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.

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 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.

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 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.

Functional magnetic resonance imaging evaluation of brain function reorganization in cerebral stroke patients after constraint-induced movement therapy

In this study, stroke patients received constraint-induced movement therapy for 3 weeks. Before and after constraint-induced movement therapy, the flexibility of their upper limbs on the affected side was assessed using the Wolf motor function test, and daily use of their affected limbs was assessed using the movement activities log, and cerebral functional reorganization was assessed by functional magnetic resonance imaging. The Wolf motor function test score and the movement activities log quantity and quality scores were significantly increased, while action performance time in the Wolf motor function test was significantly decreased after constraint-induced movement therapy. By functional magnetic resonance imaging examination, only scattered activation points were visible on the affected side before therapy. In contrast, the volume of the activated area was increased after therapy. The activation volume in the sensorimotor area was significantly different before and after therapy, and the activation area increased and appeared adjusted. In addition to the activated area around the lesions being decreased, there were also some new activated areas, including the supplementary movement area, premotor area and the ipsilateral sensorimotor area. Our findings indicate that constraint-induced movement therapy significantly improves the movement ability and daily use of the affected upper limbs in stroke patients and promotes cerebral functional reorganization.

Neurorestorative Effects of Constraint-Induced Movement Therapy after Stroke: An Integrative Review

Stroke has been considered as one of the main causes of death and of motor and cognitive sequels. Especially, many patients with upper limb hemiparesis improved their motor action and showed meaningful cortical changes after treatment with constraint-induced movement therapy. Therefore, this review aims to verify the literature about neuroimaging and behavioral evidences in the cortical reorganization through the use of the constraint-induced movement therapy. So, we conducted the literature research in indexed journals from many databases like Pubmed, Medline, Cochrane Database, Lilacs and Scielo. We concluded that the behavioral and neuroimaging studies using traditional and modified constraint-induced movement therapy promote cortical reorganization.

Effect of low level laser therapy on dental pulp during orthodontic movement

AIM: To validate the protocol described here to be used in future clinical trials related to the effect of laser therapy on dental pulp. METHODS: Histologically treated samples from eight human healthy premolar teeth obtained from the middle root level were distributed in four groups: group 1(G1) absolute control; group 2(G2) only laser irradiation; group 3(G3) exposed only to orthodontics; and group 4(G4) treated with orthodontics and laser. Laser treatment was performed at 830 nm wavelength, 100 mW(energy 80 J/cm2, 2.2 J), for 22 s in the vestibular surface and 22 s in the palatal surface, 1 mm away from the dental root mucosa. Three staining methods were performed: hematoxylin-eosin(HE), Masson's Trichrome method and Gomori's method.RESULTS: The pulp histology parameters were evaluated and the results classified in to 3 parts: an inflammatory response, soft tissue response(dental pulp) and hard tissue response(dentin and predentin). There was no inflammation(chronic or acute) in any of the evaluated groups. The zones of pulp necrosis were found in one premolar of G3 and in one of G4; in groups G2 and G4 there was higher angiogenesis than in the other two groups. G4 group presented the highest level of vascularization. A reduced nerve density was observed in G3. A G2 specimen showed increased nerve density. A higher rate of calcification was observed in G1 compared to G2. Denticles, either real or false, were observed in G1, G2 and G3. Sclerosis of dentin and focal dentin loss was observed among all the groups. Secondary dentin was present in one sample in G1 and G2. A necrosis zone was found in one sample of G3 and G4. No differences between groups were observed in the odontoblast irregularity layer but the layer was wider in the group treated with laser only. A notable difference was detected in reduction of the cell-free layer between the groups G1 and G4. The findings in pulp tissue favor its adaptative response against dental movement induced by orthodontics. No definitive conclusions may be derived as this is a pilot study. CONCLUSION: The protocol described here was shown to be an effective method to evaluate changes in dental pulp submitted to low level laser in teeth under orthodontic movement.

