Constraint-induced aphasia therapy for patients with aphasia: A systematic review

Objectives:This study aimed to systematically evaluate the effects of constraint-induced aphasia therapy(OAT)for aphasic patients reported by randomized controlled trials.Methods:Relevant randomized controlled trials were retrieved from 11 electronic databases.A methodological quality assessment was conducted in accordance with the Cochrane Handbook,and metaanalyses were performed by using RevMan 5.2.A descriptive analysis was conducted when the included trials were not suitable for a meta-analysis.Results:A total of 12 trials were included.A statistically significant group difference was shown from the meta-analysis in the results measured by the Western Aphasia Battery(random-effects model,MD=1.23,95%CI=0.31 to 2.14,P<0.01).However,there were no statistically significant differences shown in the results of the Boston Naming Test(fixed-effects model,MD=-1.79,95%CI=-11.19 to Z62,P>0.05)and Aachen Aphasia Test(fixed-effects model,MD=-1.11,95%CI=-4.49 to 2.27,P>0.05).The descriptive analysis showed positive results in language performances of naming,repetition,and comprehension.Conclusion:This systematic review indicated that CIAT was efficient for improving language performance with regard to naming,comprehension,repetition,written language,and oral language based on the current evidence.And this review provides some meaningful guides for clinical practice:expand the therapy duration to 2 or 3 h per day,focus on naming,and choose the best assessment tool.It also indicates a need for more rigorous,large-scale,and high-quality trials in the future.

Constraint-induced movement therapy in treatment of acute and sub-acute stroke: a meta-analysis of 16 randomized controlled trials

OBJECTIVE： The aim of this meta-analysis was to evaluate the clinical efficacy of constraint-induced movement therapy in acute and sub-acute stroke. DATA SOURCES： The key words were stroke, cerebrovascular accident, constraint-induced therapy, forced use, and randomized controlled trial. The databases, including China National Knowledge Infrastructure, WanFang, Weipu Information Resources System, Chinese Biomedical Literature Database, PubMed, Med- line, Embase, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews, were searched for studies on randomized controlled trials for treating acute or sub-acute stroke published before March 2016. DATA SELECTION： We retrieved relevant randomized controlled trials that compared constraint-induced movement therapy in treatment of acute or sub-acute stroke with traditional rehabilitation therapy （tradi- tional occupational therapy）. Patients were older than 18 years, had disease courses less than 6 months, and were evaluated with at least one upper extremity function scale. Study quality was evaluated, and data that met the criteria were extracted. Stata 11.0 software was used for the meta-analysis. OUTCOME MEASURES： Fugl-Meyer motor assessment of the arm, the action research-arm test, a motor activity log for amount of use and quality of movement, the Wolf motor function test, and a modified Bar- thel index. RESULTS： A total of 16 prospective randomized controlled trials （379 patients in the constraint-induced movement-therapy group and 359 in the control group） met inclusion criteria. Analysis showed significant mean differences in favor of constraint-induced movement therapy for the Fugl-Meyer motor assessment of the arm （weighted mean difference （WMD） = 10.822; 95% confidence intervals （95% CI）： 7.419-14.226）, the action research-arm test （WMD = 10.718; 95% CI： 5.704-15.733）, the motor activity log for amount of use and quality of movement （WMD = 0.812; 95% CI： 0.331-1.293） and the modified Barthel index （WMD = 10.706; 95% CI： 4.417-16.966）. CONCLUSION： Constraint-induced movement therapy may be more beneficial than traditional rehabili- tation therapy for improving upper limb function after acute or sub-acute stroke.

Constraint-induced movement therapy enhances angiogenesis and neurogenesis after cerebral ischemia/reperfusion

