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.

RESEARCH OF MOVEMENT NAVIGATION BASED ON ASSEMBLY CONSTRAINT RECOGNITION

The requirements and features of virtual assembly movement navigator areanalyzed to help operators flexibly manipulate virtual objects, precisely locate or assemble virtualparts in virtual environment. With the degree-of-freedom analysis, the assembly constrainthierarchical model is constructed and the system's constraints are built dynamically. Thus, allobjects in virtual environment can be located reasonally by the navigator. Moreover, the assemblyconstraint recognition in the process of assembly and movement correction is also discussed.

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

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

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

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

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.

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.

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.

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.

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.

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.

重复经颅磁刺激联合强制性诱导疗法对偏瘫型脑瘫患儿患侧上肢手部精细运动功能的影响

目的探讨重复经颅磁刺激(rTMS)联合强制性诱导疗法(CIMT)应用在偏瘫型脑瘫(HCP)患儿中的效果及对改善患侧上肢手部精细运动功能的作用。方法选取2021年3—12月广西医科大学第二附属医院收治的75例HCP患儿为研究对象,按照随机数字表法将其分为对照组(n=38)和观察组(n=37)。对照组采用CIMT治疗,观察组采用rTMS联合CIMT治疗,两组均持续治疗12周。比较两组患者的上肢功能、精细运动功能发育状况、腕屈肌、肘屈肌肌张力与功能独立性。结果治疗12周后,观察组Carroll上肢功能测试量表、Peabody精细发育量表评分均高于对照组,组间差异有统计学意义(P<0.05);观察组腕屈肌、肘屈肌改良Ashworth量表评分均低于对照组,组间差异有统计学意义(P<0.05);观察组儿童功能独立性评定量表评分为(88.47±5.01)分,高于对照组的(80.37±4.73)分,差异有统计学意义(P<0.05)。结论对HCP患儿实施rTMS联合CIMT治疗,可以改善上肢功能、精细运动功能、肌张力,提高功能独立性,有临床借鉴意义。

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。

改良强制性运动疗法联合新Bobath技术在老年脑卒中偏瘫患者上肢康复护理干预中的应用

目的探讨改良强制性运动疗法联合新Bobath技术在老年脑卒中偏瘫患者上肢康复护理干预中的应用效果。方法选取2022年1—12月广东医科大学附属第三医院门诊收治的84例老年脑卒中上肢偏瘫患者,采用随机数表法分为常规组(n=42)和联合组(n=42),其中常规组患者采用新Bobath疗法进行康复治疗,联合组采用改良强制性运动疗法联合新Bobath技术进行干预。比较干预前后的改良Ashworth分级评定表、改良Barthel指数、简式Fugl-Meyer评分表、临床神经功能缺损程度评定量表的得分。结果干预后联合组的改良Ashworth分级评定疗效优于常规组,差异有统计学意义(P<0.05);干预后联合组改良Barthel指数评分高于常规组,差异有统计学意义(P<0.05);干预后联合组简式Fugl-Meyer评分表评分高于常规组,差异有统计学意义(P<0.05);干预后联合组临床神经功能缺损程度评定量表评分低于常规组,差异有统计学意义(P<0.05)。结论采用改良强制性运动疗法联合新Bobath技术更能有效改善老年脑卒中偏瘫患者的上肢功能,提高日常生活质量。

太乙针灸联合改良强制性运动疗法治疗脑梗死偏瘫的临床效果

目的回顾性分析太乙针灸联合改良强制性运动疗法(mCIMT)治疗脑梗死偏瘫患者的疗效及对患者肌力、平衡能力、生活质量的影响。方法选取新郑华信民生医院2021年12月至2023年5月收治的82例脑梗死偏瘫患者病历资料,根据不同治疗方案分为两组,各41例。对照组采用mCIMT,联合组行太乙针灸联合mCIMT。对比两组疗效、肌力与平衡能力、踝背肌电图参数[胫前肌、腓肠肌积分肌电值(iEMG)]、功能性步行能力、10 m步行测试(10MWT)及生活质量。结果联合组疗效优于对照组(P<0.05);治疗后联合组腓肠肌iEMG(52.60±6.37)μV/s低于对照组(47.91±7.26)μV/s,平衡、肌力评分与胫前肌iEMG分别为(35.16±5.72)分、(4.01±0.32)分、(37.62±6.11)μV/s,高于对照组的(29.63±6.14)分、(3.74±0.51)分、(40.51±5.90)μV/s(P<0.05);治疗后联合组功能性步行能力分级改善情况优于对照组(P<0.05);治疗后联合组步长、步速、步频分别为(0.61±0.13)m、(0.54±0.17)m/s、(76.13±6.39)步/min,高于对照组的(0.54±0.15)m、(0.47±0.12)m/s、(70.16±5.97)步/min,能量消耗指数(0.72±0.21)低于对照组(0.83±0.26),P<0.05;治疗后联合组生活质量评分(195.87±27.23)分高于对照组(168.99±24.71)分(P<0.05)。结论太乙针灸联合mCIMT治疗脑梗死偏瘫疗效确切,可缓解肌肉痉挛,改善肌力、平衡与功能性步行能力,提高生活质量。

