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.

The effects of decompressive craniectomy on cerebral blood flow volume and brain metabolism in different aged patients with severe traumatic brain injury

Objective To explore effects of decompressive craniectomy on cerebral blood flow volume and brain metabolism in different aged patients with severe traumatic brain injury. Methods 71 cases were divided into three groups according age: group A( 【 30 years) ,group B ( 30 ～ 50 years) 。

Clinical significance of large decompressive craniectomy to control intractable increased intracranial pressure in patients with traumatic brain injury

Objective To investigate the role of decompressive craniectomy (DC) to decrease intractable intracranial hypertension(ICH) due to diffuse brain swelling and / or cerebral edema after severe traumatic brain injury and the time window of DC to affect on prognosis. Methods The clinical record of 132 patients who underwent DC for posttraumatic intractable ICH in our hospital from July 2003 to

Effect of mild hypothermia on glucose metabolism and glycerol of brain tissue in patients with severe traumatic brain injury

To study the effect of mild hypothermia on glucose metabolism and glycerol of brain tissue in patients with severe traumatic brain injury (sTBI).Methods All 33 patients with sTBI(GCS≤8) were randomly divided into hypothermic group and control group.Microdialysis catheters were inserted into the cerebral cortex of perilesion,relative normal brain tissue and subcutaneous tissue of abdomen in order to analyze the concentrations of lactate/pyruvate (L/P),lactate/glucose (L/G) and the glycerol(Gly) in extracellular fluid (ECF).Results In comparison with the control group,the concentration of L/G,L/P and Gly in periphery and that of L/P in ECF of the “normal brain tissue” were significantly decreased in the hypothermic group.In control group,concentration of L/G,L/P and Gly in periphery were higher than those in relative normal brain.In the hypothermic group,L/P concentration in periphery was higher than that in relative normal brain.Conclusion Mild hypothermia protects brain by decreasing concentrations of L/G,L/P and Gly in periphery and L/P concentration in “normal brain tissue”.The energy crisis and membrane phospholipid breakage in periphery are easier to happen after TBI,where mild hypothermia exerts significant protgective role.12 refs,3 tabs.

Severe bilateral anterior cingulum injury in patients with mild traumatic brain injury

The cingulum,the neural tract connecting the orbitofrontal cortex with the medial temporal lobe,plays an important role in cognition（Bush et al.,2000）.It is also important in memory because it provides cholinergic innervations to the cerebral cortex after obtaining innervation from the medial septal nucleus,the vertical nucleus of the diagonal band, and the nucleus basalis of Meynert via the medial cholinergic pathway （Nieuwenhuys et al., 2008; Naidich and Duvernoy, 2009; Hong and Jang, 2010a）.

Recovery of injured cingulum in a patient with traumatic brain injury

The cingulum is the neural fiber bundle that connects the basal forebrain and medial temporal lobe. The cingulum contains the medial cholinergic pathway, which originates from the basalis nucleus of Meynert in the basal forebrain. Therefore, it is important for memory function （Malykhin et al., 2008; Hong and Jang, 2010）. In the past, identification of the cingulum on conventional brain MRI has been impossible because it cannot discern the cingulum from other adjacent structures. Diffusion tensor tractography （DTT）, derived from diffusion tensor imaging （DTI）, allows three-dimensional visualization and estimation of the cingulum （Malykhin et al., 2008）.

Recovery of an injured anterior cingulum to the basal forebrain in a patient with brain injury: a 4-year follow-up study of cognitive function

~[he cingulum, a long neural tract extending from the orbitof- rontal cortex to the medial temporal lobe, obtains cholinergic innervation from three cholinergic nuclei in the basal fore- brain （the nucleus basalis of Meynert [Ch 4], the medial septal nucleus [Ch 1 ], and the vertical nucleus of the diagonal band [Ch 2]）, and is the passage of the medial cholinergic pathway which supplies cholinergic innervation from the basal forebrain to the cerebral cortex （Folstein et al., 1975; Selden et al., 1998; Lucas-Meunier et al., 2003）. Therefore, it is important for cog- nition, especially memory function （Selden et al., 1998）.

Weak phonation due to unknown injury of the corticobulbar tract in a patient with mild traumatic brain injury: a diffusion tensor tractography study

In this study,we report on a patient who showed weak phonation following mild traumatic brain injury（TBI）,which was demonstrated by diffusion tensor tractography（DTT）.

