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Objective:To explore any effect of the single- and dual-task treadmill training on the functioning of children with bilateral spastic cerebral palsy.Methods:Fifty children with bilateral spastic cerebral palsy were randomly divided into a single-task treadmill training group (the control group, n=25) and a dual-task treadmill training group (the observation group, n=25). All of the children also received routine rehabilitation training, and the control and observation groups also conducted single- and dual-task treadmill training in addition to the routine rehabilitation training, respectively. Before and after 2 months of treatment, each child′s gross motor functioning was quantified using sections D (standing) and E (walking, running and jumping) of the Gross Motor Function Measurement-88 (GMFM-88) instrument. Balance was quantified using the Pediatric Balance Scale (PBS) and walking mobility was quantified using a 1 minute walking test (1MWT). Modified and dual task Timed Up and Go (mTUG) tests and dual-task effects (DTE) tests were also administered. Results:There were no significant differences in average test scores between the two groups before the treatment. After the treatment significant improvement was observed in both groups. There was no significant difference between the two groups in terms of average GMFM-88, PBS and 1MWT scores, but significantly greater improvement was observed in the average dual-task mTUG and DTE results of the observation group.Conclusion:Both single- and dual-task treadmill training are effective supplements to routine rehabilitation training for children with bilateral spastic cerebral palsy. Dual-task treadmill training is more effective than the single-task version.
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Objective:To explore the effects of goals-activity-motor enrichment(GAME) therapy on the function of gross and fine motion in infants at high risk of cerebral palsy.Methods:Prospective study.A total of 116 children at high risk of cerebral palsy who met the inclusion criteria and were admitted to the Rehabilitation Department of Qingdao Women and Children′s Hospital from November 2017 to November 2019 were selected in a randomized, single-blind, controlled trial, and randomly divided into control group (58 cases) and observation group (58 cases) according to the random number table method.The two groups were then divided into mild group, moderate group and severe group according to the gross motor quotient(GMQ) of Peabody Motor Development Scale-2 (PDMS-2). During treatment, 4 cases of shedding occurred in the control group and 8 cases in the observation group, respectively.Finally, 54 cases were included in the control group and 50 cases in the observation group.The control group was given regular early intervention rehabilitation, whereas the observation group was given GAME treatment.The Gross Motor Function Measure-88 (GMFM-88), the GMQ of PDMS-2 and the fine motor quotient (FMQ) of PDMS-2 were used to assess the motor function of children before intervention and after 12 weeks of treatment.The Chi- square test or Fisher′ s exact test was used to compare gender-specific data, while the t-test was used to compare age-specific data and rehabilitation evaluation indices. Results:The GMFM-88 scores, GMQ, and FMQ of children in both groups improved significantly after treatment, and the difference was statistically significant [control group GMFM-88: (63.52±10.06) scores vs.(47.02±8.19) scores, t=-19.770, GMQ: 83.02±15.52 vs.73.56±14.72, t=-18.180, FMQ: 81.19±14.88 vs.71.22±13.92, t=-18.413, all P<0.05; observation group GMFM-88: (68.06±10.82) scores vs.(46.16±8.73) scores, t=-32.856, GMQ: 89.98±18.10 vs.72.94±13.84, t=-17.089, FMQ: 88.34±18.08 vs.72.26±13.74, t=-15.370, all P<0.05], and the GMFM-88, GMQ, and FMQ scores of the observation group were significantly higher than those of the control group after treatment, with statistically significant differences(GMFM-88: t=-2.176, GMQ: t=-2.111, FMQ: t=-2.210, all P<0.05). In the observation group, the added value score and quotient of mild group and moderate group were significantly increased compared with that of severe group, and the differences were statistically significant [GMFM-88 added value: the mild group (24.11±3.36) scores and moderate group (22.91±3.46) scores were compared with the severe group (15.70±4.08) scores, t=5.881, 5.164, all P<0.05, GMQ added value: the mild group (19.61±6.83) and moderate group (18.27±6.61) were compared with the severe group (9.80±4.29), t=4.098, 3.915, all P<0.05, the added value of FMQ: mild group (18.72±7.11) and moderate group (17.36±6.10) were compared with severe group (8.50±5.82), t=3.873, 3.863, all P<0.05]. Conclusions:GAME treatment is more effective than early rehabilitation training at improving gross and fine motor function in infants at high risk of cerebral palsy.Its benefits on mild and moderate infants at high risk of cerebral palsy are superior.
