leading cause of disability worldwide. In Ecuador, they are the leading cause of mortality and are a threat to health due to the degree of disability they can cause, which has a great socioeconomic and family impact, as well as on the quality of life of the population that suffers them. Objective. To determine the effectiveness of intensive and non-intensive rehabilitation treatment in hemiplegic patients following a stroke attended in the physical medicine and rehabilitation service of a hospital in Guayaquil, Ecuador, between 2015 and 2018. Materials and methods. Non-experimental cross-sectional study conducted in 99 outpatients with a diagnosis of stroke. The Barthel index was applied, correlating the response to intensive and non-intensive rehabilitative treatment in the time period already defined to establish the improvement in the patients' quality of life. Results. The diagnosis of stroke was more prevalent in the male sex (67.7%), and 67.7% of the cases were ischemic, with complications in 17.2% and comorbidities in 73.7%. A statistically significant association was established (p=0.010) between early initiation of rehabilitation treatment and the degree of disability and quality of life. A Chi-square of 62.878 and an alpha value of 0.0001 indicated a statistical association between intensive rehabilitation and favorable results according to the Barthel index. Conclusions. High-intensity treatment produces better functional recovery in hemiplegic patients after stroke.

Tapping at acupoints along meridian combined with thunder-fire moxibustion for upper-limb hemiplegia after stroke / 中国针灸

OBJECTIVE@#To observe the effect of tapping at acupoints along meridian combined with thunder-fire moxibustion on upper-limb muscle strength and activities of daily living in patients with upper-limb hemiplegia after stroke.@*METHODS@#A total of 140 patients with upper-limb hemiplegia after stroke were randomly divided into a combination group (35 cases, 2 cases dropped off), an acupoint-tapping group (35 cases), a moxibustion group (35 cases, 2 cases dropped off) and a routine group (35 cases). The patients in the routine group were only treated with routine treatment and nursing. On the basis of the treatment in the routine group, the patients in the acupoint-tapping group were treated with tapping along the large intestine meridian of hand @*RESULTS@#Compared before treatment, body mass indexs of shoulder abduction, elbow extension, wrist flexion as well as BI scores in the four groups were significantly increased after treatment (@*CONCLUSION@#Tapping at acupoints along meridian combined with thunder-fire moxibustion could effectively improve the upper-limb muscle strength and activities of daily living in patients with upper-limb hemiplegia after stroke, and its effect is superior to simple tapping at acupoints along meridian or thunder-fire moxibustion.

Scalp acupuncture combined with suspension training for balance dysfunction in patients with stroke: a randomized controlled trial / 中国针灸

OBJECTIVE@#To explore the effect of scalp acupuncture combined with suspension training on balance ability and motor function in stroke patients with balance dysfunction.@*METHODS@#A total of 105 stroke patients with balance dysfunction were randomly divided into a combined group (35 cases, 2 cases dropped off), a scalp acupuncture group (35 cases, 3 cases dropped off) and a suspension training group (35 cases, 2 cases dropped off). The scalp acupuncture group was treated with scalp acupuncture at bilateral suboccipital lateral line, parietal midline, upper 1/5 line of anterior oblique line of parietal and temporal and line 1 of the parietal lateral line on the opposite side of hemiplegia. The suspension training group was treated with suspension training. The combined group was treated with suspension training at the same time of scalp acupuncture. All the treatment was given once a day, 30 min each time, 5 days a week, for a total of 6 weeks. The Berg balance scale (BBS) score, balance tester and Fugl-Meyer assessment (FMA) score were used to evaluate the motor function and balance ability before treatment, 3 and 6 weeks into treatment. The clinical efficacy was evaluated in the 3 groups.@*RESULTS@#The scores of BBS and FMA in each group at 3 and 6 weeks into treatment were higher than those before treatment (@*CONCLUSION@#Scalp acupuncture combined with suspension training could improve the balance ability and motor function in stroke patients with balance dysfunction, and the curative effect is better than simple scalp acupuncture and simple suspension training.

