Résumé
BACKGROUND:Extradural cortical stimulation combines the advantages of repetitive transcranial magnetic stimulation, transcranial direct current stimulation, subdural cortical stimulation and deep brain stimulation, which can significantly improve motor and language function after stroke. OBJECTIVE:To review the theoretical research and clinical application of extradural cortical stimulation for stroke recovery. METHODS:An online retrieval of PubMed database and CNKI database between January 1995 and April 2014 was performed for articles on theoretical research and clinical application of extradural cortical stimulation for stroke recovery, with the key words of“cortical stimulation, extradural motor cortex stimulation, extradural cortical implants, extradural cortical stimulation, stroke, rehabilitation”in English and Chinese. RESULTS AND CONCLUSION:Because of implantable cortical stimulation, the advantage of extradural cortical stimulation is its minimal invasiveness, high accuracy and transdural contact with the brain. For lack of effective treatment for the chronic phase of stroke patients with motor and language dysfunction, extradural cortical stimulation may be a new therapeutic method. Motor and language functional improvement must derive from reactivation of plasticity, local enhancement of perilesional areas, enhancement of network function and inter-hemispheric balance function, and amplification of sensory input.
Résumé
Stroke rehabilitation research has shifted its focus from empiric evidence to biological targets. This article reviewed the plas-ticity of the brain, spinal cord and skeletal muscle, and suggested rehabilitation techniques targeting central nervous system and skeletal mus-cle.
Résumé
Objective To evaluate the effect of neuromuscular electrical stimulation (NMES) on swallowing function in brain injury patients with dysphagia.Methods Sixty-four patients with dysphagia were divided into A group (n=21,stimulated with T =700 ms,R =2 s,frequency =0.19 Hz),B group (n =22,T =700 ms,R =1 s,frequency =0.29 Hz),and C group (n =21,T =340 ms,R =400 ms,frequency =0.68 Hz).One pair of electrodes was placed at the midline under the chin over the submental muscle group.The intensity of stimulation ranged from 5 to 11 mA.The treatments were once a day,5 times a week,with 20 times as one course.The results were assessed with Kubota's water swallowing test before and 4 weeks after treatment.Results The water swallowing test scores were significantly reduced after treatment in all 3 groups,with significantly greater reductions in A group compared with B and C group.The effectiveness rate was 81％ in A group,73％ in B group and 67％ in C group,all statistically significant differences.Conclusion NMES can be an effective and safe treatment for dysphagia after brain injury.NMES appears to be most effective with T =700 ms,R =2 s,and a frequency of 0.19 Hz.
Résumé
OBJECTIVE: A series of Bobath concept, Bobath theoretical hypothesis and clinical practice were summarized, to proVide a better understanding of Bobath concept involved in nervous tissues repairing and functional reconstruction. METHODS: Articles concerning the Bobath treatment for stroke-related literature were retrieved in Highwire press, MEDLINE, and Google from 2001 to 2009, using the key words of "Bobath concept, stroke physical therapy". Data of each study were extracted and analyzed following retrieval. Inclusion criteria:①Bobath concept and its theoretical hypothesis. ②New development of Bobath concept in clinical practice. Exclusion criteria: Repetitive studies. The results of retrieved literatura were analyzed. RESULTS: The theoretical basis of Bobath concept is based on present-day knowledge of motor control, motor learning, neural and muscle plasticity, and biomechanics. The latest theories and viewpoints are rasourced from International Bobath Instructors Training Association and the British Bobath Tutors Association. They expounded on the Bobath concept from linking participation, activities and underlying impairments, organization of human behavior and motor control, the consequences of injury and dysfunction in the execution of movement, neural and muscle plasticity, motor learning and so. This article also discusses several important questions which meet in clinical practice. CONCLUSION: Bobath therapy, as a traditional method for stroke rehabilitation, is constantly absorbing the research results from current neuroscience, psychology and other disciplines, and blended with other treatments to promote the development of neuro-rehabilitation medicine.
Résumé
Objective To study the effect of phonophoresis on transdermal delivery of sinomenine hydrochloride ( SH ) gel in vitro. Methods Ultrasound at one of two frequencies ( 800 kHz or 1 MHz) was applied with a sonicator with a transducer in this study. The skin of male Sprague-Dawley rats was used as the model and SH gel was used as the ultrasound couplant. The permeation rate of SH was detected using a modified Franz diffusion cell maintained at 32±0.5℃ and filled with 20% polyethylene glycol 400 physiological saline solution. The transdermal phonophoresis experiments were carried out in five groups: Group Ta, f=800 kHz, / = 0.75 W/cm2, t = 10 min:Group Tb,f=1 MHz,I=0.7 W/cm2, t=10 min; Group Tc,f=1 MHz,I=0.35 W/cm2, t=10 min; Group Td,f=800 kHz, I = 1.5 W/cm2, t = 10 min and Group Tc,f=800 kHz, I=1.5 W/cm2,t=5 min. There was also a control group (C) in which the SH was allowed to diffused passively. Samples were withdrawn at the indicated intervals and the concentration of SH was determined by high-performance liquid chromatography. The transdermal parameters such as average accumulated delivery quantity per unit area Q8h, average transdermal steady delivery rate J, and Tlag were calculated. Results The Q8h and Js of the control group were 20.65±10.23 μ/cm2 and 3.02±0.11μ/cm2/h respectively. The phonophoresis parameters in groups Ta and Tb were, on average, significantly higher than in the control group. The parameters in group Tb were significantly larger, on average, than in Te. In group Td the parameters were significantly larger than in groups Ta and Te. Conclusions The results show that phonophoresis can enhance the transdermal delivery of SH. Phonophoresis variables such as frequency and time influence its effects on drug permeation. Almost no change was observed in the structure of the skin after phonophoresis, though under a scanning electron microscope the surface of the corneum appeared rough and porous. Phonophoresis is there-fore an effective and safe method for SH transdermal delivery, and the effect is positively relation with the applied intensity and exposure time.