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Occupational therapy, as one of the important subdisciplines of rehabilitation therapy, takes occupational activities as the medium or purpose of treatment and life participation as the goal of treatment to meet the growing demand for rehabilitation. According to the Minimum Standards for the Education of Occupational Therapists developed by the World Federation of Occupational Therapists, many countries and regions have formulated educational standards that meet their own national or regional characteristics. Comparatively, the number of occupational therapists is seriously insufficient, the talents cultivation is relatively lagging behind, and the education level is uneven in mainland China; while in Hongkong and Taiwan, occupational therapy has an independent education system and a relatively mature talent training model. This study summarized the practical experience and reviewed the relevant literature. Based on the summary and review, we made a comparative analysis of postgraduate education in mainland China and Taiwan from the aspects of educational system and accreditation, enrollment objects, curriculum setting and teaching methods, which would provide a reference for the improvement of occupational therapy personnel training system in mainland China.
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Undergraduate education started late in rehabilitation medicine in mainland China.At present,there are some shortcomings in current undergraduate education for rehabilitation medicine in mainland China,mainly due to the shortage of teachers,the poor pertinence of professional subjects,the broad and superficial knowledge,and the lack of close connection with the necessary professional knowledge of rehabilitation technologies.The Department of Rehabilitation in Taiwan starts its undergraduate education earlier.The curriculum has been sub-professionally oriented.Its subjects are highly targeted and detailed in content.At the same time,it emphasizes forward-looking education such as "statistics".In view of this,the mainland colleges and universities should standardize the undergraduate education of rehabilitation therapies,strengthen the training of professional teachers,pay attention to the cross-mutualism of theory and practice in the teaching plan,enrich the number of professional courses,the appropriate introduction of teaching methods of scientific research,standardize the teaching management system.
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Objective To explore the effectiveness of a myoelectricity-driven hand robot on the recovery of hand motor function early after a stroke.Methods Thirty stroke survivors were randomly assigned to either a control group (n=15) or an experimental group (n =15).Both groups received routine rehabilitation exercises,while the experimental group additionally received hand training using a robotic hand exoskeleton.Before and after 4 weeks of treatment,the motor function of the wrist and fingers in both groups were measured using the Fugl-Meyer assessment.Spasticity in the index,middle,ring and little fingers was quantified using the modified Ashworth scale.The muscle force of the fourth finger,thumb and all of the fingers during maximum voluntary extension and flexion were recorded using the robot's surface electromyography system.Results Significant increases in the average Fugl-Meyer scores in both groups were observed after 4 weeks of treatment,but the experimental group's average score was by then significantly higher than that of the control group.The experimental group's average Ashworth score and the average sEMG amplitudes were also significantly better than those of the control group.Conclusion Supplementing routine rehabilitation exercises with a hand robot can improve hand motor function and muscle force significantly,as well as relieving hand spasticity early after a stroke.
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Objective To observe the effect of virtual reality robotic hand on hand motor function and activities of daily living of pa-tients after stroke. Methods From June, 2015 to June, 2016, 32 patients with hand motor dysfunction were assigned into experimental group (n=16) and control group (n=16). The experimental group received training with virtual reality robotic hand and hand based rehabilitation, while the control group received hand based rehabilitation only, for four weeks. They were evaluated with Fugl-Meyer Assessment (FMA) of fingers and wrists and modified Barthel index (MBI) before and after treatment. Results The total score and the scores of items of FMA and MBI improved after treatment in the experimental group (Z>3.45 or t>3.45, P2.07 or t>4.18, P2.14 or t>3.20, P<0.05). Conclusion Virtual reality robotic hand training can promote the recovery of hand function and activities of daily living in patients af-ter stroke.
