EEG Changes in Time and Time-Frequency Domain During Movement Preparation and Execution in Stroke Patients.

This study investigated electroencephalogram (EEG) changes during movement preparation and execution in stroke patients. EEG-based event-related potential (ERP) technology was used to measure brain activity changes. Seventeen stroke patients participated in this study and completed ERP tests that were designed to measure EEG changes during unilateral upper limb movements in preparation and execution stages, with Instruction Response Movement (IRM) and Cued Instruction Response Movement (CIRM) paradigms. EEG data were analyzed using motor potential (MP) in the time domain and the mu-rhythm and beta frequency band response mean value (R-means) in the time-frequency domain. In IRM, the MP amplitude at Cz was higher during hemiplegic arm movement than during unaffected arm movement. MP latency was shorter at Cz and the contralesional motor cortex during hemiplegic arm movement in CIRM compared to IRM. No significant differences were found in R-means among locations, between movement sides in both ERP tests. This study presents the brain activity changes in the time and time-frequency domains in stroke patients during movement preparation and execution and supports the contralesional compensation and adjacent-region compensation mechanism of post-stroke brain reconstruction. These findings may contribute to future rehabilitation research about neuroplasticity and technology development such as the brain-computer interface.

Expert consensus on protocol of rehabilitation for COVID-19 patients using framework and approaches of WHO International Family Classifications.

Coronavirus disease 2019 (COVID-19) has widely spread all over the world and the numbers of patients and deaths are increasing. According to the epidemiology, virology, and clinical practice, there are varying degrees of changes in patients, involving the human body structure and function and the activity and participation. Based on the World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) and its biopsychosocial model of functioning, we use the WHO Family of International Classifications (WHO-FICs) framework to form an expert consensus on the COVID-19 rehabilitation program, focusing on the diagnosis and evaluation of disease and functioning, and service delivery of rehabilitation, and to establish a standard rehabilitation framework, terminology system, and evaluation and intervention systems based the WHO-FICs.

[Efficacy of acupuncture combined with computer-aided movable and measurable ankle-foot orthosis (CMM-AFO) on injury of nervus peroneus communis].

OBJECTIVE: To observe the efficacy difference among medication, medication plus rehabilitation training and medication plus rehabilitation training plus acupuncture on injury of nervus peroneus communis. METHODS: A total of 81 patients were randomly divided into a control group, an observation 1 group and an observation 2 group; three patients dropped out and 78 patients were included into statistical analysis, 26 patients in each group. The patients in the control group were treated with oral administration of mecobalamin, 500 µg per time, 3 times a day for 60 days. Based on the treatment of control group, the patients in the observation 1 group were treated with rehabilitation training by computer-aided movable and measurable ankle-foot orthosis (CMM-AFO). Based on the treatment of observation 1 group, the patients in the observation 2 group were treated with acupuncture at Jiexi (ST 41), Fenglong (ST 40), Yanglingquan (GB 34) and Zusanli (ST 36), etc, 30 min per treatment, once a day for 60 days. After 60-day treatment, the clinical efficacy was evaluated; the muscle strengths of foot dorsal stretch and digital flexion were evaluated; the motor nerve conduction velocity (MCV) and sensory nerve conduction velocity (SCV) were recorded. RESULTS: After treatment, 20 patients were cured in the observation 2 group, which was significantly higher than 8 patients in the control group and 15 patients in the observation 1 group (both P<0.05). The muscle strengths, SCV and MCV in the observation 2 group were significantly higher than those in the control group and the observation 1 group (all P<0.05). CONCLUSION: Acupuncture combined with CMM-AFO have significant efficacy on injury of nervus peroneus communis, and improve muscle strengths, SCV and MCV, which are superior to medication alone and medication plus rehabilitation training.

Electroacupuncture Stimulation of Language-Implicated Acupoint Tongli (HT 5) in Healthy Subjects: An fMRI Evaluation Study.

