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Objective To study the correlation between regional cerebral glucose metabolism and behavioral scores in middle cerebral artery occlusion(MCAO)model rats before and after the intervention of constraint induced movement therapy(CIMT),and the correlation between the natural recovery processand motor function recovery in MCAO model rats and the brain activation after CIMT intervention,and to further explore the mechanism of CIMT. Methods Twenty-two adult male Sprague-Dawley(SD)rats were randomly divided into an ischemic group treated with CIMT (CIMT,n=6),an ischemic group (Control,n=6),a sham-operated group(Sham,n=6),and a blank control group(Normal,n=4). The MCAO models of rats in the CIMT group and Control group were established by thread embolism method. The middle cerebral artery was not blocked during the operation for the Sham group,and the Normal group was not given any special treatment. After operation,rats in the CIMT group and Sham group were treated with CIMT. On the 7th day(d7)and the 22nd day(d22)after surgery,foot-fault test(FFT)and the beam balance and walking (BBW) test were used to evaluate the forelimb motor;micro positron emission tomography-computed tomography (micro PET/CT) imaging with fluorodeoxyglucose (18F-FDG) was used to scan the glucose metabolism in different brain regions of rats;Pearson correlation analysis was used to analyze the correlation between behavioral scores and glucose metabolism level in the CIMT group and Control group. Results On d7,the BBW score in the CIMT group and Control group was negatively correlated with glucose metabolism in the left insular cortex and the auditory cortex,and positively correlated with glucose metabolism in the right posterior hippocampus,superior colliculus,and inferior colliculus,with statistically significant differences;the FFT score was negatively correlated with glucose metabolism in the left somatosensory cortex, insular cortex and orbitofrontal cortex, and positively correlated with glucose metabolism in the right midbrain,with statistically significant differences. On d22, the BBW score in the CIMT group and Control group was positively correlated with glucose metabolism in the amygdala,caudate putamen,insular cortex and entorhinal cortex,and negatively correlated with glucose metabolism in the nucleus accumbens (Acb) core shell and caudate putamen in the right brain region,with statistically significant differences;the FFT score was negatively correlated with the entorhinal cortex in the right hemisphere and the difference was statistically significant. Conclusion The recovery of motor function promoted by CIMT was associated with the activation of both cerebral hemispheres in rats. The improvement of balance function promoted by CIMT in rats with cerebral ischemia was mainly related to the activation of Acb core shell in the right hemisphere. The recovery of fine grasping function promoted by CIMT may be related to the activation of the right entorhinal cortex.
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Spasticity is a common complication in stroke patients, which may be a result of supraspinal influences, spinal reflexs and biomechanical changes.
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Objective:To summarize the development of a patient with complex regional pain syndrome (CRPS) after distal radius fracture and the effect of repetitive transcranial magnetic stimulation (rTMS) combined with conventional rehabilitation on it. Methods:One patient with CRPS after left distal radius fracture was treated with rTMS combined with conventional rehabilitation for three weeks. The pain degree was evaluated with Visual Analogue Score (VAS), the edema was assessed with volume of hand and circumference of finger, and motion of joint was measured with passive range of motion. The activities of daily living was assessed with modified Barthel Index (MBS). Results:Before treatment, the VAS score was 8, the volume of left hand was 330 ml, the temperature of skin was 36.8 ℃. The activity of flexion and extension of left elbow joint, pronation and supination of left forearm, the flexion, extension, ulnar deviation and temporal deviation of left wrist, and metacarpophalangeal joints (MCP), proximal interphalangeal joint (PIP) and distal interphalangeal joint (DIP) of left hand were all limited. The circumference of left finger was larger than right finger, and the score of MBI was 85. After three weeks of treatment, the VAS score was 2, the volume of the left hand was 310 ml, the temperature of the skin was 33.8 ℃. The activities of left elbow joint, left wrist joint and left MCP, PIP, and DIP were better than before. The score of MBI was 100. Conclusion:rTMS combined with conventional rehabilitation is effective on CRPS after distal radius fracture, in the range of motion and edema of upper extremity, and activities of daily living.
