RÉSUMÉ
Objective To analyze the clinical efficacy of acupuncture combined with rehabilitation training in the treatment of post-stroke hemiplegia.Methods A retrospective study was conducted to select 121 cases of post-stroke hemiplegia patients who attended Haikou People's Hospital,Haikou Affiliated Hospital of Central South University Xiangya School of Medicine from January 2021 to January 2023,and were divided into the control group and the acupuncture group according to whether acupuncture treatment was performed or not;59 cases in the control group were given conventional rehabilitation training methods of treatment,and 62 cases in the acupuncture group were added with acupuncture treatment on the basis of the conventional rehabilitation treatment.The course of treatment was 1 month.The changes in the traditional Chinese medicine(TCM)syndrome scores of the patients in the two groups were observed before and after treatment,as well as the cerebrovascular resistance values,including carotid artery mean blood flow(Qmean),mean velocity(Vmean),cerebrovascular bed characteristic impedance(Zc),and peripheral vascular resistance(R),and the changes in the Stroke Impact Scale(SIS),China Stroke Scale(CSS),and Fugl-Meyer Assessment(FMA)in the patients in the two groups were observed before and after treatment,and the clinical efficacy of the two groups was evaluated.Results(1)The total effective rate was 93.55%(58/62)in the acupuncture group and 79.66%(47/59)in the control group.The efficacy of the acupuncture group was superior to that of the control group,and the difference was statistically significant(P＜0.05).(2)After treatment,all TCM syndrome scores and total scores of patients in the two groups were significantly improved(P＜0.05),and the acupuncture group was significantly superior to the control group in improving TCM syndrome scores,with statistically significant differences(P＜0.05).(3)After treatment,the cerebral circulatory kinetic parameters of the patients in the two groups were significantly improved(P＜0.05),and the acupuncture group was significantly superior to the control group in improving the cerebral circulatory kinetic parameters,with a statistically significant difference(P＜0.05).(4)After treatment,the SIS,CSS,and FMA scores of patients in the two groups were significantly improved(P＜0.05),and the acupuncture group was significantly superior to the control group in improving the SIS,CSS,and FMA scores,and the differences were all statistically significant(P＜0.05).Conclusion The efficacy of acupuncture in the treatment of post-stroke hemiplegia is remarkable,and its efficacy is better than that of simple conventional rehabilitation training.
RÉSUMÉ
BACKGROUND:The abnormal gait of stroke patients seriously affects their propulsive force during walking,which subsequently reduces their walking speed,walking distance,and stability,increases their risk of falls,and seriously affects their quality of life. OBJECTIVE:To review the relevant research on propulsive force deficits in stroke patients with hemiplegia,to summarize the understanding of existing researchers on propulsive force deficits,to analyze the relationship between propulsive force and gait,and finally to explain and compare the latest rehabilitation technologies used to improve propulsive force deficits,providing reference for clinical treatment. METHODS:Relevant literature was retrieved from WanFang,CNKI,PubMed,and Web of Science Core Collection through computer search.The Chinese and English search terms were"propulsive force OR propulsive,stroke OR cerebral infarction OR hemiplegia,walk* OR gait."The search time limit was from 2003 to 2023,and 71 articles were finally included for review and analysis. RESULTS AND CONCLUSION:Training targeting the hip and ankle joints may be more effective for patients'walking function,especially training with the application of flexible exoskeleton robots,but more sufficient evidence is still needed to use propulsion as a prognostic indicator of walking function in stroke patients.Biomechanical variables related to propulsive force include:the hip joint extension angle at terminal stance,ankle joint dorsiflexion torque,and knee joint extension.Damage to the corticospinal tract,cerebellar-cortical pathways,and the reticulospinal tract in hemiplegic patients are associated with reduced propulsive force and gait asymmetry.Propulsive force is crucial for the stability of healthy gait,and a decrease in propulsive force is unfavorable for gait stability.Gait symmetry is correlated with propulsive force,stride length symmetry,trunk displacement,and lower limb swing ability,with propulsive force being a key factor.Propulsive force can serve as a quantitative indicator for assessing the gait of hemiplegic patients,and evaluation of gait using propulsive force is beneficial for the long-term development of walking ability.Main rehabilitation techniques for improving propulsive force include:lower limb exoskeleton robot walking training,treadmill training combined with functional electrical stimulation,adaptive speed treadmill training,biofeedback technology,and whole-body vibration training.Among them,whole-body vibration training and biofeedback technology are more effective.The specific contributions and mechanisms of the hip,knee,and ankle joints in improving propulsive force are still controversial,but it is expected that the contributions of the hip and ankle joints are greater.Focusing on the improvement of propulsive force as a rehabilitation goal may yield more sustainable advancements in walking function.However,several current challenges persist in this field:understanding the neurobiological basis of propulsive force deficits in stroke patients,assessing the long-term efficacy of current rehabilitation techniques for enhancing propulsive force,and determining the most suitable patient populations for the application of major rehabilitation techniques aiming at improving propulsive force.These areas require further exploration by subsequent researchers.
