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@#Objective To analyze the educational characteristics of physical therapy in universities of United States, and provide reference for the international development of rehabilitation therapy education in China.Methods Based on the data collected from the official websites of three universities in the United States and the databases at home and abroad, combined with the author's learning experience, the characteristics of physical therapy education in universities of United States in detail was analyzed.Results Characteristics of physical therapy education in universities of United States had strict accreditation system, course objectives oriented by practicing competence, comprehensive curriculum plan, educational concept of student-centered, high level of teaching informatization, diversified teaching and learning evaluation system, which conformed to the goal of rehabilitation competency of World Health Organization.Conclusion Physical therapy education in United States has remarkable characteristics and a well-developed system, which has certain reference value for China.
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Objective:To explore the effect of swallowing different viscosities and volumes on the swallowing of dysphagic stroke survivors, and also penetration and aspiration.Methods:A total of 59 stroke survivors with dysphagia were evaluated using videofluoroscopy while completing the Chinese version of the volume viscosity swallow test. They were required to swallow 3, 5 and 10ml of food of medium, low, zero and high viscosity. Modified barium swallowing impairment profiles (MBSImPs) and the Rosenbek penetration aspiration scale were used for quantitative analysis.Results:Tongue control, initiation of the pharyngeal swallow and larynx closure showed the worst performance when swallowing zero-viscosity food. Oral residue performance was poor when swallowing large volumes and pharyngeal peristalsis was poor with small volumes. The risk of penetration and aspiration was greater with low-viscosity, large-volume swallowing tasks. There was a significant positive correlation between the penetration aspiration grade and total pharyngeal score. Larynx closure was especially strongly correlated with the penetration aspiration grade.Conclusions:The characteristics of physiological swallowing are closely related to the viscosity and volume of the material being swallowed. The risk of penetration and aspiration is greater with large volumes of low-viscosity food.
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Objective:To investigate the effect of botulinum neurotoxin type A (BoNT/A) on Nav1.3 sodium channels and the function of sodium current in neuropathic pain.Methods:Eighteen adult rats had a spared nerve injury (SNI) induced and then were randomly divided into a saline group and a BoNT/A group, each of 9. Another 9 rats formed a fake operation group, Five days after the SNI, BoNT/A (7U/kg or 15U/kg) or saline was subcutaneously administered into the plantar surface of a hindpaw. On the 3rd, 7th and 14th day after the injection, the SNI rats′ paw withdrawal threshold was measured. On the 7th and 14th day the expression of Nav1.3 protein in dorsal root ganglion (DRG) neurons was examined using western blotting, while any change in the functional tetrodotoxin-sensitive (TTX-S) current was recorded using the patch clamp technique.Results:Administration of BoNT/A at either 7U/kg or 15U/kg significantly increased the SNI-induced mechanical allodynia. The expression of Nav1.3 protein in DRG neurons increased significantly after the SNI, but had decreased significantly by the 7th and 14th day after the administration of BoNT/A. BoNT/A significantly decreased the current density in TTX-S sodium channels in DRG neurons following SNI.Conclusion:Administration of BoTN/A affects the expression of Nav1.3 protein and functional TTX-S current, relieving neuropathic pain.
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@#Objective To observe the effects of dual-task motor training on motor and balance function for stroke patients. Methods From January, 2016 to June, 2017, 30 patients with stroke were assigned randomly into control group (n = 15) and treatment group (n = 15). Both groups accepted routine physical therapy, the control group accepted anti-gravity treadmill training, while the treatment group accepted dual-task training with anti-gravity treadmill, for four weeks. They were measured with balance training and evaluation system, and assessed with Fugl-Meyer Assessment-lower extremity (FMA-L), Berg Balance Scale (BBS) and modified Barthel Index (MBI), before and after treatment. Results The range of swaying on X axial (Rx) and Y axial (Ry), as well as rectangle area (RecArea) decreased after treatment in the treatment group (t > 4.719, P < 0.001), while RecArea decreased in the control group (t = 5.069, P < 0.001). Ry and RecArea were less in the treatment group than in the control group (t > 2.288, P < 0.05). The scores of FMA-L, BBS and MBI improved after treatment in both groups (t > 7.316, P < 0.001), and improved more in the treatment group than in the control group (t > 2.322, P < 0.05). Conclusion The dual-task training via anti-gravity treadmill may improve motor and balance function in stroke patients, and promote the activities of daily living.
