Background: Water weight-loss walking training is an emerging physical therapy technique, which provides new ideas for improving the motor function of stroke patients and improving the quality of life of patients. How...Background: Water weight-loss walking training is an emerging physical therapy technique, which provides new ideas for improving the motor function of stroke patients and improving the quality of life of patients. However, the rehabilitation effect of water weight-loss training in stroke patients is currently unclear. Objective: To analyze the effect of water weight loss walking training in stroke patients. Methods: A total of 180 stroke patients admitted to our hospital from January 2019 to December 2021 were selected and randomly divided into two groups. The control group received routine walking training, and the research group performed weight loss walking training in water on this basis. The lower limb motor function, muscle tone grade, daily living ability, gait and balance ability were compared between the two groups before and after treatment. Results: Compared with the control group, the FMA-LE score (Fugl-Meyer motor assessment of Lower Extremity), MBI score (Modified Barthel Index) and BBS score (berg balance scale) of the study group were higher after treatment, and the muscle tone was lower (P Conclusion: Water weight loss walking training can enhance patients’ muscle tension, correct patients’ abnormal gait, improve patients’ balance and walking ability, and contribute to patients’ motor function recovery and self-care ability improvement.展开更多
Major ozonated autohemotherapy is classically used in treating ischemic disorder of the lower limbs. In the present study, we performed major ozonated autohemotherapy treatment in patients with acute cerebral infarcti...Major ozonated autohemotherapy is classically used in treating ischemic disorder of the lower limbs. In the present study, we performed major ozonated autohemotherapy treatment in patients with acute cerebral infarction, and assessed outcomes according to the U.S. National Institutes of Health Stroke Score, Modified Rankin Scale, and transcranial magnetic stimulation motor-evoked potential. Compared with the control group, the clinical total effective rate and the cortical potential rise rate of the upper limbs were significantly higher, the central motor conduction time of upper limb was significantly shorter, and the upper limb motor-evoked potential amplitude was significantly increased, in the ozone group. In the ozone group, the National Institutes of Health Stroke Score was positively correlated with the central motor conduction time and the motor-evoked potential amplitude of the upper limb. Central motor conduction time and motor-evoked potential amplitude of the upper limb may be effective indicators of motor-evoked potentials to assess upper limb motor function in cerebral infarct patients. Furthermore, major ozonated autohemotherapy may promote motor function recovery of the upper limb in patients with acute cerebral infarction.展开更多
Studies have confirmed that low-frequency repetitive transcranial magnetic stimulation can decrease the activity of cortical neurons, and high-frequency repetitive transcranial magnetic stimulation can increase the ex...Studies have confirmed that low-frequency repetitive transcranial magnetic stimulation can decrease the activity of cortical neurons, and high-frequency repetitive transcranial magnetic stimulation can increase the excitability of cortical neurons. However, there are few studies concerning the use of different frequencies of repetitive transcranial magnetic stimulation on the recovery of upper-limb motor function after cerebral infarction. We hypothesized that different frequencies of repetitive transcranial magnetic stimulation in patients with cerebral infarction would produce different effects on the recovery of upper-limb motor function. This study enrolled 127 patients with upper-limb dysfunction during the subacute phase of cerebral infarction. These patients were randomly assigned to three groups. The low-frequency group comprised 42 patients who were treated with 1 Hz repetitive transcranial magnetic stimulation on the contralateral hemisphere primary motor cortex(M1). The high-frequency group comprised 43 patients who were treated with 10 Hz repetitive transcranial magnetic stimulation on ipsilateral M1. Finally, the sham group comprised 42 patients who were treated with 10 Hz of false stimulation on ipsilateral M1. A total of 135 seconds of stimulation was applied in the sham group and high-frequency group. At 2 weeks after treatment, cortical latency of motor-evoked potentials and central motor conduction time were significantly lower compared with before treatment. Moreover, motor function scores were significantly improved. The above indices for the low- and high-frequency groups were significantly different compared with the sham group. However, there was no significant difference between the low- and high-frequency groups. The results show that low- and high-frequency repetitive transcranial magnetic stimulation can similarly improve upper-limb motor function in patients with cerebral infarction.展开更多