RÉSUMÉ
Objective To investigate the effect of compassion focused therapy on cognitive function and sense of shame in stroke patients with hemiplegia.Methods A total of 100 stroke patients with hemiplegia admitted in our hospital were included as the research objects.The patients were randomly divided into a control group admitted from December 2020 to December 2021 and an observation group admitted from January 2022 to January 2023,with 50 patients per group.The patients in the control group received cognitive behavioural therapy,while those in the observation group received compassion focused therapy as well as cognitive behavioural therapy.The sense of shame,cognitive function,self-criticism and social anxiety in the two groups were observed and compared before and at the end of the intervention.Results The score of the sense of shame in the observation group was significantly lower than that in the control group(P<0.001).The cognitive function score in the observation group was lower than that in the control group at the end of intervention(P<0.05).and the score of the sense of shame scale in the observation group was lower than that in the control group at the end of the intervention(all P<0.05).Conclusion Compassion focused therapy can significantly reduce the self-criticism and sense of shame in the stroke patients with hemiplegia,and promote the recovery of the cognitive function.
RÉSUMÉ
Objective To compare the immediate effects of acupuncture at the true and false acupoints of Yanglingquan on functional connectivity in sensorimotor network(SMN)and dorsal attentional network(DAN)of stroke patients based on functional magnetic resonance imaging(fMRI)technology;To explore the central regulatory mechanism and acupoint specificity of acupuncture in stroke patients with hemiplegia.Methods Totally 20 patients with stroke and hemiplegia were included in the study.fMRI scans of acupuncture at the true and false acupoints of Yanglingquan were performed once every 2 weeks,and motion-related SMN and DAN were extracted by independent component analysis to compare the differences in functional connectivity.Results In SMN,after acupuncture at the Yanglingquan true acupoint,the functional connectivity was enhanced compared with before acupuncture.The enhanced brain areas included the right anterior central gyrus,superior temporal gyrus,inferior frontal gyrus,cuneiform lobe,and anterior cuneiform lobe,as well as the left middle temporal gyrus,occipital gyrus,superior temporal gyrus,parahippocampal gyrus,inferior frontal gyrus,and superior temporal gyrus.After acupuncture at the Yanglingquan false acupoint,the functional connectivity was enhanced compared with before acupuncture.The enhanced brain areas included the right anterior central gyrus,superior frontal gyrus,middle frontal gyrus,and cingulate gyrus,as well as the left medial frontal gyrus,anterior cingulate gyrus,lentiform nucleus,and caudate nucleus.In DAN,after acupuncture at the Yanglingquan true acupoint,the functional connectivity was enhanced compared with before acupuncture.The enhanced brain areas included the right anterior cingulate lobe,superior temporal gyrus,middle temporal gyrus,and occipital gyrus,as well as the left cingulate gyrus,posterior cingulate gyrus,and anterior cingulate lobe.After acupuncture at the Yanglingquan false acupoint,the functional connectivity was enhanced compared with before acupuncture,and the enhanced brain areas included the right anterior cingulate gyrus,left anterior cingulate gyrus,and medial frontal gyrus.Conclusion Acupuncture at Yanglingquan can activate SMN and DAN bilateral related brain regions in patients with hemiplegia,which may promote the recovery of motor function by regulating the initiation and execution of motor activities,and has more acupoint specificity compared with false acupoint.