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Objective:To investigate the influence of dual-task treadmill training on the motor function of children with spastic hemiplegic cerebral palsy(CP).Methods:A prospective study was carried out on 36 children with spastic hemiplegic CP admitted to the Department of Rehabilitation, Qingdao Women and Children′s Hospital from March 2020 to August 2021.The subjects were divided into the control group (18 cases) and the experimental group (18 cases) by the random number sequence method.During the intervention, 2 cases in the control group dropped out of the study due to cough and fever.Finally, there were 16 cases left in the control group and 18 cases in the experimental group.Both groups received the same routine rehabilitation training.Additionally, the control group were given single-task treadmill training, while the experimental group were treated dual-task treadmill training.Before training and after 4 weeks of training, the children in the two groups were evaluated and compared by using Gross Motor Function Measure-88 (GMFM-88), Pediatric Balance Scale (PBS), Maximum Walking Speed test(MWST), single-task modified Timed Up and Go test (mTUG) and dual-task mTUG.Gender and Gross Motor Function Classification System(GMFCS) classification in general data were compared by using the Chi-square test or Fisher′ s exact test.Age and indices of rehabilitation assessment were compared by using the paired-samples t-test within groups and indepen-dent-samples t-test between the two groups. Results:There was no significant difference in the evaluation data of the GMFM-88 D score [(34.25±1.61) points vs.(34.56±1.76) points], GMFM-88 E score [(50.53±7.20) points vs. (50.61±6.75) points], PBS score [(39.06±4.34) points vs. (38.89±4.44) points], MWST time [(12.69±3.07) s vs. (13.56±2.97) s], single-task mTUG time [(11.38±2.58) s vs. (11.94±2.51) s], and dual-task mTUG time [(30.06±8.08) s vs. (31.50±8.56) s]between the control group and the experimental group before training (all P>0.05). After 4 weeks of training, the GMFM-88 score of the control group was (35.88±1.82) points in the D dimension and (51.20±6.64) points in the E dimension.Besides, the PBS score of the control group was (40.75±4.14) points, the MWST time was (10.81±2.95) s, and the single-task mTUG time was (10.06±2.52) s. As for the experimental group, the GMFM-88 score was (36.28±1.99) points in the D dimension and (53.94±6.98) points in the E dimension, the PBS score was (43.06±4.94) points, the MWST time was (10.44±2.83) s, and the single-task mTUG time was (10.56±2.73) s. The evaluation indexes of the two groups after training for 4 weeks were significantly better than those before training ( t=-3.058, -2.197, -7.132, 1.235, 2.952 in the control group, and t=-5.953, -12.432, -8.333, 3.149, 7.578 in the experimental group, all P<0.05). There was no significant difference in GMFM-88 scores in D and E dimensions, PBS scores, MWST time and single-task mTUG time between the two groups ( P>0.05). The dual-task mTUG time of the control group was (29.10±8.28) s after 4 weeks of training, which was not statistically different from that before training ( t=1.578, P>0.05). The dual-task mTUG time of the experimental group was (23.06±7.30) s after 4 weeks of training, which was significantly better than that before training ( t=13.930, P<0.05) and that of the control group ( t=2.296, P<0.05). Conclusions:Both single-task and dual-task treadmill training can remarkably improve the motor function of children with spastic hemiplegic CP.Single-task training cannot improve the motor function of children with spastic hemiplegic CP in the dual-task condition, while dual-task training can effectively improve the motor function with spastic hemiplegic CP in the dual-task condition.
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Objective:To explore the effect of goals-activity-motor enrichment (GAME) intervention on the motor function of infants with a mild or moderate developmental disorder.Methods:Randomized, single-blind, controlled trials were applied. Totally 108 infants with mild-to-moderate developmental delay, aged 0 to 12 months, were randomly divided into an observation group and a control group, each of 54. Both groups were further divided into two subgroups, a less-than-6-month-old subgroup and a not-less-than-6-month-old subgroup. All of the children received 30 minutes of routine rehabilitation training five days a week and a 60-minute family intervention every day. In addition, the control group was given traditional neuro-developmental treatment (NDT) while the observation group was provided with an intervention based on the GAME program. Before and after 8 weeks of treatment, both groups were evaluated using the Alberta infant motor scale (AMIS).Results:After the intervention, both groups′ average total scores and average scores in the different positions were significantly better than before the intervention. The average AIMS scores of the observation group supine, prone and seated, as well as their average total score were significantly higher than those of the control group after the intervention. There were no significant differences in the AIMS score increases in the different positions between the two subgroups. However, the increase in average total AIMS score of the less-than-6-month-old subgroup was significantly greater than that of the older subgroup.Conclusion:The GAME protocol can improve the motor function of infants with mild to moderate developmental disorders more effectively than a traditional NDT program. The effect is greater with younger infants.
