Purpose: This study focused on maintaining and improving the walking function of late-stage older individuals while longitudinally tracking the effects of regular exercise programs in a day-care service specialized fo...Purpose: This study focused on maintaining and improving the walking function of late-stage older individuals while longitudinally tracking the effects of regular exercise programs in a day-care service specialized for preventive care over 5 years, using detailed gait function measurements with an accelerometer-based system. Methods: Seventy individuals (17 male and 53 female) of a daycare service in Tokyo participated in a weekly exercise program, meeting 1 - 2 times. The average age of the participants at the start of the program was 81.4 years. Gait function, including gait speed, stride length, root mean square (RMS) of acceleration, gait cycle time and its standard deviation, and left-right difference in stance time, was evaluated every 6 months. Results: Gait speed and stride length improved considerably within six months of starting the exercise program, confirming an initial improvement in gait function. This suggests that regular exercise programs can maintain or improve gait function even age groups that predictably have a gradual decline in gait ability due to enhanced age. In the long term, many indicators tended to approach baseline values. However, the exercise program seemingly counteracts age-related changes in gait function and maintains a certain level of function. Conclusions: While a decline in gait ability with aging is inevitable, establishing appropriate exercise habits in late-stage older individuals may contribute to long-term maintenance of gait function.展开更多
Stroke survivors often present with abnormal gait, movement training can improve the walking performance post-stroke, and functional MRI can objectively evaluate the brain functions before and after movement training....Stroke survivors often present with abnormal gait, movement training can improve the walking performance post-stroke, and functional MRI can objectively evaluate the brain functions before and after movement training. This paper analyzes the functional MRI changes in patients with ischemic stroke after treadmill training with voluntary and passive ankle dorsiflexion. Functional MRI showed that there are some changes in some regions of patients with ischemic stroke including primary sensorimotor cortex, supplementary motor area and cingulate motor area after treadmill training. These findings suggest that treadmill training likely improves ischemic stroke patients＇ lower limb functions and gait performance and promotes stroke recovery by changing patients＇ brain plasticity; meanwhile, the novel treadmill training methods can better training effects.展开更多
BACKGROUND Dystonic gait(DG) is one of clinical symptoms associated with functional dystonia in the functional movement disorders(FMDs). Dystonia is often initiated or worsened by voluntary action and associated with ...BACKGROUND Dystonic gait(DG) is one of clinical symptoms associated with functional dystonia in the functional movement disorders(FMDs). Dystonia is often initiated or worsened by voluntary action and associated with overflow muscle activation. There is no report for DG in FMDs caused by an abnormal pattern in the ankle muscle recruitment strategy during gait.CASE SUMMARY A 52-year-old male patient presented with persistent limping gait. When we requested him to do dorsiflexion and plantar flexion of his ankle in the standing and seating positions, we didn’t see any abnormality. However, we could see the DG during the gait. There were no evidences of common peroneal neuropathy and L5 radiculopathy in the electrodiagnostic study. Magnetic resonance imaging of the lumbar spine, lower leg, and brain had no definite finding. No specific finding was seen in the neurologic examination. For further evaluation, a wireless surface electromyography(EMG) was performed. During the gait, EMG amplitude of left medial and lateral gastrocnemius(GCM) muscles was larger than right medial and lateral GCM muscles. When we analyzed EMG signals for each muscle, there were EMG bursts of double-contraction in the left medial and lateral GCM muscles, while EMG analysis of right medial and lateral GCM muscles noted regular bursts of single contraction. We could find a cause of DG in FMDs.CONCLUSION We report an importance of a wireless surface EMG, in which other examination didn’t reveal the cause of DG in FMDs.展开更多