RÉSUMÉ
Objective:To observe the effect of electroacupuncture(EA)combined with routine language and motor training on limb and language function,depression,and serum brain injury markers in patients with ischemic stroke. Methods:A total of 86 patients with ischemic stroke were selected and divided into an observation group and a control group using the random drawing method,with 43 cases in each group.Both groups received routine stroke treatments.The control group was additionally treated with routine language and motor training,and the observation group was additionally treated with EA treatment on the basis of the intervention of the control group.Changes in the limb function score,language function score,depression score,and brain injury marker protein were compared between the two groups,and the treatment safety of the two groups was evaluated. Results:The Fugl-Meyer assessment scale scores of both groups were higher than those before treatment(P<0.05),and the Fugl-Meyer assessment scale score of limb function of the observation group was higher than that of the control group(P<0.05).The language function score of the observation group was higher than that of the control group after treatment(P<0.05).The Montgomery-Asberg depression rating scale(MADRS)scores of the observation group were lower than those of the control group after treatment(P<0.05).The levels of brain injury markers heart-type fatty acid-binding protein(H-FABP),glial fibrillary acidic protein(GFAP),and annexin a7(ANXA7)of the observation group were lower than those of the control group(P<0.05).The incidence rate of adverse reactions in the two groups was 14.0%and 9.3%,respectively,with no statistically significant difference between the groups(P>0.05). Conclusion:EA combined with language and motor training is effective in the treatment of ischemic stroke.It can promote the recovery of limb motor function and language function,inhibit the occurrence of depression,and reduce the levels of brain injury markers,with good safety.
RÉSUMÉ
ObjectiveTo observe the effect of neural mobilization based on shoulder control training on shoulder pain and upper limb function in stroke patients with hemiplegia. MethodsFrom January, 2020 to November, 2021, 43 patients with hemiplegia after stroke in the Second People's Hospital of Nantong were randomly divided into control group (n = 21) and treatment group (n = 22). The control group received shoulder control training, while the treatment group received neural mobilization in addition. Before and after four weeks of treatment, they were evaluated with the Numeric Rating Scale (NRS) of pain and Fugl-Meyer Assessment-Upper Extremities (FMA-UE). ResultsOne case dropped off in the control group and two cases dropped off in the treatment group. After treatment, the NRS score and FMA-UE score improved in both groups (|t| >7.898, P < 0.001), and they were better in the treatment group than in the control group (|t| >2.337, P < 0.05). ConclusionNeural mobilization based on shoulder control training can significantly alleviate shoulder pain and improve upper limb motor function in stroke patients with hemiplegia.
RÉSUMÉ
Objective To conduct a comparative analysis of the biomechanical characteristics of the lower limbs during stair descent in patients with hemiplegia using different method to provide theoretical references for reducing fall risk during stair descent.Methods Ten healthy subjects and 20 patients with hemiplegia were selected,and their kinematic and dynamic data during stair descent were collected using the Qualisys Motion capture system and the Kistler three-dimensional dynamometer.Their biomechanical characteristics and fall risks were also analyzed.Results Compared with that of healthy subjects and patients that step on the healthy side(SHS),the range of motion(ROM)of the affected side in the lower-limb joints of patients that step on the affected side(SAS)was smaller.SHS reduced the flexion and extension ranges of the healthy side of the knee joint,and the ROM of the affected side in the lower-limb joints of SHS patients was greater than that of SAS patients.The ground reaction force(GRF)curve changes of SAS patients in left and right directions during stair descent were relatively consistent with those of normal subjects.The maximum vertical GRF of the affected side in SAS patients at the moment of landing was 1.05 times the body weight,whereas that of the healthy side was 1.25 times the body weight,which was lower than that of normal subjects(1.5 times the body weight).The maximum vertical GRF of the healthy side in SHS patients at the moment of landing was 1.85 times the body weight,which was higher than that of SAS patients and normal subjects.Conclusions Compared with that of SAS patients,the affected limb side of SHS patients has a greater ROM and vertical GRF at the moment of landing during stair descent,making SHS difficult to master.SAS is most consistent with the biomechanical characteristics during stair descent of patients with hemiplegia.