Background:Virtual reality(VR)technology is increasingly used in stroke rehabilitation.This study aimed to investigate the effectiveness of using the glasses-free VR training to improve motor function of upper limb in...Background:Virtual reality(VR)technology is increasingly used in stroke rehabilitation.This study aimed to investigate the effectiveness of using the glasses-free VR training to improve motor function of upper limb in patients with stroke.Methods:Twelve patients with stroke were recruited to participate in the intervention of 3 weeks.At the baseline and post intervention,two times of evaluation including Fugl-Meyer upper-extremity scale(FMS-UE),transcranial magnetic stimulation(TMS)measurement and motion evaluation were performed.Results:No significant difference was observed between two groups at baseline evaluation.After the intervention,the FMS-UE scores presented a greater improvement in the VR group compared with the control group.TMS measurement showed that there was significant difference in cortex latency and central motor conduction time between two groups after the intervention,but no significant difference in the amplitude of motor event potential was observed.In addition,there was a significant correlation between game scores and FMS-UE scores.Conclusions:The novel glasses-free VR training was at least as effective as conventional occupational therapy in upper limb motor function,improving nerve conduction time and corticospinal excitability in patient with stroke.展开更多
BACKGROUND: Botulinum toxin type A (BTX-A) is mostly to be used to treat various diseases of motor disorders, whereas its effect on muscle spasm after stroke and brain injury needs further observation. OBJECTIVE: To o...BACKGROUND: Botulinum toxin type A (BTX-A) is mostly to be used to treat various diseases of motor disorders, whereas its effect on muscle spasm after stroke and brain injury needs further observation. OBJECTIVE: To observe the effect of BTX-A plus rehabilitative training on treating muscle spasm after stroke and brain injury. DESIGN: A randomized controlled observation. SETTINGS: Department of Rehabilitation, Department of Neurology and Department of Neurosurgery, the Second Hospital of Hebei Medical University. PARTICIPANTS: Sixty inpatients with brain injury and stroke were selected from the Department of Rehabilitation, Department of Neurology and Department of Neurosurgery, the Second Hospital of Hebei Medical University from January 2001 to August 2006. They were all confirmed by CT and MRI, and had obvious increase of spastic muscle strength in upper limbs, their Ashworth grades were grade 2 or above. The patients were randomly divided into treatment group (n =30) and control group (n =30). METHODS: ① Patients in the treatment group undertook comprehensive rehabilitative trainings, and they were administrated with domestic BTX-A, which was provided by Lanzhou Institute of Biological Products, Ministry of Health (S10970037), and the muscles of flexion spasm were selected for upper limbs, 20-25 IU for each site. ② Patients in the treatment group were assessed before injection and at 1 and 2 weeks, 1 and 3 months after injection respectively, and those in the control group were assessed at corresponding time points. The recovery of muscle spasm was assessed by modified Ashworth scale (MAS, grade 0-Ⅳ; Grade 0 for without increase of muscle strength; Grade Ⅳ for rigidity at passive flexion and extension); The recovery of motor function of the upper limbs was evaluated with Fugl-Meyer Assessment (FMA, total score was 226 points, including 100 for exercise, 14 for balance, 24 for sense, 44 for joint motion, 44 for pain and 66 for upper limb); The ADL were evaluated with Barthel index, the total score was 100 points, 60 for mild dysfunction, 60-41 for moderate dysfunction, < 40 for severe dysfunction). MAIN OUTCOME MEASURES: Changes of MAS grade, FMA scores and Barthel index before and after BTX-A injection. RESULTS: All the 60 patients with brain injury and stroke were involved in the analysis of results. ① FMA scores of upper limbs: The FMA score in the treatment group at 2 weeks after treatment was higher than that before treatment [(14.98±10.14), (13.10±9.28) points, P < 0.05], whereas there was