Constraint-induced movement therapy after cerebral ischemia stimulates axonal growth by decreasing expression levels of Nogo-A,RhoA,and Rho-associated kinase(ROCK)in the ischemic boundary zone.However,it remains unclear if there are any associations between the Nogo-A/RhoA/ROCK pathway and angiogenesis in adult rat brains in pathological processes such as ischemic stroke.In addition,it has not yet been reported whether constraint-induced movement therapy can promote angiogenesis in stroke in adult rats by overcoming Nogo-A/RhoA/ROCK signaling.Here,a stroke model was established by middle cerebral artery occlusion and reperfusion.Seven days after stroke,the following treatments were initiated and continued for 3 weeks:forced limb use in constraint-induced movement therapy rats(constraint-induced movement therapy group),intraperitoneal infusion of fasudil(a ROCK inhibitor)in fasudil rats(fasudil group),or lateral ventricular injection of NEP1-40(a specific antagonist of the Nogo-66 receptor)in NEP1-40 rats(NEP1-40 group).Immunohistochemistry and western blot assay results showed that,at 2 weeks after middle cerebral artery occlusion,expression levels of RhoA and ROCK were lower in the ischemic boundary zone in rats treated with NEP1-40 compared with rats treated with ischemia/reperfusion or constraint-induced movement therapy alone.However,at 4 weeks after middle cerebral artery occlusion,expression levels of RhoA and ROCK in the ischemic boundary zone were markedly decreased in the NEP1-40 and constraint-induced movement therapy groups,but there was no difference between these two groups.Compared with the ischemia/reperfusion group,modified neurological severity scores and foot fault scores were lower and time taken to locate the platform was shorter in the constraint-induced movement therapy and fasudil groups at 4 weeks after middle cerebral artery occlusion,especially in the constraint-induced movement therapy group.Immunofluorescent staining demonstrated that fasudil promoted an immune response of nerve-regeneration-related markers(BrdU in combination with CD31(platelet endothelial cell adhesion molecule),Nestin,doublecortin,NeuN,and glial fibrillary acidic protein)in the subventricular zone and ischemic boundary zone ipsilateral to the infarct.After 3 weeks of constraint-induced movement therapy,the number of regenerated nerve cells was noticeably increased,and was accompanied by an increased immune response of tight junctions(claudin-5),a pericyte marker(a-smooth muscle actin),and vascular endothelial growth factor receptor 2.Taken together,the results demonstrate that,compared with fasudil,constraint-induced movement therapy led to stronger angiogenesis and nerve regeneration ability and better nerve functional recovery at 4 weeks after cerebral ischemia/reperfusion.In addition,constraint-induced movement therapy has the same degree of inhibition of RhoA and ROCK as NEP1-40.Therefore,constraint-induced movement therapy promotes angiogenesis and neurogenesis after cerebral ischemia/reperfusion injury,at least in part by overcoming the Nogo-A/RhoA/ROCK signaling pathway.All protocols were approved by the Institutional Animal Care and Use Committee of China Medical University,China on December 9,2015(approval No.2015 PS326 K).

Modified constraint-induced movement therapy alters synaptic plasticity of rat contralateral hippocampus following middle cerebral artery occlusion

Modified constraint-induced movement therapy is an effective treatment for neurological and motor impairments in patients with stroke by increasing the use of their affected limb and limiting the contralateral limb.However,the molecular mechanism underlying its efficacy remains unclear.In this study,a middle cerebral artery occlusion(MCAO)rat model was produced by the suture method.Rats received modified constraint-induced movement therapy 1 hour a day for 14 consecutive days,starting from the 7^th day after middle cerebral artery occlusion.Day 1 of treatment lasted for 10 minutes at 2r/min,day 2 for 20 minutes at 2 r/min,and from day 3 onward for 20 minutes at 4 r/min.CatWalk gait analysis,adhesive removal test,and Y-maze test were used to investigate motor function,sensory function as well as cognitive function in rodent animals from the 1st day before MCAO to the 21^st day after MCAO.On the 21^st day after MCAO,the neurotransmitter receptor-related genes from both contralateral and ipsilateral hippocampi were tested by micro-array and then verified by western blot assay.The glutamate related receptor was shown by transmission electron microscopy and the glutamate content was determined by high-performance liquid chromatography.The results of behavior tests showed that modified constraint-induced movement therapy promoted motor and sensory functional recovery in the middle cerebral artery-occluded rats,but had no effect on cognitive function.The modified constraint-induced movement therapy upregulated the expression of glutamate ionotropic receptor AMPA type subunit 3(Gria3)in the hippocampus and downregulated the expression of the beta3-adrenergic receptor gene Adrb3 and arginine vasopressin receptor 1 A,Avprla in the middle cerebral artery-occluded rats.In the ipsilateral hippocampus,only Adra2 a was downregulated,and there was no significant change in Gria3.Transmission electron microscopy revealed a denser distribution the more distribution of postsynaptic glutamate receptor 2/3,which is an a-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid receptor,within 240 nm of the postsynaptic density in the contralateral cornu ammonis 3 region.The size and distribution of the synaptic vesicles within 100 nm of the presynaptic active zone were unchanged.Western blot analysis showed that modified constraint-induced movement therapy also increased the expression of glutamate receptor 2/3 and brain-derived neurotrophic factor in the hippocampus of rats with middle cerebral artery occlusion,but had no effect on Synapsin I levels.Besides,we also found modified constraint-induced movement therapy effectively reduced glutamate content in the contralateral hippocampus.This study demonstrated that modified constraint-induced movement therapy is an effective rehabilitation therapy in middle cerebral artery-occluded rats,and suggests that these positive effects occur via the upregulation of the postsynaptic membrane a-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid receptor expression.This study was approved by the Institutional Animal Care and Use Committee of Fudan University,China(approval No.201802173 S)on March 3,2018.