Appearance of a neural bypass between injured cingulum and brainstem cholinergic nuclei of a patient with traumatic brain injury on follow-up diffusion tensor tractography images

The human brain is known to contain a maximum of eight cholinergic nuclei： the basal forebrain region： the medial septal nucleus （Ch 1）, the vertical nucleus of the diagonal band （Ch 2）, the horizontal limb of the diago- nal band （Ch 3）, and the nucleus basalis of Meynert （Ch 4）; the brainstem： the pedunculopontine nucleus （Ch 5）, the laterodorsal tegmental nucleus （Ch 6）, and the para- bigeminal nucleus （Ch 8）; and the thalamus： the medial habenular nucleus （Ch 7） （Nieuwenhuys et al., 2008; Naidich and Duvernoy, 2009）. The cingulum is the neu- ral tract extending from the orbitofrontal cortex to the medial temporal lobe （Mufson and Pandya, 1984）. The cingulum plays an important role in memory because it is a passage of the medial cholinergic pathway, which pro- vides cholinergic innervations to the cerebral cortex after originating from Ch 1 and Ch 2 as well as Ch 4 （mainly） （Selden et al., 1998; Nieuwenhuys et al., 2008; Hong and lang, 2010）.

Effects of hyperbaric oxygen treatment on GCS after traumatic brain injury in patients

Objective To evaluate the effects of hyperbaric oxygen therapy (HBOT) on Glasgow Coma Scale (GCC) after traumatic brain injury (TBI) in patients. Methods One hundred and thirty-eight patients with traumatic brain injury were treated by routine therapy combined with HBOT and 29 patients by routine therapy.

Study on difference between intravascular cooling system and traditional moderate hypothermia in patients with severe traumatic brain injury

Objective To study difference between intravascular cooling system and traditional moderate hypothermia in patients with severe traumatic brain injury. Methods Eighty sTBI patients were randomly divided into intravascular hypothermic groups (IVT) and traditional moderate hypothermia groups(HT) . Inclusion criteria included a Glasgow Coma Scale(GCS) score ≤8 and time from injury to admission must be within 12 hours.

Quantitative electroencephalography in predicting on outcome of awakening in long-term unconscious patients after severe traumatic brain injury

Objective To explore quantitative electroencephalography in unconscious patients after severe traumatic brain injury (TBI) to predict awakening. Methods All cases were divided into two groups(the awake group 19 cases and the unfavourable prognosis group 22 cases).Two weeks after admission the original EEGs were preformed in 41 patients suffering from severe TBI with duration of disturbance of

Unusual neural tract between injured fornix and pedunculopontine nucleus in a patient with traumatic brain injury

It has been known that four cholinergic nuclei are located in the septal region and basal forebrain （Ch 1： medial septal nucleus, Ch 2： vertical nucleus of the diagonal band, Ch 3： horizontal limb of the diagonal band and Ch 4： nucleus basalis of Meynert） and two are located in the brainstem （Ch 5： pedunculopontine nucleus and Ch 6： laterodorsal tegmental nucleus） （Selden et al., 1998; Lucas-Meunier et al., 2003; Mesulam, 2004; Nieuwenhuys et al., 2007）. The fornix transfers information on episodic mem- ory between the medial diencephalon and the medial temporal lobe （Afifi and Bergman, 2005; Wolk and Budson, 2010）. The fornix is known to obtain cholinergic innervation from Ch 1 and Ch 2, and to project to the hippocampal formation （Selden et al., 1998; Lucas-Meunier et al., 2003; Mesulam, 2004; Nieu- wenhuys et al., 2007; Dere et al., 2008; Naidich and Duvernoy, 2009; Isaacson and Pribram, 2013）.

Electroencephalogram and evoked potential parameters examined in Chinese mild head injury patients for forensic medicine

Objective To evaluate the usefulness of quantitative electroencephalogram （QEEG）, flash visual evoked potential （F-VEP） and auditory brainstem responses （ABR） as indicators of general neurological status. Methods Comparison was conducted on healthy controls （N=30） and patients with brain concussion （N=60） within 24 h after traumatic brain injury. Follow-up study of patient group was completed with the same standard paradigm 3 months later. All participants were recorded in multi-modality related potential testing in both early and late concussion at the same clinical setting. Glasgow coma scale, CT scanning, and physical examinations of neuro-psychological function, optic and auditory nervous system were performed before electroencephalogram （EEG） and evoked potential （EEG-EP） testing. Any participants showed abnormal changes of clinical examinations were excluded from the study. Average power of frequency spectrum and power ratios were selected for QEEG testing, and latency and amplitude of F-VEP and ABR were recorded. Results Between patients and normal controls, the results indicated： （1） Highly significance （P 〈 0.01） in average power of α1 and power ratios of θ/α1, 0/α2, α1/α2 of EEG recording; （2） N70-P 100 amplitude of F-VEP in significant difference at early brain concussion; and （3） apparent prolongation of Ⅰ～Ⅲ inter-peak latency of ABR appeared in some individuals at early stage after concussion. The follow-up study showed that some patients with concussion were also afflicted with characteristic changes of EEG components for both increments of α1 average power and θ/α2 power ratio after 3 months recording. Conclusion EEG testing has been shown to be more effective and sensitive than evoked potential tests alone on detecting functional state of patients with mild traumatic brain injury （MTBI）. Increments of α1 average power and θ/α2 power ratio are the sensitive EEG parameters to determining early concussion and evaluating outcome of postconcussion symptoms （PCS）. Follow-up study associated with persistent PCS may be consistent with the postulate of substantial biological, rather than psychological origin. The study suggests that combination of EEG and EP parameters can contribute to the evaluation of brain function as a whole for clinical and forensic applications.