no significant difference at corresponding time point in the control group. The FMA scores at 1 and 3 months in the treatment group [(23.36±10.69), (35.36±11.36) points] were higher than those in the control group [(20.55±10.22), (30.33±10.96) points, P < 0.01]. ② MAS grades of upper limbs: There were obviously fewer cases of grade Ⅲ in MAS at 2 weeks after treatment than before treatment in the treatment group (0, 9 cases, P < 0.05), whereas there was no obvious difference in the control group. There were obviously fewer cases of grade Ⅲ in MAS at 2 weeks and 1 month after treatment in the treatment group (0, 0 case) than the control group (5, 2 cases, P < 0.01). ③ Barthel index of upper limbs: The Barthel index at 2 weeks after treatment was higher than that before treatment in the treatment group [(30.36±22.25), (28.22±26.21) points, P < 0.05], whereas there was no significant difference in the control group. The Barthel indexes at 1 and 3 months after treatment in the treatment group were obviously higher than those in the control group [(20.55±10.22), (30.33±10.96) points, P < 0.01]. CONCLUSION: BTX-A has obvious efficacy on decreasing muscle tension after stroke and brain injury, and relieving muscle spasm; Meanwhile, the combination with rehabilitative training can effectively ameliorate the motor function of upper limbs and ADL of the patients.展开更多
Objective: To observe the effects of Xingnao Kaiqiao acupuncture(醒脑开窍针) on the motor function of upper limb and hand in the recovery period after stroke. Methods: Seventy-six cases of hemiplegia patients with isc...Objective: To observe the effects of Xingnao Kaiqiao acupuncture(醒脑开窍针) on the motor function of upper limb and hand in the recovery period after stroke. Methods: Seventy-six cases of hemiplegia patients with ischemic stroke were divided into the treatment group and the control group(n=38 in each). Based on the Brunnstrom's stage of Xingnao Kaiqiao acupuncture combined with rehabilitation training was used in the treatment group, and the control group was given rehabilitation training. FuglMeyer Assessment of the upper extremity(FMA-UE), Action Research Arm Test(ARAT) and Simple Test for Evaluating hand Function(STEF) were adopted separately to compare scores before treatment and 8 weeks after treatment. Results: The difference was not statistically significant in the two groups of patients for comparison of FMA-UE, ARAT and STEF scores before treatment(P>0.05). The difference was statistically significant in the two groups of score comparison of FMA-UE, ARAT and STEF after treatment(P<0.05). Conclusion: The Xingnao Kaiqiao acupuncture has its unique advantages in improving recovery of motor function of upper limb and hand in recovery period after stroke.展开更多
BACKGROUND: Temperature of axilla could be affected due to motor dysfunction of limbs and neural changes of vessel after ischemic stroke. OBJECTIVE: To observe the effect of percutaneous neuromuscular electric stimula...BACKGROUND: Temperature of axilla could be affected due to motor dysfunction of limbs and neural changes of vessel after ischemic stroke. OBJECTIVE: To observe the effect of percutaneous neuromuscular electric stimulation (PNES) on difference in temperature of axilla and analyze the relationship between function of limbs and difference in temperature of axilla. DESIGN: Randomized grouping and controlled observation. SETTING: Department of Neurology, General Hospital of Shenyang Military Area Command of Chinese PLA. PARTICIPANTS: Sixty patients with ischemic stroke were selected from Neurological Department of General Hospital of Shenyang Military Area Command of Chinese PLA from January to June 2003. All cases were diagnosed with clinical diagnosis criteria of ischemic stroke established by the Fourth Chinese Classification of Cerebrovasular Disease and CT examination and received neuromuscular electric stimulation (NES). Patients were randomly divided into control group and treatment group with 30 in each group. METHODS: Control group: Patients received routinely neurological therapy. Treatment group: Except routine therapy, patients suffered from NES at 48 hours after hospitalization. NMT-91 NES equipment was used to stimulated injured limbs with low frequency once 30 minutes a day in total of 10 times a course, especially extensor muscle of upper limb and flexor muscle of lower limb. Prescription of hemiplegia was internally decided by equipment with the output frequency of 200 Hz. Intensity of electric output could cause muscle contraction. The therapy needed two or three courses. Temperature of bilateral axilla was measured every day to calculate the difference with the formula of (temperature of axilla on the injured side - temperature of