Duchenne muscular dystrophy (DMD) is a genetic disorder linked to chromosome Xp21, due to absence of dystrophin production. It is clinically characterized by progressive muscle weakness, fatigue, and development of jo...Duchenne muscular dystrophy (DMD) is a genetic disorder linked to chromosome Xp21, due to absence of dystrophin production. It is clinically characterized by progressive muscle weakness, fatigue, and development of joint contractures that compromise general motor functionality, mainly the gait. Objective: To characterize the motor function and decrease gait in children with DMD using the Portuguese version of the Motor Function Measure scale (MFM-P). Methods: A review of medical records including chronological age and scores from MFM-P of children with a DMD who attended at the Neuromuscular Diseases Clinic at Campinas State University (UNICAMP), Brazil was performed in this study. A total of 36 medical records of male patients with confirmed clinical diagnosis of DMD, ambulatory or not, regardless of age;excluding those with other associated diseases or other types of muscular dystrophies were selected. Data were analyzed using Kolmogorov-Smirnov and Spearman correlation statistical tests. Results: Analysis of all data collected showed that 75% of our sample had D1 scores lower than 41.02%. There was a linear relationship between the scores of D2 and D3, but no association between D2 and D1 scores was noted. D1 score was between 40% and 80% in those patients presenting D2 scores between 80% and 100%. In all cases patients with low total score presented a greater risk for loss of gait and their functionality. Conclusion: The standing posture and the postural transfers were the worst activities observed in children with DMD, with positive correlation between proximal and distal motor function. Even with high scores according MFM-P in proximal function, the children showed strong predictors for loss of gait.展开更多
<strong><span style="font-family:Verdana;">INTRODUCTION</span></strong><span><span><span style="font-family:;" "=""><span style="fon...<strong><span style="font-family:Verdana;">INTRODUCTION</span></strong><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">:</span><span style="font-family:Verdana;"> Gait asymmetry can become very pronounced in patie</span></span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">nts who have suffered a stroke. The impairment of trunk function in some stroke patients can restrict thorax mobility and cause respiratory muscle weakness. Trunk and neck dysfunction are believed to affect the gait in stroke patients. </span><b><span style="font-family:Verdana;">OBJECTIVE</span></b><span style="font-family:Verdana;">: This study aimed to investigate the relationship between gait asymmetry and respiratory function in stroke patients by measuring the step time and trunk acceleration. </span><b><span style="font-family:Verdana;">METHODS</span></b><span style="font-family:Verdana;">: This study employed a cross-sec</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">- </span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">tional design. Thirty stroke patients participated in this study. The symmetry index (SI) and Lissajous index (LI) were used to evaluate asymmetry during walking. The respiratory function and respiratory muscle strength were eva</span><span style="font-family:Verdana;">luated by spirometry. We examined the relation between SI or LI and the res</span><span style="font-family:Verdana;">piratory function/respiratory muscle strength in patients with stroke. </span><b><span style="font-family:Verdana;">RE</span></b></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">- </span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">SULTS</span></b></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">: The results of our analysis demonstrated that the SI was significantly correlated with the inspiratory and expiratory muscle strength and the </span><span><span style="font-family:Verdana;">LI was significantly correlated with the percentage of the predicted vital capacity (respectively, r = <span style="white-space:nowrap;">﹣</span>0.386, r = <span style="white-space:nowrap;">﹣</span>0.392, r = <span style="white-space:nowrap;">﹣</span>0.446;p < 0.05). </span><b><span style="font-family:Verdana;">CONCLUSION</span></b><span style="font-family:Verdana;">: </span></span><span style="font-family:Verdana;">The present study is the first to indicate a relationship between gait asymmetry and respiratory function in stroke patients.</span></span></span></span>展开更多