Effectiveness of Modified Constraint Induced Movement Therapy and Bilateral Arm Training on Upper Extremity Function after Chronic Stroke: A Comparative Study

Statement of the Problem: Upper limb hemiparesis is a common impairment underlying disability after Stroke. Transfer of treatment to daily functioning remains a question for traditional approaches used in treatment of upper extremity hemiparesis. Approaches based on Motor Learning principles may facilitate the transfer of treatment to activities of daily living. Methodology: Forty one subjects with chronic stroke, attending department of occupational therapy, National Institute for the Orthopaedically Handicapped, Kolkata, West Bengal, India participated in a single blinded randomized pre-test and post-test control group training study. Subjects were randomized over three intervention groups receiving modified Constraint Induced Movement Therapy (n = 13), Bilateral Arm training (n = 14), and an equally intensive conventional treatment program (n = 14). Subjects in the bilateral arm training group participated in bilateral symmetrical activities, where as subjects in constraint induced movement therapy group performed functional activities with the affected arm only and conventional group received conventional Occupational Therapy. Each group received intensive training for 1 hour/day, 5 days/week, for 8 weeks. Pre-treatment and post-treatment measures included the Fugl-Meyer measurement of physical performance (FMA- upper extremity section), action research arm test, motor activity log. Assessments were administered by a rater blinded to group assignment. Result: Both m-CIMT (p = 0.01) and bilateral arm training (p = 0.01) group showed statistically significant improvement in upper extremity functioning on Action Research Arm Test score in comparison to the conventional therapy group (p = 0.33). The bilateral arm training group had significantly greater improvement in upper arm function (Proximal Fugl-Meyer Assessment score, p = 0.001);while the constraint induced movement therapy group had greater improvement of hand functions (Distal Fugl-Meyer Assessment score, p = 0.001. There is an improvement seen in Quality of movement in the Conventional Therapy group. (p = 0.001). Conclusion: Both the treatment techniques can be used for upper extremity management in patients with chronic stroke. Bilateral arm training may be used to improve upper arm function and m-CIMT may be used to improve hand functions, while the group that received modified constraint induced movement therapy had greater improvement.

Dance Movement Therapy: A Promising Lifestyle Intervention in the Management of Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease(COPD),a progressive multicomponent malady with high morbidity and mortality,is an important public health challenge,throughout the world.Despite remarkable progress in its diagnostic and therapeutic modalities,significant number of patients,especially the elderly,continue to suffer from distressing dyspnoea and harrowing extra-pulmonary manifestations limiting their daily activities,with resultant exercise intolerance.Dance Movement Therapy(DMT),a pleasurable and feasible exercise,has been found to be equally efficacious when compared to routinely prescribed physical exercises.Moreover,it has aesthetic expression,attractive to both genders irrespective of age,tempting to those with disabilities,and a fruitful tool in developing self-confidence.During the current stressful situation,caused by COVID-19 pandemic,the COPD patients,notably those over 70 years,are particularly vulnerable to intensification of symptoms and some of them may experience serious disorders of mental illness.Home isolation,social distancing,limiting outdoor activities and prohibiting participation in group exercises,though being appropriate prophylactic measures,are likely to add to already existing physical inactivity and heighten stress and depression,with deleterious effects on overall well-being.Solo dancing,while restricted to home,is a highly accessible,doable,sustainable and well rewarding alternative.

Design of Rehabilitation Training Device for Finger-Tapping Movement Based on Trajectory Extraction Experiment

Patients with stroke, tendon injury and cardiovascular disease commonly have the sequelae of hand dysfunction which seriously affects the patients’ ability in daily life. Previous studies have found that the function of finger-tapping movement accounts for 80% of the hand function, and the recovery of the motor ability of the finger-tapping can greatly improve the patients’ self-care ability. Therefore, a rehabilitation training device to restore the finger-tapping movement is designed. In the study, anthropometry was applied to measure the dynamic and static dimensions of human hands in the finger-tapping movement. Subjects were selected according to the selected size range, and an experimental platform was built. Sampling points were set at key positions of index fingers and thumbs, and characteristic points of coronal planes and sagittal planes were recorded at a frequency of 10 frames per second. MATLAB was used to optimize the fitting of the scatter plot, and the fitted spatial curve parameters were input into the modeling software to establish the joint motion trajectory model and assist the design of rehabilitation training devices. It is proved that the device is ergonomic, and can effectively achieve the finger-tapping movement rehabilitation training of patients.

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.