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Objective To study the effects of the rehabilitation robot-assisted task-oriented training on the hand function in patients after stroke. Methods From June, 2015 to September, 2016, 35 inpatients suffering from stroke were randomly allocated to control group (n=17) and trial group (n=18). Based on the routine rehabilitation, the trial group accepted robot-assisted task-oriented training, while the control group accepted therapist-assisted task-oriented training, for two weeks. They were measured the active range of motion (AROM) of fingers, assessed with fingers motor of Fugl-Meyer Assessment (FMA) and modified Barthel Index (MBI) invovled with hands before and after train-ing. Results The inpatients dropped three in the control group, two in the trial group. AROM of extension and flexion of all the fingers, the AROM of extension and total of three fingers of thumb, index and middle, and the total AROM of each finger improved in the trial group af-ter training (t>2.937, P2.528, P2.535, P2.000, P2.000, P0.05). The scores of feeding, dressing, toilet transfers, bathing, groom-ing of MBI and the total score of them improved in the trial group after training (Z>2.041, P0.05). Conclusion The rehabilitation robot-assisted task-oriented training can improve AROM of hemiplegic fingers and grip function.
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Objective To investigate the features of native Hakka speakers' ability to identify Cantonese tones.Methods Twenty native Cantonese speakers and 12 native Hakka speakers were given the Hongkong Cantonese tone identification test.Results Neither group was troubled by similar vowel and consonant sounds.The Cantonese group could identify all tones well except distinguishing tones 5 and 2 (89％) and tones 4 and 6 (89％).The Hakkas had the most difficulty distinguishing tones 3 and 6 (70.0％),but significant differences were observed between the two groups in the identification of tones 2 and 5 and 2 and 4.Conclusion A native Hakka speaker's ability to identify Cantonese tones may be closely related to the tone's pitch,tonal patterns as well as the Hakka tone system.
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Objective To observe the effect of high frequency repetitive transcranial magnetic stimulation ( rTMS) on executive function in patients after stroke .Methods Thirty-six stroke patients with executive dysfunction in the Second Affiliated Hospital of Guangzhou Medical University from March 2016 to April 2017 were randomly divided into experimental group ( n=18 ) and control group ( n=18 ) .The experimental group received 10 Hz rTMS of the left dorsolateral prefrontal cortex ( DLPFC ) and cognitive functional training , while the control group received sham rTMS and cognitive functional training , for four weeks.Mini-Mental State Examination(MMSE), Wisconsin Card Classification Test(WCST), Digit Symbol Test( DST) and Digital Span ( DS) were used for cognitive assessment at baseline and therapy completed . Results After a four weeks therapy , the total number of responses showed no significant difference in WCST between two groups.But the control group after treatment showed that MMSE score (17.44 ±4.73) and DST score (4.50 (2.75, 8.25)) were improved compared with that before treatment (MMSE score 15.28 ±4.61, t=-8.371, P=0.000;DST score 4.00 (2.75, 7.25), Z=-2.122, P=0.049), and the DS score and the numbers of correction , classification and continuous errors of WCST showed no significant difference compared with that before treatment .The experimental group after treatment showed that MMSE score (20.67 ±4.59), DST score (7.50(4.75, 12.50)), DS score (recite in order 7.00 (7.00, 8.00), recite in reverse order 3.00 (2.00, 4.00)), the numbers of correction of WCST (24.61 ± 8.30), the numbers of continuous errors (12.17 ±5.08), the numbers of classification (2.00 (2.00, 3.00) were improved compared with that before treatment ( MMSE score 15.50 ±5.24, t=-21.013, P=0.000;DST score 3.00(1.00, 7.00), Z=-3.757, P=0.000; DS score recited in order 6.00(5.00, 6.00), Z=-3.703, P=0.000;DS score recited in reverse order 2.00(1.00, 3.00), Z=-3.494, P=0.000;The numbers of correction of WCST (16.50 ±9.34), t=-6.544, P=0.000); The numbers of continuous errors (18.06 ±5.63, t=9.744, P=0.000); The numbers of classification (1.00 (1.00, 2.00), Z=-3.900, P=0.000 ).And the curative effect was better than that of control group . Conclusion High frequency rTMS combined with cognitive function training can improve the executive dysfunction of stroke patients , and the improvement is better than cognitive functional training alone .