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Objective To observe the effect of kinesthetic imagery and visual imagery on upper limb rehabilitation among stroke survivors.Methods Forty-five hemiplegic stroke survivors were randomly assigned into a kinesthetic imagery training group (n=14),a visual imagery training group (n=15) or a control group (n=16).In addition to conventional rehabilitation,patients in the kinesthetic and visual imagery training groups were given 30 minutes of the appropriate imagery training once a day,five days per week for four weeks,while the control group relaxed or received health education for the same time.Before and after the 4-week intervention,the upper limb section of the Fugl-Meyer assessment (FMA-UE) and the modified Barthel index (MBI) were used to evaluate the motor function of the subjects' upper limb and their ability in the activities of daily living respectively.Results Before the intervention,there were no significant differences in the average FMA-UE and MBI scores among the 3 groups.After the intervention there was no significant difference between the average FMA-UE and MBI scores of the two training groups,but both were significantly better than the control group's averages.Conclusion Either kinesthetic or visual imagery training can improve the upper limb function of stroke survivors and their abihty in the activities of daily living.Their effectiveness is not significantly different.
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Motor imagery can be classified in several ways, and assessed with various measures. There is a set of program to perform the motor imagery therapy. There are many reasearches about the effects of motor imagery for upper limbs rehabilitation in patients after stroke. Task-based and resting-state functional MRI explore the activation of various areas and functional linkages in cerebral network.
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Objective To study the effect of bilateral arm training on cortical reorganization in cerebral infarction patients using blood oxygen level-dependent functional MRI (BOLD-fMRI).Methods Fourteen cerebral infarction subjects with moderate to severe upper limb impairment participated in this randomized and single-blinded training study.Subjects in the bilateral arm training group (n =7) practiced bilateral symmetrical or opposite activities,while the control group (n =7) performed conventional,mainly unilateral,arm training.Those in both groups received fMRI scans before and after the training with passive elbow movement as the task in the imaging.Results Both groups had significant improvements in their average scores on the Fugl-Meyer upper extremity assessment and in their modified Barthel index scores after the treatment,and there were no significant differences between the two groups.Brain activation had increased in both groups after the treatment,especially in the bilateral training group.After the treatment,the first motor area (M 1),the first somatosensory area and the supplementary motor area on both sides were activated in the bilateral training group.Moreover,for patients in the bilateral training group with injuries of moderate severity,the M1 of the opposite side tended to be activated,while for those more severely injured the same side had a tendency to be activated.Conclusion Convalescing subcortical infarction patients with moderate to severe upper limb impairment benefit from bilateral arm training in terms of motor activity and performing activities in daily life.It may be related to the normalization of inhibition between the hemispheres of the bilateral cerebral cortex and the reconnection of ipsilateral corticospinal pathways.
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Objective To study the immune system regulatory effects of CD8+CD28-regulatory T lymphocytes in an experimental bone marrow mesenchymal stem cell treatment of autoimmune encephalomyelitis.Methods A model of autoimmune encephalomyelitis (EAE) was established in twenty-eight C57BL/6 female mice,6 to 8 weeks old weighing 16 to 20 g using myelinoligodendrocyte glycoprotein 35-55 amino acid peptide (MOG35-55).The mice were randomly divided into a phosphate-buffered solution (PBS) group (n =7),an MSCs-Low group [n =7 which received an injection of 2× 105 mesenchymal stem cells (MSCs)],an MSCs-Med group (n=7,1× 106 MSCs),and an MSCs-High group (n=7,5×106 MSCs).Their clinical condition was then evaluated daily.On the 15th day after the MOG35-55 immunization,the different MSC doses were administered intravenously via the tail.On the 30th day the mice were sacrificed to observe any neuropathology of the spinal cord.At the same time,FACS flow cytometry was used to assay CD8+CD28-T cells in the spleen.Results Compared with the PBS control group,the MSC treatment effectively alleviated illness among the mice by the 15th day after the immunization.The maximum and average disease scores and clinical illness scores had all improved significantly.The medium dosage worked best.Neuropathological analysis showed that the MSC treatment could significantly reduce the invasion of inflammatory cells and minimize demyelination in the spinal cord.Furthermore,the CD8+ CD28-regulatory T cells in the spleens of the MSCtreated animals increased compared with the PBS control group,though the secreted levels of IL-10 showed no obvious difference.Conclusions Treatment with MCSs can promote the recovery of neural function in autoimmune encephalomyelitis,at least in mice.CD8+CD28-regulatory T cells may not be the main effector cells,playing only a synergistic therapeutic role.