RÉSUMÉ
Objective To observe the effect of knee isometric training on mild to moderate lower limb muscle spasticity in stroke patients.Methods A total of 130 stroke hemiplegia patients were prospectively included in this study.They were admitted to Xiangcheng People's Hospital of Suzhou City between August 2021 and December 2023 and numbered according to the order of collection.The patients were then randomly assigned to either the control group or the isokinetic group using a random number table.Each group consisted of 65 cases.Both groups underwent conventional rehabilitation training(5 days a week,40 minutes per day),with the isokinetic group receiving additional isokinetic muscle training(5 days a week,20 minutes per day)on top of the conventional rehabilitation training.The treatment period lasted for 6 weeks.The surface electromyographic signals of the rectus femoris muscle on the affected side were analyzed for their root-mean-square(RMS),integral electromyographic(iEMG)values,the modified Ashworth scale(MAS)scores,knee flexors and extensors peak torque and its ratio,the Fugl-Meyer assessment scale-lower extremity(FMA-LE)scores,and the 10 m walk test were used before and after the treatments to compare the surface electromyography of rectus femoris,the degree of muscle spasticity and exercise capacity of the lower extremities of the two groups.Results Prior to treatment,there were no statistically significant differences between the two groups in terms of the RMS of the rectus femoris muscle,iEMG values,MAS scores,peak torque of the flexor and extensor muscles and their ratio,FMA-LE score,and step speed(all P＞0.05).RMS of the rectus femoris muscle,iEMG values,MAS scores,peak torque of the knee flexors and extensors and their ratios,FMA-LE scores,and step speed improved in control group after treatment compared to before treatment([12.3±2.2]μV vs.[15.5± 2.9]μV,[24.8±2.3]μV·s vs.[29.2±3.1]μV·s,[1.34±0.15]points vs.[1.56± 0.25]points,[20.8±3.4]N·m vs.[12.3±2.5]N·m,[34.5±2.3]N·m vs.[26.3±3.6]N·m,0.60±0.16 vs.0.47±0.14,[26.1±2.9]points vs.[21.3±2.4]points,[0.61±0.14]m/s vs.[0.46±0.15]m/s;all P＜0.05).Rectus femoris muscle RMS,iEMG values,MAS scores,peak torque of the flexor and extensor muscles and their ratio,FMA-LE scores and step speed after treatment in the isokinetic group were(10.9±1.8)μV,(22.4±2.1)μV·s,(1.25±0.18)points,(28.7±3.0)N·m,(41.5±2.8)N·m,0.69±0.18,(29.0±2.3)points,(0.69±0.18)m/s,compared with pretreatment(respectively[15.4±2.2]μV,[29.6±3.0]μV·s,[1.58±0.34]points,[12.6± 2.3]N·m,[26.1±3.1]N·m,0.48±0.17,[21.5±2.1]points,[0.48±0.17]m/s)and control group after treatment,the differences were statistically significant(all P＜0.05).Before treatment,the differences in rectus femoris muscle RMS and iEMG values between patients with mild spasticity and patients with moderate spasticity in the isokinetic group and the corresponding patients with mild spasticity and moderate spasticity within the control group were not statistically significant(all P＞0.05).After treatment,the rectus femoris muscle RMS and iEMG values in patients with mild spasticity within the isokinetic group([10.2±1.0]μV and[20.2±2.0]μV·s,respectively)were statistically different from those before treatment([14.1±2.3]μV and[28.1±3.2]μV·s,respectively)and those after treatment in patients with mild spasticity within the control group([11.4±1.7]μV and[23.6±2.5]μV·s respectively;all P＜0.05);the rectus femoris muscle RMS and iEMG values in patients with moderate spasticity within the isokinetic group improved compared with the pre-treatment period([11.8±1.5]μV vs.[16.9±2.6)μV,and[24.9±2.2]μV·s vs.[31.3±3.8]μV·s,respectively;both P＜0.05),and with the control group after treatment(RMS and iEMG values of[13.2±2.5]μV and[26.1± 2.7]μV·s,respectively),the difference in RMS was statistically significant(P＜0.01),and the difference in iEMG values was not statistically significant(P＞0.05).Conclusion Isokinetic muscle training has a positive effect on improving mild-to-moderate muscle spasticity of the lower limb knee extension,and the effect is more significant the lighter the degree of spasticity.
RÉSUMÉ
A Imaginação Motora (IM) é a representação mental de um ato motor sem a execução real do movimento, e ativa as mesmas áreas cerebrais do movimento real, mesmo na presença de paralisia, perda de membro ou visão, podendo ser utilizado no processo de conservação e estimulação de engramas cerebrais no processo de recuperação motora de um membro paralisado. Método: Homem, 34 anos, hemiplegia direita pós Acidente Vascular Cerebral (AVC) isquêmico. Realizou exercícios com profissional de Educação Física, duas vezes/semana, 50 minutos/sessão, durante 19 semanas, além do programa convencional de reabilitação multidisciplinar. A intervenção baseou-se na IM para flexão e extensão do joelho do lado paralisado, seguida da tentativa do mesmo movimento ativo. Resultados: Amplitude de movimento ativa (ADM_A) dos flexores do joelho direito iniciou em 217° com carga mínima do equipamento (5 kg). Em seguida, o profissional solicitava ao paciente que imaginasse que estava realizando o movimento e depois tentasse realizá-lo. Após 19 semanas, a ADM_A foi de 112°. Conclusão: Ganhos em ADM_A de 8,48° para a flexão de joelho do hemicorpo paralisado representa uma diferença mínima clinicamente importante em pacientes pós-AVC. A IM aumenta a demanda cognitiva nas áreas motoras cerebrais, aumentando a plasticidade, resultando em ganhos motores que impactam no prognóstico de capacidade e funcionalidade, justificando seu uso como método de treinamento na recuperação pós-AVC. A IM associada ao treinamento de força na reabilitação contribui para a recuperação de sequelas pós-AVC.