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
The three-phase Enriched Environment(EE)paradigm has been shown to promote post-stroke functional improvement,but the neuronal mechanisms are still unclear.In this study,we applied a multimodal neuroimaging protocol c...The three-phase Enriched Environment(EE)paradigm has been shown to promote post-stroke functional improvement,but the neuronal mechanisms are still unclear.In this study,we applied a multimodal neuroimaging protocol combining magnetic resonance imaging(MRI)and positron emission tomography(PET)to examine the effects of post-ischemic EE treatment on structural and functional neuroplasticity in the bilateral sensorimotor cortex.Rats were subjected to permanent middle cerebral artery occlusion.The motor function of the rats was examined using the DigiGait test.MRI was applied to investigate the EE-induced structural modifications of the bilateral sensorimotor cortex.[^(18)F]-fluorodeoxyglucose PET was used to detect glucose metabolism.Blood oxygen level-dependent(BOLD)-functional MRI(fMRI)was used to identify the regional brain activity and functional connectivity(FC).In addition,the expression of neuroplasticity-related signaling pathways including neurotrophic factors(BDNF/CREB),axonal guidance proteins(Robo1/Slit2),and axonal growth-inhibitory proteins(NogoA/NgR)as well as downstream proteins(RhoA/ROCK)in the bilateral sensorimotor cortex were measured by Western blots.Our results showed the three-phase EE improved the walking ability.Structural T2 mapping imaging and diffusion tensor imaging demonstrated that EE benefited structure integrity in the bilateral sensorimotor cortex.PET-MRI fused images showed improved glucose metabolism in the corresponding regions after EE intervention.Specifically,the BOLD-based amplitude of low-frequency fluctuations showed that EE increased spontaneous activity in the bilateral motor cortex and ipsilateral sensory cortex.In addition,FC results showed increased sensorimotor connectivity in the ipsilateral hemisphere and increased interhemispheric motor cortical connectivity and motor cortical-thalamic connectivity following EE intervention.In addition,a strong correlation was found between increased functional connectivity and improved motor performance of limbs.Specifically,EE regulated the expression of neuroplasticity-related signaling,involving BDNF/CREB,Slit2/Robo1,as well as the axonal growth–inhibitory pathways Nogo-A/Nogo receptor and RhoA/ROCK in the bilateral sensorimotor cortex.Our results indicated that the three-phase enriched environment paradigm enhances neuronal plasticity of the bilateral sensorimotor cortex and consequently ameliorates post-stroke gait deficits.These findings might provide some new clues for the development of EE and thus facilitate the clinical translation of EE.展开更多
The corticoreticular tract （CRT） is known to be involved in walking and postural control. Using diffusion tensor tractography （DTT）, we investigated the relationship between the CRT and gait dysfunction, includ- i...The corticoreticular tract （CRT） is known to be involved in walking and postural control. Using diffusion tensor tractography （DTT）, we investigated the relationship between the CRT and gait dysfunction, includ- ing trunk instability, in pediatric patients. Thirty patients with delayed development and 15 age-matched, typically-developed （TD） children were recruited. Fifteen patients with gait dysfunction （bilateral trunk instability） were included in the group A, and the other 15 patients with gait dysfunction （unilateral trunk instability） were included in the group B. The Growth Motor