The burden of upper motor neuron involvement is correlated with the bilateral limb involvement interval in patients with amyotrophic lateral sclerosis:a retrospective observational study

Amyotrophic lateral sclerosis is a rare neurodegenerative disease characterized by the involvement of both upper and lower motor neurons.Early bilateral limb involvement significantly affects patients'daily lives and may lead them to be confined to bed.However,the effect of upper and lower motor neuron impairment and other risk factors on bilateral limb involvement is unclear.To address this issue,we retrospectively collected data from 586 amyotrophic lateral sclerosis patients with limb onset diagnosed at Peking University Third Hospital between January 2020 and May 2022.A univariate analysis revealed no significant differences in the time intervals of spread in different directions between individuals with upper motor neuron-dominant amyotrophic lateral sclerosis and those with classic amyotrophic lateral sclerosis.We used causal directed acyclic graphs for risk factor determination and Cox proportional hazards models to investigate the association between the duration of bilateral limb involvement and clinical baseline characteristics in amyotrophic lateral sclerosis patients.Multiple factor analyses revealed that higher upper motor neuron scores(hazard ratio[HR]=1.05,95%confidence interval[CI]=1.01–1.09,P=0.018),onset in the left limb(HR=0.72,95%CI=0.58–0.89,P=0.002),and a horizontal pattern of progression(HR=0.46,95%CI=0.37–0.58,P<0.001)were risk factors for a shorter interval until bilateral limb involvement.The results demonstrated that a greater degree of upper motor neuron involvement might cause contralateral limb involvement to progress more quickly in limb-onset amyotrophic lateral sclerosis patients.These findings may improve the management of amyotrophic lateral sclerosis patients with limb onset and the prediction of patient prognosis.

Analysis of the Effect of Limb Rehabilitation Therapy Combined with Transcranial Magnetic Stimulation Therapy on Muscle Activity in Patients with Upper Limb Dysfunction After Cerebral Infarction

Objective:To analyze the effect of limb rehabilitation therapy combined with transcranial magnetic stimulation therapy on muscle activity in patients with upper limb dysfunction after cerebral infarction(CI).Methods:320 patients with upper limb dysfunction after CI were selected,all of whom were treated in our hospital between June 2021 and June 2023.They were randomly grouped according to the lottery method into the control group(limb rehabilitation therapy,160 cases)and the intervention group(transcranial magnetic stimulation therapy+limb rehabilitation therapy,160 cases).The upper limb function scores,neuro-electrophysiological indicators,daily living ability scores,and quality of life scores of the two groups were compared.Results:Compared with the control group,upper limb function scores and daily living ability scores in the intervention group were higher after treatment,and the neuro-electrophysiological indicators of the intervention group were lower after treatment(P<0.05).Conclusion:Transcranial magnetic stimulation therapy combined with limb rehabilitation therapy has significant effects in patients with upper limb dysfunction after CI and is worthy of promotion and application.

Analysis of the Effect of Transcutaneous Electrical Stimulation of Acupoints Combined with Rehabilitation Training in The Treatment of Upper Limb Dysfunction After Stroke

Objective:To analyze the effect of combining transcutaneous electrical acupoint stimulation(TEAS)with rehabilitation training in patients with upper limb dysfunction after stroke(ULDAS).Methods:A total of 130 ULDAS patients who were hospitalized and rehabilitated in Wuxi Xinwu District Rehabilitation Hospital from May 2021 to May 2023 were selected and randomly divided into Group A(65 cases,rehabilitation training)and Group B(65 cases,rehabilitation training+TEAS).The effects of the two groups were compared.Results:After treatment,the upper limb functional indexes of Group B were better than those of Group A(P<0.05).The rate of muscle tone grades 0-4 in Group B was higher than those of Group A(P<0.05).Conclusion:The function of upper limbs and muscle strength of ULDAS patients improved by combining TEAS with rehabilitation training.