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@#The enriched environment is an artificial environment for animal models of rodentia. In the enriched environment, model animals may improve synaptic plasticity, inhibit apoptisis and regulate autophage after hypoxic-ischemic brain damage, that promote the recovery.
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Objective To explore the effects of environmental enrichment (EE) on learning and memory ability and the expression of brain-derived neurotrophic factor (BDNF) and synaptophysin in hippocampus of neonatal rats with hypoxic-ischemic brain damage(HIBD).Methods Forty Wistar neonatal male rats aged 7 days were randomly divided into EE intervention for 6 hours(6 h EE) group (n =10),EE intervention for 12 hours (12 h EE) group (n =10),model group (n =10) and sham group (n =10).The first 3 groups were performed with HIBD.The 6 h EE and 12 h EE group received EE stimuli for 6 h and 12 h respectively,once a day for 14 days.Learning and memory of the rats were tested by using Morris water maze.The expression levels of BDNF and synaptophysin in hippocampus were determined with Western blot.Results The escape latency of all groups gradually reduced with the increase of training days,but there was no significant difference in the escape latency among the 4 groups (F =0.237,P ＞ 0.05).The rats in the 6 h EE group,12 h EE group and model group spent less time in the target quadrant and showed a significant reduction of BDNF and synaptophysin(6 h EE group:0.529 ± 0.038,0.889 ± 0.027;12 h EE group:0.660 ± 0.034,1.114 ± 0.037;model group:0.225 ± 0.015,0.672 ± 0.057) in the hippocampus compared with the sham group (0.803 ± 0.026,1.347 ± 0.092) (all P ＜ 0.01).In the 6 h EE group and 12 h EE group,the rats significantly increased the time spent in target quadrant and aggrandized the expression of BDNF and synaptophysin in hippocampus compared with the model group.Moreover,the 12 h EE group had a better performance than the 6 h EE group in the space exploration and the expression of BDNF and synaptophysin.Conclusion EE is helpful for improving learning and memory ability in neonatal rats with HIBD,which may be associated with up-regulating the expression of BDNF and synaptophysin in hippocampus.
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Objective To observe the effects of early exercise on the expression of synaptophysin pro-tein and Nissl bodies in the hippocampus after hypoxic-ischemic brain damage( HIBD) , and to investigate possi-ble mechanisms. Methods A total of 35 neonatal Wistar rats aged 7 days were randomly divided into a train-ing group of 13, a control group of 11 and a sham-operation group of 11. HIBD was induced in the rats of the training and control groups, while those in the sham-operation group had the left common carotid artery separa-ted, but without ligation. Seven days after successful modeling, the training group began swimming training for 10 min every day lasting for 14 days, while the other groups were not trained. Western blotting was used to detect the expression of synaptophysin in the affected hippocampus of the brain based on the ratio of the gray band val-ues for synaptophysin and beta. Nissl staining was applied to observe the number of Nissl bodies and the morphol-ogy of the neurons in the hippocampus. Results The average expression of synaptophysin in the sinistrocere-bral hippocampus of the rats in the control group was significantly lower than that in the sham-operation group, but significantly higher than that of the training group. The control group had significantly fewer Nissl bodies than the sham-operation group, but significantly more than the training group. Conclusion Early training can in-crease the expression of synaptophysin and the number of Nissl body in the hippocampus after hypoxic-ischemic brain damage.
