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: ① Patients 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. ② Patients 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; Grade Ⅳ for 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. ① FMA 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]. ② MAS grades of upper limbs: There were obviously fewer cases of grade Ⅲ in 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 grade Ⅲ in 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). ③ Barthel 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.

New Characteristics of Active Life Expectancy of the Elderly in China

Life expectancy of the elderly is a significant problem in China, and it changes not only the health care, but also the pension. This study used tracking data from the Chinese Urban and Rural Elderly Population Survey to calculate the age-specific Active Life Expectancy (ALE) of the Chinese elderly population aged 60 years and over. For analysis, this population was divided into different sub-populations according to gender, census register and region. The main conclusions of our study are as follows: 1) The quality of life for elderly males may be greater than that for elderly females;2) There were significant differences in Active Life Expectancy (ALE) and Inactive Life Expectancy (ILE) between urban and rural elderly;3) The differences in ALE between the eastern, central and western regions of China were not significant;and 4) The increased remaining life expectancy of the elderly was mainly attributed to the extended ALE in the lower age group and the expanded ILE in the higher age group. This study expands the knowledge of Chinese elderly’s life expectancy in different health status.

Patient Life Experience and Activity of Daily Living before and after Total Knee Arthroplasty

Background: As the population ageing, more patients suffer from joint disease. Joint replacement surgery performed in Taiwan is about 10,000 to 20,000 cases yearly. Aims: The purpose of this study is to realize Total Knee Arthroplasty (TKA) patients’ views about life experiences and difficulty in daily life before and after the surgery. Methods: In this study, in-depth interview with interview guideline was used to analyze patients’ experience by using a qualitative research method, and questionnaires were used to collect quantity data. Results: 1) A total of 20 participants were recruited. Average age was 75.15 (SD = 6.468). Eighteen of the participants were female and the other two were male. The majority of participants indicated that their home facilities were convenient or very convenient. 2) Motivations of the participants to undergo TKA were joint pain, limited joint range of motion, and weakness in legs. Participants’ expectations after surgery were no more pain and ease in walking, and able to manage daily life. 3) Depending on the time after surgery, joint pain and walking ability had improved to some extent. The joint range of motion increased, but kneeling remained difficult, and the participants’ mood and exercise capacity were improved. Conclusions: The finding can be as a reference for clinical practitioner to provide preoperative education for total knee arthroplasty patients.

早期护理干预对颅脑损伤患者的影响研究

目的探讨早期护理干预对颅脑损伤患者的影响,为颅脑损伤患者的护理提供临床经验。方法将70例颅脑损伤患者根据收治顺序单双号分为观察组和对照组,每组35例,对照组患者按照颅脑损伤常规护理方法进行护理,观察组患者采取早期护理干预措施,两组均干预一个月,对比观察两组干预前后Fugl-Meyer运动量表(FMA)、Barthel指数、简明精神状态检查量表(MMSE)评分变化。结果干预后,两组FMA、Barthel指数、MMSE评分均较干预前显著升高,差异有统计学意义(P<0.05);观察组干预后FMA、Barthel指数、MMSE评分分别为(88.62±8.76)、(72.64±8.26)、(33.63±5.51)分,显著高于对照组干预后,差异有统计学意义(P<0.05)。结论早期护理干预可以显著改善颅脑损伤患者肢体运动功能、日常生活活动能力和认知功能。

Smart Devices Based Multisensory Approach for Complex Human Activity Recognition

Sensors based Human Activity Recognition(HAR)have numerous applications in eHeath,sports,fitness assessments,ambient assisted living(AAL),human-computer interaction and many more.The human physical activity can be monitored by using wearable sensors or external devices.The usage of external devices has disadvantages in terms of cost,hardware installation,storage,computational time and lighting conditions dependencies.Therefore,most of the researchers used smart devices like smart phones,smart bands and watches which contain various sensors like accelerometer,gyroscope,GPS etc.,and adequate processing capabilities.For the task of recognition,human activities can be broadly categorized as basic and complex human activities.Recognition of complex activities have received very less attention of researchers due to difficulty of problem by using either smart phones or smart watches.Other reasons include lack of sensor-based labeled dataset having several complex human daily life activities.Some of the researchers have worked on the smart phone’s inertial sensors to perform human activity recognition,whereas a few of them used both pocket and wrist positions.In this research,we have proposed a novel framework which is capable to recognize both basic and complex human activities using builtin-sensors of smart phone and smart watch.We have considered 25 physical activities,including 20 complex ones,using smart device’s built-in sensors.To the best of our knowledge,the existing literature consider only up to 15 activities of daily life.

Does vitamin D affect disease severity in patients with ankylosing spondylitis？

Background Vitamin D has been found to have a role in the function of the immune system. There have been a lot of studies investigating a relation between vitamin D and disease activity in ankylosing spondylitis （AS）. However, there have not been any studies arranging AS in groups according to vitamin D levels and determining any differences among these patients in terms of disease activity, functional status, quality of life, and other clinical parameters. The aim of this study is to compare 25-hydroxy-vitamin D3 （25（OH）D3） levels in AS patients with those in normal healthy subjects and to determine the relationship between 25（OH）D3 levels and AS disease activity, functional status, and quality of life. Methods Ninety-nine consecutive patients and 42 healthy volunteers were included in this study. After a comparison between the patient group and the control group, the patient group was divided into normal, insufficient and deficient subgroups according to the plasma 25（OH）D3 levels for another comparison. Results The differences in the 25（OH）D3 level between the patient and the control groups were statistically insignificant. The number of AS patients whose 25（OH）D3 levels were classified as normal, insufficient, and deficient were 34, 29, and 36, respectively. Erythrocyte sedimentation rate （ESR）, C-reactive protein （CRP）, and Bath AS Disease Activity Index （BASDAI） scores were higher in the low （including insufficient and deficient） 25（OH）D3 level subgroups （P 〈0.05）. The Bath AS Functional Index （BASFI） and AS Quality of Life （ASQoL） scores were significantly different between the normal and the deficient subgroups （P 〈0.05）. Pain, BASDAI, ESR, and CRP were inversely correlated to the 25（OH）D3 levels （P 〈0.05）. Conclusions The plasma 25（OH）D3 levels may decrease in AS patients and this may negatively affect disease activity, functional status and quality of life.