Effects of different frequencies of repetitive transcranial magnetic stimulation on the recovery of upper limb motor dysfunction in patients with subacute cerebral infarction

Studies have confirmed that low-frequency repetitive transcranial magnetic stimulation can decrease the activity of cortical neurons, and high-frequency repetitive transcranial magnetic stimulation can increase the excitability of cortical neurons. However, there are few studies concerning the use of different frequencies of repetitive transcranial magnetic stimulation on the recovery of upper-limb motor function after cerebral infarction. We hypothesized that different frequencies of repetitive transcranial magnetic stimulation in patients with cerebral infarction would produce different effects on the recovery of upper-limb motor function. This study enrolled 127 patients with upper-limb dysfunction during the subacute phase of cerebral infarction. These patients were randomly assigned to three groups. The low-frequency group comprised 42 patients who were treated with 1 Hz repetitive transcranial magnetic stimulation on the contralateral hemisphere primary motor cortex （M1）. The high-frequency group comprised 43 patients who were treated with 10 Hz repetitive transcranial magnetic stimulation on ipsilateral M1. Finally, the sham group comprised 42 patients who were treated with 10 Hz of false stimulation on ipsilateral M1. A total of 135 seconds of stimulation was applied in the sham group and high-frequency group. At 2 weeks after treatment, cortical latency of motor-evoked potentials and central motor conduction time were significantly lower compared with before treatment. Moreover, motor function scores were significantly improved. The above indices for the low- and high-frequency groups were significantly different compared with the sham group. However, there was no significant difference between the low- and high-frequency groups. The results show that low- and high-frequency repetitive transcranial magnetic stimulation can similarly improve upper-limb motor function in patients with cerebral infarction.

Major ozonated autohemotherapy promotes the recovery of upper limb motor function in patients with acute cerebral infarction

Major ozonated autohemotherapy is classically used in treating ischemic disorder of the lower limbs In the present study, we performed major ozonated autohemotherapy treatment in patients with acute cerebral infarction, and assessed outcomes according to the U.S. National Institutes of Health Stroke Score, Modified Rankin Scale, and transcranial magnetic stimulation motor-evoked potential. Compared with the control group, the clinical total effective rate and the cortical potential rise rate of the upper limbs were significantly higher, the central motor conduction time of upper limb was significantly shorter, and the upper limb motor-evoked potential amplitude was significantly increased, in the ozone group. In the ozone group, the National Institutes of Health Stroke Score was positively correlated with the central motor conduction time and the motor-evoked potential amplitude of the upper limb. Central motor conduction time and motor-evoked potential amplitude of the upper limb may be effective indicators of motor-evoked potentials to assess upper limb motor function in cerebral infarct patients. Furthermore, major ozonated autohemotherapy may promote motor function recovery of the upper limb in patients with acute cerebral infarction.

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.

Evaluation of the Curative Effect of "Xingnao Kaiqiao" Acupuncture Based on Brunnstrom Staging on Upper Limb and Hand Motor Function in the Recovery Period after Stroke

Objective: To observe the effects of Xingnao Kaiqiao acupuncture(醒脑开窍针) on the motor function of upper limb and hand in the recovery period after stroke. Methods: Seventy-six cases of hemiplegia patients with ischemic stroke were divided into the treatment group and the control group(n=38 in each). Based on the Brunnstrom's stage of Xingnao Kaiqiao acupuncture combined with rehabilitation training was used in the treatment group, and the control group was given rehabilitation training. FuglMeyer Assessment of the upper extremity(FMA-UE), Action Research Arm Test(ARAT) and Simple Test for Evaluating hand Function(STEF) were adopted separately to compare scores before treatment and 8 weeks after treatment. Results: The difference was not statistically significant in the two groups of patients for comparison of FMA-UE, ARAT and STEF scores before treatment(P>0.05). The difference was statistically significant in the two groups of score comparison of FMA-UE, ARAT and STEF after treatment(P<0.05). Conclusion: The Xingnao Kaiqiao acupuncture has its unique advantages in improving recovery of motor function of upper limb and hand in recovery period after stroke.