Function Classification System, Functional Ambulation Category scale, and Functional Ambulation Category scale were used for measurement of functional state. Fractional anisotropy, apparent diffusion coefficient, fiber number, and tract integrity of the CRT and corticospinal tract were measured. Diffusion parameters or integrity of corticospinal tract were not significantly different in the three study groups. However, CRT results revealed that both CRTs were disrupted in the group A, whereas CRT disruption in the hemispheres contralateral to clinical mani- festations was observed in the group B. Fractional anisotropy values and fiber numbers in both CRTs were decreased in the group A than in the group TD. The extents of decreases of fractional anisotropy values and fiber numbers on the ipsilateral side relative to those on the contralateral side were greater in the group B than in the group TD. Functional evaluation data and clinical manifestations were found to show strong correlations with CRT status, rather than with corticospinal tract status. These findings suggest that CRT status appears to be clinically important for gait function and trunk stability in pediatric patients and DTT can help assess CRT status in pediatric patients with gait dysfunction.展开更多
目的:运用Meta分析方法系统评价康复外骨骼机器人对脑卒中患者下肢运动功能的康复疗效,并比较不同下肢外骨骼机器人的疗效差异,为脑卒中下肢运动功能障碍患者选择适合的外骨骼机器人提供科学理论依据。方法:计算机检索Cochrane Library...目的:运用Meta分析方法系统评价康复外骨骼机器人对脑卒中患者下肢运动功能的康复疗效,并比较不同下肢外骨骼机器人的疗效差异,为脑卒中下肢运动功能障碍患者选择适合的外骨骼机器人提供科学理论依据。方法:计算机检索Cochrane Library、PubMed、Web of Science、Embase、中国知网、维普和万方数据库的相关文献,收集从建库至2022年11月发表的关于探讨下肢康复外骨骼机器人改善脑卒中患者下肢运动功能的随机对照临床试验。由2名研究人员进行文献检索与筛选,使用Cochrane 5.1.0偏倚风险评估工具和Jadad量表对纳入文献进行质量评价。采用RevMan 5.4和Stata 17.0软件对结局指标进行Meta分析。结果:①最终纳入22篇文献,Jadad评分显示均为高质量文献,共865例患者,试验组436例、对照组429例。②Meta分析结果显示,与对照组相比,外骨骼机器人可显著提高脑卒中患者下肢运动功能(Fugl-Meyer Assessment of Lower Extremity,FMA-LE)评分(MD=2.63,95%CI:1.87-3.38,P<0.05)、平衡功能(Berg Balance Scale,BBS)评分(MD=3.62,95%CI:1.21-6.03,P<0.05)、站起-走测试量表(Timed Up and Go,TUG)评分(MD=-2.77,95%CI:-4.48至-1.05,P<0.05)和步频(MD=3.15,95%CI:1.57-4.72,P<0.05),但对功能性步行量表(Functional Ambulation Category Scale,FAC)评分(MD=0.30,95%CI:-0.01-0.61,P>0.05)和6 min步行测试(6-minute walk test,6MWT)评分(MD=3.77,95%CI:-6.60-14.14,P>0.05)的提高不明显。③网状Meta分析结果显示,FMA-LE评分:平地行走式外骨骼(MD=10.23,95%CI:3.81-27.49,P<0.05)和减重式外骨骼(MD=33.66,95%CI:11.49-98.54,P<0.05)与常规康复治疗相比均能改善FMA-LE评分,排序结果为减重式外骨骼>平地行走式外骨骼>常规康复治疗;BBS评分:减重式外骨骼(MD=79.86,95%CI:2.34-2725.99,P<0.05)与常规康复治疗相比能显著改善BBS评分,排序结果为减重式外骨骼>平地行走式外骨骼>常规康复治疗;FAC评分:平地行走式外骨骼(MD=1.38,95%CI:1.00-1.90,P<0.05)与常规康复治疗相比能显著改善FAC评分,排序结果为平地行走式外骨骼>减重式外骨骼>常规康复治疗;TUG评分:减重式外骨骼与常规康复治疗相比(MD=0.07,95%CI:0.01-0.51,P<0.05)能显著改善TUG评分,排序结果为平地行走式外骨骼>减重式外骨骼>常规康复治疗。结论:康复外骨骼机器人可以改善脑卒中患者平衡、步行以及日常生活活动能力,其中减重式外骨骼在提高下肢运动功能和平衡功能方面疗效更优,平地行走式外骨骼在提高功能性步行和转移能力方面疗效更佳。展开更多
文摘Purpose: This study focused on maintaining and improving the walking function of late-stage older individuals while longitudinally tracking the effects of regular exercise programs in a day-care service specialized for preventive care over 5 years, using detailed gait function measurements with an accelerometer-based system. Methods: Seventy individuals (17 male and 53 female) of a daycare service in Tokyo participated in a weekly exercise program, meeting 1 - 2 times. The average age of the participants at the start of the program was 81.4 years. Gait function, including gait speed, stride length, root mean square (RMS) of acceleration, gait cycle time and its standard deviation, and left-right difference in stance time, was evaluated every 6 months. Results: Gait speed and stride length improved considerably within six months of starting the exercise program, confirming an initial improvement in gait function. This suggests that regular exercise programs can maintain or improve gait function even age groups that predictably have a gradual decline in gait ability due to enhanced age. In the long term, many indicators tended to approach baseline values. However, the exercise program seemingly counteracts age-related changes in gait function and maintains a certain level of function. Conclusions: While a decline in gait ability with aging is inevitable, establishing appropriate exercise habits in late-stage older individuals may contribute to long-term maintenance of gait function.
