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.

Tinnitus characteristics and associated variables on Tinnitus Handicap Inventory among a Hungarian population

Background:Tinnitus is a sound precepted without an external sound stimulus.Its background can be categorised into primary and secondary cases.The secondary cases include pathologies of the external,middle and inner ear.Tinnitus can be objective or subjective;the latter can only identified by the sufferer.Previous research results have shown that tinnitus significantly affects the quality of life and daily functioning.Objectives:To analyse the impact of tinnitus on the daily functioning and the possible influence of demographical data and tinnitus duration on it.Methods:630 patients(265 males and 365 females,25e85 years of age)suffering from primary tinnitus were enrolled.In the Hungarian language,these patients completed the Tinnitus Handicap Inventory(THI)questionnaire and underwent a complete otorhinolaryngological examination.IBM SPSS V24 software was used for data processing;correlation tests,the Mann-Whitney U and Kruskal-Wallis nonparametric tests were used.Results:According to the THI questionnaires outcomes,most patients(62.5%)were presented with a mild handicap.Based on statistical analysis,no significant correlation was observed between the total THI points and the age of the patients,along with the duration and localisation of the symptoms.However,the total THI scores of male and female patients significantly differed,indicating higher THI values in the female group(p=0.00052*).Conclusions:The tinnitus severity was not affected by the duration,localisation of the symptoms and age but by gender,indicating higher values in the case of females.

Age-trends in Cognitive Function and Quality of Life: Sex Differences in a Community Population in Taiwan region,China

Population aging has developed into a significant area of concern in developed countries, especially in relation to thepreservation of functional independence and the quality of life (QoL). However, information on the contribution ofsex differences in quality of life and cognitive function is scarce. Therefore, this study aimed to investigate potentialdifferences in cognitive function and QoL between males and females. For this study, we recruited 382 healthy subjectsaged 19–79 years from communities in Southern Taiwan region,China. Cognitive function and QoL were assessed using the UCSD Performance-based Skills Assessment, Brief Version (UPSA-B) and World Health Organization Quality ofLife Instruments (WHOQOL-BREF), respectively. The effects of sex, age groups, and interaction of sex and ageon the UPSA-B and WHOQOL-BREF scores were examined. We found that the financial and communicationdomains of the UPSA-B showed declining trends with age in both sexes, although these trends were more obviousin females than in males. In the domain of Physical Capacity, QoL showed an age-increased trend in males, whileQoL in the Environment domain showed an age-increased trend in females. Regarding the relationships betweencognitive function and QoL, we found that the financial skill and communication skill of UPSA-B was positivelycorrelated to the psychological well-being domain of WHOQOL-BREF, in males of age <40 years. In conclusion,our findings demonstrate differential relationships between cognitive function and QoL between males and females,which could serve as a basis for further study between cognitive function and quality of life in communities.

Beyond Reading Comprehension--Cultivating Critical Readers through Critical Press News Reading

English newspapers, which have already been widely used as supplementary readings in an input-poor Chinese EFL context, are chosen and modified as needed for the proficiency levels of the class and used with suitable activities and exercises that engage students in an active and purposeful construction of the meaning of the text in extensive reading instruction. However, critical reading of the press news, which requires readers moving beyond comprehension, is rarely involved. This article, using Fairclough＇s critical discourse analysis （henceforth, CDA） as the theoretical framework, and Halliday＇s systemic functional grammar （henceforth, SFG） as the analytical tool in the analysis of the news texts, makes a sample analysis of the critical news reading from China Daily on China＇s response to the US-led campaign against terrorism after the September 11 events, 2001. The analysis made is undertaken in three stages： （1） the Transitivity analysis of the headlines, （2） the textual meaning of the clauses in terms of Themes, and （3） the explanations made to give grounding for the preceding analysis. The paper concludes with the hypothesis that integrating critical news reading into extensive reading instruction will not only improve students＇ reading skills, but also increase their adequate comprehension to the reading materials, as well as cultivate their critical reading competence.