Leap Motion-based virtual reality training for improving motor functional recovery of upper limbs and neural reorganization in subacute stroke patients

Virtual reality is nowadays used to facilitate motor recovery in stroke patients. Most virtual reality studies have involved chronic stroke patients; however, brain plasticity remains good in acute and subacute patients. Most virtual reality systems are only applicable to the proximal upper limbs （arms） because of the limitations of their capture systems. Nevertheless, the functional recovery of an affected hand is most difficult in the case of hemiparesis rehabilitation after a stroke. The recently developed Leap Motion controller can track the fine movements of both hands and fingers. Therefore, the present study explored the effects of a Leap Motion-based virtual reality system on subacute stroke. Twenty-six subacute stroke patients were assigned to an experimental group that received virtual reality training along with conventional occupational rehabilitation, and a control group that only received conventional rehabilitation. The Wolf motor func- tion test （WMFT） was used to assess the motor function of the affected upper limb; functional magnetic resonance imaging was used to measure the cortical activation. After four weeks of treatment, the motor functions of the affected upper limbs were significantly improved in all the patients, with the improvement in the experimental group being significantly better than in the control group. The action perfor- mance time in the WMFT significantly decreased in the experimental group. Furthermore, the activation intensity and the laterality index of the contralateral primary sensorimotor cortex increased in both the experimental and control groups. These results confirmed that Leap Motion-based virtual reality training was a promising and feasible supplementary rehabilitation intervention, could facilitate the recovery of motor functions in subacute stroke patients. The study has been registered in the Chinese Clinical Trial Registry （registration number： ChiCTR-OCH- 12002238）.

Therapeutic Application of High-Frequency rTMS Combined with Intensive Occupational Therapy for Pediatric Stroke Patients with Upper Limb Hemiparesis: A Case Series Study

Low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) applied to the non-lesional hemisphere is reported to significantly improve motor function of the affected upper limb in adult stroke patients with hemiparesis. For pediatric stroke patients, the beneficial effects of LF-rTMS have been already confirmed in a randomized controlled study. However, there is no report of therapeutic application of high-frequency rTMS (HF-rTMS) in this patient population. In this case series study, we introduced HF-rTMS combined with intensive occupational therapy (OT) in two pediatric hemiparetic patients. We studied two children (8- and 9-year-old boys, both right-handed) with post-stroke upper limb hemiparesis (chronic phase). Both patients underwent 22 treatment sessions of HF-rTMS/OT during 15-day hospitalization. The HF-rTMS was applied over the lesional motor cortex at a frequency of 10Hz for 15 minutes in each session. One session of intensive OT consisted of 30-min one-to-one training and 30-min self-exercise. Motor function of the affected upper limb was serially evaluated with Fugl-Meyer Assessment (FMA), Wolf Motor Function Test (WMFT), Simple Test for Evaluating hand Function (STEF), and Ten-second Test. Neither of the patients showed any adverse effects. Both patients showed improvement of motor function in the affected upper limb and were able to use the affected upper limb in some activities of daily living. In the two post-stroke pediatric patients, HF-rTMS/OT was safe and improved upper limb muscle function. Confirmation of these effects in a larger population is needed.

Application of MET Technique after Upper Limb Dysfunction after Breast Cancer Surgery