OBJECTIVE: To explore brain activations associated with electroacupuncture simulation at Tongli (HT 5) and its comparison with brain activations during picture-naming task. METHODS: Twenty healthy subjects were enrolled in this study. Half of them received electroacupuncture stimulation at HT 5 (ACUP group) and the other half of them received stimulation at a nonmeridian sham acupoint (SHAM group). All subjects performed picture-naming task. Each subject finished two runs of functional magnetic resonance imaging examinations in one session and picture-naming task was performed before electroacupuncture stimulation. Subjective brain activations were obtained using generalized linear model and inter-group analyses were performed after that. RESULTS: The electroacupuncture stimulation at HT 5 induced significant brain activations in both the anterior and posterior language regions, including the left inferior frontal gyrus, which was in consistent with activations induced during picture-naming task. Group analysis showed a tendency of increased activation of ACUP group in left inferior frontal gyrus compared with SHAM group (P<0.05 FDR corrected). CONCLUSIONS: Electroacupuncture treatment at the acupoint HT 5 has modulation effect on typical language-implicated brain regions in healthy subjects, which provides supporting evidence for beneficial effects of needling at HT 5 for recovery of language function in aphasia.

An Unobtrusive Computerized Assessment Framework for Unilateral Peripheral Facial Paralysis.

Unilateral peripheral facial paralysis (UPFP) is a form of facial nerve paralysis and clinically classified according to conditions of facial symmetry. Prompt and precise assessment is crucial to neural rehabilitation of UPFP. The prevalent House-Brackmann (HB) grading system relies on subjective judgments with significant interobservation variation. Therefore, to explore an objective method for the UPFP assessment, clinical image sequences are captured using a web camera setup while 5 healthy and 27 UPFP subjects perform a group of predefined actions, including keeping expressionless, raising brows, closing eyes, bulging cheek, and showing teeth in turn. First, facial region is decided using Haar cascade classifier, and then landmark points are acquired by a supervised descent method. Second, these landmark points are used to generate a group of features reflecting the structural parameters of regions of eyebrows, eyes, nose, and mouth, respectively. Third, correlation coefficients are computed between the raw features HB scores. To reduce feature dimensions, only those with correlation coefficients larger than an empirically selected value, 0.35, are input into a support vector machine to generate a classifier. With the classifier, exact match (discrepancy = 0 between result from proposed method and HB scores) rate at 49.9%, and loose match (discrepancy = 1) rate at 87.97% are achieved on the experiment data. After sample augmentation, the final rate is increased to 90.01%, outperformed previous reports. In conclusion, it is demonstrated with an unobtrusive web camera setup, encouraging results have been generated with the proposed framework in this exploratory study.

Evaluation of normal swallowing functions by using dynamic high-density surface electromyography maps.

BACKGROUND: Swallowing is a continuous process with substantive interdependencies among different muscles, and it plays a significant role in our daily life. The aim of this study was to propose a novel technique based on high-density surface electromyography (HD sEMG) for the evaluation of normal swallowing functions. METHODS: A total of 96 electrodes were placed on the front neck to acquire myoelectric signals from 12 healthy subjects while they were performing different swallowing tasks. HD sEMG energy maps were constructed based on the root mean square values to visualize muscular activities during swallowing. The effects of different volumes, viscosities, and head postures on the normal swallowing process were systemically investigated by using the energy maps. RESULTS: The results showed that the HD sEMG energy maps could provide detailed spatial and temporal properties of the muscle electrical activity, and visualize the muscle contractions that closely related to the swallowing function. The energy maps also showed that the swallowing time and effort was also explicitly affected by the volume and viscosity of the bolus. The concentration of the muscular activities shifted to the opposite side when the subjects turned their head to either side. CONCLUSIONS: The proposed method could provide an alternative method to physiologically evaluate the dynamic characteristics of normal swallowing and had the advantage of providing a full picture of how different muscle activities cooperate in time and location. The findings from this study suggested that the HD sEMG technique might be a useful tool for fast screening and objective assessment of swallowing disorders or dysphagia.