基金supported by the Natural Science Foundation of China,No.30973165
文摘Stroke survivors often present with abnormal gait, movement training can improve the walking performance post-stroke, and functional MRI can objectively evaluate the brain functions before and after movement training. This paper analyzes the functional MRI changes in patients with ischemic stroke after treadmill training with voluntary and passive ankle dorsiflexion. Functional MRI showed that there are some changes in some regions of patients with ischemic stroke including primary sensorimotor cortex, supplementary motor area and cingulate motor area after treadmill training. These findings suggest that treadmill training likely improves ischemic stroke patients＇ lower limb functions and gait performance and promotes stroke recovery by changing patients＇ brain plasticity; meanwhile, the novel treadmill training methods can better training effects.
文摘BACKGROUND Dystonic gait(DG) is one of clinical symptoms associated with functional dystonia in the functional movement disorders(FMDs). Dystonia is often initiated or worsened by voluntary action and associated with overflow muscle activation. There is no report for DG in FMDs caused by an abnormal pattern in the ankle muscle recruitment strategy during gait.CASE SUMMARY A 52-year-old male patient presented with persistent limping gait. When we requested him to do dorsiflexion and plantar flexion of his ankle in the standing and seating positions, we didn’t see any abnormality. However, we could see the DG during the gait. There were no evidences of common peroneal neuropathy and L5 radiculopathy in the electrodiagnostic study. Magnetic resonance imaging of the lumbar spine, lower leg, and brain had no definite finding. No specific finding was seen in the neurologic examination. For further evaluation, a wireless surface electromyography(EMG) was performed. During the gait, EMG amplitude of left medial and lateral gastrocnemius(GCM) muscles was larger than right medial and lateral GCM muscles. When we analyzed EMG signals for each muscle, there were EMG bursts of double-contraction in the left medial and lateral GCM muscles, while EMG analysis of right medial and lateral GCM muscles noted regular bursts of single contraction. We could find a cause of DG in FMDs.CONCLUSION We report an importance of a wireless surface EMG, in which other examination didn’t reveal the cause of DG in FMDs.
文摘Duchenne muscular dystrophy (DMD) is a genetic disorder linked to chromosome Xp21, due to absence of dystrophin production. It is clinically characterized by progressive muscle weakness, fatigue, and development of joint contractures that compromise general motor functionality, mainly the gait. Objective: To characterize the motor function and decrease gait in children with DMD using the Portuguese version of the Motor Function Measure scale (MFM-P). Methods: A review of medical records including chronological age and scores from MFM-P of children with a DMD who attended at the Neuromuscular Diseases Clinic at Campinas State University (UNICAMP), Brazil was performed in this study. A total of 36 medical records of male patients with confirmed clinical diagnosis of DMD, ambulatory or not, regardless of age;excluding those with other associated diseases or other types of muscular dystrophies were selected. Data were analyzed using Kolmogorov-Smirnov and Spearman correlation statistical tests. Results: Analysis of all data collected showed that 75% of our sample had D1 scores lower than 41.02%. There was a linear relationship between the scores of D2 and D3, but no association between D2 and D1 scores was noted. D1 score was between 40% and 80% in those patients presenting D2 scores between 80% and 100%. In all cases patients with low total score presented a greater risk for loss of gait and their functionality. Conclusion: The standing posture and the postural transfers were the worst activities observed in children with DMD, with positive correlation between proximal and distal motor function. Even with high scores according MFM-P in proximal function, the children showed strong predictors for loss of gait.