Motor Imagination (MI) is the mental representation of a motor act without the actual execution of the movement. It activates the same brain areas as real movement, even in the presence of paralysis, missing limb or vision, and can be used in the process of conserving and stimulating brain engrams in the process of motor recovery of a paralyzed limb. Method: We report a 34-year-old patient with right hemiplegia due to ischemic stroke. He performed exercises with a Physical Educator professional, twice a week, 50 minutes/session, for 19 weeks, in addition to the conventional multidisciplinary rehabilitation program. The intervention was based on MI for flexion and extension of the knee on the paralyzed side, followed by the attempt of the same active movement. Results: Active range of motion (ROM_A) of the right knee flexors started at 217° with the minimum equipment load (11 lbs). Then, the professional asked the patient to imagine that he was performing the movement and then try to perform it. After 19 weeks, ROM_A was 112° Conclusion: The ROM_A gain of 8.48° for knee flexion of the paralyzed hemibody represents a clinically important minimal difference in post-stroke patients. MI increases the cognitive demand on the brain's motor networks, increasing plasticity, resulting in motor gains that impact the prognosis of capacity and functionality, justifying its use as a training method in post-stroke recovery. MI associated with strength training in rehabilitation contributes to the recovery of post stroke sequelae.
RÉSUMÉ
Abstract Background: Intermittent theta-burst stimulation and repetitive peripheral magnetic stimulation can improve motor function in poststroke patients, but the therapeutic effect of this combination remains unclear. Objective: To determine the effects of central intermittent theta-burst stimulation and repetitive peripheral magnetic stimulation on upper limb function. Methods: Fifty-six subacute stroke patients were randomly assigned to three groups: the CMS (n = 18), peripheral magnetic stimulation (PMS) (n = 19) and CPS (n = 19) groups. The CMS group received intermittent theta-burst stimulation and peripheral false stimulation, while the PMS group received repetitive peripheral magnetic stimulation and central false stimulation once a day for five days a week over four weeks. The CPS group received intermittent theta-burst stimulation and repetitive peripheral magnetic stimulation simultaneously once daily for four weeks. The Fugl-Meyer Assessment, Action Research Arm Test, Modified Barthel Index and Modified Ashworth Scale evaluated outcomes before and after four weeks of treatment. Results: The motor function scores of all groups were significantly increased after treatment compared with before treatment, while the Modified Ashworth Scale score showed no significant change. There was a significant difference in the motor function score of the CPS group compared with that of the CMS and PMS groups, but there was no significant improvement in the Modified Ashworth Scale score. Conclusion: Combining the two treatment methods can improve patients' motor function and daily living abilities but cannot improve muscle tone.
Resumen Antecedentes: La estimulación intermitente de theta-burst y la estimulación magnética periférica repetitiva pueden mejorar la función motora en pacientes postictus, pero el efecto terapéutico de esta combinación sigue sin estar claro. Objetivo: Determinar el efecto de la estimulacion central intermitente theta-burst y la estimulación magnética repetitiva periférica en la función del miembro superior. Métodos: Se asignaron aleatoriamente a tres grupos 56 pacientes con ictus subagudo: CMS (n = 18), estimulación magnética periferica (PMS) (n = 19) y CPS(Cm1) (n = 19). El grupo CMS recibió estimulación intermitente de theta-burst y falsa estimulación periférica, el grupo PMS recibió estimulación magnética periférica repetitiva y falsa estimulación central una vez al día durante cinco días a la semana a lo largo de cuatro semanas. El grupo SPC recibió estimulación intermitente theta-burst y estimulación magnética periférica repetitiva simultáneamente una vez al día durante cuatro semanas. Se utilizaron la Fugl-Meyer Assessment, Action Research Arm Test, Modified Barthel Index and Modified Ashworth Scale para evaluar losresultados antes y después de cuatro semanas de tratamiento. Resultados: Las puntuaciones de la función motora de todos los grupos aumentaron significativamente después del tratamiento en comparación con antes del tratamiento, mientras que la puntuación de la Escala de Ashworth Modificada no mostró cambios significativos. Hubo una diferencia significativa en la puntuación de la función motora del grupo CPS en comparación con la de los grupos CMS y PMS, pero no hubo una mejora significativa en la puntuación de la Escala de Ashworth Modificada. Conclusiones: La combinación de los dos métodos de tratamiento puede mejorar la función motora y las capacidades de la vida diaria de los pacientes, pero no puede mejorar el tono muscular.