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Objective To observe the effect of high frequency repetitive transcranial magnetic stimulation ( rTMS) on executive function in patients after stroke .Methods Thirty-six stroke patients with executive dysfunction in the Second Affiliated Hospital of Guangzhou Medical University from March 2016 to April 2017 were randomly divided into experimental group ( n=18 ) and control group ( n=18 ) .The experimental group received 10 Hz rTMS of the left dorsolateral prefrontal cortex ( DLPFC ) and cognitive functional training , while the control group received sham rTMS and cognitive functional training , for four weeks.Mini-Mental State Examination(MMSE), Wisconsin Card Classification Test(WCST), Digit Symbol Test( DST) and Digital Span ( DS) were used for cognitive assessment at baseline and therapy completed . Results After a four weeks therapy , the total number of responses showed no significant difference in WCST between two groups.But the control group after treatment showed that MMSE score (17.44 ±4.73) and DST score (4.50 (2.75, 8.25)) were improved compared with that before treatment (MMSE score 15.28 ±4.61, t=-8.371, P=0.000;DST score 4.00 (2.75, 7.25), Z=-2.122, P=0.049), and the DS score and the numbers of correction , classification and continuous errors of WCST showed no significant difference compared with that before treatment .The experimental group after treatment showed that MMSE score (20.67 ±4.59), DST score (7.50(4.75, 12.50)), DS score (recite in order 7.00 (7.00, 8.00), recite in reverse order 3.00 (2.00, 4.00)), the numbers of correction of WCST (24.61 ± 8.30), the numbers of continuous errors (12.17 ±5.08), the numbers of classification (2.00 (2.00, 3.00) were improved compared with that before treatment ( MMSE score 15.50 ±5.24, t=-21.013, P=0.000;DST score 3.00(1.00, 7.00), Z=-3.757, P=0.000; DS score recited in order 6.00(5.00, 6.00), Z=-3.703, P=0.000;DS score recited in reverse order 2.00(1.00, 3.00), Z=-3.494, P=0.000;The numbers of correction of WCST (16.50 ±9.34), t=-6.544, P=0.000); The numbers of continuous errors (18.06 ±5.63, t=9.744, P=0.000); The numbers of classification (1.00 (1.00, 2.00), Z=-3.900, P=0.000 ).And the curative effect was better than that of control group . Conclusion High frequency rTMS combined with cognitive function training can improve the executive dysfunction of stroke patients , and the improvement is better than cognitive functional training alone .
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Executive impairment is one of the common sequelae of stroke, which seriously affects the quality of life of patients. Repeti-tive transcranial magnetic stimulation (rTMS), as a new type of electrophysiological technique, has been used in the clinical treatment of Post-Stroke Executive Impairment (PSEI). This paper summarized the survey of PSEI, the basic principle and mechanism of rTMS, clinical application of rTMS for PSEI and its safety. Clinical studies showed that high frequency stimulation, low frequency stimulation, and combi-nation with other therapeutic methods were effective in PSEI. However, there was no unified theory about the mechanism and the best treat-ment plan of rTMS for PSEI.
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@#Objective To observe the effect of resistance breathing training on breast cancer related lymphedema. Methods Sixty breast cancer patients with lymphedema after operation from October, 2013 to April, 2015 were randomly divided into control group (n=30) and experiment group (n=30). The control group received routine rehabilitation and manual lymphatic drainage, while the experiment group received resistance breathing training in addition, for four weeks. Their flow of lymph was measured with emission computer tomography (ECT), and their upper arm circumferences were measured, their upper limb volumes were measured with water displacement before and after treatment. Results The flow of lymph increased in both groups after treatment (t>3.446, P<0.05), while the difference of bilateral upper arm circumferences (t>2.143, P<0.05) and upper limb volumes (t>1.562, P<0.05) reduced, and all the indices improved more in the experiment group than in the control group (t>1.982, P<0.05). Conclusion Resistance breathing training may increase the back flow of lymph, to relieve the lymphedema of injured extremity.