文摘<strong><span style="font-family:Verdana;">INTRODUCTION</span></strong><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">:</span><span style="font-family:Verdana;"> Gait asymmetry can become very pronounced in patie</span></span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">nts who have suffered a stroke. The impairment of trunk function in some stroke patients can restrict thorax mobility and cause respiratory muscle weakness. Trunk and neck dysfunction are believed to affect the gait in stroke patients. </span><b><span style="font-family:Verdana;">OBJECTIVE</span></b><span style="font-family:Verdana;">: This study aimed to investigate the relationship between gait asymmetry and respiratory function in stroke patients by measuring the step time and trunk acceleration. </span><b><span style="font-family:Verdana;">METHODS</span></b><span style="font-family:Verdana;">: This study employed a cross-sec</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">- </span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">tional design. Thirty stroke patients participated in this study. The symmetry index (SI) and Lissajous index (LI) were used to evaluate asymmetry during walking. The respiratory function and respiratory muscle strength were eva</span><span style="font-family:Verdana;">luated by spirometry. We examined the relation between SI or LI and the res</span><span style="font-family:Verdana;">piratory function/respiratory muscle strength in patients with stroke. </span><b><span style="font-family:Verdana;">RE</span></b></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">- </span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">SULTS</span></b></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">: The results of our analysis demonstrated that the SI was significantly correlated with the inspiratory and expiratory muscle strength and the </span><span><span style="font-family:Verdana;">LI was significantly correlated with the percentage of the predicted vital capacity (respectively, r = <span style="white-space:nowrap;">﹣</span>0.386, r = <span style="white-space:nowrap;">﹣</span>0.392, r = <span style="white-space:nowrap;">﹣</span>0.446;p < 0.05). </span><b><span style="font-family:Verdana;">CONCLUSION</span></b><span style="font-family:Verdana;">: </span></span><span style="font-family:Verdana;">The present study is the first to indicate a relationship between gait asymmetry and respiratory function in stroke patients.</span></span></span></span>
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 National Natural Science Foundation of China(82174471).
文摘The three-phase Enriched Environment(EE)paradigm has been shown to promote post-stroke functional improvement,but the neuronal mechanisms are still unclear.In this study,we applied a multimodal neuroimaging protocol combining magnetic resonance imaging(MRI)and positron emission tomography(PET)to examine the effects of post-ischemic EE treatment on structural and functional neuroplasticity in the bilateral sensorimotor cortex.Rats were subjected to permanent middle cerebral artery occlusion.The motor function of the rats was examined using the DigiGait test.MRI was applied to investigate the EE-induced structural modifications of the bilateral sensorimotor cortex.[^(18)F]-fluorodeoxyglucose PET was used to detect glucose metabolism.Blood oxygen level-dependent(BOLD)-functional MRI(fMRI)was used to identify the regional brain activity and functional connectivity(FC).In addition,the expression of neuroplasticity-related signaling pathways including neurotrophic factors(BDNF/CREB),axonal guidance proteins(Robo1/Slit2),and axonal growth-inhibitory proteins(NogoA/NgR)as well as downstream proteins(RhoA/ROCK)in the bilateral sensorimotor cortex were measured by Western blots.Our results showed the three-phase EE improved the walking ability.Structural T2 mapping imaging and diffusion tensor imaging demonstrated that EE benefited structure integrity in the bilateral sensorimotor cortex.PET-MRI fused images showed improved glucose metabolism in the corresponding regions after EE intervention.Specifically,the BOLD-based amplitude of low-frequency fluctuations showed that EE increased spontaneous activity in the bilateral motor cortex and ipsilateral sensory cortex.In addition,FC results showed increased sensorimotor connectivity in the ipsilateral hemisphere and increased interhemispheric motor cortical connectivity and motor cortical-thalamic connectivity following EE intervention.In addition,a strong correlation was found between increased functional connectivity and improved motor performance of limbs.Specifically,EE regulated the expression of neuroplasticity-related signaling,involving BDNF/CREB,Slit2/Robo1,as well as the axonal growth–inhibitory pathways Nogo-A/Nogo receptor and RhoA/ROCK in the bilateral sensorimotor cortex.Our results indicated that the three-phase enriched environment paradigm enhances neuronal plasticity of the bilateral sensorimotor cortex and consequently ameliorates post-stroke gait deficits.These findings might provide some new clues for the development of EE and thus facilitate the clinical translation of EE.