Superiority of motor imagery acupuncture in improving muscle tension for patients with upper limb hemiplegia of stroke in early stage / 中国针灸

OBJECTIVE@#To verify the superiority of motor imagery acupuncture in improving muscle tension for patients with upper limb hemiplegia in early stroke.@*METHODS@#A total of 64 patients of stroke hemiplegia with upper limb flaccid paralysis were randomly divided into an observation group (32 cases, 1 case dropped off ) and a control group (32 cases, 4 cases dropped off ). The observation group was treated with motor imagery acupuncture (both acupuncture and motor imagery therapy at affected upper limb were performed).The control group was treated with acupuncture plus motor imagery therapy at affected lower limb, 2 h later after acupuncture, motor imagery therapy was applied to upper limb. Baihui (GV 20) to Taiyang (EX-HN 5) of healthy side, Fengchi (GB 20) and Jianyu (LI 15), Jianjing (GB 21), Quchi (LI 11), Waiguan (TE 5) on the affected side, ect. were selected in both groups, once a day, 5 times a week for 4 weeks. Before and after treatment, 4, 8 weeks after treatment, the modified Ashworth scale (MAS) grade and Brunnstrom stage were compared in the two groups.@*RESULTS@#Compared before treatment, the muscle tension of shoulder, elbow and wrist each time point after treatment was increased in the two groups (@*CONCLUSION@#Motor imagery acupuncture could promote hemiplegia upper limb muscle tension recovery in patients of stroke hemiplegia with upper limb flaccid paralysis, make the patients gradually shift to the separate fine movement mode, inhibit and relieve the appearance and development of spasm.

Resultados terapéuticos de la aplicación de acupuntura y craneopuntura en pacientes hemipléjicos por accidente cerebrovascular isquémico / Therapeutic results of the application of acupuncture and craniopuncture in hemiplegic patients due to ischemic stroke

RESUMEN Introducción: las enfermedades cerebrovasculares son afecciones por pérdida funcional transitoria o permanente de una parte del sistema nervioso central, generalmente son de instalación súbita, causadas por: oclusiones arteriales, trombos, émbolos o por rotura de una arteria encefálica. Objetivo: determinar los resultados terapéuticos de la aplicación de la craneopuntura y acupuntura somática en pacientes hemipléjicos con diagnóstico de accidente cerebrovascular isquémico. Métodos: se realizó una investigación cuasi-experimental y prospectiva en el Hospital Universitario Clínico Quirúrgico Cmdte. Manuel Fajardo Rivero, Santa Clara, en el período de octubre 2015 a septiembre 2018. La población estuvo constituida por los pacientes ingresados en los servicios de Medicina Interna y Medicina Tradicional. Se conformaron dos grupos: estudio y control (17 pacientes en cada uno). Se realizó una entrevista médica a los pacientes, se aplicó el índice de Barthel y se confeccionó la historia clínica tradicional. Ambos grupos recibieron tratamiento fisioterapéutico y al grupo estudio se le añadió la craneopuntura y la acupuntura somática. Resultados: predominaron los pacientes del sexo masculino y el grupo etario de 70 a 79 años. La deficiencia de yin del riñón prevaleció en la muestra estudiada; se evidenció un mayor número de pacientes autónomos frágiles en el grupo estudio, en el cual, un 52,9 % presentó una evolución de la capacidad funcional satisfactorio, acompañada de un tiempo terapéutico corto. Conclusiones: los pacientes hemipléjicos por accidente cerebrovascular isquémico tratados con craneopuntura y acupuntura somática, mostraron resultados terapéuticos favorables, en comparación con el grupo que no recibió este tratamiento.

