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INTRODUCTION: To observe the clinical efficacy of ultrasound-guided stellate ganglion block (SGB) + extracorporeal shock wave therapy (ESWT) for limb spasticity in patients with ischemic stroke. METHODS: A total of 60 patients with post-stroke limb spasticity in our hospital were selected and randomly divided into four groups (n = 15). In the control group, patients received routine rehabilitation training. Based on routine rehabilitation training, SGB group patients underwent ultrasound-guided SGB, ESWT group patients received ESWT, and SGB + ESWT group patients received ultrasound-guided SGB combined with ESWT. The total treatment course was one month. The Modified Barthel Index (MBI) score, Fugl-Meyer Assessment and upper limb rehabilitation training system were applied to evaluate the activities of daily living, upper limb motor function and upper limb performance before and after treatment. Finally, the improvement after treatment was compared among different groups. RESULTS: After treatment, compared with the control group, the MBI score and the upper limb score based on Fugl-Meyer Assessment in the SGB, ESWT, and SGB + ESWT groups were significantly increased (P < 0.05). Furthermore, compared with the SGB and ESWT groups, SGB + ESWT exhibited a higher upper limb function score (P < 0.05), while the MBI score was not significantly different (P > 0.05). In terms of upper limb performance ability, patients in the SGB, ESWT and SGB + ESWT groups had better fitting degree, participation and exertion of exercise than those in the control group, and the SGB + ESWT group patients had the same movement trajectory as robots. CONCLUSION: Ultrasound-guided SGB and ESWT can reduce the muscle tension of patients, alleviate spasticity, promote the motor function of the upper limb, and improve the working performance of patients. However, the effect of SGB combined with ESWT is better.
Subject(s)
Extracorporeal Shockwave Therapy , Ischemic Stroke , Stroke Rehabilitation , Humans , Activities of Daily Living , Ischemic Stroke/therapy , Muscle Spasticity/therapy , Muscle Spasticity/drug therapy , Stellate Ganglion , Treatment Outcome , Ultrasonography, InterventionalABSTRACT
Temporomandibular disorder is a musculoskeletal disease with complex, multifactorial etiology regarding improper functioning of the stomatognathic system (masticatory muscles, temporomandibular joints, and surrounding structures). This article presents medical emergencies occurring among patients treated for temporomandibular disorders, which tend to constitute a severe difficulty for practitioners during their clinical practice. Examples of the most common emergencies of this type are disc displacement without reduction and a sudden contraction of the inferior part of the lateral pterygoid muscle. The latter occurs in cases of uncontrolled and incorrect use of the anterior repositioning splints and the hypertrophy of the coronoid process of the mandible. The sudden attacks of pain of secondary trigeminal neuralgia are also discussed in this article, together with their specific nature, which is significantly different from the nature of the pain of primary trigeminal neuralgia, yet the two types of neuralgia can be easily confused when the primary one takes the painful form. Subsequent emergencies discussed are myofascial pain syndrome, traumatic and inflammatory states of the temporomandibular joints, subluxation, and the consequences of intense occlusive parafunctions. Finally, the recommended therapeutic methods, which are used as part of the treatment in the cases of aforementioned emergencies, are described in this mini-review article, emphasizing that the implementation of the incorrect treatment and rehabilitation for emergencies of temporomandibular disorders may lead to permanent damage to the soft tissue structures of the temporomandibular joints.
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Objective: To compare the effect of scalp acupuncture and scalp acupuncture plus acupuncture exercise therapy (AET) on walking ability in children with spastic cerebral palsy (CP). Methods: A total of 60 spastic CP children with gross motor function classification system (GMFCS) grades Ⅰ-Ⅲ were divided into a control group and an observation group by the random number table method, with 30 cases in each group. Both groups were treated with the same conventional rehabilitation and scalp acupuncture therapy for CP. The control group received conventional rehabilitation first and then scalp acupuncture. The observation group received AET, which was to receive the conventional rehabilitation and scalp acupuncture simultaneously. Before and after treatment, the clinical efficacy was evaluated by the modified Ashworth scale (MAS) score, scores of dimensions D and E of the gross motor function measure (GMFM) scale, walking speed, and walking distance. Results: During treatment, there were 2 dropouts in the observation group. After 3 courses of treatment, the MAS scores in both the control group and observation group decreased compared with the same group before treatment (P<0.05), and the scores of dimensions D and E of the GMFM, walking speed, and walking distance were increased (P<0.05); the between-group comparison showed that the MAS score in the observation group was lower than that in the control group (P<0.05), and the scores of dimensions D and E of the GMFM, walking speed, and walking distance in the observation group were higher or longer than those in the control group (P<0.05). Conclusion: W ith the same treatments, scalp acupuncture combined with AET is superior to the conventional scalp acupuncture method in reducing lower-limb muscle tone, improving standing balance ability, and walking stability in children with spastic CP.
