Correlation study between motor rehabilitation level and psychological state in patients with limb movement disorders after stroke

BACKGROUND The psychological state of patients with post stroke limb movement disorders undergoes a series of changes that affect rehabilitation training and recovery of limb motor function.AIM To determine the correlation between motor rehabilitation and the psychological state of patients with limb movement disorders after stroke.METHODS Eighty patients with upper and lower limb dysfunction post stroke were retrospectively enrolled in our study.Based on Hospital Anxiety and Depression Scale(HADS)scores measured before rehabilitation,patients with HADS scores≥8 were divided into the psychological group;otherwise,the patients were included in the normal group.Motor function and daily living abilities were compared between the normal and psychological groups.Correlations between the motor function and psychological status of patients,and between daily living ability and psychological status of patients were analyzed.RESULTS After 1,2,and 3 wk of rehabilitation,both the Fugl-Meyer assessment and Barthel index scores improved compared to their respective baseline scores(P<0.05).A greater degree of improvement was observed in the normal group compared to the psychological group(P<0.05).There was a negative correlation between negative emotions and limb rehabilitation(-0.592≤r≤-0.233,P<0.05),and between negative emotions and daily living ability(-0.395≤r≤-0.199,P<0.05).CONCLUSION There is a strong correlation between motor rehabilitation and the psychological state of patients with post stroke limb movement disorders.The higher the negative emotions,the worse the rehabilitation effect.

Botulinum toxin type A plus rehabilitative training for improving the motor function of the upper limbs and activities of daily life in patients with stroke and brain injury

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:①Patients 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.②Patients 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;GradeⅣfor 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.①FMA 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].②MAS grades of upper limbs:There were obviously fewer cases of gradeⅢin 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 gradeⅢin 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).③Barthel 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.

Axonal remodeling in the corticospinal tract after stroke： how does rehabilitative training modulate it？

Stroke causes long-term disability, and rehabilitative training is commonly used to improve the consecutive functional recovery. Following brain damage, surviving neurons undergo morphological alterations to reconstruct the remaining neural network. In the motor system, such neural network remodeling is observed as a motor map reorganization. Because of its significant correlation with functional recovery, motor map reorganization has been regarded as a key phenomenon for functional recovery after stroke. Although the mechanism underlying motor map reorganization remains unclear, increasing evidence has shown a critical role for axonal remodeling in the corticospinal tract. In this study, we review previous studies investigating axonal remodeling in the corticospinal tract after stroke and discuss which mechanisms may underlie the stimulatory effect of rehabilitative training. Axonal remodeling in the corticospinal tract can be classified into three types based on the location and the original targets of corticospinal neurons, and it seems that all the surviving corticospinal neurons in both ipsilesional and contralesional hemisphere can participate in axonal remodeling and motor map reorganization. Through axonal remodeling, corticospinal neurons alter their output selectivity from a single to multiple areas to compensate for the lost function. The remodeling of the corticospinal axon is influenced by the extent of tissue destruction and promoted by various therapeutic interventions, including rehabilitative training. Although the precise molecular mechanism underlying rehabilitation-promoted axonal remodeling remains elusive, previous data suggest that rehabilitative training promotes axonal remodeling by upregulating growth-promoting and downregulating growth-inhibiting signals.

Architectural Design of a Cloud Robotic System for Upper-Limb Rehabilitation with Multimodal Interaction

The rise in the cases of motor impairing therapy. Due to the current situation that the service illnesses demands the research for improvements in rehabilitation of the professional therapists cannot meet the need of the motorimpaired subjects, a cloud robotic system is proposed to provide an Internet-based process for upper-limb rehabilitation with multimodal interaction. In this system, therapists and subjects are connected through the Internet using client/server architecture. At the client site, gradual virtual games are introduced so that the subjects can control and interact with virtual objects through the interaction devices such as robot arms. Computer graphics show the geometric results and interaction haptic/force is fed back during exercising. Both video/audio information and kinematical/physiological data axe transferred to the therapist for monitoring and analysis. In this way, patients can be diagnosed and directed and therapists can manage therapy sessions remotely. The rehabilitation process can be monitored through the Internet. Expert libraries on the central server can serve as a supervisor and give advice based on the training data and the physiological data. The proposed solution is a convenient application that has several features taking advantage of the extensive technological utilization in the area of physical rehabilitation and multimodal interaction.