Disappearance of unaffected motor cortex activation by repetitive transcranial magnetic stimulation in a patient with cerebral infarct

The ipsilateral motor pathway from the unaffected motor cortex to the affected extremity is one of the motor recovery mechanisms following stroke （Jang, 2011）. Because stroke patients who had shown recovery by this mechanism usually showed poorer motor function, compared with patients who showed recovery by other mechanisms, several researchers have considered this mechanism as a maladaptive plasticity （]ang, 2013）.

Changes in motor function in the unaffected hand of stroke patients should not be ignored

Motor function changes in the unaffected hand of stroke patients with hemiplegia. These changes are often ignored by clinicians owing to the extent of motor disability of the affected hand. Finger tapping frequency and Lind-mark hand function score showed that the motor function of unaffected hands in stroke patients was poorer than that of a healthy control hand. After 2 weeks of rehabilitation treatment, motor function of the unaffected hand of stroke patients was obviously improved. Therefore, attention should also be paid to motor function in the unaffected hand of stroke patients with hemiplegia during rehabilitation.

Alternation in F-wave parameters of median nerve from unaffected extremity in stroke patients with hemiplegia under dynamic state

BACKGROUND: For many years, the extremities of stroke patients are divided into affected side and unaffected side according to clinical symptoms and body signs. Moreover, previous rehabilitation function training is developed simply aiming to the dysfunction manifested by unaffected extremity. Problems of unaffected extremity are always ignored, such as left- and right- side connection dysfunction, abnormal muscular tension of unaffected side and so on. OBJECTIVE: To observe neurophysiological change characteristics of unaffected extremity of stroke patients with hemiplegia by electromyographical method. DESIGN: Case-control observation. SETTING: First Hospital, Jilin University. PARTICIPANTS: Eighty stroke patients with hemiplegia confirmed by skull CT or MRI, who firstly hospitalized in the Department of Neurology, First Hospital, Jilin University between July 2004 and March 2005, were retrieved. They were scored > 8 points in Glasgow Coma Scale and had stable vital sign. Nineteen normal persons who received healthy examination in the clinic were involved in normal control group. Following the classification criteria of Brunnstrom's Recovery Stages of Stroke (BRSS), 80 stroke patients with hemiplegia were assigned into 3 groups: BRSS Ⅰ-Ⅱ group (n =36), BRSS Ⅲ-Ⅳ group (n =23) and BRSSⅤ-Ⅵ (n =21). METHODS: F-wave parameters of median nerve of unaffected extremity were detected by electromyographical technique. The recording electrode (muscular belly of abductor pollicis brevis) and reference electrode (first finger bone) were connected with grounding electrode. Stimulating electrode was placed in the median part of wrist joint with stimulation intensity of 130% that of threshold stimulation, stimulation frequency of 2 Hz, current pulse width of 0.2 ms, time course of 5 ms and sensitivity of 2 mV. The F-wave of median nerve of affected extremity under the resting stage (static status) and that of unaffected extremity under the maximum resistant contracted state were detected in order. The amplitude and appearance percentage of F wave were recorded. MAIN OUTCOME MEASURES: Comparison of F-wave parameters of median nerve between the unaffected extremity of stroke patients with hemiplegia and the extremity of control subjects under different status. RESULTS: All the patients accomplished the detection, and all of them participated in the final analysis. ①Under dynamic status, the amplitude and appearance percentage of F wave of unaffected extremity of patients in BRSS Ⅲ-Ⅳ group were significantly higher than those in the normal control group, respectively[(0.803 9±0.157 3) mV vs. (0.406 7±0.170 3) mV; (0.856 1±0.266 8)% vs. (0.650 0±0.197 6)%, P < 0.05]. Under static status, there were no significant differences in F-wave parameters of median nerve in the unaffected extremity of patients between BRSS Ⅰ-Ⅱ group and BRSS Ⅴ-Ⅵ group (P > 0.05). ②F-wave parameters of median nerve of unaffected extremity of patients in BRSS Ⅰ-Ⅱ group and BRSS Ⅴ-Ⅵ group under dynamic statewere higher than those under static status, without significant difference (P > 0.05), while the amplitude and appearance percentage of F wave of median nerve of unaffected extremity of patients in BRSS Ⅲ-Ⅳ group under dynamic statewere significantly higher than those under static state[(0.803 9±0.157 3) mV vs. (0.391 7±0.131 6) mV; (0.856 1±0.266 8 )% vs.(0.639 1 ±0.259 4)%,P < 0.05]. ③ There was no significant difference in F wave parameters among groups under static state(P > 0.05). However, under dynamic status, the amplitude and appearance percentage of F wave parameters of median nerve of unaffected extremity of patients in BRSS Ⅲ-Ⅳ group [(0.803 9±0.157 3) mV,(0.856 1±0.266 8)%] were significantly lower than those in the other two groups [(0.395 1±0.148 8),(0.437 1±0.157 6) mV;(0.612 5±0.232 8)%,(0.657 1±0.232 5)%,P < 0.05]. CONCLUSION: With the development of disease condition and the increase of muscular tension at anesthetic side, combination motor of affected extremity is caused following movement and muscular tension enhances to non-anesthetic-side. Therefore, F-wave parameters increase under dynamic status.

Activation of less affected corticospinal tract and poor motor outcome in hemiplegic pediatric patients:a diffusion tensor tractography imaging study

The less affected hemisphere is important in motor recovery in mature brains.However,in terms of motor outcome in immature brains,no study has been reported on the less affected corticospinal tract in hemiplegic pediatric patients.Therefore,we examined the relationship between the condition of the less affected corticospinal tract and motor function in hemiplegic pediatric patients.Forty patients with hemiplegia due to perinatal or prenatal injury（13.7±3.0 months）and 40 age-matched typically developing controls were recruited.These patients were divided into two age-matched groups,the high functioning group（20 patients）and the low functioning group（20 patients）using functional level of hemiplegia scale.Diffusion tensor tractography images showed that compared with the control group,the patient group of the less affected corticospinal tract showed significantly increased fiber number and significantly decreased fractional anisotropy value.Significantly increased fiber number and significantly decreased fractional anisotropy value in the low functioning group were observed than in the high functioning group.These findings suggest that activation of the less affected hemisphere presenting as increased fiber number and decreased fractional anisotropy value is related to poor motor function in pediatric hemiplegic patients.

天真的叙述者——余华小说叙述个性别解

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