axilla on the healthy side). Motor function of limbs was measured with Fugl-Meyer Motor Assessment (FMA) during hospitalization and at 2 and 4 hours after hospitalization. Among 90 points, upper and lower limb function was 54, equilibrium function 10, sensory function 10, and motion of joint 16. The higher the scores were, the better the function was. Correlation of data was dealt with linear correlation analysis. MAIN OUTCOME MEASURES: Assessment and correlation between difference in temperature of axilla and motor function of injured limbs during hospitalization and at 2 and 4 weeks after hospitalization. RESULTS: All 60 patients with ischemic stroke were involved in the final analysis. ① Difference in temperature: Difference of 2 and 4 weeks after hospitalization was lower than that in control group and at just hospitalization [treatment group: (0.056±0.000), (0.024±0.003) ℃; control group: (0.250±0.001), (0.131±0.001) ℃; hospitalization: (0.513±0.001) ℃, P < 0.05-0.01]. ② FMA scores: Scores of 2 and 4 weeks after hospitalization were higher than those in control group and at just hospitalization [treatment group: (43.50±15.09), (67.97±18.21) points; control group: (33.33±13.54), (40.87±19.34) points; hospitalization: (26.43±11.87) points, P < 0.05-0.01]. ③ Correlation: Difference in temperature of axilla was negative correlation with FMA scores (r= -0.255 1, P < 0.05). CONCLUSION: ① PNES can accelerate recovery of limb function and decrease temperature of axilla of patients with ischemic stroke. ② The lower the difference in temperature is, the better the functional recovery is.展开更多
目的:研究双侧经颅直流电刺激(dual-hemispheric transcranial direct current stimulation,Dual-tDCS)对慢性期脑卒中患者上肢运动功能的影响,为治疗慢性期脑卒中上肢功能障碍提供基于神经机制的理论依据。方法:选取某院24例慢性期脑...目的:研究双侧经颅直流电刺激(dual-hemispheric transcranial direct current stimulation,Dual-tDCS)对慢性期脑卒中患者上肢运动功能的影响,为治疗慢性期脑卒中上肢功能障碍提供基于神经机制的理论依据。方法:选取某院24例慢性期脑卒中上肢运动功能障碍患者,按照随机数字表法将其分为研究组(n=13)和对照组(n=11)。对照组采用tDCS伪刺激联合常规康复治疗,研究组采用Dual-tDCS联合常规康复治疗。治疗前后,采用Fugl-Meyer运动功能评定量表上肢部分(Fugl-Meyer assessment upper limb scale,FMA-UL)及日常生活活动能力(activities of daily living,ADL)测评量表对患者活动能力进行评估。对比治疗前后初级运动皮层(M1区)与全脑功能连接(functional connectivity,FC)的变化。使用SPSS 24.0统计学软件进行数据分析。结果:治疗后,2组患者的FMA-UL、ADL评分比治疗前均显著提高,且研究组评分明显高于对照组,差异有统计学意义(P<0.05)。M1区与全脑FC分析显示,治疗后对照组健侧M1区到患侧枕中回、健侧舌回、健侧角回FC降低(P<0.01);患侧M1区未见FC变化脑区。治疗后研究组健侧M1区到健侧小脑、健侧小脑蚓部FC降低,到患侧中央前回FC增加(P<0.01);患侧M1区到患侧小脑、患侧颞中回FC增加,到健侧中央前回FC降低(P<0.01)。结论:Dual-tDCS对大脑的神经调控作用可改善慢性期卒中患者运动和非运动相关脑区的FC,可能是慢性期脑卒中上肢运动功能障碍的康复机制。展开更多
目的观察针刺联合镜像疗法治疗脑卒中患者上肢运动功能障碍的临床疗效。方法将90例脑卒中上肢运动功能障碍患者按随机数字表法分为对照1组(30例,给予针刺治疗)、对照2组(30例,给予镜像疗法治疗)和观察组(30例,给予针刺联合镜像疗法治疗)...目的观察针刺联合镜像疗法治疗脑卒中患者上肢运动功能障碍的临床疗效。方法将90例脑卒中上肢运动功能障碍患者按随机数字表法分为对照1组(30例,给予针刺治疗)、对照2组(30例,给予镜像疗法治疗)和观察组(30例,给予针刺联合镜像疗法治疗),疗程均为2周。比较3组患者治疗前后Fugl-Meyer评估量表上肢板块(Fugl-Meyer assessment upper extremity,FMA-UE)评分,Wolf运动功能测试(Wolf motor function test,WMFT)量表评分,改良Barthel指数(modified Barthel index,MBI),国际功能、残疾和健康分类(international classification of functioning,disability and health,ICF)评分及伸腕主动运动范围(active range of motion,AROM)和基于FMA-UE评分判定临床疗效。结果观察组临床疗效优于对照1组和对照2组(P<0.05);治疗后3组患者FMA-UE评分、WMFT评分、MBI均较治疗前显著增加(P<0.05),ICF评分显著减少(P<0.05),且观察组FMA-UE评分、WMFT评分、MBI增加程度,ICF评分减少程度显著大于对照1组和对照2组(P<0.05);治疗后观察组患者伸腕AROM显著大于对照1组和对照2组(P<0.05)。结论针刺联合镜像疗法能有效改善脑卒中患者上肢运动功能障碍。展开更多
目的探讨以针康法为主的中医整合康复技术对脑卒中后偏瘫患者的干预效果及对患者肢体肌力、肢体运动功能的影响。方法将医院针灸科、康复科收治的脑卒中后偏瘫患者90例纳入研究,随机分为对照组与中医整合康复组,各45例。两组均给予脑卒...目的探讨以针康法为主的中医整合康复技术对脑卒中后偏瘫患者的干预效果及对患者肢体肌力、肢体运动功能的影响。方法将医院针灸科、康复科收治的脑卒中后偏瘫患者90例纳入研究,随机分为对照组与中医整合康复组,各45例。两组均给予脑卒中常规西药治疗,对照组在此基础上给予常规康复训练,中医整合康复组在常规治疗基础上给予针康法、易筋经联合推拿治疗,共治疗8周后判定疗效。比较两组的中医证候积分,比较治疗前后患者肢体肌力[徒手肌力检查(Manual muscle testing,MMT)]、肌张力[改良Ashworth分级标准(MAS)]、肢体运动功能[Fug-Meyer运动功能量表(Fugl-Meyer assessment scale,FMA)]、神经功能[美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)]及生活质量[脑卒中专用生活质量量表(Stroke Specific Quality of Life,SS-QOL)]。彩色多普勒超声测定颈总动脉收缩期最大流速(Peak systolic velocity,PSV)、舒张末期最低流速(End diastolic velocity,EDV)及阻力指数(Resistance index,RI)等脑血流动力学参数。结果两组治疗后半身不遂、偏身麻木、口舌歪斜、言语謇涩、步履不稳、气短乏力等中医证候积分及总积分均较治疗前显著降低(P<0.05),中医整合康复组显著低于对照组(P<0.05)。中医整合康复组的显效率(51.1%,23/45)和有效率(95.5%,43/45)均明显优于对照组[24.4%(11/45)和82.2%(37/45)],组间比较差异有统计学意义(P<0.05)。两组治疗后MMT、FAM、SS-QOL评分及PSV、EDV值均较治疗前显著升高(P<0.05),中医整合康复组显著高于对照组(P<0.05);两组治疗后MAS、NIHSS评分及RI值均较治疗前显著降低(P<0.05),中医整合康复组显著低于对照组(P<0.05)。结论以针康法为主的中医整合康复技术治疗脑卒中后偏瘫效果显著,能够明显增强患者肢体肌力,降低肌张力,改善患者的肢体运动功能和神经功能,提高患者生活质量。展开更多
