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Objective:To explore the effects of dual task training assisted by a lower limb rehabilitation robot on lower extremity mobility and the walking ability of stroke survivors.Methods:Sixty-one stroke survivors were randomly divided into a control group and an experimental group with 30 in the control group and 31 in the experimental group. In addition to routine exercise training and physical therapy, both groups were given cognitive-motor dual task training 5 times a week for 3 weeks. But only in the experimental group was the dual task training assisted by a lower limb rehabilitation robot. Both groups′ lower limb motor function, walking ability, cognition, balance and ability in the activities of daily living were evaluated before and after the experiment using the Fugl-Meyer lower extremity assessment (FMA-LE), functional ambulation categories (FAC), the digital span test (DST), the Berg Balance Scale (BBS) and the Modified Barthel Index (MBI). Additionally, 6 survivors of a right hemisphere stroke from the experimental group received cognitive-motor dual task training both with and without the robotic assistance alternately. Near-infrared functional brain imaging was applied before and after the intervention, and the functional network connectivity of the resting brains was analyzed.Results:After the intervention the average FMA-LE, FAC, BBS and MBI scores had improved in both groups, with the improvement in the experimental group significantly better than in the control group on average. In terms of cognition there was no significant difference in the DST forward and backward assessment results between the two groups. The analysis of brain network functional connectivity showed that the intensity of functional connectivity between the left prefrontal cortex (PFC) and the left premotor cortex and supplementary motor cortex (PMC/SMA) increased significantly more, on average, after training assisted by the robot.Conclusion:Dual task training with the assistance of a lower limb rehabilitation robot can effectively improve the lower limb motor function, walking, balance and ability in the activities of daily living of stroke survivors. Enhanced functional connection of the PFC and the PMC/SMA in the healthy hemisphere induced by the robot may be the cause.
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Objective:To explore the synchronization effect of whole-body vibration therapy combined with squat-up train-ing on ambulation of patients with stroke. Method:40 stroke survivors who could walk independently with supervision or assistive devices,were recruit-ed from the Department of Rehabilitation Medicine,Huashan Hospital Affiliated to Fudan University(Pudong Cam-pus)and were randomly divided into the WBVT group and the control group.Both groups received conven-tional rehabilitation treatment for 40 minutes per day.The WBVT group was given additional whole-body vibra-tion therapy while squat-up training for another 20 minutes a day.The control group added sham stimulation of standing on the vibration platform with no vibration for the same amount of time per day.At the begin-ning of enrollment and after 4 weeks intervention,participants received two times evaluation by the wearable three-dimensional gait assessment instrument for the function of walking,and the electromyographic signals of the rectus femoris and long head of the biceps femoris were collected by surface electromyography instrument and statistical analysis on the data before and after the intervention. Result:After 4 weeks intervention,the stride speed and stride length of both groups improved siginificanlty(P＜0.05),while the WBVT group was better than the control group(P＜0.05).The swing angle of knee(flex-ion or extention)in the WBVT group improved significantly after intervention compared with the control group.At the single leg support phase(SS)of affected side,the differences were found in the synergistic contraction rate of the rectus femoris and biceps femoris in the bilateral lower extremity of the WBVT group after the in-tervention(P＜0.05).At the swing phase(SW)of affected side,the differences were found in the synergistic contraction rate of the rectus femoris and biceps femoris in the bilateral lower extremity between the two groups before and after the intervention(P＜0.05),but the affected side of the WBVT group was better than that the control group after intervention(P＜0.05). Conclusion:Whole-body vibration therapy combined with rhythmic squat-up synchronous training can improve the stride speed,stride length and synergistic contraction rate of lower limb muscles for better ambulation of patients with stroke.
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ObjectiveTo explore the effect of multi-sensory artificial intelligence feedback gait training on the recovery of walking function in stroke patients based on enriched environment theory. MethodsFrom July, 2021 to June, 2023, a total of 80 stroke patients in Huashan Hospital Affiliated to Fudan University were randomly divided into control group (n = 40) and experimental group (n = 40). Both groups received routine rehabilitation in the lying and seated positions, for 40 minutes. The control group received ground walking training, for 20 minutes, while the experimental group received multi-sensory feedback gait training in enriched environment, for 20 minutes. Before and after four weeks intervention, the digital motion monitoring treadmill was used to mearsure step speed, step length, hip and knee swing angle and weight symmetry. They were assessed with Berg Balance scale (BBS), Fugl-Meyer Assessment-Lower Extremities (FMA-LE) and Barthel Index (BI). ResultsAfter intervention, the hip swing angle, step length of both sides and step speed significantly improved in both groups (|t| > 3.162, P < 0.05), and they were better in the experimental group than in the control group (|t| > 2.568, P < 0.05); the average knee joint swing angle and bilateral weight-bearing symmetry significantly improved in the experimental group (|t| > 3.249, P < 0.01); the scores of BBS, FMA-LE and BI improved in both groups (|t| > 3.569, P < 0.01), and they were better in the experimental group than in the control group (|t| > 2.922, P < 0.05). ConclusionMulti-sensory feedback gait training based on enriched environment theory could effectively improve the walking and balance of stroke patients, and increase the ability of independence.