RÉSUMÉ
The brain is a system with multidimensional organization and architecture and requires a continuous supply of blood in order to normally function. If blood flow is interrupted for more than a few seconds, the brain is deprived of blood and oxygen, causing death in nerve cells in the affected area. Stroke in children after birth appears even more rarely than in adults. For the study, 10 children with hemiplegic cerebral palsy (7 boys and 3 girls) participated (mean age 10, 9 years), from the “General Hospital Hippocratio” of Thessaloniki, according to the inclusion criteria. The strength of the upper extremity was measured using the Jamar dynamometer and for the assessment of the balance the pediatric balance scale (PBS) affected and contralateral hands, results were analyzed and compared with norms for age and sex and related to the affected balance. It was found that the strength of the non-affected upper extremities was also reduced according to the data of the normal children and the balance was also affected because of the stroke. Physiotherapy programs may include exercises that give emphasis on the non-affected upper extremities, more similar research must be done on a bigger population.
RÉSUMÉ
Background: Cerebral palsy (CP) is a diagnostic term used to describe a group of motor syndromes resulting from disorders of early brain development. CP remains unexplained in most cases and is typically diagnosed outside the neonatal period. Visual impairment decreases the quality of life and hearing impairment hampers linguistic development. This study aimed to observe the visual and hearing impairment of children with cerebral palsy associated with developmental disabilities. Material & Methods: This is a cross-sectional observational descriptive study carried out in the department of Paediatric Neurology CMH Dhaka from March 2018 to February 2022. The participants (N=120) were from birth to 12 years of age. Detailed information was obtained in each case according to protocol. The pediatric neurologist based on the study definition crosschecked the diagnosis. The hearing assessment was done with the help of an Otolaryngologist in the department of Otolaryngology and the ophthalmological evaluation was done with the help of an ophthalmologist of the department of ophthalmology of CMH Dhaka. Hearing impairment, Ophthalmological motor disturbance, and developmental disabilities were correlated. A convenience sampling technique was used in this study. Relevant data were collected from hospital records. All the information was recorded in the fixed protocol. Collected data were classified, edited, coded, and entered into the computer for statistical analysis by using SPSS 2021. Results: In this study, among the 120 children with CP, the mean age of the study was 5.57(SD±3.89) age range of 2-12 years Males were 82(68%) and females were 38(32%), male-female ratio (sex M: F 2.15: 1). Spastic quadriplegia constitutes the predominant group 59(49%), followed by Spastic diplegia 21(18%), Spastic hemiplegia 20(17.5%), dyskinetic CP 09(8%), 7(6%) were mixed CP and 4(3%) were hypotonic CP. Hearing impairment was found in 87 (72%) cases and visual impairment was detected in 92(76%). Among them, the child with Spastic Quadriplegic (83%) and diplegic CP (62%) children had a hearing impairment. Regarding vision, no fix and follow were observed in 69(57%) cases. Among the studied CP child (n=120) 16 children (13.33%) had normal eye finding and 104 (86%) had abnormal eye findings. Refractive error (32.5%) and Squint (19%) were the most common ocular defect among studied patients. Other ocular defect were nystagmus(10%), optic atrophy(12.5%), microphthalmia(10%), corneal opacity(3%), optic hypoplasia(4.1%), cataract(2.5%), pigmentary retinopathy(5%), retro-lental fibroplasias(3.3%) and ptosis(2.5%). In children with hypotonic (athetoid) and mixed CP, almost all (11 of 11) children had visual impairment. Spastic quadriplegic CP children (80%) and Spastic diplegic CP children (90%) had one or more domains of visual impairment. Conclusion: Cerebral Palsy is a non-progressive various form of neurological disorder in children. Early visual screening and hearing assessment can help CP children to minimize mental retardation, learning difficulties, and speech delay.