Object:Explore the application and actual effect of MET(Muscle Energy)technology after breast cancer surgery with upper limb dysfunction.Methods:Taking 40 female breast cancer patients who underwent surgical treatment in our hospital from September 2017 to June 2019 as the research objects,all of them successfully completed modified radical mastectomy for breast cancer.According to different nursing methods,the patients were randomly divided into two groups.The experiment There were 20 cases in each group and the control group.The control group was given routine functional recovery exercise intervention after the operation,and the experimental group added MET technology to the base of the control group.One month after the operation,the functional recovery of the affected limbs of the two groups of patients was effectively assessed.The upper limb dysfunction of the two groups was compared by statistical methods,and the shoulder joint range of motion(ROM)was used for performance.Results:Through early functional recovery training and MET technology,19 cases of ROM in the experimental group showed compliance(95%),compared with only 14 cases(70%)in the control group.The difference in upper limb dysfunction between the two groups is very obvious with statistical significance(P<0.05).Conclusions:Early functional recovery training combined with muscle energy technology can promote the recovery of upper limb dysfunction after breast cancer surgery faster and better,which is conducive to the recovery of patients as soon as possible and improve the quality of life.

间歇性Theta节律刺激联合床旁康复训练治疗在急性重症脑卒中患者上肢运动障碍恢复中的应用

目的 探讨间歇性Theta节律刺激联合康复训练治疗在急性重症脑卒中患者上肢运动障碍恢复中的应用。方法 我院收治的94例急性重症脑卒中偏瘫患者,根据单双号法分为训练组(常规康复训练)与电刺激组(间歇性Theta节律刺激联合康复训练)各47例。对比两组临床疗效(NIHSS)、治疗前后上肢运动情况[Fugl-Meyer评分(FMA)、改良Barthel指数(MBI)、上肢运动指数(MI)]、电刺激指标[中枢运动传导时间(CMCT)、运动诱发电位(MEP)]、表面肌电信号及脑血流动力学指标(外周阻力、平均血流速度、平均血流量)变化。结果 治疗第1、2、4周,两组NHISS逐渐下降,且各时间段电刺激组低于训练组(P<0.05);治疗后两组FMA、MBI、MI评分均上升,且电刺激组均高于训练组(P<0.05);两组CMCT、MEP均下降,且电刺激组均低于训练组(P<0.05);两组肱二头肌屈肘、肱三头肌伸肘时表面肌电信号上升,且电刺激组均高于训练组(P<0.05),肱二头肌伸肘、肱三头肌屈肘时组内或组间比较差异均无统计学意义(P>0.05);两组外周阻力下降,平均血流速度与血流量提高,且电刺激组外周阻力低于训练组,平均血流速度与血流量高于训练组(P<0.05);两组均未发现明显不良反应。结论 间歇性Theta节律刺激联合康复训练可恢复急性重症脑卒中偏瘫患者上肢运动功能,改善肌电信号与脑血流动力学指标,疗效显著,值得推广。

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.

Impacts of the combined treatment of Tongdu Tiaoshen moxibustion and rehabilitation training on the motor function recovery of the upper limbs in the patients with apoplectic hemiplegia

Objective:To observe the impacts of the combined treatment of Tongdu Tiaoshen moxibustion(moxibustion for promoting the circulation of the governor vessel and regulating the spirit)and rehabilitation training on the motor function recovery in the patients with apoplectic hemiplegia.Methods:A total of 50 patients with apoplectic hemiplegia and qualified in the trial recruitment criteria were divided into two groups according to random number table,25 cases in each group.In the control group,the simple rehabilitation training was provided.In the observation group,on the base of the treatment as the control group,Tongdu Tiaoshen moxibustion was given.Main acupoints:Baihul(百会GV20),Fengfu(风府GV16)and Dazhui(大椎GV14).The treatment was given once a day,6 treatments a week,4 weeks as one course and two courses of treatment were required.Before and after treatment,the scores of Fugle-Meyer assessment(FMA),the modified Barthel index(MBI)and action research arm test(ARAT)were detected before and after treatment in the two groups separately.Results:After 4 and 8 weeks of treatment,the scores of FMA,MBI and ARAT were all improved obviously as compared with those before treatment respectively in patients of the two groups(all P<0.01).After8 weeks of treatment,the score of each scale in the observation group was more obviously improved as compared with the control group(all P<0.05).The difference in the clinical therapeutic effect was significant statistically between the two groups(P=0.005).Conclusion:The combined treatment of Tongdu Tiaoshen moxibustion and rehabilitation training promotes the recovery of the upper limb motor function and improves the self-ability of living activities in the patients with apoplectic hemiplegia.The long-term effect of this combined therapy is superior to that of simple rehabilitation training.