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@#Functional magnetic resonance imaging (fMRI), a newly developing technique, contains function, anatomy and image, which makes the real-time, dynamic and non-invasive measurement of the functional brain imaging availability. This paper summarized the characteristics of fMRI in health and stroke populations, introduced the advances of fMRI in neuroplasticity, rehabilitation assessment and prognosis in hand movement dysfunction in patients with stroke, and discussed the difficulty fMRI faced in rehabilitation assessment and the further researches.
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BACKGROUND:Our previous studies confirmed that NGF-PEG-PLGA-NPs has good sustained release effect and biological activity in vitro, and can induce the differentiation of PC12 cel s into neuron-like cel s. OBJECTIVE:To investigate the feasibility of neuronal differentiation of neural stem cel s from septal area of fetal brain induced by NGF-PEG-PLGA-NPs and its influence on PI3K/Akt signaling pathway. METHODS:According to optimization prescription, NGF-PEG-PLGA-NPs were prepared by multiple emulsion solvent diffusion method. Neural stem cel s were induced to neuronal differentiation in six groups, including control group, NGF group, NGF-PEG-PLGA-NPs group, LY294002 group, LY294002+NGF group and LY294002+NGF-PEG-PLGA-NPs group. Neurons were identified by immunofluorescence, while phosphorylation levels of Akt in PI3K/Akt signaling pathway were detected by western blotting. RESULTS AND CONCLUSION:The proportions ofβ-Tubulin III-positive neurons in control group, NGF group, NGF-PEG-PLGA-NPs group, LY294002 group, LY294002+NGF group and LY294002+NGF-PEG-PLGA-NPs group were (22.80±2.58)%, (35.80±3.98)%, (35.40±5.77)%, (26.60±3.87)%, (21.20±2.59)%and (25.80±7.22)%, respectively. There were no statistical differences in neuronal differentiation between NGF group and NGF-PEG-PLGA-NPs group (P>0.05), but the ratios of neural differentiation in the two groups were both higher than that in the other four groups (P0.05), but the phosphorylation levels of Akt were both higher than other four groups (P0.05), but the phosphorylation levels of Akt were higher than LY294002 group (P<0.05). Results suggest that NGF-PEG-PLGA-NPs promoted neural differentiation of neural stem cel s. The role might be related to increasing phosphorylation levels of Akt in PI3K/Akt signaling pathway.
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Patients often suffered limb dysfunction after stroke. Upper limb and hand function recovered more slowly than lower limb, and became one of the research focuses in rehabilitation medicine. Timely and effective assessments were important to guide the rehabilita-tion treatment, evaluate the treatment efficacy and predict functional recovery of upper extremity and hand function. The assessment meth-ods of upper limb and hand motor function included subjective evaluations and objective evaluations. The former included different kinds of scales, which involved assessment focusing on muscle, motor pattern, change of upper limb and hand function. While the latter contained biomechanics, neuroelectrophysiology, functional magnetic resonance imaging, upper limb robotic evaluation system and so on. Scales were proved to have good reliability and validity. But they could not show patients' function accurately because of the subjectivity, and the data could not be kept. Evaluation system with computer was applied in clinical practice more and more widely. In this review, we summarized the assessments on upper limb and hand motor function in patients after stroke.
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Objective To investigate the effect of alternating cooling and heating whirlpool bath on patients with shoulder-hand syn-drome in stage I after stroke. Methods 60 patients with shoulder-hand syndrome in stage I after stroke were randomly divided into control group (n=30) and observation group (n=30). The control group received comprehensive rehabilitation training including exercise therapy, concentric winding, joint mobilization and ideation training, 30 minutes every time, twice a day, 5 days a week for 4 weeks. The observation group received alternating cooling (12~15℃) and heating (37~43℃) whirlpool bath treatment 20 minutes every time in addition, twice a day, 5 days a week for 4 weeks. Visual Analogue Scale (VAS), hand drainage volume, modified Ashworth Scale (MAS), Fugl-Meyer Assess-ment (FMA) and Barthel Index (BI) were used to assess the upper limb pain, the degree of edema, muscle tension, motor function and activi-ties of daily living. Results Before treatment, there was no significant difference in the scores of VAS, MAS, FMA and BI, and the hand drainage volume between 2 groups (P>0.05). 4 weeks after treatment, all the indexes improved in both groups (P<0.05), and were better in the observation group than in the control group (P<0.01). Conclusion The effect of alternating cooling and heating whirlpool bath may fur-ther improve the symptoms of shoulder-hand syndrome in stage I after stroke.