Risk factors for brain injury in patients with exertional heatstroke:A 5-year experience

Purpose:Minimal data exist on brain injury in patients with exertional heatstroke(EHS)in developing country.In this study,we explored the risk factors for brain injury induced by EHS 90-day after onset.Methods:A retrospective cohort study of patients with EHS was conducted in the intensive care unit of the General Hospital of Southern Theater Command of PLA in China from April 2014 to June 2019.Patients were divided into non-brain injury(fully recovered)and brain injury groups(comprising deceased patients or those with neurological sequelae).The brain injury group was further subdivided into a death group and a sequela group for detailed analysis.General information,neurological performance and information on important organ injuries in the acute stage were recorded and analysed.Multivariable logistic regression was used to identify risk factors for brain injury after EHS and mortality risk factors for brain injury,and Kaplan-Meier survival curve was used to evaluate the effect of the neurological dysfunction on survival.Results:Out of the 147 EHS patients,117 were enrolled,of which 96(82.1%)recovered,13(11.1%)died,and 8(6.8%)experienced neurological sequelae.Statistically significant differences were found between non-brain injury and brain injury groups in age,hypotension,duration of consciousness disorders,time to drop core body temperature below 38.5℃,lymphocyte counts,platelet counts,procalcitonin,alanine aminotransferase,aspartate aminotransferase,creatinine,cystatin C,coagulation parameters,international normalized ratio,acute physiology and chronic health evaluation II scores,sequential organ failure assessment(SOFA)scores,and Glasgow coma scale scores(all p<0.05).Multivariate logistic regression showed that age(OR=1.090,95%CI:1.02-1.17,p=0.008),time to drop core temperature(OR=8.223,95%CI:2.30-29.40,p=0.001),and SOFA scores(OR=1.676,95%CI:1.29-2.18,p<0.001)are independent risk factors for brain injury induced by EHS.The Kaplan-Meier curves suggest significantly prolonged survival(p<0.001)in patients with early Glasgow coma scale score>8 and duration of consciousness disorders≤24 h.Conclusions:Advanced age,delayed cooling,and higher SOFA scores significantly increase the risk of brain injury post-EHS.These findings underscore the importance of rapid cooling and early assessment of organ failure to improve outcomes in EHS patients.

Application of functional near-infrared spectroscopy in the healthcare industry:A review

Functional near-infrared spectrosoopy(NIRS),a growing neuroimaging modality,has been utilized over the past few decades to understand the neuronal behavior in the brain.The technique has been used to assess the brain hemodynamics of impaired cohorts as well as able-bodied.Neuroimaging is a critical technique for patients with inpaired cognitive or motor behaviors.The portable nature of the fNIRS system is suitable for frequent monitoring of the patients who exhibit impaired brain activity.This study comprehensively reviews brain impaired patients:The studies involving patient populations and the diseases discussed in more than 10 works are included.Eleven diseases examined in this paper include autism spectrum disorder,attentiondeficit hyperactivity disorder,epilepsy,depressive disorders,anxiety and panic disorder,schizophrenia,mild cognitive impairment,Alzheimer's disease,Parkinson's disease,stroke,and traumatic brain injury.For each disease,the tasks used for exarmination,NIRS variables,and significant findings on the impairment are discussed.The channel configurations and the regions of interest are also outlined.Detecting the occurrence of symptoms at an earlier stage is vital for better rehabilitation and faster recovery.This paper ilustrates the usability of fNIRS for early detection of inpairment and the usefulness in monitoring the rehabilitation process.Finally,the limitations of the current fNIRS systems(ie,nonexistence of a standard method and the lack of well-established features for classification)and future research directions are discussed.The authors hope that the findings in this paper would lead to advanced breakthrough discoveries in the fNIRS field in the future.