ABSTRACT Introduction: cerebrovascular diseases are affections due to temporary or permanent functional loss of a part of the central nervous system, generally they are of sudden installation and are caused by arterial occlusions, thrombi, emboli or by rupture of an encephalic artery. Objective: to determine therapeutic results of the application of craniopuncture and somatic acupuncture in hemiplegic patients diagnosed with ischemic stroke. Methods: a quasi-experimental and prospective investigation was carried out at ‟Cmdte. Manuel Fajardo Rivero" Clinico-Surgical University Hospital in Santa Clara, from October 2015 to September 2018. The population consisted of patients admitted to the Internal Medicine and Traditional Medicine services. Two groups were formed: study and control (17 patients in each one). A medical interview to the patients was carried out, Barthel Index was applied and a traditional medical record was drawn up. Both groups received physiotherapeutic treatment and craniopuncture and somatic acupuncture were added to the study group. Results: male patients and the age group from 70 to 79 years predominated. Kidney -yin deficiency prevailed in the sample studied; a greater number of frail autonomous patients was evidenced in the study group, in which 52.9% had a satisfactory evolution of functional capacity, accompanied by a short therapeutic time. Conclusions: hemiplegic patients due to ischemic stroke treated with craniopuncture and somatic acupuncture, showed favorable therapeutic results, in comparison with the group that did not receive this treatment.

Tumor de Klatskin y metástasis cerebral como presentación inusual en cáncer de mama / Klatskin tumor and brain metastasis in a breast cancer patient: Case report

Introducción: El cáncer de mama es la principal causa de muerte en mujeres a nivel mundial, se los clasifica en base a la expresión del receptor de estrógenos, de progesterona y de ERBB2. El tumor de Klatskin es infrecuente y se origina en la bifurcación del conducto biliar extrahepático. Presentación del caso: Paciente femenina de 60 años con diagnóstico de cáncer de mama estadío IIIB, que presenta hemiplejía derecha secundaria a lesión cerebral metastásica, inicialmente catalogada como neurocisticercosis. Después de 1 año 7 meses desarrolla ictericia colestásica cuya evaluación clínica permite evidenciar tumor de Klatskin mediante colangioresonancia. Discusión: El presente caso muestra una paciente con múltiples metástasis secundarias a cáncer de mama. Incluyendo, de igual manera, un tumor de Klatskin, el cual fue descubierto posterior a un síndrome colestásico. Son pocos los casos de la literatura que registran procesos metastásicos hacia conductos biliares con origen en un carcinoma ductal infiltrante. Conclusiones: Pocos casos en la literatura registran procesos metastásicos hacia las vías biliares con origen en infiltración ductal carcinoma; sin embargo, es fundamental informar para la evidencia clínica y el estudio de la literatura.

Introduction: Breast cancer is the principal cause of death in women worldwide, classi ed based on the expression of estrogen receptor, progesterone, and ERBB2. Klatskin tumor is rare and originates in the bifurcation of the extrahepatic bile duct. Case presentation: A 60 years old female patient diagnosed with stage IIIB breast cancer presents right hemiplegia secondary to metastatic brain injury, initially classi ed as neurocysticercosis. After one year and seven months, she developed cholestatic jaundice, whose clinical evaluation allows Klatskin tumor evidence through cholangioresonance. Discussion: The present case is about a patient with multiple metastases secondary to breast cancer. Including, in the same way, a Klatskin tumor, which was discovered after a cholestatic syndrome. Conclusions: Few cases in the literature register metastatic processes towards bile ducts originating from in ltrating ductal carcinoma; however, it is essential to report for clinical evidence and study of the literature.