肌力训练与神经肌肉电刺激干预髌股关节痛患者下肢功能和生物力学的变化

背景:下肢髋膝周肌力训练与神经肌肉电刺激通常是针对髌股关节痛较为安全有效的康复治疗手段,但其所起的干预作用机制目前仍不清楚。目的:明确肌力训练与神经肌肉电刺激对髌股关节痛患者疼痛、下肢功能和生物力学特征的影响。方法:招募37例髌股关节痛患者,随机分为2组,肌力训练结合电刺激组(试验组)19例,单纯肌力训练组(对照组)18例,进行为期6周、每周3次的干预训练。干预后采用目测类比评分法和膝前痛量表评估患者膝关节疼痛等级和功能水平,应用红外运动捕捉系统与三维测力台同步采集跑步测试时膝关节运动学和动力学数据,以重复测量的双因素方差分析(组别*时间)进行数据分析。结果与结论:①试验组和对照组在干预后较干预前目测类比评分均显著减小(P<0.001),膝前痛量表评分均显著提高(P_(试验组)<0.001,P_(对照组)=0.001);且试验组膝前痛量表评分在干预后高于对照组(P=0.001);②试验组和对照组在干预后跑步测试中的膝最大屈曲角度(P=0.011)、膝关节伸展力矩峰值(P<0.001)、内旋力矩峰值(P=0.008)、髌股关节应力峰值(P<0.001)、髌股关节反作用力峰值(P<0.001)等指标均较干预前显著降低;③结果说明,单纯肌力训练和肌力训练结合电刺激干预均有助于改善髌股关节痛患者的主观痛感和下肢功能水平,并有助于改善跑步时的运动模式及降低髌股关节应力;与单纯肌力训练相比,肌力训练结合电刺激干预改善患者下肢功能的效果更为显著。

Mulligan动态关节松动术对肌肉骨骼疾病治疗效果及机制的研究进展

研究综述了Mulligan动态关节松动术在治疗不同肌肉骨骼疾病中的效果,包括肩袖损伤、肱骨外上髁炎、腰痛、慢性踝关节不稳等,并探讨了该技术的干预机制。研究发现,Mulligan动态关节松动术治疗常见的肌肉骨骼系统疾病的即时效果显著,包括减轻疼痛、增加关节活动度、改善肢体功能,并且在改善关节活动度方面有明显优势,但其长期效果需要进一步研究。Mulligan动态关节松动术的潜在治疗机制为:1)在生物力学方面,可能通过特别定向的动态关节滑动纠正2个关节面微小的错误排列,继而加强薄弱处的肌肉力量并拉伸紧张的肌肉,恢复身体机能;2)在神经生理学方面,优化处理疼痛的大脑区域之间的功能连接;降低脊髓兴奋性和疼痛敏感性;降低TNF-α、IL-6炎症因子,并促进内啡肽和5-羟色胺等神经递质的释放。

心外科高流量氧疗患者运动恐惧水平及影响因素

目的探讨心外科高流量氧疗患者运动恐惧水平及其影响因素。方法采用一般资料调查表、运动自我效能量表、医学应对方式问卷、心脏病运动恐惧量表对260例心外科高流量氧疗患者进行调查。结果心外科高流量氧疗患者运动恐惧量表总分为(43.46±4.53)分。多元线性回归分析结果显示,年龄、文化程度、运动自我效能、医学应对方式是心外科高流量氧疗患者运动恐惧的独立影响因素(F=50.800,P<0.001,R^(2)=0.500,ΔR^(2)=0.482)。结论心外科高流量氧疗患者运动恐惧水平需引起重视,医护人员需重点关注高龄、文化程度偏低、运动自我效能较低、采取屈服或回避应对方式的心外科高流量氧疗患者,并为其提供个体化的干预方案。

Magnetic resonance-guided focused ultrasound for essential tremor:a prospective,single center,single-arm study