Early constraint-induced movement therapy affects behavior and neuronal plasticity in ischemia-injured rat brains

Constraint-induced movement therapy is an effective rehabilitative training technique used to improve the restoration of impaired upper extremity movement after stroke. However, whether constraint-induced movement therapy is more effective than conventional rehabilitation in acute or sub-acute stroke remains controversial. The aim of the present study was to identify the optimal time to start constraint-induced movement therapy after ischemic stroke and to explore the mechanisms by which constraint-induced movement therapy leads to post-stroke recovery. Sixty-four adult male Sprague-Dawley rats were randomly divided into four groups: sham-surgery group, cerebral ischemia/reperfusion group, early constraint-induced movement therapy group, and late constraint-induced movement therapy group. Rat models of left middle cerebral artery occlusion were established according to the Zea Longa line embolism method. Constraint-induced movement therapy was conducted starting on day 1 or day 14 in the early constraint-induced movement therapy and late constraint-induced movement therapy groups, respectively. To explore the effect of each intervention time on neuromotor function, behavioral function was assessed using a balance beam walking test before surgery and at 8 and 21 days after surgery. The expression levels of brain-derived neurotrophic factor, nerve growth factor and Nogo receptor were evaluated using real time-polymerase chain reaction and western blot assay to assess the effect of each intervention time. The results showed that the behavioral score was significantly lower in the early constraint-induced movement therapy group than in the cerebral ischemia/reperfusion and late constraint-induced movement therapy groups at 8 days. At 21 days, the scores had significantly decreased in the early constraint-induced movement therapy and late constraint-induced movement therapy groups. At 8 days, only mild pyknosis appeared in neurons of the ischemic penumbra in the early constraint-induced movement therapy group, which was distinctly better than in the cerebral ischemia/reperfusion group. At 21 days, only a few vacuolated cells were observed and no obvious inflammatory cells were visible in late constraint-induced movement therapy group, which was much better than at 8 days. The mRNA and protein expression levels of brain-derived neurotrophic factor and nerve growth factor were significantly higher, but expression levels of Nogo receptor were significantly lower in the early constraint-induced movement therapy group compared with the cerebral ischemia/reperfusion and late constraint-induced movement therapy groups at 8 days. The changes in expression levels at 21 days were larger but similar in both the early constraint-induced movement therapy and late constraint-induced movement therapy groups. Besides, the protein nerve growth factor level was higher in the late constraint-induced movement therapy group than in the early constraint-induced movement therapy group at 21 days. These results suggest that both early(1 day) and late(14 days) constraint-induced movement therapy induces molecular plasticity and facilitates functional recovery after ischemic stroke, as illustrated by the histology. The mechanism may be associated with downregulation of Nogo receptor expression and upregulation of brain-derived neurotrophic factor and nerve growth factor expression.

Constraint-induced movement therapy promotes brain functional reorganization in stroke patients with hemiplegia

Stroke patients with hemiplegia exhibit flexor spasms in the upper limb and extensor spasms in the lower limb, and their movement patterns vary greatly. Constraint-induced movement therapy is an upper limb rehabilitation technique used in stroke patients with hemiplegia; however, studies of lower extremity rehabilitation are scarce. In this study, stroke patients with lower limb hemiplegia underwent conventional Bobath therapy for 4 weeks as baseline treatment, followed by constraint-induced movement therapy for an additional 4 weeks. The 10-m maximum walking speed and Berg balance scale scores significantly improved following treatment, and lower extremity motor function also improved. The results of functional MRI showed that constraint-induced movement therapy alleviates the reduction in cerebral functional activation in patients, which indicates activation of functional brain regions and a significant increase in cerebral blood perfusJon. These results demonstrate that constraint-induced movement therapy promotes brain functional reorganization in stroke patients with lower limb hemiplegia.