Efectos de una terapia basada en estimulación eléctrica funcional de activación bimanual combinada con el entrenamiento de biofeedback electromiográfico en la función motora de la extremidad superior parética en sujetos secuelados de accidente cerebrovascular / Effects of a therapy based on a functional electrical stimulation of bimanual activation combined with the training of electromyographic biofeedback on the motor function of the upper limb in subjects with stroke

Resumen Introducción El accidente cerebrovascular constituye la principal causa de muerte y discapacidad en Chile. Más del 85% de los pacientes sufren hemiplejía y más del 69% discapacidad motora funcional de las extremidades superiores. Esta alteración genera impacto en el uso de la extremidad superior, afectando las diversas actividades de la vida diaria de las personas. No existen estudios que combinen terapia de biofeedback electromiográfico y activación bimanual con estimulación eléctrica funcional en sujetos secuelados de Accidente cerebrovascular (ACV). Por esto, surge el interés de determinar el efecto que tiene un protocolo de entrenamiento basado en Estimulación Eléctrica Funcional (EEF) con activación bimanual y terapia de biofeedback en la función de la extremidad superior. Metodología: 15 sujetos secuelados de ACV entre 40 y 85 años reclutados en el área de neurorrehabilitación ambulatoria de Clínica Dávila, aleatorizados en un grupo experimental y en dos grupos controles de 5 sujetos. En cada sesión el grupo experimental entrenará quince minutos de activación bimanual con electroestimulación funcional y luego un programa de entrenamiento de biofeedback de diez minutos, mientras que el grupo control 1 y control 2 entrenaron en las mismas condiciones pero con EEF placebo y BF-EMG placebo respectivamente Resultados Existieron cambios significativos en el grupo experimental luego de la intervención. Conclusión Este estudio sugiere la estimulación eléctrica funciona y biofeedback como una herramienta para la rehabilitación de la extremidad superior paréticas en sujetos secuelados de ACV.

Introduction: Stroke is the leading cause of death and disability in Chile. More than 85% of patients suffer from hemiplegia and more than 69% functional motor disability of the upper extremities. This alteration generates an impact on the use of the upper limb, affecting the various activities of people's daily lives. There are no studies that combine electromyographic biofeedback therapy and bimanual activation with functional electrical stimulation in subjects with stroke. Therefore, there is interest in determining the effect of a training protocol based on Functional Electrical Stimulation (FES) with bimanual activation and biofeedback therapy on the function of the upper limb. Methodology: 15 subjects with stroke between 40 and 85 years recruited in the outpatients neurorehabilitation program of Clínica Dávila, randomized in an experimental group and in two control groups of 5 subjects. In each session the experimental group will train fifteen minutes of bimanual activation with functional electrostimulation and then a ten-minute biofeedback training program, while the control 1 and control 2 group trained under the same conditions but with placebo FES and placebo BF-EMG respectively. Results There were significant changes in the experimental group after the intervention. Conclusion This study suggests the electrical stimulation works and biofeedback as a tool for the rehabilitation of the upper limb in subjects with stroke.

Discovery of Apraxia (Historical Note) / Descoberta da apraxia (Nota Histórica)

Skilled movements certainly exist since the dawn of the humans, embedded in the actions of daily living, and also represented by tools and weapons making and use, as well as by artistic activities as drawing and engraving. A very long period of time elapsed until such actions were recognized as special, and the designation 'praxis' was attributed to such ability of produce refined movements. Another long time passed, and only recently disturbances of such actions caused by brain lesions were identified, leading to the concept of 'apraxia'. Studies on this subject progressed quickly, and in a few decades reached the state resembling to what is seen nowadays.

Movimentos hábeis certamente existem desde a aurora dos humanos, incluídos nas ações da vida diária e também representados na feitura e uso de ferramentas e de armas, assim como por atividades artísticas como desenhar e gravar. Decorreu um longo período de tempo até que tais ações fossem reconhecidas como especiais e a designação de 'praxia' foi atribuída para tais habilidades para produzir movimentos refinados. Outro tempo prolongado passou, e apenas recentemente desordens de tais ações causadas por lesões cerebrais fossem identificadas, levando ao conceito de 'apraxia'. Estudos sobre esse assunto progrediram rapidamente e em poucas décadas alcançaram o estado que se assemelha ao que é visto atualmente.