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Objective:To investigate the clinical effects of scalp acupuncture combined with cognitive therapy on cognitive impairment after traumatic brain injury. Methods:From June, 2016 to October, 2017, 60 patients with cognitive impairment after traumatic brain injury were randomly divided into scalp acupuncture group (n = 20), cognitive training group (n = 20) and combined group (n = 20), who accepted their own therapies for 40 times. They were assessed with Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and modified Barthel Index (MBI) before and after treatment. Results:All the groups improved in the scores of MMSE, MoCA and MBI after treatment (F > 21.923, P < 0.001), which were the best in the combined group (F > 3.423, P < 0.05). Conclusion:Combination of scalp acupuncture and cognitive training is more effective on cognitive impairment after traumatic brain injury.
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Serotonin selective reuptake inhibitors (SSRIs) have been widely used for post-stroke depression. Recently, SSRIs are considered as an effective drug to improve motor function after stroke. Mechanism of SSRIs improving motor function after ischemic stroke involves extensive factors, and there is no definitive conclusion yet. While, the effects of SSRIs on motor function after stroke remains debatable. Besides, there are potential risks of SSRIs in the treatment of stroke. It is necessary to evaluate the benefits and risks of SSRIs for patients with ischemic stroke.
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Objective:To observe the effect of grasping training under a dynamic wrist-hand orthosis (Saebo Glove) on upper limb and hand function in chronic stroke patients. Methods:From October, 2018 to January, 2019, eleven patients with hemiplegia in upper limb and hand after chronic stroke were recruited. They received conventional rehabilitation and grasping training under dynamic wrist-hand orthosis for three weeks. They were tested surface electromyography of flexor and extensor muscle of wrist and upper limb, assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Action Reach Arm Test (ARAT), modified Ashworth Scale (MAS), modified Tardieu Scale (MTS) and Triple Spasticity Scale (TSS), and measured grip force, active range of motion of wrist and metacarpophalangeal joints before and after treatment. Results:The scores of FMA, ARAT and TSS, and active range of motion of wrist flexor improved after treatment (t > 2.739, P < 0.05). Conclusion:Grasping training assisted with dynamic wrist-hand orthosis can improve upper limb and hand function of motor and release spasticity in hemiplegics after chronic stroke.
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Objective To summarize the development and treatment for complex regional pain syndrome (CRPS) type I only involving hand after stroke.Methods One patient accepted comprehensive rehabilitation for six weeks. He was assessed with Visual Analogue Scale (VAS) of pain and modified Barthel Index, his hand volume and fingers circumference, and passive range of motion (PROM) of fingers and wrist was measured, before and after treatment.Results The score of VAS, and the hand volume and the fingers circumference decreased, while PROM and the score of modified Barthel Index increased after treatment.Conclusion Post-stroke CRPS type I can only affect the wrist and hand. Comprehensive rehabilitation may improve the function and activities of daily living.
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Mirror therapy (MT), was first used for phantom limb pain, and afterwards used widely for stroke and peripheral nerve injury, etc. The mechanism of MT is obscure and various, mainly included mirror neuron system, visual feedback, facili-tation of motor pathways, and so on. A large quantity of researches claimed that training of unaffected limb activated ip-silateral cortex, changed conduction of pyramid tracts, and promote motor function recovery of affected limb, which cor-rected motor deficits and improved function of patients with hemiplegia (eg. finger movement and wrist flexion-exten-tion function).
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Objective: To investigate the prognostic value of plasma C-reactive protein (CRP) level in patients with paraquat poisoning. Methods: This study included 162 patients with paraquat poisoning. The data of plasma paraquat, CRP level and arterial blood gas were analyzed. Cox regression analysis was applied to evaluate the risk factors of prognosis. Receiver operating characteristics curve analysis and area under curve were used to calculate the predictive power of significant variable. Differences in patient survival were determined using the Kaplan-Meier method and a log-rank test. Results: Plasma CRP level was significantly increased in non-survival patients compared with survival patients ( P < 0.05), and positively correlated with plasma paraquat level ( P < 0.05). Cox regression analysis revealed that plasma CRP level was an independent prognostic marker of mortality within 30 days. The receiver operating characteristics curve analysis indicated that area under curve of plasma CRP level was 0.867 (95% CI: 0.81-0.93), and the cut-off value was 18 mg/L, and patients with CRP level over this value had a poor survival time compared with those with less than this value. Conclusions: These results suggest that plasma CRP level is distinct increased in patients with paraquat poisoning, and the plasma CRP level may be useful for the prediction of prognosis in paraquat poisoning.