小针刀联合经颅磁刺激治疗脑梗死后遗症期上肢痉挛的疗效观察

目的:研究小针刀联合经颅磁刺激(Transcranial Magnetic Stimulation.TMS)在改善脑梗死后遗症期患者上肢痉挛症状中的临床疗效。方法:选取2021年6月~2023年6月在本院就诊的80例脑梗死后遗症期上肢轻至中度痉挛患者,随机将其分为小针刀组(n=26)、TMS组(n=27)、联合组(n=27)。所有患者在常规康复训练基础上,小针刀组进行小针刀治疗,TMS组进行经颅磁治疗,联合组进行联合治疗。治疗前后评估患者的Fugl-Meyer量表分数、临床痉挛指数分数,运动诱发电位,和静息运动阈值。结果:三组患者治疗后Fugl-Meyer评分均提高,临床痉挛指数评分均下降(P<0.01),其中联合治疗组的FuglMeyer评分高于单一治疗组,临床痉挛指数评分低于单一治疗组(P<0.01):三组患者治疗后运动诱发电位潜伏期均缩短,波幅增高(P<0.01),其中联合治疗组的运动诱发电位潜伏期短于单一治疗组,波幅高于单一治疗组(P<0.01):三组患者治疗后静息运动阈值均下降(P<0.01),其中联合治疗组的静息运动阈值低于单一治疗组(P<0.01)。结论:小针刀联合经颅磁刺激治疗能有效缓解脑梗死后上肢功能痉挛患者的上肢痉挛、中枢神经系统功能及大脑皮层兴奋性,疗效优于单一治疗方法。

脑卒中后上肢运动功能与注意力的相关性:一项多中心横断面研究

背景上肢运动功能障碍是脑卒中后常见的功能障碍,注意力可能对上肢运动功能的恢复有影响,但目前上肢运动功能与注意力的相关性研究证据较少。目的探索脑卒中后上肢运动功能与注意力的相关性,为临床解决上肢功能康复问题提供新的思考角度。方法选取2023年3—10月在全国26家单位康复医学科住院的脑卒中患者480例为研究对象。采用Fugl-Meyer上肢运动功能评分(FMA-UL)和蒙特利尔认知评估量表(MoCA)分别评估患者上肢运动功能和注意力,采用Pearson相关性分析探究FMA-UL总分与MoCA中注意力评估项目得分的相关性。结果480例患者中有105例没有完成完整的评估,最终纳入脑卒中患者375例;平均FMA-UL总分(31.26±22.49)分;平均MoCA-注意力部分总分(4.74±1.60)分;平均注意-数字顺背/倒背任务得分(1.62±0.63)分;平均注意-读到1敲一下桌面任务得分(0.74±0.45)分;注意-100连续减7任务得分(2.39±0.95)分。男性患者FMA-UL总分高于女性(P<0.05)。全部患者的FMA-UL总分与MoCA-注意力部分总分、注意-数字顺背/倒背任务得分、注意-读到1敲一下桌面任务得分、注意-100连续减7任务得分均呈正相关(r值分别为0.226、0.146、0.195、0.182,P<0.05);男性患者的FMA-UL总分与MoCA-注意力部分总分、注意-数字顺背/倒背任务得分、注意-读到1敲一下桌面任务得分、注意-100连续减7任务得分均呈正相关(r值分别为0.236、0.128、0.213、0.197,P<0.05)。结论脑卒中后上肢运动功能与注意力具有相关性且呈正相关,其中持续性注意力与上肢运动功能的相关程度较高,注意力的广度与上肢运动功能的相关程度较低。按照性别分组后,男性患者的上肢运动功能与注意力相关性同上,而女性患者的上肢运动功能与注意力相关性不显著,性别可能对上肢运动功能和注意力的相关性存在影响。