Dual mobility total hip arthroplasty for the treatment of femoral neck fracture with hemiplegia / 中国骨伤

OBJECTIVE@#To investigate the clinical effects of dual mobility total hip prosthesis in treating femoral neck fracture patients with hemiplegia.@*METHODS@#A retrospective analysis was performed on 18 patients with femoral neck fracture combined with hemiplegia who underwent dual mobility total hip prosthesis replacement from March 2014 to December 2016. The follow up data of these patients was complete. There were 5 males and 13 females, aged 65 to 70 years old with an average of (66.50±1.38) years. The left side was involved in 12 cases, while the right side in 6 cases. There were 4 cases with Garden Ⅲ type and 14 cases with type Ⅳ. Limb muscle strength of hemiplegia were in grade Ⅳ. The posterior-lateral approach of hip joint was used in surgery for all patients. The implant position, dislocation and loosening of the prosthesis were evaluated by X-ray examination. Harris hip score and the Merle D'aubigne score were used to assess the hip function in the follow up.@*RESULTS@#The operation duration was for 70-90 (81.56±7.48) min and the blood loss during the operation was for 160-200 (170.32± 12.56) ml. No blood was transfused during the operation. Postoperative incisions were healed at the first stage. The follow-up time was for 28-60(36.0±3.5) months. Harris hip score increased from 16.94±0.73 preoperatively to 96.19±1.27 at the final follow-up(<0.05). Merle D 'Aubigne score increased from 3.96±0.06 preoperatively to 16.81±0.63 at the final follow-up(< 0.05). No fracture or nerve or vascular injury were found during the operation. The postoperative X-ray showed that the prosthesis was in good position. No complications such as joint dislocation, dislocation of prosthesis, loosening of prosthesis, fracture around the prosthesis, pain in the front of thethigh, fracture of the self tapping screw in the ilium, and delayed infection occurred in the patients after operation.@*CONCLUSION@#Dual mobility total hip prosthesis has the advantages of both good initial stability and low dislocation rate of the prosthesis, and the clinical application of total hip replacement in hemiplegic femoral neck fracture is satisfactory.

Influence of acupuncture combined with rehabilitation therapy on limb motor function and serum cAMP and cGMP in patients with hemiplegia of cerebral ischemic stroke / 中国针灸

OBJECTIVE@#To evaluate the therapeutic effect of the combined treatment with balance acupuncture therapy and exercise re-learning rehabilitation therapy and the impact on serum cAMP and cGMP in the patients with hemiplegia of cerebral ischemic stroke.@*METHODS@#A total of 90 patients of hemiplegia of cerebral ischemic stroke were randomized into an observation group and a control group, 45 cases in each one. All of the patients in the two groups received health education, diet guidance, routine symptomatic treatment as well as exercise re-learning rehabilitation therapy. Additionally, in the observation group, balance acupuncture therapy was applied, in which, the acupoints on the aspect of the human body, on the governor vessel and bladder meridian were adopted in the morning and those on the aspect of the human body, on the conception vessel and kidney meridian were stimulated in the afternoon. In the control group, the regular acupuncture was given. In the two groups, both acupuncture and rehabilitation therapies were given 5 days a week, 2 week-treatment as one course and totally 2 courses were required. Separately, before and after treatment, the score of Fugl-Meyer assessment (FMA) and the score of Chinese stroke scale (CSS) were recorded, the levels of cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP) detected in serum and the clinical therapeutic effect were evaluated in the two groups.@*RESULTS@#After treatment, FMA score was increased in the patients of either of the groups as compared with that before treatment (<0.01) and CSS score decreased as compared with that before treatment (<0.01). After treatment, FMA score in the observation group was higher than that in the control group (<0.01) and CSS score was lower than the control group (<0.01). After treatment, the level of serum cAMP of the patients in either of the groups was increased as compared with that before treatment (<0.01) and that of cGMP decreased as compared with that before treatment (<0.01). After treatment, the level of cAMP in the observation group was higher than that in the control group (<0.01) and that of cGMP was lower than the control group (<0.01). The total effective rate was 93.3% (42/45) in the observation group, better than 73.3% (33/45) in the control group (<0.01).@*CONCLUSION@#The balance acupuncture therapy combined with exercise re-learning rehabilitation effectively improves the motor function of the affected limb, relieves injury and regulate the levels of serum cAMP and cGMP in the patients with hemiplegia of ischemic stroke.

