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Objective To investigate insula cortex activation evoked by stimulating different acupoints of lower extremity.Methods Twenty healthy male right-handed subjects were recruited to receive functional magnetic resonance imaging(fMRI)examination with a whole-body 3T Siemens Trio system for whole-brain imaging.Participants were at rest during scanning and were instructed to relax with their eyes closed,without falling asleep.A blockdesigned method was applied for acupoint stimulation.The examined acupoints on the right lower extremity were stimulated,respectively,resulting in 4 experimental conditions.Stimulation was performed by brushing the subject's skin over each acupoint with a sponge at a frequency of approximately 2 Hz.Images were analyzed using SPM5 software package.Group analysis was performed with the mixed-effects model.Small volume correction was used to investigate insula cortex activation under each condition at a threshold of P ＜ O.01,with a 6-mm radius centered on the local maxima of activation in insula cortex.The scope of insula cortex was determined with SPM anatomy toolbox.Results All the examined acupoints induced activation in contralateral insula cortex.Activation clusters evoked by different acupoints presented various types of locations and shapes,and all of them located in the posterior part of insula cortex.Activation in the ipsilateral insula cortex was not found for all examined acupoints.Conclusions Stimulating lower extremity acupoints can activate posterior insula cortex.This effect may promote the recovery of dysphagia via several mechanisms including facilitating the initiation of swallowing,improving oral and pharyngeal sensation,and reducing taste disturbance.
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Objective To investigate any effects of rubbing acupoints on the right leg on activation and deactivation responses in the human cerebellum. Methods Ten male, healthy, right-handed subjects were examined using functional magnetic resonance imaging (fMRI) while their Zusanli (ST36) , Yanglingquan (GB34),Fenglong (ST40) and Sanyinjiao (SP6) acupoints on the right lower extremity were stimulated. A block-designed method was applied. A piece of sponge was used to rub all the above-mentioned acupoints for stimulation. The mean values of the activation and deactivation signals in different cerebellar zones induced by stimulating each acupoint were calculated.Results Each acupoint could modulate cerebellum function in its specific way, but all acupoints induced the largest mean values in the Vermis Crus I area. The largest deactivation effects for all acupoints except Sanyinjiao were located in the Vermis VI area. For each acupoint, left and right side activation effects of the 20 zones of the cerebellum were basically consistent, though the mean values of most zones were higher on the right side. Conclusions The four acupoints studied not only shared common modulating effects, but also showed point-specific influence on cerebellum function. The effects exerted by each acupoint on the Vermis were greater than that on the cerebellar hemispheres. The phenomena observed in this study could contribute to acupoint selection during rehabilitation.
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Objective To establish a new approach based on mathematical morphology that can effectively reduce the drifts in functional magnetic resonance imaging (fMRI) signals. Methods Based on investigation of the characteristic of drifted fMRI signals, a mathematical morphology method for baseline drift correction was presented. Results With both simulated data and real fMRI data, the results of the experiment showed that the mathematical morphology method can effectively correct the baseline drifts. Conclusion Both linear and nonlinear drifts can be removed with the proposed method without any statistical model assumption.
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Objective To investigate the radiation exposure of patients during videofluoroscopic swallowing studies (VFSSs) through literature study. Methods The English literature was searched using PUBMED with the search expression:(radiation) AND (swallow) AND (MBS OR VFSS OR barium OR dysphagia).The Chinese lite-rature was searched using CNKI with the search expression:(FT=dysphagia+deglutition disorder+swallowing function disorder) and (FT=radiation exposure+radiation injury+radiation protection+radiation+radiation dose). Results PUBMED returned 11 original articles and one review article focusing on the radiation exposure of patients during a VFSS.In addition,there were two review articles which mentioned this issue.These studies were published from 1990 to 2009.No original or review article was found through CNKI searching.Conclusions Radi-ation exposure of patients during a VFSS is an issue that has been neglected in China.
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@#This paper would discuss the concepts about motor imagery and differences to motor execution. The application of motor imagination in rehabilitation was described. The problem of the way to observe the motor imagery and executing task of motor imagery effectively are emphasized. Finally we provide an addressing on motor imagery questionnaires.