经颅直流电刺激对慢性期脑卒中偏瘫患者上肢运动功能的疗效分析

目的:研究双侧经颅直流电刺激(dual-hemispheric transcranial direct current stimulation,Dual-tDCS)对慢性期脑卒中患者上肢运动功能的影响,为治疗慢性期脑卒中上肢功能障碍提供基于神经机制的理论依据。方法:选取某院24例慢性期脑卒中上肢运动功能障碍患者,按照随机数字表法将其分为研究组(n=13)和对照组(n=11)。对照组采用tDCS伪刺激联合常规康复治疗,研究组采用Dual-tDCS联合常规康复治疗。治疗前后,采用Fugl-Meyer运动功能评定量表上肢部分(Fugl-Meyer assessment upper limb scale,FMA-UL)及日常生活活动能力(activities of daily living,ADL)测评量表对患者活动能力进行评估。对比治疗前后初级运动皮层(M1区)与全脑功能连接(functional connectivity,FC)的变化。使用SPSS 24.0统计学软件进行数据分析。结果:治疗后,2组患者的FMA-UL、ADL评分比治疗前均显著提高,且研究组评分明显高于对照组,差异有统计学意义(P<0.05)。M1区与全脑FC分析显示,治疗后对照组健侧M1区到患侧枕中回、健侧舌回、健侧角回FC降低(P<0.01);患侧M1区未见FC变化脑区。治疗后研究组健侧M1区到健侧小脑、健侧小脑蚓部FC降低,到患侧中央前回FC增加(P<0.01);患侧M1区到患侧小脑、患侧颞中回FC增加,到健侧中央前回FC降低(P<0.01)。结论:Dual-tDCS对大脑的神经调控作用可改善慢性期卒中患者运动和非运动相关脑区的FC,可能是慢性期脑卒中上肢运动功能障碍的康复机制。

Bobath康复训练改善脑卒中后肩手综合征患者上肢运动功能效果分析

目的 探讨Bobath康复训练改善脑卒中后肩手综合征(SHS)患者上肢运动功能效果。方法 采用便利抽样方法选取2022年4月至2023年1月南通市第三人民医院(南通大学附属南通第三医院)康复科收治的110例脑卒中后SHS患者作为研究对象,根据随机数字表法分为研究组和对照组,各55例。2组患者均实施基础护理,对照组实施常规康复锻炼,研究组同时联合Bobath康复训练。干预前后,对比2组患者Fugl-Meyer量表(FMA)评分、肩关节活动度评分、肩手综合征评定量表(SHSS)评分及患侧上肢Ashworth分级。结果 干预后,2组患者FMA评分及肩关节前屈、后伸、外展角度均大于干预前,且研究组大于对照组(P<0.05)。干预后,2组患者SHSS评分均低于干预前,且研究组低于对照组(P<0.05)。干预前,2组患者中不同Ashworth分级患者占比差异无统计学意义(P>0.05);干预后,研究组Ashworth分级0~Ⅰ+级患者占比高于对照组(P<0.05)。结论 对脑卒中后SHS患者实施Bobath康复训练可提高上肢功能及肩关节活动度,可改善患者患侧上肢痉挛情况。