Ultrasonic Measurement of Dynamic Muscle Behavior for Poststroke Hemiparetic Gait.

Quantitative evaluation of the hemiparesis status for a poststroke patient is still challenging. This study aims to measure and investigate the dynamic muscle behavior in poststroke hemiparetic gait using ultrasonography. Twelve hemiparetic patients walked on a treadmill, and EMG, joint angle, and ultrasonography were simultaneously recorded for the gastrocnemius medialis muscle. Pennation angle was automatically extracted from ultrasonography using a tracking algorithm reported previously. The characteristics of EMG, joint angle, and pennation angle in gait cycle were calculated for both (affected and unaffected) sides of lower limbs. The results suggest that pennation angle could work as an important morphological index to continuous muscle contraction. The change pattern of pennation angle between the affected and unaffected sides is different from that of EMG. These findings indicate that morphological parameter extracted from ultrasonography can provide different information from that provided by EMG for hemiparetic gait.

[Dynamic Estimation of Medial Gastrocnemius Activities in Post-stroke Hemiparetic Gait Using Ultrasonography].

Quantitative evaluation on the level of hemiparesis for post-stroke patients is still challenging. In this study, we proposed an innovative method for investigating in vivo muscle behavior in hemiparetic gait. A wearable data collection platform was developed for the simultaneous acquisition of ultrasonography (US), electromyography (EMG) and joint angle during gait cycles. Using this platform, we studied twelve hemiparetic patients during walking on a treadmill and analyzed the corresponding characteristics of their medial gastrocnemius (GM) muscle. Several interesting outputs are achieved such as the observation that dynamic ranges of the both the pennation angle (PA) of GM and EMG signal from same side were more diffused, for the affected side than for the unaffected side. The results suggested that the proposed multimodal signal acquisition and wearable platform is capable of providing comprehensive in vivo information regarding dynamics of ankle and medial gastrocnemius. The proposed platform could be a promising tool for the assessment of hemiparesis patients.

An efficient framework for estimation of muscle fiber orientation using ultrasonography.

BACKGROUND: Muscle fiber orientation (MFO) is an important parameter related to musculoskeletal functions. The traditional manual method for MFO estimation in sonograms was labor-intensive. The automatic methods proposed in recent years also involved voting procedures which were computationally expensive. METHODS: In this paper, we proposed a new framework to efficiently estimate MFO in sonograms. We firstly employed Multi-scale Vessel Enhancement Filtering (MVEF) to enhance fascicles in the sonograms and then the enhanced images were binarized. Finally, line-shaped patterns in the binary map were detected one by one, according to their shape properties. Specifically speaking, for the long-and-thinner regions, the orientation of the targeted muscle fibre was directly computed, without voting procedures, as the orientation of the ellipse that had the same normalized second central moments as the region. For other cases, the Hough voting procedure might be employed for orientation estimation. The performance of the algorithm was evaluated using four various group of sonograms, which are a dataset used in previous reports, 33 sonograms of gastrocnemius from 11 young healthy subjects, one sonogram sequence including 200 frames from a subject and 256 frames from an aged subject with cerebral infarction respectively. RESULTS: It was demonstrated in the experiments that measurements of the proposed method agreed well with those of the manual method and achieved much more efficiency than the previous Re-voting Hough Transform (RVHT) algorithm. CONCLUSIONS: Results of the experiments suggested that, without compromising the accuracy, in the proposed framework the previous orientation estimation algorithm was accelerated by reduction of its dependence on voting procedures.

MRI evaluation of metal acupuncture needles.