Constraint-induced movement therapy promotes motor function recovery and downregulates phosphorylated extracellular regulated protein kinase expression in ischemic brain tissue of rats

Motor function impairment is a common outcome of stroke.Constraint-induced movement therapy（CIMT）involving intensive use of the impaired limb while restraining the unaffected limb is widely used to overcome the effects of＇learned non-use＇and improve limb function after stroke.However,the underlying mechanism of CIMT remains unclear.In the present study,rats were randomly divided into a middle cerebral artery occlusion（model）group,a CIMT＋model（CIMT）group,or a sham group.Restriction of the affected limb by plaster cast was performed in the CIMT and sham groups.Compared with the model group,CIMT significantly improved the forelimb functional performance in rats.By western blot assay,the expression of phosphorylated extracellular regulated protein kinase in the bilateral cortex and hippocampi of cerebral ischemic rats in the CIMT group was significantly lower than that in the model group,and was similar to sham group levels.These data suggest that functional recovery after CIMT may be related to decreased expression of phosphorylated extracellular regulated protein kinase in the bilateral cortex and hippocampi.

Modified constraint-induced movement therapy enhances cortical plasticity in a rat model of traumatic brain injury:a resting-state functional MRI study

Modified constraint-induced movement therapy(mCIMT)has shown beneficial effects on motor function improvement after brain injury,but the exact mechanism remains unclear.In this study,amplitude of low frequency fluctuation(ALFF)metrics measured by resting-state functional magnetic resonance imaging was obtained to investigate the efficacy and mechanism of mCIMT in a control co rtical impact(CCI)rat model simulating traumatic brain injury.At 3 days after control co rtical impact model establishment,we found that the mean ALFF(mALFF)signals were decreased in the left motor cortex,somatosensory co rtex,insula cortex and the right motor co rtex,and were increased in the right corpus callosum.After 3 weeks of an 8-hour daily mClMT treatment,the mALFF values were significantly increased in the bilateral hemispheres compared with those at 3 days postoperatively.The mALFF signal valu es of left corpus callosum,left somatosensory cortex,right medial prefro ntal cortex,right motor co rtex,left postero dorsal hippocampus,left motor cortex,right corpus callosum,and right somatosensory cortex were increased in the mCIMT group compared with the control cortical impact group.Finally,we identified brain regions with significantly decreased mALFF valu es at 3 days postoperatively.Pearson correlation coefficients with the right forelimb sliding score indicated that the improvement in motor function of the affected upper limb was associated with an increase in mALFF values in these brain regions.Our findings suggest that functional co rtical plasticity changes after brain injury,and that mCIMT is an effective method to improve affected upper limb motor function by promoting bilateral hemispheric co rtical remodeling.mALFF values correlate with behavio ral changes and can potentially be used as biomarkers to assess dynamic cortical plasticity after traumatic brain injury.

Speech and language therapy for aphasia following subacute stroke

The aim of this study was to investigate the time window, duration and intensity of optimal speech and language therapy applied to aphasic patients with subacute stroke in our hospital. The study consisted of 33 patients being hospitalized for stroke rehabilitation in our hospital with first stroke but without previous history of speech and language therapy. Sixteen sessions of impairment-based speech and language therapy were applied to the patients, 30-60 minutes per day, 2 days a week, for 8 successive weeks. Aphasia assess- ment in stroke patients was performed with Giilhane Aphasia Test-2 before and after treatment. Compared with before treatment, fluency of speech, listening comprehension, reading comprehension, oral motor evaluation, automatic speech, repetition and naming were improved after treatment. This suggests that 16 seesions of speech and language therapy, 30-60 minutes per day, 2 days a week, for 8 successive weeks, are effective in the treatment of aphasic patients with subacute stroke.