基于IMB模型的康复干预对老年脑梗死患者上肢功能运动功能及神经功能的影响

目的探讨信息-动机-行为技巧(IMB)下的康复干预在老年脑梗死患者中的应用效果。方法将符合本研究纳入及排除标准的116例脑梗死患者随机分成2组各58例,对照组采用常规康复,观察组采用基于IMB模型的康复干预。2组患者均在院内进行为期1个月的康复训练,院外监督患者继续进行2个月的康复训练并线上汇报每日康复训练情况,共连续干预3个月后评估2组患者上肢功能、运动功能、神经功能、生活质量及并发症发生情况。结果干预后2组患者Fugl-Meyer评估量表(FMA)及上肢Wolf(沃尔夫)运动功能测试量表(WMFT)评分均增加,且观察组增加幅度更显著[FMA:(25.91±4.42)分比(29.37±4.58)分,t=4.140,P<0.05;WMFT:(30.42±3.56)分比(34.29±4.05)分,t=5.466,P<0.05]。干预后2组患者FCA及BBS评分均增加,且观察组分值增加幅度更显著[FCA评分:(50.08±8.21)分比(57.63±8.58)分,t=4.842,P<0.05;BBS评分:(31.98±5.36)分比(37.41±5.79)分,t=5.241,P<0.05]。干预后2组患者NIHSS评分均降低,ADL评分均增加,且观察组分值变化幅度更显著[NIHSS评分:(9.60±1.73)分比(6.83±1.55)分,t=9.082,P<0.05;ADL评分:(75.33±5.56)分比(80.74±5.82)分,t=5.119,P<0.05]。干预后2组患者WHOQOL-BREF量表各维度评分及总分均升高,且观察组患者WHOQOL-BREF量表各维度评分及总分值变化幅度更显著(P<0.05)。观察组并发症发生率(1.72%)与对照组(18.97%)相比显著降低(P<0.05)。结论基于IMB模型的康复干预有效改善了老年脑梗死患者上肢功能、运动功能及神经功能,提高了患者生活质量,降低了并发症发生率。

“手脑感知-手脑运动”理论在脑卒中后上肢康复中的应用

上肢运动功能障碍是脑卒中后患者面临的主要问题,寻求更多有效的康复技术对减轻患者功能障碍程度、提升生活质量具有重要意义。本研究关注感觉功能对上肢运动功能恢复的重要作用,并对“手脑感知-手脑运动”理论开展进一步的解读。在该理论的指导下,课题组就手脑感知康复评估与训练系统创建手脑感知训练五步法(感觉评估、感觉宣教、感觉训练、任务导向性训练和感觉认知)、手脑感知-脑机接口训练范式、手脑感知-镜像疗法训练范式和“手脑感知-手脑运动”理论的其他应用进行阐述,分析了“手脑感知-手脑运动”理论与“中枢-外周-中枢”闭环康复理论的关系,以期为康复医务人员在治疗脑卒中后上肢感觉、运动功能障碍提供参考依据与启发。

针刺联合镜像疗法治疗脑卒中患者上肢运动功能障碍临床疗效观察

目的观察针刺联合镜像疗法治疗脑卒中患者上肢运动功能障碍的临床疗效。方法将90例脑卒中上肢运动功能障碍患者按随机数字表法分为对照1组(30例,给予针刺治疗)、对照2组(30例,给予镜像疗法治疗)和观察组(30例,给予针刺联合镜像疗法治疗),疗程均为2周。比较3组患者治疗前后Fugl-Meyer评估量表上肢板块(Fugl-Meyer assessment upper extremity,FMA-UE)评分,Wolf运动功能测试(Wolf motor function test,WMFT)量表评分,改良Barthel指数(modified Barthel index,MBI),国际功能、残疾和健康分类(international classification of functioning,disability and health,ICF)评分及伸腕主动运动范围(active range of motion,AROM)和基于FMA-UE评分判定临床疗效。结果观察组临床疗效优于对照1组和对照2组(P<0.05);治疗后3组患者FMA-UE评分、WMFT评分、MBI均较治疗前显著增加(P<0.05),ICF评分显著减少(P<0.05),且观察组FMA-UE评分、WMFT评分、MBI增加程度,ICF评分减少程度显著大于对照1组和对照2组(P<0.05);治疗后观察组患者伸腕AROM显著大于对照1组和对照2组(P<0.05)。结论针刺联合镜像疗法能有效改善脑卒中患者上肢运动功能障碍。