RÉSUMÉ
The last few years, the main purpose of the treatment of the hemiplegic patient, is to regain his ability to execute functional activities of daily living independently. According to the latest studies, the effectiveness as well as the importance of task-oriented approach (TOA), is apparent and determining to reacquire the patient’s lost independency, through the practice of the specified functional activities. The aim of this study is to investigate a program of TOA on gait of hemiplegic patients. A sample of 5 post stroke patients was selected from according to the inclusion criteria. A TOA intervention was executed through the practice of 10 functional activities, related to gait, from Monday to Friday for 4 weeks. At the end of each week, gait and balance assessments were performed through the 10-meter walk test (10 MWT), the Berg balance scale (BBS), and the timed up and go test (TUG). The analysis indicates that TOA is extremely effective for stroke patients with mediocre and minor gait and balance deficits, as the difference was statistically significant (p<0.05). The statistically significant difference was from the first assessment T1 to the final assessment T5 and was proven through BBS, TUG and 10 MWT. In conclusion, TOA is a quite beneficial and a cost-effective intervention for the rehabilitation of gait and balance for stroke patients, while consequently improving the quality of their everyday life, independently from their original functional status.
RÉSUMÉ
ObjectiveTo observe the effect of transcranial direct current stimulation (tDCS) on motor function of upper limbs of stroke patients with hemiplegia. MethodsFrom October, 2020 to October, 2021, 65 patients from Wuhan No.1 Hospital were randomly divided into control group (n = 32) and observation group (n = 33). All the patients received routine rehabilitation and mirror therapy, and the observation group received tDCS in addition, for four weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Action Research Arm Test (ARAT) and modified Barthel index (MBI) before and after treatment. ResultsThe scores of FMA-UE, ARAT and MBI improved in the both groups after treatment (|t| > 10.455, Z = -2.793, P < 0.001), and all the scores were better in the observation group than in the control group (|t| > 4.152, Z = -2.045, P < 0.05). ConclusionThe combination of tDCS can effectively promote the recovery of upper limb motor function of stroke patients.
RÉSUMÉ
ObjectiveTo investigate and analyze the knowledge, attitude and behavior of oral health for hemiplegic patients. MethodsFrom August 15 to September 15, 2019, patients with hemiplegia caused by central nervous system damages such as stroke and traumatic brain injury in Beijing Bo'ai Hospital were investigated their demographic information, oral health behavior, oral health knowledge, oral health attitude and utilization of oral health services through paper questionnaires. ResultsA total of 200 questionnaires were sent out and 184 valid questionnaires were collected. There were 103 patients with good brushing habits, and the highest proportion was in independent walkers (χ2 = 6.564，P = 0.038). The average score of oral health knowledge was 5.3, and the average accuracy of oral health knowledge was 75.7%. The average score of oral health attitude was 3.3, and the average positive attitude was 81.8%. Both the knowledge and attuite scores were not significant in different characteristics (Z < 5.299, P > 0.05). There were 59 patients visiting institute of stomatology in past twelve months, and there was no significant difference among genders and travel modes (χ2 < 4.707, P > 0.05). ConclusionThe brushing habits is well in independent walkers. The oral health knowledge and attitude of hemiplegia patients need to be improved, and the utilization of oral health services is low.
RÉSUMÉ
ObjectiveTo explore the correlation among knee hyperextension angle, lower limb joints kinematics parameters and the activation of main muscles of lower limb in stroke hemiplegic patients with knee hyperextension during walking. MethodsFrom August, 2020 to September, 2021, 24 stroke hemiplegic patients with knee hyperextension and 24 healthy subjects matched with sex, age, height and body mass with knee hyperextension were analyzed with three-dimensional gait analysis system and the wireless surface electromyography acquisition system, to record the range of motion of pelvis, hip, knee and ankle joints in sagittal plane, and the activation of bilateral gluteus maximus, biceps femoris, vastus medialis and gastrocnemius medialis. ResultsAs the maximum of knee hyperextension, range of motion of the joints in sagittal plane and the activation of the muscles were different between the patients and the healthy subjects during the single-support phase of walking (|t| > 3.080, P < 0.01), and the maximum of knee hyperextension correlated with the activation of gluteus maximus in the patients (r = -0.532, P < 0.01), and the range of motion of ankle plantar flexion in both the patients and the healthy subjects (r > 0.686, P < 0.001). ConclusionThe correction for knee hyperextension gait in stroke hemiplegic patients may not only need to pay attention to knee joint control, but also need further treatment of ankle control and hip muscle function.