高压氧舱治疗对脑损伤后遗症患者的康复效果评估

目的:探讨高压氧舱治疗对脑损伤后遗症患者的康复效果。方法:选取2023年1月至2024年1月期间新疆医科大学第一附属医院收治的80例脑损伤后遗症患者,依据随机数表法将其分为对照组和观察组,每组40例,对照组接受常规治疗和干预,观察组在常规治疗和干预基础上联合高压氧舱治疗,评价两组患者血清氧化应激指标、神经营养因子指标水平,以及神经功能、认知功能、运动功能及生存质量。结果:治疗后观察组血清氧化应激指标中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、基质金属蛋白酶9(MMP-9)及活性氧(ROS)水平均低于对照组,差异有统计学意义(t=5.578、11.065、3.706,P<0.05),神经营养因子泛素羧基末端水解酶L1(UCH-L1)、神经元特异烯醇化酶(NSE)以及血清钙结合蛋白(S100-β)水平均低于对照组,血清氧化应激指标脑氧摄取率(CERO2)高于对照组,差异有统计学意义(t=5.170、4.277、4.130、2.260,P<0.05);治疗后观察组美国国立卫生研究院卒中量表(NIHSS)评分低于对照组,精神状况评价量表(MMSE)评分高于对照组,差异有统计学意义(t=15.874、7.820,P<0.05);Loewenstein认知功能评定量表(LOTCA)、简化FuglMeyer运动功能量表(FMA)上、下肢评分均高于对照组,差异有统计学意义(t=14.051、4.766、8.622,P<0.05);世卫组织生存质量表(WHOQOL-BREF)中生理、心理、社会及环境评分均高于对照组,差异有统计学意义(t=19.968、21.979、18.077、19.695,P<0.05)。结论:脑损伤后遗症患者应用高压氧舱治疗,利于调整血清氧化应激指标、神经营养因子指标水平,可改善神经功能缺损,促进认知及运动功能恢复,提升生存质量。

分析高压氧对重症脑外伤患者康复治疗的临床应用效果

目的分析高压氧疗法应用于重症脑外伤患者康复治疗期间的疗效。方法方便选取2020年6月—2023年6月青岛市城阳区人民医院收治的98例重症脑外伤患者,根据治疗方案的不同分为两组,每组49例,对照组接受常规康复治疗,研究组在对照组基础上加用高压氧治疗,比较两组患者康复治疗效果。结果研究组治疗有效率(97.96%)显著高于对照组(81.63%),差异有统计学意义(χ^(2)=7.127,P<0.05)。治疗前,两组患者神经功能缺损评分比较,差异无统计学意义(P>0.05);治疗后,研究组神经功能缺损评分低于对照组,差异有统计学意义(P<0.05)。治疗前,两组患者格拉斯哥昏迷量表(Glasgow Coma Scale,GCS)评分比较,差异无统计学意义(P>0.05);治疗后,研究组GCS评分高于对照组,差异有统计学意义(P<0.05)。研究组并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论重症脑外伤患者在常规康复治疗的基础上予以高压氧治疗,可提升患者的康复速度,改善患者的神经功能,预防并发症的出现,疗效确切。

中医康复护理在脑外伤术后患者后遗症康复中的临床价值

目的探讨中医康复护理在脑外伤术后患者后遗症康复中的临床价值。方法选取南通市通州区中医院2023年1月至2023年10月收治的160例脑外伤术后患者为研究对象,按照随机数字表法分为对照组(80例)与观察组(80例)。对照组采用常规护理,观察组采用中医康复护理。比较两组神经功能与认知功能。结果两组护理后NIHSS评分均低于护理前,观察组NIHSS评分低于对照组,差异有统计学意义(P<0.05)。两组护理后NCSE评分均高于护理前,观察组NCSE评分高于对照组,差异有统计学意义(P<0.05)。结论中医康复护理在脑外伤术后患者后遗症康复中的临床价值较高,有助于改善患者神经功能与认知功能。

早期康复联合系统心理干预对脑损伤患者运动功能及预后的影响

目的分析早期康复联合系统心理干预对脑损伤患者运动功能及预后的影响。方法选取本院于2020年1月—2022年12月收治的90例脑损伤患者,根据不同干预方法将其分成A组与B组,每组45例。A组实施早期康复干预,B组实施早期康复联合系统心理干预,对比两组患者的神经功能、心理状态、认知功能、运动功能、生活能力、并发症发生情况及预后情况。结果两组干预前神经功能、心理状态、认知功能、运动功能及生活能力对比无统计学意义(P>0.05);两组干预后各项指标优于干预前,且B组优于A组(P<0.05);B组并发症发生率低于A组(P<0.05);B组预后良好率高于A组(P<0.05)。结论早期康复联合系统心理干预的效果显著,可在较大程度上改善患者的神经功能,减轻其负性情绪,提高认知功能、运动功能和生活能力,且可减少并发症,有利于预后,可采纳、推行。