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Objective To observe the effect of wheel running exercise on subventricular zone neurogenesis and the neural function in rats post cerebral ischemia. Methods 48 adult male Sprague-Dawley rats were induced cortical infarcts with left middle artery occlusion and were housed in either standard (control group, n=24) or wheel running (exercise group, n=24). They were assessed with neurological severi-ty scores (NSS), and the expression of Ki67 was determined with immunofluorescence, 3, 7, 14 and 21 days after training. Results Com-pared with the control group, the number of Ki67-labeled cells in subventricular significantly increased in the exercise group 14 and 21 days after ischemia (P<0.05), and the NSS decreased since 7 days after ischemia (P<0.05). Conclusion Wheel running may promote the neuro-genesis in subventricular of adult rats after cerebral infarction, which may associate with the recovery of neural function.
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Objective To investigate the clinical efficacy of exercise cupping plus acupuncture in treating acute lumbar sprain. Method Sixty-four patients with acute lumbar sprain were randomly allocated to treatment and control groups, 32 cases each. The treatment group received exercise cupping plus acupuncture and the control group, acupuncture alone. After one treatment and one course of treatment, the therapeutic effects were evaluated using the VAS for pain, lumbar joint activity and the clinical effect assessment. Result After one course of treatment, the total efficacy rate was 96.9% in the treatment group, which was significantly higher than 84.4% in the control group (P<0.05). After one treatment and one course of treatment, the VAS score was significantly lower in the treatment group than in the control group (P<0.05) and lumbar joint activity improved significantly in the treatment group compared with the control group (P<0.05). Conclusion Exercise cupping plus acupuncture is more effective than acupuncture alone in treating acute lumbar sprain.
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Objective To test the reliability and validity of the brief International Classification of Functioning, Disability and Health (ICF) core sets for Chinese stroke patients using Rasch model analysis. Methods The body functions of 38 Chinese stroke patients were measured using the brief ICF core sets. The qualifiers of the 20items were measured by two raters and analyzed using FACETS statistical software. The intra-rater reliability and validity were tested by using the separation index and separation reliability and fit analysis. Results The brief ICF core sets had good internal consistency and reliability (person separation index = 6.02, person separation reliability = 0.94 ) with these Chinese patients. The raters showed significantly different strictness in rating, but their ratings had good internal self-consistency. The construct validity was good for the body functions of the ICF component ( separation index = 10.50, separation reliability = 0.80) , but misfitting and overfitting were found in items b117, b152and b755. Conclusion The body function of the brief ICF core sets has good reliability and validity for Chinese stroke patients. A many-facet Rasch measurement model can provide comprehensive information and has good application prospects for testing the reliability and validity of ICF core sets.
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@#ObjectiveTo study the effects and feasibility of balloon dilatation on cricopharyngeal achalasia in children with dysphagia. MethodsOne 21-month-old child was reported. ResultsAfter 14 times dilatation therapy, the video fluoroscopic swallowing study showed that the bolus can pass the cricopharyngeus. The residuals in the epiglottis and piriform sinuses reduced. No bucking and aspiration happened and the cricopharygeus muscle relaxed normally. The gastric tube can be removed and the child got full per-oral nutrition. ConclusionBalloon dilatation is effective to relax the cricopharygeus muscle and improve the swallowing function of children with dysphagia because of cricopharyngeal achalasia.
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Objective To investigate activation patterns in the motor cortex of patients with cerebral infarction by blood oxygen level dependent-functional magnetic resonance imaging ( BOLD-fMRI) , and to explore the brain's functional reorganization mechanism. Methods Sixteen patients ( 12 men and 4 women, age 37 to 80, mean 61.0±11.3) who had suffered a subcortical infarction within the previous 3 months were studied. All the patients received fMRI scanning during passive flexion-extension movement of both the affected and unaffected wrist separately.Brain functional mapping was acquired with SPM2 software. Activation patterns in the brain were compared between the affected and unaffected hands. Results The volume and intensity of the activated areas were diverse, but showed some order. When the affected hand moved, the fMRI map showed general hyperactivation. When the unaffected hand moved, the contralateral M1 and S1 were activated. Conclusions After cerebral infarction, the brain cortex showed compensatory changes. As the main motor cortex (M1) was deactivated, the subsidiary motor areas such as the PMC, SMA, CMA, IPL, PFC and CRB were activated. The activated motor areas could shift to the area around the lesion, and the non-motor area was activated also.