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Objective To evaluate the functional changes in the isometric,concentric and eccentric muscle strength of the knee extensors and flexors in patients with knee osteoarthritis,and to explore the relationship among these contractions.Methods A Biodex System-3 isokinetic test system was used to assess the isometric,concentric and eccentric strength of the knee extensors and flexors of the involved and uninvolved limbs of 54 patients suffering from osteoarthritis.Results The strength of the knee extensors and flexors of the involved limbs was significantly less than that of the uninvolved legs in the different contraction modes(P＜0.05).The difference was especially marked in concentric and eccentric contraction at low angular velocity.The hamstrings/quadriceps ratio and the dy- namic control ratio showed abnormalities in the muscle balance of the hamstrings and quadriceps.Conclusion Iso- kinetic testing should be applied and the hamstrings/quadriceps ratio and the dynamic control ratio should be analyzed in evaluating patients with knee osteoarthritis.
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Objective To observe the effects of standardized three stage rehabilitation treatment on the neu- rological deficit scores (NDS) and ADL performance of ischemic stroke patients.Methods A total of 164 ischemic stroke patients were recruited and randomly divided into a rehabilitation group and a control group.The neurological function and ADL performance of the patients were assessed by using NDS and Modified Barthcl Index (MBI) at the admission,at the end of 1st,3rd and 6th months post stroke.Results No significant differences were found be- tween the rehabilitative and the control groups with regard to NDS and MBI at admission.The NDS demonstrated a decreasing tendency,while the MBI score an increasing tendency in both groups.In the control group,significant difference of NDS was found between admission and the end of 1st month as well as between the end of the 1 st and the 3rd months.In rehabilitation group,significant difference was revealed between all the time points with regard to NDS and MBI scores.At the end of the 1st,3rd and 6th months,the MBI scores of the rehabilitation group were signifi- cantly higher than those of the control group,indicating that the ADL performance of those treated with standardized three-stage rehabilitation protocol was improved quicker than those without the protocol.Conclusion Standardized three-stage rehabilitation treatment could improve the neurological function and ADL performance of the ischemic stroke patients.
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Objective To investigate the effects of standardized tertiary rehabilitation (STR) on limb motor function (LMF) after stroke.Methods Eighty-two patients were divided into a primary cerebral infarction group (PCI group) and a primary cerebral hemorrhage group (PCH group),and then randomly further divided into experi- mental and control sub-groups.All patients received routine internal medicine treatment,supplemented with stand- ardized tertiary" rehabilitation in the experimental groups.All patients were assessed with the simplified Fugl-Meyer motor function assessment (S-FMMFA) at enrollment,and 1,3 and 6 months after their stroke.Results The scores of the experimental groups were higher than those of the controls.The experimental groups scores were 26.10% of normal at the time of the enrollment,and improved to 42.52%,65.62% and 83.71% by the end of the 1st,3rd and 6th month,respectively.The control groups started at 18.51%,and progressed to 24.85% ,37.24% and 45.84% over the same interval.Conclusion STR was associated with improved LMF scores of stroke pa- tients.
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Objective To determine the extent and distribution of error in knee joint proprioception and e- valuate the relationship between knee joint proprioception and pain and dysfunction.Methods Twenty-eight knee OA patients (19 female and 9 male) were compared with 27 age-matched healthy adults (20 female and 7 male). Knee joint proprioception was measured with a repositioning test on the Biodex dynamometer.The pain and knee dys- function were assessed with Visual Analogue Scale and Lequesne Index,respectively.Results Knee OA patients produced 79% more proprioception errors than the healthy subjects (P