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Objective: To observe the improving effect of muscle regions of meridians needling method on the upper limb function in children with cerebral palsy of spastic hemiplegic type. Methods: A total of 100 children with cerebral palsy of spastic hemiplegia type were divided into a treatment group and a control group according to the visiting sequence, with 50 cases in each group. The control group was treated with conventional rehabilitation plus conventional acupuncture treatment. The treatment group was treated with conventional rehabilitation plus muscle regions of meridians needling method. The electromyography (EMG) signal values of triceps brachii and pronator teres were detected before treatment, and 3 months and 6 months after treatment. The clinical efficacy was evaluated by Peabody developmental motor scale-fine motor (PDMS-FM) and fine motor function measure (FMFM). Results: Three and six months after treatment, the EMG signal values of triceps brachii and pronator teres, grasping scores and visual-motor integrated scores of PDMS-FM and the FMFM scores in both groups increased to varying degrees compared with the same group before treatment, and the intra-group differences were all statistically significant (all P<0.05). Six months after treatment, the results of the above three items in the treatment group were all better than those in the control group, and the differences between the groups were statistically significant (all P<0.05). Conclusion: Muscle regions of meridians needling method added on the basis of conventional rehabilitation can effectively reduce the muscle tone of upper limb and enhance the muscle strength, and improve the upper limb function in children with cerebral palsy of spastic hemiplegia type. The efficacy is superior to that of the conventional rehabilitation plus conventional acupuncture treatment.
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Objective:To observe the clinical efficacy of traditional tuina plus modern rehabilitation in the treatment of lower limb extensor spasticity during stroke recovery.Methods:A total of 93 stroke patients who met the inclusion criteria were randomly divided into an observation group and a control group.Forty-four patients in the observation group were treated with traditional tuina plus modern rehabilitation,and 49 patients in the control group were treated with modern rehabilitation.The modified Ashworth scale (MAS),the Fugl-Meyer assessment scale (FMA) and the modified Barthel index (MBI) were used to evaluate the knee extensors state,lower limb motor function and activities of daily living (ADL) of the two groups.Results:After treatment,the overall efficacy of the observation group was better than that of the control group,and the difference was statistically significant (P＜0.05).After treatment,the MAS scores of both groups were significantly lower,FMA and MBI scores were significantly higher,and the differences were statistically significant in each group (P＜0.01).After treatment,the MAS score of the observation group was lower than that of the control group,and the difference between the groups was statistically significant (P＜0.01).The MBI score of the observation group was higher than that of the control group,and the difference between the two groups was statistically significant (P＜0.05).There were significant differences in the post-treatment changes in MAS,FMA and MBI scores between the two groups (all P＜0.05).Conclusion:Traditional tuina plus modern rehabilitation therapy can effectively alleviate or prevent lower limb extensor spasticity after stroke,and improve limb mobility and ADL.Hence,it is worthy of clinical promotion.
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Objective:To observe the effect of warm joint needling plus rehabilitation techniques on the balance function and quality of life (QOL) of patients with spastic hemiplegia after ischemic cerebral stroke.Methods:Ninety patients with spastic hemiplegia after ischemic cerebral stroke were randomized into a rehabilitation group,a warm joint needling group and an observation group,with 30 cases in each group.The rehabilitation group was intervened by Bobath therapy,the warm joint needling group was treated with joint needling on the affected side plus warm needling,and the observation group was given the same rehabilitation treatment as the rehabilitation group together with the same warm joint needling as the warm joint needling group.The three groups were treated once another day,1 month as a treatment course for 6 months.Before the treatment,and respectively after 2-week,1-month,3-month,and 6-month treatment,the modified Ashworth scale (MAS) was used to measure the anti-spasm ability of the lower limb,the Berg balance scale (BBS) was adopted to evaluate the balance function,and the stroke-specific quality of life scale (SS-QOL)was employed to estimate the QOL.Results:After 3-month and 6-month treatment,the lower-limb MAS scores in the observation group were significantly better than those in the rehabilitation group and the warm joint needling group (all P＜0.05).After 1-month,3-month and 6-month treatment,the BBS scores in the observation group were significantly better than those in the rehabilitation group and the warm joint needling group (all P＜0.05).After 2-week,1-month,3-month and 6-month treatment,the SS-QOL scores in the observation group were markedly better than those in the rehabilitation group and the warm joint needling group (all P＜0.05).Conclusion:Warm joint needling plus rehabilitation can effectively improve the lower-limb spasticity state,balance function and QOL in patients with spastic hemiplegia after ischemic cerebral stroke.