Efficacy of acupuncture as an adjuvant to speech and language therapy for aphasia after ischemic stroke:a protocol of systematic review and meta-analysis

Background:Aphasia is one of the common complications of stroke.Speech and language therapy is a conventional treatment for aphasia following stroke.However,rehabilitation often remains unsatisfactory after speech and language therapy alone.Acupuncture may be effective for aphasia after stroke.We designed this systematic review to assess the efficacy and safety of acupuncture as an adjunct to speech and language therapy for aphasia following ischemic stroke.Methods:An extensive search will be performed in databases including Cochrane Central Register of Controlled Trials,PubMed,Web of Science,EMBASE,China National Knowledge Infrastructure,Sinomed,Wei Pu Date and Wan Fang Data.No limitation will be set in language,publication date or status of the study.The primary outcomes include scores of Western Aphasia Battery and Aphasia Quotient.The secondary outcomes include Scales of Clinical Rehabilitation Research Center Aphasia Examination,Communicative Abilities in Daily Living,Aphasia Battery of Chinese,Chinese Functional Communication Profile,adverse reactions,etc.Results:All of the data will be processed with Review Manager software.Cochrane‘risk of bias’tool will be used to assess the risk of bias.Conclusion:This study will contribute to the selection of appropriate therapies for aphasia after ischemic stroke and the development of clinical guidelines on this topic.

Visualizing Aphasia in Linguistics From 2000 to 2019

This paper aims to visualize the research of aphasia from a linguistic perspective for the two decades from 2000 to 2019,identifying the changes in research focus and the future emerging trends of aphasia studies in linguistics.Applying the bibliometric approach,the present study reviewed 3,004 publications with the topic word“aphasia”in the framework of linguistics.The dataset was created from the Web of Science database ranging from 2000 to 2019.Using the CiteSpace tool,document co-citation analysis,betweenness centrality(BC)measurement and citation burst detection were conducted to explore and determine the thematic patterns,critical studies,and emerging trends of this knowledge domain.Twelve thematic patterns in these two decades were identified,indicating that researchers have focused on language impairment in aphasia,aphasia therapy and other topics associated with aphasia.Meanwhile,papers with high BC reveal the connections among different research clusters.In addition,bursts of detected citations demonstrate that treatment aiming at the enhanced quality of daily life,the utilization of discourse tasks and treatments at the discourse level,deeper exploration of primary progressive aphasia in terms of clinical data and the application of working memory assessment,and the role of working memory(WM)training in rehabilitation will possibly attract more attention in the future.On the basis of the cluster landscape,BC and citation bursts,the review found that scholars paid extensive attention to the alleviation of communication deficits in the linguistic exploration of aphasia.

Therapies for children with cerebral palsy A Web of Science-based literature analysis

OBJECTIVE： To identify global research trends in three therapies for children with cerebral palsy. DATA RETRIEVAL： We performed a bibliometric analysis of studies on therapies for children with cerebral palsy from 2002 to 2011 retrieved from Web of Science. SELECTION CRITERIA： Inclusion criteria： （a） peer-reviewed published articles on botulinum toxin, constraint-induced movement therapy, or acupuncture for children with cerebral palsy indexed in Web of Science; （b） original research articles, reviews, meeting abstracts, proceedings papers, book chapters, editorial material, and news items; and （c） publication between 2002 and 2011. Exclusion criteria： （a） articles that required manual searching or telephone access; （b） documents that were not published in the public domain; and （c） a number of corrected papers from the total number of articles. MAIN OUTCOME MEASURES： （1） Number of publications on the three therapies; （2） annual publication output, distribution by journals, distribution by institution, and top-cited articles on botulinum toxin; （3） annual publication output, distribution by journal, distribution by institution, and top-cited articles on constraint-induced movement therapy; （4） annual publication, distribution by journal, distribution by institution, and top-cited articles on acupuncture. RESULTS： This analysis, based on Web of Science articles, identified several research trends in studies published over the past 10 years of three therapies for children with cerebral palsy. More articles on botulinum toxin for treating children with cerebral palsy were published than the articles regarding constraint-induced movement therapy or acupuncture. The numbers of publications increased over the 10-year study period. Most papers appeared in journals with a focus on neurology, such as Developmental Medicine and Child Neurology and Journal of Child Neurology.Research institutes publishing on botulinum toxin treatments for this population are mostly in the Netherlands, the United States of America, and Australia; those publishing on constraint-induced movement therapy are mostly in Australia and the United States of America; and those publishing on acupuncture are mostly in China, Sweden and the United States of America.CONCLUSION： Analysis of literature and research trends indicated that there was no one specific therapy to cure cerebral palsy. Further studies are still necessary.