OBJECTIVE: To evaluate the MR compatibility of three metal acupuncture needles (a standard stainless steel needle, a gold needle and an austenitic stainless steel needle) by comparing their imaging artefacts, radiofrequency heating effects and ease of operation. METHODS: The MRI artefacts of the three metal needles were first evaluated by placing them in an agar gel phantom and performing MRI of the phantom. The increase in temperature during MRI was recorded using an MR-compatible fibreoptic thermometer. MRI of acupuncture at SP6 was performed using the MR-compatible gold needle and the austenitic stainless steel needle. RESULTS: The standard stainless steel acupuncture needle produced large imaging artefacts on MRI. The gold needle was superior for MRI but not rigid enough for some clinical applications such as scalp acupuncture. The austenitic stainless steel needle is non-ferromagnetic and compatible with MRI. None of these acupuncture needles introduced radiofrequency heating during MRI. CONCLUSIONS: The evaluation of MR compatibility showed that gold and austenitic stainless steel needles are MR-compatible and therefore can be used for MRI of acupuncture.

Human cord blood-derived mononuclear cell transplantation for viral encephalitis-associated cognitive impairment: a case report.

INTRODUCTION: Herpes simplex virus is the most common cause of sporadic viral encephalitis. Cognitive impairments persist in most patients who survive herpes simplex virus-caused encephalitis after undergoing currently available treatments. This is the first report on the development of human cord blood-derived mononuclear cell transplantation as a new treatment intervention to improve the prognosis of sequelae of viral encephalitis. CASE PRESENTATION: An 11-year-old Han Chinese boy developed sequelae of viral encephalitis with cognitive, mental and motor impairments in the 8 months following routine treatments. Since receiving allogeneic cord blood-derived mononuclear cell transplantation combined with comprehensive rehabilitation therapies 7 years ago, the patient's health has significantly improved and remained stable. CONCLUSIONS: Human cord blood-derived mononuclear cell transplantation may be a potential therapeutic strategy for treating the neuropsychiatric and neurobehavioral sequelae of viral encephalitis.

Human umbilical cord blood-derived mononuclear cell transplantation: case series of 30 subjects with hereditary ataxia.

BACKGROUND: The differential diagnosis for hereditary ataxia encompasses a variety of diseases characterized by both autosomal dominant and recessive inheritance. There are no curative treatments available for these neurodegenerative conditions. This open label treatment study used human umbilical cord blood-derived mononuclear cells (CBMC) combined with rehabilitation training as potential disease modulators. METHODS: 30 patients suffering from hereditary ataxia were treated with CBMCs administered systemically by intravenous infusion and intrathecally by either cervical or lumbar puncture. Primary endpoint measures were the Berg Balance Scale (BBS), serum markers of immunoglobulin and T-cell subsets, measured at baseline and pre-determined times post-treatment. RESULTS: A reduction of pathological symptoms and signs was shown following treatment. The BBS scores, IgG, IgA, total T cells and CD3+CD4 T cells all improved significantly compared to pre-treatment values (P < 0.01~0.001). There were no adverse events. CONCLUSION: The combination of CBMC infusion and rehabilitation training may be a safe and effective treatment for ataxia, which dramatically improves patients' functional symptoms. These data support expanded double blind, placebo-controlled studies for these treatment modalities.

Safety evaluation of allogeneic umbilical cord blood mononuclear cell therapy for degenerative conditions.

BACKGROUND: The current paradigm for cord blood transplantation is that HLA matching and immune suppression are strictly required to prevent graft versus host disease (GVHD). Immunological arguments and historical examples have been made that the use of cord blood for non-hematopoietic activities such as growth factor production, stimulation of angiogenesis, and immune modulation may not require matching or immune suppression. METHODS: 114 patients suffering from non-hematopoietic degenerative conditions were treated with non-matched, allogeneic cord blood. Doses of 1-3 x 10(7) cord blood mononuclear cells per treatment, with 4-5 treatments both intrathecal and intravenously were performed. Adverse events and hematological, immunological, and biochemical parameters were analyzed for safety evaluation. RESULTS: No serious adverse effects were reported. Hematological, immunological, and biochemical parameters did not deviate from normal ranges as a result of therapy. CONCLUSION: The current hematology-based paradigm of need for matching and immune suppression needs to be revisited when cord blood is used for non-hematopoietic regenerative purposes in immune competent recipients.