文摘Background: Water weight-loss walking training is an emerging physical therapy technique, which provides new ideas for improving the motor function of stroke patients and improving the quality of life of patients. However, the rehabilitation effect of water weight-loss training in stroke patients is currently unclear. Objective: To analyze the effect of water weight loss walking training in stroke patients. Methods: A total of 180 stroke patients admitted to our hospital from January 2019 to December 2021 were selected and randomly divided into two groups. The control group received routine walking training, and the research group performed weight loss walking training in water on this basis. The lower limb motor function, muscle tone grade, daily living ability, gait and balance ability were compared between the two groups before and after treatment. Results: Compared with the control group, the FMA-LE score (Fugl-Meyer motor assessment of Lower Extremity), MBI score (Modified Barthel Index) and BBS score (berg balance scale) of the study group were higher after treatment, and the muscle tone was lower (P Conclusion: Water weight loss walking training can enhance patients’ muscle tension, correct patients’ abnormal gait, improve patients’ balance and walking ability, and contribute to patients’ motor function recovery and self-care ability improvement.
基金supported by the Guangdong Province Medical Science Research Fund, No. B200258
文摘Major ozonated autohemotherapy is classically used in treating ischemic disorder of the lower limbs. In the present study, we performed major ozonated autohemotherapy treatment in patients with acute cerebral infarction, and assessed outcomes according to the U.S. National Institutes of Health Stroke Score, Modified Rankin Scale, and transcranial magnetic stimulation motor-evoked potential. Compared with the control group, the clinical total effective rate and the cortical potential rise rate of the upper limbs were significantly higher, the central motor conduction time of upper limb was significantly shorter, and the upper limb motor-evoked potential amplitude was significantly increased, in the ozone group. In the ozone group, the National Institutes of Health Stroke Score was positively correlated with the central motor conduction time and the motor-evoked potential amplitude of the upper limb. Central motor conduction time and motor-evoked potential amplitude of the upper limb may be effective indicators of motor-evoked potentials to assess upper limb motor function in cerebral infarct patients. Furthermore, major ozonated autohemotherapy may promote motor function recovery of the upper limb in patients with acute cerebral infarction.
基金several colleague therapists of the Rehabilitation Medicine Department of the Affiliated Hospital of Qingdao University of China for their support and selfless help
文摘Studies have confirmed that low-frequency repetitive transcranial magnetic stimulation can decrease the activity of cortical neurons, and high-frequency repetitive transcranial magnetic stimulation can increase the excitability of cortical neurons. However, there are few studies concerning the use of different frequencies of repetitive transcranial magnetic stimulation on the recovery of upper-limb motor function after cerebral infarction. We hypothesized that different frequencies of repetitive transcranial magnetic stimulation in patients with cerebral infarction would produce different effects on the recovery of upper-limb motor function. This study enrolled 127 patients with upper-limb dysfunction during the subacute phase of cerebral infarction. These patients were randomly assigned to three groups. The low-frequency group comprised 42 patients who were treated with 1 Hz repetitive transcranial magnetic stimulation on the contralateral hemisphere primary motor cortex(M1). The high-frequency group comprised 43 patients who were treated with 10 Hz repetitive transcranial magnetic stimulation on ipsilateral M1. Finally, the sham group comprised 42 patients who were treated with 10 Hz of false stimulation on ipsilateral M1. A total of 135 seconds of stimulation was applied in the sham group and high-frequency group. At 2 weeks after treatment, cortical latency of motor-evoked potentials and central motor conduction time were significantly lower compared with before treatment. Moreover, motor function scores were significantly improved. The above indices for the low- and high-frequency groups were significantly different compared with the sham group. However, there was no significant difference between the low- and high-frequency groups. The results show that low- and high-frequency repetitive transcranial magnetic stimulation can similarly improve upper-limb motor function in patients with cerebral infarction.
基金This study was supported by National Natural Science Foundation of China(Nos.31771016,32071316,and 81971224)partly supported by Guangdong Basic and Applied Basic Research Foundation(No.2020A1515011356)+1 种基金Guangzhou Research Collaborative Innovation Projects(No.201907010034)the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences(No.2020-JKCS005).