The safety and effectiveness of magnetic resonance-guided focused ultrasound thalamotomy has been broadly established and validated for the treatment of essential tremor.In 2018,the first magnetic resonance-guided focused ultrasound system in Chinese mainland was installed at the First Medical Center of the PLA General Hospital.This prospective,single center,open-label,single-arm study was part of a worldwide prospective multicenter clinical trial(ClinicalTrials.gov Identifier:NCT03253991)conducted to confirm the safety and efficacy of magnetic resonance-guided focused ultrasound for treating essential tremor in the local population.From 2019 to 2020,10 patients with medication refractory essential tremor were recruited into this open-label,single arm study.The treatment efficacy was determined using the Clinical Rating Scale for Tremor.Safety was evaluated according to the incidence and severity of adverse events.All of the subjects underwent a unilateral thalamotomy targeting the ventral intermediate nucleus.At the baseline assessment,the estimated marginal mean of the Clinical Rating Scale for Tremor total score was 58.3±3.6,and this improved after treatment to 23.1±6.4 at a 12-month follow-up assessment.A total of 50 adverse events were recorded,and 2 were defined as serious.The most common intraoperative adverse events were nausea and headache.The most frequent postoperative adverse events were paresthesia and equilibrium disorder.Most of the adverse events were mild and usually disappeared within a few days.Our findings suggest that magnetic resonance-guided focused ultrasound for the treatment of essential tremor is effective,with a good safety profile,for patients in Chinese mainland.

不同强化训练对脑性瘫痪儿童上肢运动功能效果的网状Meta分析

目的系统评价上肢强化训练对脑瘫儿童上肢运动功能的效果。方法构建PICO架构,检索PubMed、Embase、Cochrane Library、Scopus、Web of Science、中国知网、中国生物医学文献数据库、维普和万方数据库,搜集关于上肢强化训练改善脑瘫儿童上肢运动功能的随机对照试验,检索时限均为2010年1月至2024年3月。按照Cochrane系统评价手册和物理治疗证据数据库量表对纳入文献进行质量评价,由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.4和Stata 17.0进行网状Meta分析。结果共纳入27篇文献,包括1173例患者,涉及3种上肢强化训练。强制性运动疗法、改良强制性运动疗法和手-臂双侧强化训练均可提高辅助手功能评分与Peabody精细运动功能评分;强制性运动疗法和改良强制性运动疗法可提高上肢技能质量量表评分;手-臂双侧强化训练可提高儿童生活功能量表评分。在提高辅助手功能、上肢技能质量量表评分和Peabody精细运动功能评分方面,强制性运动疗法为最佳干预方式;在提高儿童生活功能量表评分方面,手-臂双侧强化训练为最佳干预方式。结论上肢强化训练可显著改善脑瘫儿童的上肢运动功能、精细运动功能和日常生活活动能力,强制性运动疗法在改善上肢运动功能和精细运动功能方面效果最好,手-臂双侧强化训练在提高日常生活活动能力方面疗效最佳。

针刺疗法联合早期综合康复训练对脑外伤术后运动障碍患者的影响

目的探讨针刺疗法联合早期综合康复训练对脑外伤术后运动障碍患者的影响。方法选取南阳市中心医院2020年1月至2022年8月收治的103例脑外伤术后运动障碍患者为研究对象,按照康复方案分为早期康复训练组(51例)和针刺联合康复训练组(52例)。早期康复训练组接受早期综合康复训练,针刺联合康复训练组在早期综合康复训练的基础上接受针刺疗法。康复治疗2个月后,对比两组临床疗效、治疗前后三维步态参数(步速、步频、左右步长差、患肢摆动相)、神经功能指标[神经元烯醇化酶(NSE)、胶质纤维酸性蛋白(GFAP)、C反应蛋白(CRP)]、跌倒效能[修订版跌倒效能量表(MFES)]、平衡能力[Berg平衡量表(BBS)]、日常生活能力[改良Barthel指数评定量表(MBI)]。结果康复治疗后,针刺联合康复训练组总有效率为90.38%,高于早期康复训练组的72.55%(P<0.05);康复治疗后,针刺联合康复训练组步速、步频、患肢摆动相高于早期康复训练组,左右步长差低于早期康复训练组(P<0.05);康复治疗后,针刺联合康复训练组血清NSE、GFAP、CRP水平低于早期康复训练组(P<0.05);康复治疗后,针刺联合康复训练组MFES、BBS、MBI评分高于早期康复训练组(P<0.05)。结论针刺疗法联合早期综合康复训练康复治疗脑外伤术后运动障碍患者的疗效确切,可改善三维步态、跌倒效能,提高日常生活能力,促进神经功能、运动功能恢复。