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Objective To explore the effect of the exogenous phosphorylation cyclic adenosine monophosphate response element bind-ing protein (pCREB) antibody on the expression of apoptotic regulated genes (Bcl-2 and c-Jun) in hippocampus after status convulsivus (SC), to elucidate the role and regulation mechanism of pCREB in convulsive brain injury. Methods Seizures were induced in 24 adult Wi-star rats with lithium-pilocarpine intraperitoneal injection (SC group), another 24 rats were as the normal controls (NC group). Each group was divided into no injection subgroup, normal saline injection subgroup and anti pCREB subgroup according to the injection contents of lat-eral ventricle, with 8 cases in each group. They were sacrificed 6 hours after injection. Both the protein and mRNA expression of Bcl-2 and c-Jun in bilateral hippocampus were detected by immunohistochemistry and in situ hybridization, respectively. Results There was no signifi-cant difference in Bcl-2 protein/mRNA expression among 3 subgroups in the NC group (P>0.05). In the SC group, the expression of Bcl-2 protein/mRNA were lower in the anti pCREB subgroup than in the no injection subgroup and normal saline injection subgroup (P<0.05). There was significant difference in c-Jun protein/mRNA expression among 3 subgroups in both NC group and SC group (P<0.001). The ex-pression of c-Jun protein/mRNA was higher in the normal saline injection subgroup and the anti pCREB subgroup than in the no injection group (P<0.05), especially in the anti pCREB subgroup (P<0.05). Conclusion Exogenous anti-pCREB antibody can down-regulate the ex-pression of Bcl-2 and up-regulate the expression of c-Jun in hippocampal cells after SC.
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Objective To investigate the clinical characteristics of speech disorders in children with cerebral palsy (CP) and any relationship between those characteristics and cranial magnetic resonance images.Methods A sample of 138 children with CP were given the ＜ s-s ＞ language development test,a Chinese-language articulation test and oral motor scores to quantify their functional speech and articulation.The characteristics of their speech disorders,articulation and oral motor dysfunction were then related with abnormalities in their cranial magnetic resonance images (MRIs).Results Of the 138 MRIs,only 9 were normal.Three showed non-specific abnormalities (delayed myelination and/or broadening of the space outside the brain) and 122 (91％) showed specific abnormalities.Among the children with specific abnormalities,51.6％ had speech reception delay and 74.6％ had speech expression delays.The dysarthria rate was 71.3％,including 8.7％ with no speech ability at all.The main MRI abnormalities were lesions of the basal ganglia (23％),lesions of the cerebellum (11.5％),periventricular leukomalacia (PVL) (47.5％),extensive cortical or subcortical lesions (6.6％) and focal cerebral injury (11.5 ％).The corresponding oral motor scores increased successively.The children with lesions of the basal ganglia or cerebellum were most likely to manifest speech expression delay and dysarthria.The children with cortical or subcortical lesions or PVL also showed speech expression delay and dysarthria.However,the children who had a focal cerebral injury generally performed well on the speech ability assessment.Twelve children had no speaking ability at all,and in 7 of them the lesions were of the basal ganglia.Conclusions The probability and severity of speech disorders in children with cerebral palsy relate with specific abnormalities detectable with cranial MRI.Those with lesions of the basal ganglia or cerebellum will be more likely to show more severe speech disorders.
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@#ObjectiveTo explore the influences of age and duration of status convulsivus （SC） on mitochondrial membrane potential (△Ψm） in hippocampus. MethodsConvulsive seizures for 30 min or 3 h (30 min SC or 3 h SC) were induced in 80 infant (20 d after birth) and 80 adult Wistar rats (IRs ＆ ARs respectively) with lithium-pilocarpine ip. The rats were sacrificed at 6 different time points from the 3rd hour to 7th day after SC termination. The mitochondrial △Ψm in hippocampal cells was determined with flow cytometry. ResultsThe mitochondrial △Ψm in hippocampal cells started to decrease at the 3th hour after SC in both IRs and ARs. The bottom level was reached at the 6th hour after SC ［(6.08±0.43) in IRs and (5.70±0.63) in ARs ) ］. Both of them were significantly lower than that of control group (P<0.01） and began to increase at 12th hour after SC. On the 7th day after 30 minutes SC, the level of mitochondrial △Ψm in IRs increased to the level of control, while the level in ARs was still lower than that of control (P<0.05）. At the 3rd hour, the 3rd and the 7th day after SC, the levels of mitochondrial △Ψm in IRs were obviously higher than those in ARs. Compared with the same time point after 30 min SC, the levels of mitochondrial △Ψm at the 3rd and the 6th hour after 3 h SC were much lower in different age groups (P<0.05）. Except the effect of the age-related difference, there was a positive correlation between the duration of SC and the changes of mitochondrial △Ψm in partial correlation analysis （r=0.71，P<0.05）. ConclusionSevere seizure could induce the mitochondrial △Ψm decreased in hippocampus. Age and duration of SC were important factors associated with the mitochondrial △Ψm decrease. There may be an internal protective response against brain damage in premature brain.