文摘Background:Virtual reality(VR)technology is increasingly used in stroke rehabilitation.This study aimed to investigate the effectiveness of using the glasses-free VR training to improve motor function of upper limb in patients with stroke.Methods:Twelve patients with stroke were recruited to participate in the intervention of 3 weeks.At the baseline and post intervention,two times of evaluation including Fugl-Meyer upper-extremity scale(FMS-UE),transcranial magnetic stimulation(TMS)measurement and motion evaluation were performed.Results:No significant difference was observed between two groups at baseline evaluation.After the intervention,the FMS-UE scores presented a greater improvement in the VR group compared with the control group.TMS measurement showed that there was significant difference in cortex latency and central motor conduction time between two groups after the intervention,but no significant difference in the amplitude of motor event potential was observed.In addition,there was a significant correlation between game scores and FMS-UE scores.Conclusions:The novel glasses-free VR training was at least as effective as conventional occupational therapy in upper limb motor function,improving nerve conduction time and corticospinal excitability in patient with stroke.
基金a grant from the Tackle Key Problem and Planning Projectin Science and Technology of Hebei Province,No.052761224
文摘BACKGROUND: Botulinum toxin type A (BTX-A) is mostly to be used to treat various diseases of motor disorders, whereas its effect on muscle spasm after stroke and brain injury needs further observation. OBJECTIVE: To observe the effect of BTX-A plus rehabilitative training on treating muscle spasm after stroke and brain injury. DESIGN: A randomized controlled observation. SETTINGS: Department of Rehabilitation, Department of Neurology and Department of Neurosurgery, the Second Hospital of Hebei Medical University. PARTICIPANTS: Sixty inpatients with brain injury and stroke were selected from the Department of Rehabilitation, Department of Neurology and Department of Neurosurgery, the Second Hospital of Hebei Medical University from January 2001 to August 2006. They were all confirmed by CT and MRI, and had obvious increase of spastic muscle strength in upper limbs, their Ashworth grades were grade 2 or above. The patients were randomly divided into treatment group (n =30) and control group (n =30). METHODS: ① Patients in the treatment group undertook comprehensive rehabilitative trainings, and they were administrated with domestic BTX-A, which was provided by Lanzhou Institute of Biological Products, Ministry of Health (S10970037), and the muscles of flexion spasm were selected for upper limbs, 20-25 IU for each site. ② Patients in the treatment group were assessed before injection and at 1 and 2 weeks, 1 and 3 months after injection respectively, and those in the control group were assessed at corresponding time points. The recovery of muscle spasm was assessed by modified Ashworth scale (MAS, grade 0-Ⅳ; Grade 0 for without increase of muscle strength; Grade Ⅳ for rigidity at passive flexion and extension); The recovery of motor function of the upper limbs was evaluated with Fugl-Meyer Assessment (FMA, total score was 226 points, including 100 for exercise, 14 for balance, 24 for sense, 44 for joint motion, 44 for pain and 66 for upper limb); The ADL were evaluated with Barthel index, the total score was 100 points, 60 for mild dysfunction, 60-41 for moderate dysfunction, < 40 for severe dysfunction). MAIN OUTCOME MEASURES: Changes of MAS grade, FMA scores and Barthel index before and after BTX-A injection. RESULTS: All the 60 patients with brain injury and stroke were involved in the analysis of results. ① FMA scores of upper limbs: The FMA score in the treatment group at 2 weeks after treatment was higher than that before treatment [(14.98±10.14), (13.10±9.28) points, P < 0.05], whereas there was no significant difference at corresponding time point in the control group. The FMA scores at 1 and 3 months in the treatment group [(23.36±10.69), (35.36±11.36) points] were higher than those in the control group [(20.55±10.22), (30.33±10.96) points, P < 0.01]. ② MAS grades of upper limbs: There were obviously fewer cases of grade Ⅲ in MAS at 2 weeks after treatment than before treatment in the treatment group (0, 9 cases, P < 0.05), whereas there was no obvious difference in the control group. There were obviously fewer cases of grade Ⅲ in MAS at 2 weeks and 1 month after treatment in the treatment group (0, 0 case) than the control group (5, 2 cases, P < 0.01). ③ Barthel index of upper limbs: The Barthel index at 2 weeks after treatment was higher than that before treatment in the treatment group [(30.36±22.25), (28.22±26.21) points, P < 0.05], whereas there was no significant difference in the control group. The Barthel indexes at 1 and 3 months after treatment in the treatment group were obviously higher than those in the control group [(20.55±10.22), (30.33±10.96) points, P < 0.01]. CONCLUSION: BTX-A has obvious efficacy on decreasing muscle tension after stroke and brain injury, and relieving muscle spasm; Meanwhile, the combination with rehabilitative training can effectively ameliorate the motor function of upper limbs and ADL of the patients.