Photobiomodulation with Super-Pulsed Laser Shows Efficacy for Stroke and Aphasia: Case Studies

Background: Brain disorders have become more and more common today, due to both the aging population and the ever-expanding sports community. However, a new therapeutic technology called photobiomodulation (PBM) is giving hope to thousands of individuals in need. Traumatic brain injury (TBI), dementia, post traumatic stress (PTSD) and attention deficit (ADD) disorders are in many cases quickly and safely improved by PBM. PBM employs red or near-infrared (NIR) light (600 - 1100 nm) to stimulate healing, protect tissue from dying, increase mitochondrial function, improve blood flow, and tissue oxygenation. PBM can also act to reduce edema, increase antioxidants, decrease inflammation, protect against apoptosis, and modulate the microglial activation state. All these effects can occur when light is delivered to the head, and can be beneficial in both acute and chronic brain conditions. Methods: In this case series, we used a high power, FDA-approved superpulsed laser system applied to the head to treat four chronic stroke patients. Patients received as few as three 6 - 9 minute treatments over a one-week period. The follow up time varied, but in one case was two years. Results: Patients showed significant improvement in their speech and verbal skills. Improvements were also noticed in walking ability, limb movement, less numbness, and better vision. Conclusion: The use of PBM in stroke rehabilitation deserves to be tested in controlled clinical trials, because this common condition has no approved pharmaceutical treatment at present.

TREATMENT OF CEREBRAL PALSY WITH APHASIA BY LINGUISTIC TRAINING COMBINED WITH ACUPUNCTURE

Objective： To explore the best remedies for cerebral palsy with aphasia. Methods： A total of 76 cases of cerebral palsy children with aphasia were evenly randomized into control group and treatment group. Patients of treatment group were treated with “consciousness-restoring needling” plus linguistic training and these of control group treated with simple linguistic training method. Acupuncture was given once every other day, and linguistic training conducted once 6 times a week, with 10 times being a therapeutic course and the interval between two weeks being 10 - 15 days. Following 3 courses of treatment, the therapeutic effect was analyzed. Results. After 3 courses of treatment, of the two 38 cases in treatment and control groups, 27 （71.1% ） and 13 （34.2%） had remarkable improvement in their symptoms. The therapeutic effect of treatment group was significantly superior to that of control group （P 〈 0.01 ）. The developmental quotient values of speech of treatment and control groups were 56.36 ± 19.77 and 46.96± 15.63 respectively, displaying that acupuncture could significantly improve cerebral palsy patients＇ speaking ability （P〈0 05）. Conclusion. The therapeutic effect of acupuncture therapy plus linguistic training is significantly superior to that of simple linguistic training .

言语-语言治疗在卒中后失语症中的应用进展

言语-语言治疗是卒中后失语症患者语言康复的金标准,目前国内治疗方式较为单一,干预素材不充分,亟需多元化康复手段以满足不同患者康复需求,使其效果最大化。本文将言语-语言治疗分为言语认知治疗及功能性沟通两方面,对训练方法及临床应用进行综述,以期为临床语言康复实践提供参考。

针刺联合语言康复训练对卒中后失语病人非语言认知功能影响的Meta分析

目的:评价针刺联合语言康复训练对卒中后失语(PSA)病人非语言认知功能的影响及其对语言功能的改善,探索PSA病人语言和非语言认知功能改善间的关联。方法:计算机检索PubMed、EMbase、the Cochrane Library、Web of Science、EBSCO、Scopus、中国期刊全文数据库(CNKI)、万方数据库(WanFang Data)、维普中文科技期刊数据库(VIP)从建库至2022年6月1日发表的针刺联合语言康复训练改善PSA病人非语言认知功能的随机对照试验(RCT)研究,由2位研究者独立完成文献筛选、数据提取、研究偏倚风险评估工作,采用RevMan 5.4.1软件进行Meta分析。结果:共纳入15项RCT,涉及1 192例病人。Meta分析结果显示:针对语言功能方面,针刺联合语言康复训练治疗PSA的有效率优于对照组[OR=5.15,95%CI(3.10, 8.58),P<0.000 01],失语商高于对照组[MD=10.87, 95%CI(8.16, 13.59),P<0.000 01];针对非语言认知功能方面,针刺联合语言康复训练治疗后PSA病人蒙特利尔认知评估量表(MoCA)评分[MD=3.98, 95%CI(3.43, 4.53),P<0.000 01]、简易智力状态检查量表(MMSE)评分[MD=3.35, 95%CI(0.87, 5.82),P=0.008]均高于对照组,汉密尔顿抑郁量表(HAMD)评分[MD=-8.22, 95%CI(-8.68,-7.75),P<0.000 01]、汉密尔顿焦虑量表(HAMA)评分[MD=-7.47, 95%CI(-7.82,-7.13),P<0.000 01]、脑卒中失语抑郁量表(SADQ)评分[MD=-3.95, 95%CI(-5.51,-2.39),P<0.000 01]均低于对照组。结论:现有证据表明,针刺联合语言康复训练能有效改善PSA病人的非语言认知功能,缓解其焦虑、抑郁情绪,非语言认知功能的改善可能伴随着语言功能的改善。