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@#Objective To identify the risk factors for osteoporosis in patients with hemiplegia. Methods The total body bone mineral density (BMD) of 366 patients with hemiplegia in the stage of rehabilitation was measured with dual-energy X-ray absorptiometry. The data of the patients were analyzed with multiple logistic regressions. Results The incidence of osteoporosis was 15.3 % (56/366) in the cohort. ≥60 years old (OR=5.434, 95% CI:2.734～10.801), duration of disease (OR=1.046, 95% CI:1.013～1.080), body mass index (BMI) (OR=0.746,95% CI:0.622～0.840),ADL level (OR=0.618, 95% CI: 0.444～0.858) were independently correlated with osteoporosis in patients with hemiplegia. Conclusion Patients with hemiplegia in the stage of rehabilitation were at a high risk of osteoporosis. Aged over 60 years old, lower BMI, longer duration of disease and ADL level were independent risk factors for osteoporosis, which called for supervision and prophylaxis on osteoporosis.
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@#Diet modification is a common and important approach for dysphagia rehabilitation. Categories of foods/liquids, suitable volumes per swallow, and effective methods of posture adjustment can be selected through Video Fluoroscopic Swallowing Study (VFSS)/Modified Barium Swallow (MBS), to determine a safe and valid strategy of diet modification. Diet modification based on VFSS/MBS will ensure eating ability and promote swallowing function in dysphagia patients to the greatest extent.
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@#Diet modification is a common and important approach for dysphagia rehabilitation. Categories of foods/liquids, suitable volumes per swallow, and effective methods of posture adjustment can be selected through Video Fluoroscopic Swallowing Study (VFSS)/Modified Barium Swallow (MBS), to determine a safe and valid strategy of diet modification. Diet modification based on VFSS/MBS will ensure eating ability and promote swallowing function in dysphagia patients to the greatest extent.
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@#Objective To observe the changes of functional magnetic resonance imaging(fMRI) when performing transcutaneous electrical nerve stimulation(TENS) in Du Channel of the patient with brain trauma.Methods TENS was applied to the acupoints of Mingmen and Yaoyangguan in a patient with brain trauma.The changes of brain function when TENS performed were observed with fMRI.Results Compared with rest status,multiple brain areas were activated during stimulation.Conclusion TENS in Du Channel may influence neural plasticity course after brain injury.
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@#Objective To investigate the changes of bone mineral density (BMD) and bone mass and the influencing factors in patients with hemiplegia.Methods The total BMD, bone mass, lean mass and fat mass of 366 patients (313 stroke cases and 53 TBI cases) with hemiplegia were tested by dual-energy X-ray absorptiometry, as well as the clinical features of all patients, were studied.Results The bone masses in the paretic side (upper limb, lower limb and trunk) decreased significantly compared with nonparetic side ( P<0.01); the differences of bone masses (%) in upper limb, lower limb and trunk between paretic and nonparetic side decreased with duration of disease or trauma ( P<0.01). The multivariable stepwise regression analyses showed that the total bone mass and total BMD were negatively correlated with age and duration of disease significantly (all P<0.01), and positively correlated with body mass index (BMI) significantly ( P<0.01), the total BMD was also positively correlated with lean mass ( P<0.01) and ADL level ( P<0.05).Conclusion The bone mass deceases in the paretic side significantly, and gets worse with the duration of disease. Age, duration of disease or trauma and BMI influence total BMD and bone mass; in addition, total BMD is correlated with total lean mass and ADL level.
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Objective To explore fMRI data with independent component analysis (ICA) in order to investigate effects of transcutaneous electrical acupoint stimulation (TEAS) on brain function. Methods The experiment was performed on a whole-body 1.5 T GE Signa Excite MRI scanner with which the brain oxygenation level dependent (BOLD)/EPI images were acquired from a female traumatic brain injury patient. A block designed protocol was used. Both durations of rest and TEAS were 30 seconds. The data processing was performed with GIFT, Statistical Parametric Mapping 5 (SPM5) and MRIcro. Results from ICA and SPM were compared. Results Extended Infomax algorithm provided by GIFT found thirteen independent components (ICs), each of which contained a spatial map and a corresponding time course. The spatial maps associated with task-related ICs resembled the activation maps from SPM5 but were not totally identical. In addition, the time courses of these ICs differed from the shape of canonical HRF model used by SPM. Conclusion ICA is a good choice to investigate data and obtain prior knowledge before using model-based methods such as SPM.