基金Shandong Province Traditional Chinese Medicine Technology Development Program。
文摘Objective: To observe the effects of Xingnao Kaiqiao acupuncture(醒脑开窍针) on the motor function of upper limb and hand in the recovery period after stroke. Methods: Seventy-six cases of hemiplegia patients with ischemic stroke were divided into the treatment group and the control group(n=38 in each). Based on the Brunnstrom's stage of Xingnao Kaiqiao acupuncture combined with rehabilitation training was used in the treatment group, and the control group was given rehabilitation training. FuglMeyer Assessment of the upper extremity(FMA-UE), Action Research Arm Test(ARAT) and Simple Test for Evaluating hand Function(STEF) were adopted separately to compare scores before treatment and 8 weeks after treatment. Results: The difference was not statistically significant in the two groups of patients for comparison of FMA-UE, ARAT and STEF scores before treatment(P>0.05). The difference was statistically significant in the two groups of score comparison of FMA-UE, ARAT and STEF after treatment(P<0.05). Conclusion: The Xingnao Kaiqiao acupuncture has its unique advantages in improving recovery of motor function of upper limb and hand in recovery period after stroke.
基金a grant from Military Tenth Five-Year Key Research Project Foundation, No. mymjzyy 010
文摘BACKGROUND: Temperature of axilla could be affected due to motor dysfunction of limbs and neural changes of vessel after ischemic stroke. OBJECTIVE: To observe the effect of percutaneous neuromuscular electric stimulation (PNES) on difference in temperature of axilla and analyze the relationship between function of limbs and difference in temperature of axilla. DESIGN: Randomized grouping and controlled observation. SETTING: Department of Neurology, General Hospital of Shenyang Military Area Command of Chinese PLA. PARTICIPANTS: Sixty patients with ischemic stroke were selected from Neurological Department of General Hospital of Shenyang Military Area Command of Chinese PLA from January to June 2003. All cases were diagnosed with clinical diagnosis criteria of ischemic stroke established by the Fourth Chinese Classification of Cerebrovasular Disease and CT examination and received neuromuscular electric stimulation (NES). Patients were randomly divided into control group and treatment group with 30 in each group. METHODS: Control group: Patients received routinely neurological therapy. Treatment group: Except routine therapy, patients suffered from NES at 48 hours after hospitalization. NMT-91 NES equipment was used to stimulated injured limbs with low frequency once 30 minutes a day in total of 10 times a course, especially extensor muscle of upper limb and flexor muscle of lower limb. Prescription of hemiplegia was internally decided by equipment with the output frequency of 200 Hz. Intensity of electric output could cause muscle contraction. The therapy needed two or three courses. Temperature of bilateral axilla was measured every day to calculate the difference with the formula of (temperature of axilla on the injured side - temperature of axilla on the healthy side). Motor function of limbs was measured with Fugl-Meyer Motor Assessment (FMA) during hospitalization and at 2 and 4 hours after hospitalization. Among 90 points, upper and lower limb function was 54, equilibrium function 10, sensory function 10, and motion of joint 16. The higher the scores were, the better the function was. Correlation of data was dealt with linear correlation analysis. MAIN OUTCOME MEASURES: Assessment and correlation between difference in temperature of axilla and motor function of injured limbs during hospitalization and at 2 and 4 weeks after hospitalization. RESULTS: All 60 patients with ischemic stroke were involved in the final analysis. ① Difference in temperature: Difference of 2 and 4 weeks after hospitalization was lower than that in control group and at just hospitalization [treatment group: (0.056±0.000), (0.024±0.003) ℃; control group: (0.250±0.001), (0.131±0.001) ℃; hospitalization: (0.513±0.001) ℃, P < 0.05-0.01]. ② FMA scores: Scores of 2 and 4 weeks after hospitalization were higher than those in control group and at just hospitalization [treatment group: (43.50±15.09), (67.97±18.21) points; control group: (33.33±13.54), (40.87±19.34) points; hospitalization: (26.43±11.87) points, P < 0.05-0.01]. ③ Correlation: Difference in temperature of axilla was negative correlation with FMA scores (r= -0.255 1, P < 0.05). CONCLUSION: ① PNES can accelerate recovery of limb function and decrease temperature of axilla of patients with ischemic stroke. ② The lower the difference in temperature is, the better the functional recovery is.