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Objective To investigate the changes of surface electromyographic signal during lumbar flexion-extension after sling exer-cise therapy (SET) in patients with chronic nonspecific low back pain (CNLBP). Methods 30 patients with CNLBP received SET, 3 times a week for 4 weeks. The surface electromyographic signals of erector spinae and multifidus of both sides were collected, when they were in erect position, flexion motion, maximum voluntary flexion, and back to erect position, before and after intervention. The average electro-myogram (AEMG) was analyzed, and the flexion-relaxion ratio (FRR) was compared. Results The FRRs of both erector spinae and multifi-dus were lower in the painful side than in the healthy side before intervention (P<0.05). There was no significant difference in the FRRs of both erector spinae and multifidus between 2 sides after intervention. Conclusion SET may improve the active motion function of the erec-tor spinae and multifidus of the painful side and recovery of flexion-relaxation phenomenon.
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With the rapid progress of rehabilitation in China, how to construct the accreditation system of physical therapy (PT) educa-tion has become a critical consideration. This article introduced the background, role, management and process about the accreditation sys-tem of PT education in United States in order to promote the development of PT education in China.
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Objective To investigate the effect of rehabilitation professional training. Methods Based on the 10 tertiary hospitals in Guangzhou, Guangdong, the professionals from communitiy hospitals were trained. The scores of knowledge and practice tests were ana-lyzed in 2 terms of training. Results The students performed better in the practice test (82.01±8.91) than knowledge (71.08±10.05) (P<0.01). The score of knowledge tests was better in the second term than the first (P<0.05), no difference between them in the score of practice test. Conclusion Rehabilitation professional training in Guangzhou can improve the ability of service of medical rehabilitation.
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@#Objective To investigate the changes of surface electromyographic signal during lumbar flexion-extension after sling exercise therapy (SET) in patients with chronic nonspecific low back pain (CNLBP). Methods 30 patients with CNLBP received SET, 3 times a week for 4 weeks. The surface electromyographic signals of erector spinae and multifidus of both sides were collected, when they were in erect position, flexion motion, maximum voluntary flexion, and back to erect position, before and after intervention. The average electromyogram (AEMG) was analyzed, and the flexion-relaxion ratio (FRR) was compared. Results The FRRs of both erector spinae and multifidus were lower in the painful side than in the healthy side before intervention (P<0.05). There was no significant difference in the FRRs of both erector spinae and multifidus between 2 sides after intervention. Conclusion SET may improve the active motion function of the erector spinae and multifidus of the painful side and recovery of flexion-relaxation phenomenon.
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@# Objective To investigate the effect of rehabilitation professional training. Methods Based on the 10 tertiary hospitals in Guangzhou, Guangdong, the professionals from communitiy hospitals were trained. The scores of knowledge and practice tests were analyzed in 2 terms of training. Results The students performed better in the practice test (82.01±8.91) than knowledge (71.08±10.05) (P<0.01). The score of knowledge tests was better in the second term than the first (P<0.05), no difference between them in the score of practice test. Conclusion Rehabilitation professional training in Guangzhou can improve the ability of service of medical rehabilitation.
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@#With the rapid progress of rehabilitation in China, how to construct the accreditation system of physical therapy (PT) education has become a critical consideration. This article introduced the background, role, management and process about the accreditation system of PT education in United States in order to promote the development of PT education in China.