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Objective To observe the effects of transcutaneous electrical acupoint stimulation (TEAS) on hand dysfunction after stroke. Methods From March, 2013 to June, 2015, 56 cases of stroke with hand dysfunction were divided into group A (n=28) and group B (n=28). Both groups received basic rehabilitation, while group B received TEAS in addition, for six weeks. They were evaluated with Brunnstrom Grades, Manunl Muscle Test (MMT), Fugl- Meyer Assessment (FMA) of fingers, Motor Status Scale (MSS), modified Ashworth Scale (MAS), National Institutes of Health Stroke Scale (NIHSS), Motor Hand Functional Status Score and Barthel Index (BI). Results The scores of FMA of fingers, MMT of wrist flexion, MSS, MAS and BI were more in group B than in group A (t>2.2527, P0.05). Conclusion TEAS can promote the recovery of hand function and the activi-ties of daily living in patients after stroke.
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Objective To study the effects of acupuncture at myofascial trigger points on spastic foot drop and inversion after stroke. Methods From May, 2014 to May, 2016, 50 stroke patients were randomly divided into control group (n=25) and observation group (n=25). Both groups accepted routine rehabilitation, while the observation group accepted acupuncture at myofascial trigger points per day in addi-tion. They were assessed with Visual Analogue Scale (VAS) of pain, modified Ashworth Scale (MAS), range of motion (ROM) of ankle, sim-plified Fugl-Meyer Assessment (FMA) for lower limbs and maximum walking speed (MWS) in ten metres before and six weeks after treat-ment. Results The scores of VAS, MAS, and FMA, the ROM of ankle, and MWS improved after treatment (t>6.845, P5.586, P<0.001). Conclusion Acupuncture at myofascial trigger points can release spasm to reduce foot drop and inversion in patients with stroke.
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Objective To explore treatment of bile duct variation in Laparoscopic Cholecystectom.Methods The author retrospectively analyzed the clinical data of 7 cases with bile duct variation in 2 000 patients performing Laparoscopic Cholecystectomy.Among the 7 cases,2 cases had small hepatic duct openings in the gallbladder bed;2 cases had cystic duct openings in the right hepatic duct;2 cases had accessory right hepatic duct;and one case had rare variation whose right hepatic bile duct and the jejunum connect together.2 cases of the first variation had no bile leakage,adopting the suture method in LC.Among 2 cases of the second variation(all found in LC),one case had bile spillage in the junction of the cystic duct and the right hepatic duct,so the operator converses to laparotomy,cuts the gallbladder,sutures the break,and the patient had no bile leakage at last;The other one case was anatomized clearly under the cavity mirror.Among 2 cases of the third variation,one had no bile leakage,whose accessory hepatic duct was ligated in LC.The other one case had bile leakage after LC,so the operator converses to laparotomy,clips the accessory hepatic duct,and extract the drainage tube until there was no bile drainage.The last case was mistaken and cut it,the next day biliary peritonitis appeared,so the bile leakage was sewed up under the laparoscope.Results The seven cases were followed 1 ~3 years,they had no jaundice and their liver function was normal.Conclusion Careful-ly dissect Calot's triangle in LC,observe bile leakage after LC;improve the level of understanding and dealing bile duct variation in LC,don't cut the duct which is known to us.We should treat differently according to particular case.
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A 51-year-old male patient was presented to our hospital for inspection of right renal space-occupying lesions. CT revealed soft tissue density in the right renal pelvis and renal pelvis ureter transitional crumb, for which a clinical diagnosis of right renal cancer was made. After laparoscopic radical resection of the right kidney, pathological examination supported the diagnosis of idiopathic retroperitoneal fibrosis. With an unclear pathogenesis, idiopathic retroperitoneal fibrosis presents with atypical clinical manifestations but shows specific features in imaging examination. Its treatment is individualized according to the specific condition for which conservative medical or surgical treatment can be considered. Retroperitoneal fibrosis has a low incidence and a high misdiagnosis rate, and imaging examinations remain currently the primary modality for diagnosis with specific findings.