文摘目的:研究双侧经颅直流电刺激(dual-hemispheric transcranial direct current stimulation,Dual-tDCS)对慢性期脑卒中患者上肢运动功能的影响,为治疗慢性期脑卒中上肢功能障碍提供基于神经机制的理论依据。方法:选取某院24例慢性期脑卒中上肢运动功能障碍患者,按照随机数字表法将其分为研究组(n=13)和对照组(n=11)。对照组采用tDCS伪刺激联合常规康复治疗,研究组采用Dual-tDCS联合常规康复治疗。治疗前后,采用Fugl-Meyer运动功能评定量表上肢部分(Fugl-Meyer assessment upper limb scale,FMA-UL)及日常生活活动能力(activities of daily living,ADL)测评量表对患者活动能力进行评估。对比治疗前后初级运动皮层(M1区)与全脑功能连接(functional connectivity,FC)的变化。使用SPSS 24.0统计学软件进行数据分析。结果:治疗后,2组患者的FMA-UL、ADL评分比治疗前均显著提高,且研究组评分明显高于对照组,差异有统计学意义(P<0.05)。M1区与全脑FC分析显示,治疗后对照组健侧M1区到患侧枕中回、健侧舌回、健侧角回FC降低(P<0.01);患侧M1区未见FC变化脑区。治疗后研究组健侧M1区到健侧小脑、健侧小脑蚓部FC降低,到患侧中央前回FC增加(P<0.01);患侧M1区到患侧小脑、患侧颞中回FC增加,到健侧中央前回FC降低(P<0.01)。结论:Dual-tDCS对大脑的神经调控作用可改善慢性期卒中患者运动和非运动相关脑区的FC,可能是慢性期脑卒中上肢运动功能障碍的康复机制。
文摘目的观察针刺联合镜像疗法治疗脑卒中患者上肢运动功能障碍的临床疗效。方法将90例脑卒中上肢运动功能障碍患者按随机数字表法分为对照1组(30例,给予针刺治疗)、对照2组(30例,给予镜像疗法治疗)和观察组(30例,给予针刺联合镜像疗法治疗),疗程均为2周。比较3组患者治疗前后Fugl-Meyer评估量表上肢板块(Fugl-Meyer assessment upper extremity,FMA-UE)评分,Wolf运动功能测试(Wolf motor function test,WMFT)量表评分,改良Barthel指数(modified Barthel index,MBI),国际功能、残疾和健康分类(international classification of functioning,disability and health,ICF)评分及伸腕主动运动范围(active range of motion,AROM)和基于FMA-UE评分判定临床疗效。结果观察组临床疗效优于对照1组和对照2组(P<0.05);治疗后3组患者FMA-UE评分、WMFT评分、MBI均较治疗前显著增加(P<0.05),ICF评分显著减少(P<0.05),且观察组FMA-UE评分、WMFT评分、MBI增加程度,ICF评分减少程度显著大于对照1组和对照2组(P<0.05);治疗后观察组患者伸腕AROM显著大于对照1组和对照2组(P<0.05)。结论针刺联合镜像疗法能有效改善脑卒中患者上肢运动功能障碍。
文摘目的探讨以针康法为主的中医整合康复技术对脑卒中后偏瘫患者的干预效果及对患者肢体肌力、肢体运动功能的影响。方法将医院针灸科、康复科收治的脑卒中后偏瘫患者90例纳入研究,随机分为对照组与中医整合康复组,各45例。两组均给予脑卒中常规西药治疗,对照组在此基础上给予常规康复训练,中医整合康复组在常规治疗基础上给予针康法、易筋经联合推拿治疗,共治疗8周后判定疗效。比较两组的中医证候积分,比较治疗前后患者肢体肌力[徒手肌力检查(Manual muscle testing,MMT)]、肌张力[改良Ashworth分级标准(MAS)]、肢体运动功能[Fug-Meyer运动功能量表(Fugl-Meyer assessment scale,FMA)]、神经功能[美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)]及生活质量[脑卒中专用生活质量量表(Stroke Specific Quality of Life,SS-QOL)]。彩色多普勒超声测定颈总动脉收缩期最大流速(Peak systolic velocity,PSV)、舒张末期最低流速(End diastolic velocity,EDV)及阻力指数(Resistance index,RI)等脑血流动力学参数。结果两组治疗后半身不遂、偏身麻木、口舌歪斜、言语謇涩、步履不稳、气短乏力等中医证候积分及总积分均较治疗前显著降低(P<0.05),中医整合康复组显著低于对照组(P<0.05)。中医整合康复组的显效率(51.1%,23/45)和有效率(95.5%,43/45)均明显优于对照组[24.4%(11/45)和82.2%(37/45)],组间比较差异有统计学意义(P<0.05)。两组治疗后MMT、FAM、SS-QOL评分及PSV、EDV值均较治疗前显著升高(P<0.05),中医整合康复组显著高于对照组(P<0.05);两组治疗后MAS、NIHSS评分及RI值均较治疗前显著降低(P<0.05),中医整合康复组显著低于对照组(P<0.05)。结论以针康法为主的中医整合康复技术治疗脑卒中后偏瘫效果显著,能够明显增强患者肢体肌力,降低肌张力,改善患者的肢体运动功能和神经功能,提高患者生活质量。