RÉSUMÉ
Objective:To revaluate the systematic reviews/meta-analysis of the literature on acupuncture in the treatment of stroke spastic hemiplegia.Methods:CNKI, Wangfang, VIP, CBM, Cochrane Library, PubMed and Embase were searched for systematic reviews/meta-analyses of acupuncture in the treatment of stroke spastic hemiplegia from the establishment of the databases to July 27, 2022. AMSTAR 2 Scale, Prisma statement (2020) and GRADE system were used to evaluate the quality of the collected literature.Results:A total of 5 systematic reviews/meta-analyses were included, all of which were rated as very low by AMSTAR 2. The 5 studies involved a total of 22 outcome measures, and the GRADE rating results were intermediate evidence in 5, low evidence in 8, and very low evidence in 9.Conclusions:Acupuncture therapy has certain therapeutic effects on reducing the degree of limb spasms and improving limb motor function in patients. However, the methodological quality of the included literature is poor, and there is limited high-level evidence to support conclusions. More high-quality experimental research is still needed to provide strong evidence-based medicine evidence.
RÉSUMÉ
Objective:To explore the correlation between the single nucleotide variation of profibrin-1 (PFN1) gene and secondary osteoporosis (OP) after stroke and its influence on bone metabolism indexes.Methods:120 patients with post-stroke hemiplegia who were treated in our hospital from Jan. 2019 to Jun. 2023 were selected as study objects and divided into OP group and non-OP group. Levels of vitamin D[25- (OH) D], tartrate-resistant acid phosphatase (TRAP) , osteocalcin (BGP) , serum type I procollagen amino terminal prolongation brain (P1NP) and type I collagen basal terminal β special sequence (β-CTX) were detected in all patients. Two SNPS (rs6559 and rs78224458) in PFN1 gene were genotyped.Results:There were significant differences in serum 25- (OH) D, TRAP, P1NP and β-CTX levels between OP group and non-OP group ( P<0.05) . The GG, GA and AA genotypes at rs6559 of PFN1 gene were significantly different between OP and non-OP patients ( P<0.05) . The combined model showed that compared with GG genotype carriers, the risk of secondary OP in GA and AA genotype carriers was 3.250 and 5.417 times higher, respectively. The results of the dominant model showed that the risk of secondary OP was 3.792 times higher in patients with mutant genes (GA or AA) than in patients with GG genotype. Recessive model results showed that patients with AA genotype had a 3.810-fold increased risk of secondary OP compared with GG and GA carriers. There was no significant difference in TT, TC, CC genotype distribution, genetic model and allele frequency at rs78224458 of PFN1 gene between OP patients and non-OP patients ( P>0.05) . There were no significant differences in 25- (OH) D, TRAP or BGP among the rs6559 GG, GA and AA genotypes of PFN1 gene ( P>0.05) , while there were significant differences in P1NP andβ-CTX levels among the three groups ( P<0.05) . Conclusion:The rs78224458 variation of PFN1 gene is associated with secondary OP in patients with hemiplegia after stroke, and may affect the bone metabolism indexes of patients.
RÉSUMÉ
Objective:To observe any effect of low-frequency whole body resonant stimulation on the ba-lance and walking ability of hemiplegic stroke survivors.Methods:Sixty-six stroke survivors with hemiplegia were randomly divided into a low-frequency resonance training group, a high-frequency vibration training group and a control group, each of 22. All received routine exercise training at individualized intensities. All three groups underwent five 1-minute cycles of 7Hz, 15Hz or 1Hz stimulation twice a day, five days a week for eight weeks. Before and after the intervention, balance and walking ability were evaluated using the Berg Balance Scale, the timed up and go test and a 10m walking test. Step length, step frequency and step speed were also measured.Results:There were no significant differences among the three groups before the training. Afterward, significant improvement was observed in all of the groups in terms of all of the measurements. The average results of the low-frequency resonance training group were at that point significantly better than the other two groups′ averages, while the high-frequency vibration training group′s results were superior to those of the control group.Conclusion:Resonance training at 7Hz is the most effective in improving the balance and walking ability of stroke survivors with hemiplegia.
RÉSUMÉ
Objective:To observe any effect of using the International Classification of Functioning, Disability and Health (ICF) rehabilitation set in rehabilitating the physical ability of hemiplegic stroke survivors.Methods:Ninety stroke survivors with hemiplegia were selected and randomly divided into an observation group ( n=45) and a control group ( n=45). The observation group was first assessed using the ICF and then given 60 minutes of individualized rehabilitation, 5 or 6 times a week for 4 weeks in addition to a weekly one-hour rehabilitation course. The control group were evaluated and treated traditionally. Before and after the intervention, both groups were evaluated using the Fugl-Meyer exercise assessment (FM) and functional independence assessment (FIM). Results:After the treatment the average upper and lower limb scores as well as the total FM scores had improved significantly. Those of the observation group were then significantly different from the control group′s averages.Conclusion:Basing rehabilitation on the ICF can more effectively improve the physical functioning of hemiplegic stroke survivors.