基金supported by Basic Science Research Program through the National Research Foundation of Korea(NRF)funded by the Ministry of Education,Science and Technology(2012-013997)
文摘The corticoreticular tract （CRT） is known to be involved in walking and postural control. Using diffusion tensor tractography （DTT）, we investigated the relationship between the CRT and gait dysfunction, includ- ing trunk instability, in pediatric patients. Thirty patients with delayed development and 15 age-matched, typically-developed （TD） children were recruited. Fifteen patients with gait dysfunction （bilateral trunk instability） were included in the group A, and the other 15 patients with gait dysfunction （unilateral trunk instability） were included in the group B. The Growth Motor Function Classification System, Functional Ambulation Category scale, and Functional Ambulation Category scale were used for measurement of functional state. Fractional anisotropy, apparent diffusion coefficient, fiber number, and tract integrity of the CRT and corticospinal tract were measured. Diffusion parameters or integrity of corticospinal tract were not significantly different in the three study groups. However, CRT results revealed that both CRTs were disrupted in the group A, whereas CRT disruption in the hemispheres contralateral to clinical mani- festations was observed in the group B. Fractional anisotropy values and fiber numbers in both CRTs were decreased in the group A than in the group TD. The extents of decreases of fractional anisotropy values and fiber numbers on the ipsilateral side relative to those on the contralateral side were greater in the group B than in the group TD. Functional evaluation data and clinical manifestations were found to show strong correlations with CRT status, rather than with corticospinal tract status. These findings suggest that CRT status appears to be clinically important for gait function and trunk stability in pediatric patients and DTT can help assess CRT status in pediatric patients with gait dysfunction.
文摘目的:运用Meta分析方法系统评价康复外骨骼机器人对脑卒中患者下肢运动功能的康复疗效,并比较不同下肢外骨骼机器人的疗效差异,为脑卒中下肢运动功能障碍患者选择适合的外骨骼机器人提供科学理论依据。方法:计算机检索Cochrane Library、PubMed、Web of Science、Embase、中国知网、维普和万方数据库的相关文献,收集从建库至2022年11月发表的关于探讨下肢康复外骨骼机器人改善脑卒中患者下肢运动功能的随机对照临床试验。由2名研究人员进行文献检索与筛选,使用Cochrane 5.1.0偏倚风险评估工具和Jadad量表对纳入文献进行质量评价。采用RevMan 5.4和Stata 17.0软件对结局指标进行Meta分析。结果:①最终纳入22篇文献,Jadad评分显示均为高质量文献,共865例患者,试验组436例、对照组429例。②Meta分析结果显示,与对照组相比,外骨骼机器人可显著提高脑卒中患者下肢运动功能(Fugl-Meyer Assessment of Lower Extremity,FMA-LE)评分(MD=2.63,95%CI:1.87-3.38,P<0.05)、平衡功能(Berg Balance Scale,BBS)评分(MD=3.62,95%CI:1.21-6.03,P<0.05)、站起-走测试量表(Timed Up and Go,TUG)评分(MD=-2.77,95%CI:-4.48至-1.05,P<0.05)和步频(MD=3.15,95%CI:1.57-4.72,P<0.05),但对功能性步行量表(Functional Ambulation Category Scale,FAC)评分(MD=0.30,95%CI:-0.01-0.61,P>0.05)和6 min步行测试(6-minute walk test,6MWT)评分(MD=3.77,95%CI:-6.60-14.14,P>0.05)的提高不明显。③网状Meta分析结果显示,FMA-LE评分:平地行走式外骨骼(MD=10.23,95%CI:3.81-27.49,P<0.05)和减重式外骨骼(MD=33.66,95%CI:11.49-98.54,P<0.05)与常规康复治疗相比均能改善FMA-LE评分,排序结果为减重式外骨骼>平地行走式外骨骼>常规康复治疗;BBS评分:减重式外骨骼(MD=79.86,95%CI:2.34-2725.99,P<0.05)与常规康复治疗相比能显著改善BBS评分,排序结果为减重式外骨骼>平地行走式外骨骼>常规康复治疗;FAC评分:平地行走式外骨骼(MD=1.38,95%CI:1.00-1.90,P<0.05)与常规康复治疗相比能显著改善FAC评分,排序结果为平地行走式外骨骼>减重式外骨骼>常规康复治疗;TUG评分:减重式外骨骼与常规康复治疗相比(MD=0.07,95%CI:0.01-0.51,P<0.05)能显著改善TUG评分,排序结果为平地行走式外骨骼>减重式外骨骼>常规康复治疗。结论:康复外骨骼机器人可以改善脑卒中患者平衡、步行以及日常生活活动能力,其中减重式外骨骼在提高下肢运动功能和平衡功能方面疗效更优,平地行走式外骨骼在提高功能性步行和转移能力方面疗效更佳。