电针法刺激颞前线治疗运动性失语临床观察

目的观察电针断续波刺激头颞部颞前线治疗运动性失语的临床效果。方法选取康复医学科2022年1月—2022年7月收治的90例脑卒中后运动性失语患者,按照随机数字表法分为对照组、试验1组和试验2组,各30例。三组均给予基础治疗,对照组只接受语言康复治疗,试验1组在对照组基础上针刺头颞部两鬓内的双侧颞前线,试验2组在试验1组基础上加用电针输出断续波。分别在治疗前、治疗2周及治疗4周后通过汉语失语症评定量表(ABC)进行康复治疗言语语言功能评定。结果治疗总有效率试验1组为86.67%(26/30)、试验2组为96.67%(29/30),均明显高于对照组的53.33%(16/30)(P<0.05)。治疗后,两试验组ABC各项评分及总分均显著高于对照组(P<0.05)。结论电针法刺激头颞部颞前线治疗运动性失语的效果确切,尤其是在表达、听理解和复述方面效果显著,能够提升患者日常生活语言沟通能力,恢复其神经功能缺损,值得临床推广。

基于祛风化痰针刺法探讨卒中后遗症期构音障碍治疗思路

目前临床治疗卒中后构音障碍,多以针灸结合言语康复为主。依据中医学理论,此病病机总属风痰扰窍,故治疗以祛风化痰、通络利咽为原则。吴清明确立“祛风化痰”针刺法,选取风池、完骨、廉泉及丰隆为主穴,配合针法刺激,以改善病灶部位的微循环障碍,促进受损构音组织的功能恢复,临床治疗脑卒中急性期构音障碍取得较好疗效,但对肌肉组织僵硬挛缩、纤维化的后遗症期患者的治疗作用欠佳,而针刀疗法治疗痉挛硬化的软组织病变具有肯定优势。基于临床治疗现状,结合此病的病因病机,笔者提出运用“祛风化痰”针刺法以“调神”,并结合解剖学,选取构音肌群起止点以“调形”,形与神共调,以期为临床治疗卒中后构音障碍带来一种新的思路与策略。

针刺治疗脑卒中后失语症的研究进展

脑卒中后失语症(PSA)是常见的脑卒中后遗症,患者主要表现为言语功能受损,严重影响其生活质量。针刺治疗PSA的临床效果显著,包括单一治疗(体针疗法、头皮针疗法、舌针疗法等)和综合治疗(多种针刺疗法联合应用)。该文查阅了近年来针刺治疗PSA的相关研究,总结不同针刺疗法的治疗特点与优势,为临床治疗PSA提供参考。

Schuell语言训练联合rTMS对缺血性脑卒中病人 失语康复效果影响

目的探究Schuell语言训练联合重复经颅磁刺激(rTMS)对缺血性脑卒中病人失语康复效果的影响。方法选取2020年1月—2022年9月江苏卫生健康职业学院附属高淳医院收治的112例缺血性脑卒中后失语病人为研究对象,随机分为对照组和观察组,每组56例。对照组采用Schuell语言训练治疗,观察组在对照组疗法基础上联合rTMS治疗。对比两组病人的日常生活的语言沟通能力(CFCP)、汉语失语(ABC)评分和简易智力精神状态检查量表(MMSE)评分等指标。结果两组病人治疗前CFCP、ABC和MMSE评分差异无统计学意义(P>0.05)。两组治疗后各指标均较治疗前明显升高,差异有统计学意义(t=10.646~133.303,P<0.01);观察组治疗后各评分及其治疗前后差值均明显高于对照组,差异均有统计学意义(t治疗后=3.483~38.375,t前后差=3.115~33.338,P<0.01)。结论Schuell语言训练联合rTMS对改善缺血性脑卒中病人的失语康复疗效更佳。