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@#: Rehabilitation medicine is a medical branch which focused on functional recovery. Function Evaluation is very important in assessing the function of patients, the effect of treatment and the efficiency of rehabilitation. Comprehensive Function Evaluation includes evaluation of physical, psychological, speech and society. Vocal, mental and social evaluation have deep cultural and national background. Therefore every country must have its own Function Evaluation Method. Now we present our design for Comprehensive Evaluation. Based on the cooperation of Department of Rehabilitation, Department of Neurology, Department of Spinal Cord Injury, Department of Speech Therapy and Department of Psychology. The advantages of this method are as follows: 1. The style of ADL, speech and thinking are suitable for the condition of our country. 2. The evaluation result adopts hundred work system, it is easy for medical staff, patients and their family to understand and communicate the result. 3. We make it more accurate, comprehensive and reliable by some simple tests on speech pathology and psychology. 4. We overcome some disadvantages of evaluation indexes because it is not correct and is difficult to be understood before. Now every evaluation index has quantity standard. 5. It is simple and practical. Each subtest takes 20 minutes or more. 6. It has been tested by normal people. The norm and severity grade had been developed. 7. The reliability is tested and is proved to be dependable.
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@#One hundred and fourty-nine normal persons were tested to gain the normal scale of Comprehensive Function Evaluation(CFE).It includes seven items eighteen categories.The result demonstrated that fifteen categories of normal persons in age of twenty to sixty-nine incuding understanding and expressing,feeding,grooming,dressing clothes,dressing trousers and skirts,bathing,bowel and bladder management,control of sphincter of bowel and bladder,bed wheelchair mobility,bathtub-wheelchair mobility,ambulation,up and down the stairs,which gained one hundred degrees each,memory ninty eight to one hundred degrees,problem solving ability eighty-four to one hundred degrees,social communication ninty-nine to one hundred degrees.We conclude preliminarily:CFE is an individual ability evaluation of preson,demonstrating the comprehensive function of presons which were in aga of twenty to sixty nine,educated in and above primary school.It can be used as a main scale to evaluate the guality and effect of rehabilitation sequence,and has practical value to improve rehabilitation medical level.
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@#Presented in this paper is a preliminary report on reliability study of comprehensive function evaluation.One hundred and five normal persons were evaluated twice in the interval of one month.The result revealed significant statistical difference,Kappa=0.79,u=7.938>2.56,P<0.01,demonstrating the substantial agreement of these two evaluations.The result suggests that the scale has substantial intra observer agreement and high reliability.The personal comprehensive function could be evaluated completely in the scale.It would be significant not only in practice but also in theory to improve the rehabilitation evaluation and rehabilitation medical level.
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@#康复医学是以恢复患者功能为中心的医学分支。因此，功能评定无论是在客观地评定患者的功能方面，还是在最终评定治疗结果和康复效率方面都是极为重要的。全面的功能评定包括躯体、精神、言语和社会四个方面。其中，言语、社会功能和认知功能中的思维方式，都具有强烈的民族文化色彩。因此，每个国家都应该有切合自己国情的功能评定方法。但由于我国康复医学发展较晚，至今尚无一套既切合国情，又全面、实用和可靠的功能评定方法。有鉴于此，我们在“中心”顾问室、神经康复科、脊髓损伤康复科、言语治疗科、心理科和老年病科的通力合作下，经过近2年的研究，在吸收国际先进经验的基础上，密切结合国情，设计了本文所述的综合功能评定法。其优点有：1．在饮食、起居等生活方式方面以及在言语、社会、思维等方面，均切合我国国情。2．评定结果采用群众熟悉的100分制，使医务人员、患者和患者家属均易于理解，便于交流和沟通。3．在言语、认知等功能的评定方面，直接由言语和心理学家选择一些简易的言语和心理学测试项目，提高了量表的准确性、全面性和可靠性。4．各项评定指标的量化程度高，在言语、认知和社会方面尤其如此，克服了一些量表中对此类项目的评定指标不够具体和不易掌握的不足。5.简便实用，一次检查对正常人仅需20分钟左右，对患者则无负担。6.本法已在128名正常人中应用，并求出了正常值，据此拟定了功能障碍严重程度的等级，可供参考和应用。7.信度经过检验，证明可靠。 综合功能评定法的正常值、功能障碍严重程度分级及信度研究结果，将陆续报道。