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Objective To study the effects of rehabilitation training on angiogenesis and its ultrastructure and expression of CD32 in the peri-infarction region of rats with focal cerebral infarction. Methods Sixty-six Spra-gue-Dawley rats with experimental left middle cerebral artery occlusion (MCAO) were used as subjects in this study. All the rats were randomly divided into three groups: a rehabilitation training group (n=30), which was given bar rotating, balancing and rolling exercises everyday after 48 hours post MCAO; a control group (n = 30) and a sham-operated group (n=6), which were fed in cages with no special training exercises. Then brain tissues were fixed on the 3rd d, 7th d, 14th d after MCAO, for observing the morphological alterations of microvessels in peri-infarction re-gion using transmission electron microscope, immunohistochemistry and Western blotting were used to measure the ex-pression of CD31, which acted as the marker of the neogenetic microvessels. Results (1) It showed that the capil-lary endothelial cells were less edematous in the rehabilitation training group, and there were less pinocytosis bullae in basal membrane more integral nucleus of endothelial cells in rehabilitation training group when compared with those in the control group. (2) Expression of CD31 can be observed in peri-infarction region in both groups from the 3rd d on-wards, and peaked on the 7th d, and then gradually went down after the 14th d. Comparison between the 2 groups showed that the expression of CD31 in rehabilitation training group was higher than that in the control group at every time point, but statistical difference between the 2 groups in this regard could be revealed only on the 7th d (P< 0.05), Conclusion Rehabilitation training could promote ultrastruetural recovery of microvessels and induce an-giogenesis in peri-infaretion region, and it might be one of the mechanisms of neural functional recovery in rats after MCAO.
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Objective To study the effects of rehabilitative training on motor function and expression of GAP-43 and SYN in rats with local cerebral infarction. Methods A total of 76 male adult Sprague-Dawley rats were randomly divided into a rehabilitative training group(n=32),a control group(n=32),and a sham-operated group(n=1 2).All the rats were subjected to left middle cerebral artery occlusion(MCAO)with the suture occlu sion.Motor training programs including balancing,grasping,rotating and walking exercises were administered to the rats of the rehabilitative training group at 48 hours post-operation,while those of other two groups were reared in their original living status without any special training.The animals were given behavioral tests with Bederson test,balancing wood test,net screen test to assess the functional outcome,and immunohistochemistry staining was employed to evaluate the exDression of GAP-43 and SYN in peri-infarction cortex at the 3rd,7th,21 st,35th days after MACO,respectively. Results The scores of behavioral tests in the rehabilitative training group was better than those in the control group(P＜0.05)at the 7th,21 st,35th day after MCAO,and the immunostaining showed that expression of GAP-43 was higher in the rehabilitative training group than that in the control group(P＜0.05)and the sham operated group(P＜0.01)at the 7th and 21 st days post-operation,respectively,and that the expression of SYN was higher in the rehabilitative training group than that in the control(P＜0.05)and the sham operated groups(P＜0.05)at the 21 st and the 35th days post-operation,respectively. Conclusion Rehabilitative training can improve func tional recovery in rats with local cerebral infarction,and the function enhancement may be partially attributed to the up-regulation of expression of GAP-43 and SYN in peri-infarction cortex.
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Objective To compare the effects of semi conductor laser nasal cavity irradiation with He Ne laser intravenous irradiation therapy on patients with brain lesion. Methods Ninety six cases of cerebral infarction(CI), traumatic brain injury(TBI) were randomly divided into semi conductor laser group (group A, n =50, ?=650nm , 2.4mW, 30mins/nasal cavity), He Ne laser group (group B, n =46, ?=632.8nm, 2.5mW, 40mins/ intermedia cubiti vein or basilic vein). The changes of the blood lipids, hemorheology parameters, scores with Fugl Meyer movement scale and Barthel index assessment were compared after the semi conductor laser and He Ne laser irradiation. Results After laser irradiation,The CHOL, TG, LDL, ESR and HCT were significantly reduced in both groups( P 0.05). The brain damage area was reduced in all the patients as revealed by CT examination. Conclusion The influence of the two kinds of laser irradiation therapies is similar when applied in patients with brain injury. But semi conductor laser nasal cavity irradiation is a simple, safe, inexpensive therapy for the patients.
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AIM To determine whether botulinum toxin A (BTXa) is an effective and safe treatment for lower limb spasticity and improve walking ability after stroke or traumatic brain injury. METHODS 27 cases with stroke or traumatic brain injury affecting the muscles of lower extremity were selected to receive local intramuscular injection. The injected dose is between 50～100 U?(muscle) -1. All patients received rehabilitation therapy that focused on walking training. Patients were assessed at entry, and 2, 4 weeks post-treatment. The muscle tone was assessed by the modified Ashworth Scale, the changes of time-distance parameters was measured by footprint gait analysis. The correlation relationship between muscles tone and gait parameters was analysed. RESULTS Compared to pretreatment values, the total muscles spasticity, walking distance, and speed were significantly improved in all groups respectively, decrease in the modified Ashworth Score (P