- balance penetrating acupuncture combined with rehabilitation training on upper limb spasticity in stroke hemiplegia / 中国针灸

OBJECTIVE@#To compare the therapeutic effect of - balance penetrating acupuncture combined with rehabilitation training and single rehabilitation training on upper limb spasticity in patients with stroke hemiplegia.@*METHODS@#A total of 60 patients with upper limb spasticity of stroke hemiplegia were randomized into an observation group and a control group, 30 cases in each one. On the basis of conventional western medication, rehabilitation training was adopted in the control group. On the basis of treatment in the control group, - balance penetrating acupuncture was applied from Jianyu (LI 15) to Binao (LI 14), Quchi (LI 11) to Shaohai (HT 3), Yanglingquan (GB 34) to Yinlingquan (SP 9), Xuanzhong (GB 39) to Sanyinjiao (SP 6), etc. of the affected side in the observation group. The treatment was given once a day, 5 days were as one course, with a 2-day interval between two courses, 4 courses were required in both groups. The classification of modified Ashworth spasticity scale (MAS), surface integrated electromyogram (iEMG) of affected upper limb and the scores of National Institute of Health stroke scale (NIHSS), Fugl-Meyer assessment (FMA) of upper limb and modified Barthel index (MBI) before and after treatment were observed, the therapeutic effect was evaluated in both groups.@*RESULTS@#①After treatment, the MAS classification reduced in both groups (<0.05), the cases of grade 0 to Ⅰ in the observation group were more than those in the control group (<0.05); iEMG values of the maximum isometric voluntary contraction of affected usculus biceps brachii, musculus triceps brachii, musculus flexor carpi, musculus extensor carpi, extensor digitorum, aductor pollicis brevis were increased in both groups (<0.05), and the variations of iEMG of above muscles on the affected side in the observation group were larger than those in the control group (<0.05). ②After treatment, the scores of NIHSS were decreased (<0.05), the scores of FMA, MBI were increased in both groups (<0.05), and the variations of NIHSS, FMA and MBI scores were larger than those in the control group (<0.05). ③The total effective rate was 93.3% (28/30) in the observation group, which was superior to 70.0% (21/30) in the control group (<0.05).@*CONCLUSION@#- balance penetrating acupuncture combined with rehabilitation training can improve upper limb spasticity, heighten the motor function of upper limb and daily self care in patients with stroke hemiplegia, its therapeutic effect is superior to single rehabilitation training.

Clinical and Genetic Spectrum of ATP1A3-Related Disorders in a Korean Pediatric Population

Research progress on joint replacement for hemiplegic femoral neck fracture / 中国骨伤

With China's aging society, the number of patients with hemiplegia caused by cerebrovascular accident is increasing gradually. The risk of hip fracture in the first year after the onset of this kind of patients is 4 times higher than that of ordinary people, and most of them occur in the side of hemiplegia. For senile femoral neck fracture, artificial joint replacement is almost the first choice of treatment, with mature operation technology and good curative effect. At present, it is considered that if the muscle strength of hemiplegic side can reach grade III after cerebral vascular accident, hip arthroplasty can be the first choice for hemiplegic patients with hemiplegic femoral neck fracture. However, the situation of hemiplegic patients is different from that of ordinary people. The hemiplegic limbs may have muscle atrophy, muscle strength imbalance, osteoporosis and other problems, which brings difficulties to the formulation of surgical plan. This paper mainly discusses the choice of surgical approach, the use of total hip arthroplasty or hemiarthroplasty, the use of cemented prosthesis or cementless prosthesis, and how to reduce the incidence of postoperative dislocation The purpose is to provide more reference evidence for orthopedic doctors in clinical decision-making.