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Objective:To observe the effect of applying tuina to exterior-interiorly connected meridians for post-stroke upper limb spasticity. Methods:A total of 150 patients with post-stroke upper limb spasticity were randomly allocated into a treatment group (n=75) and a control group (n=75) by the random number table. Patients in the treatment group received tuina on exterior-interiorly connected meridians, whereas patients in the control group received standard rehabilitation therapy. The therapeutic efficacies in both groups were observed after 3 weeks of treatment. Results:The total effective rate in the treatment group was 89.3%, versus 61.3% in the control group, showing a statistically significant difference (P Conclusion:Applying tuina to exterior-interiorly connected meridians can obtain an exact efficacy for post-stroke upper limb spasticity.
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Objective: To observe the effect of acupuncture, tuina plus rehabilitative therapy on lower limb motor dysfunction in infants with spastic cerebral palsy. Methods:A total of 60 infants with spastic cerebral palsy were randomly divided into a treatment group and a control group by random digital table, 30 cases in each group. The treatment group was treated with acupuncture, tuina therapy plus rehabilitative therapy of Western medicine. The control group was simply treated with rehabilitative therapy of Western medicine, as same as that for the treatment group. The assessment was respectively given to the sick infants before the treatment and after the treatment of six months, to evaluate lying and rolling scores in dimension A, to evaluate sitting score in dimension B, to evaluate crawling and kneeling scores in dimension C, and evaluate standing score in dimension D in the gross motor functions and determine the muscle tone of the gastrocnemius muscle by modified Ashworth scale (MAS). Results:The differences were not statistically significant in comparison of the gross motor functions and the muscle tone of the gastrocnemius muscle between the two groups of sick infants before the treatment (P>0.05); after the treatment of six months, the above items were obviously improved in the two groups (P Conclusion:Acupuncture, tuina plus rehabilitative therapy of Western medicine are remarkable in the therapeutic effects in the treatment of motor disorders of the lower limbs in the sick infants with spastic cerebral palsy. This therapeutic method is safe, simple and convenient and needs to be clinically popularized and applied.
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Objective: To observe the clinical efficacy of acupuncture plus motor therapy for postapoplectic spastic hemiplegia and provide reference for rehabilitation care of patients with spastic hemiplegia after stroke. Methods:A total of 87 cases with postapoplectic spastic hemiplegia were randomly allocated into a treatment group and a control group. Patients in both groups received basic treatments to control blood pressure, blood sugar, blood fat and improve circulation. The 43 cases in the treatment group received acupuncture combined with motor therapy, whereas the 44 cases in the control group received motor therapy alone (same as the treatment group). The treatment was conducted once a day, for a total of 3 sessions. One session consisted of 10 times and there was a 1-day interval between two sessions. Then the changes in modified Ashworth scale (MAS) score and Fugl-Meyer assessment scale (FMA) score and clinical efficacy were observed. Results:After treatment, the MAS scores were significantly decreased in both groups, showing intra-group statistical differences (P<0.01). The MAS score in the treatment group was significantly lower than that in the control group, showing a between-group statistical difference (P<0.01). The total effective rate was 69.8% in the treatment group, versus 45.5% in the control group, showing a between-group statistical difference (P<0.05). After treatment, the FMA scores were significantly increased in both groups, showing intra-group statistical differences (P<0.01); and the FMA score in the treatment group was significantly higher than that in the control group, showing a between-group statistical difference (P<0.05). Conclusion:Acupuncture combined with motor therapy is better than motor therapy alone in alleviating postapoplectic limb spasticity, improving the limb motor function and increasing the activities of daily living (ADL).
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Objective:To evaluate the literature quality of randomized controlled trials of acupuncture plus rehabilitation for post-stroke limb spasm in the recent ten years in China. Methods:By searching four databases of China National Knowledge Internet (CNKI), Wanfang Academic Journal Full-text Database (Wanfang), Chongqing VIP Database (CQVIP) and Chinese Biomedical Literature Database (CBM), randomized controlled trial (RCT) of acupuncture plus rehabilitation for the treatment of post-stroke limb spasm were screened and selected. In accordance with 2010 edition of the consolidated standards of reporting trials (CONSORT) and standards for reporting interventions in clinical trials of acupuncture (STRICTA), the quality evaluation was processed for RCT documents. Results:Finally, 50 documents were selected. The issues of titles, sample size calculation, application of randomization and blind method, subject’s procedure, conclusion and estimated value, explanation of trial limitation, auxiliary intervention measures and therapeutic plans, and background of therapists exist in most documents. Conclusion:Currently, RCT documents about acupuncture plus rehabilitation for the treatment of post-stroke limb spasm are generally of low quality. In the future, it is necessary to standardize the reports of the clinical trials based upon CONSORT and STRICTA, in order to enhance the document quality.