水下可重构机器人腿部结构设计与自由度分析

水利工程对水下机器人功能要求多样化,本文以水下可重构机器人为研究对象,研究腿部结构可重构使机器人具有多种移动模式,预期实现一机多用。本文将通过锁死UPS支链中等效球副中的一个转动,重构出3类U*PU支链,分析了各类支链的约束特点,得出Ⅰ类U*PU支链改变自由度的性质,Ⅱ类改变自由度的方向,Ⅲ类是一种不变自由度支链。基于含Ⅲ类U*PU支链的4-U*PU并联机构,设计水下可重构机器人的腿部结构,使其腿部具有2T2R和1R2T两种运动模式。采用旋量理论研究了腿部结构各运动模式变换过程中的自由度性质,分析机器人可重构性,使其满足爬行和蠕动两种运动需求。

动态腕手矫形器结合改良强制性运动疗法对脑卒中偏瘫患者上肢和手功能障碍的效果

目的观察动态腕手矫形器结合改良强制性运动疗法(mCIMT)对脑卒中偏瘫患者上肢及手功能的影响。方法2022年2月至2023年12月,复旦大学附属华山医院脑卒中恢复期患者32例,随机分为对照组(n=16)和试验组(n=16)。两组均接受常规康复训练,采用改良强制性运动疗法,每天健侧上肢佩戴约束手套4 h;试验组同时患侧上肢佩戴动态腕手矫形器4 h;每周5 d,连续3周。分别于治疗前后采用Wolf运动功能量表(WMFT)、手臂动作调查测试(ARAT)和握力评估上肢运动功能,动作活动记录量表(MAL)评估动作使用量(AOU)和动作完成质量(QOM),汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)评估情绪变化,采用表面肌电图观察训练前后患/健侧腕背伸肌均方根值(RMS)比。结果治疗后,两组WMFT、ARAT、MAL-QOM、HAMA评分和患/健侧腕背伸肌RMS比均改善(|t|>2.179,P<0.05),试验组WMFT和握力的进步值优于对照组(|t|>2.343,P<0.05);试验组握力、MAL-AOU和HAMD评分均改善(|t|>2.819,P<0.05)。结论动态腕手矫形器结合mCIMT可以促进偏瘫患者上肢和手功能的恢复。

路网约束下基于灰狼算法的机器人路径规划

机器人在规划路径时,由于初始路径群体数量多,且存在大量冗余个体,导致路径规划普遍存在效率低、可靠性不高等问题,为此设计一种路网约束下基于灰狼算法的机器人路径规划方法。利用多传感器采集车辆、环境等道路数据,推算车辆行驶速度、交通量及密度,使用信息守恒理论平滑计算交通数据,运用负指数函数构建证据理论信度,引入卡尔曼滤波器实现道路交通数据融合,构成完整路网架构;使用灰狼算法规划机器人路径,将狼群中适应度最高的3匹狼拟作头狼,通过搜寻猎物、包围猎物与进攻猎物来创建数学模型,更新灰狼方位了解其移动情况,完成机器人路径自适应规划。实验结果表明,所提方法时效性强,在静态、动态环境下均能实现机器人最优路径规划,且在动态环境下仅迭代4次就可找到最优路径,为机器人的高效率应用提供技术帮助。

基于“少阳为枢”理论探讨四逆散在儿科的临床运用

小儿之体,阴阳二气稚嫩,尚未成熟,在生长发育过程中,小儿随着阳气的升发,不断建立新的阴阳平衡状态。“少阳学说”可以全面阐述小儿的生理特性和病理特点,强调少阳在阴阳交会、表里转换、脏腑协调、生长发育以及情志调节等方面的关键枢纽作用。“少阳为枢”作为“少阳学说”的核心理论,可体现小儿生长发育中的动态平衡。若少阳枢机正常,则阴平阳秘,五脏安和;若少阳枢机不利,则阴阳失衡,脏腑失和,气机郁滞,疾病由生。四逆散作为调和少阳枢机的经典方剂,通过疏肝解郁、升阳降逆,调节小儿气机,促进阴阳平衡。在儿科临床多种疾病中运用四逆散可疏利枢机,助枢纽功能恢复,附验案一则以供临床参考。

经颅直流电刺激联合改良强制性使用技术在脑卒中患者中的疗效观察

目的:探索经颅直流电刺激联合改良强制性使用对脑卒中患者上肢运动功能和日常生活能力的影响。方法:84名脑卒中患者随机分为A、B、C3组,A组采取常规康复方案,B组在A组基础上增加改良强制性使用技术,C组在B组基础上增加经颅直流电刺激,对3组患者在治疗前(T1)、治疗2周(T2)、治疗4周(T3)、出院后1个月(T4)、出院后2个月(T5)时进行改良Barthel指数(MBI)、Fugl-Meyer上肢运动功能评估表(FMA-UE)和Wolf运动功能评分(WMFT)并进一步分析。结果:3组患者MBI、FMA-UE、WMFT结果显示组别与时间存在交互作用(F=28.96,F=16.64,F=56.11,均P<0.01)。3个结局指标中各组组间比较显示:B组较A组,在T1、T2时差异无统计学意义,在T3、T4、T5时,B组3项评分均高于A组,差异有统计学意义(P<0.05);C组较A组,在T1时差异无统计学意义,在T2、T3、T4、T5时,C组3项评分均高于A组,差异具有统计学意义(P<0.05);C组较B组,在T1、T2时差异无统计学意义,在T3、T4、T5时C组3项评分均高于B组,差异有统计学意义(P<0.05)。结论:经颅直流电刺激联合改良版强制性使用技术能有效改善脑卒中患者上肢运动功能和日常生活能力,且疗效在疗程结束后可以继续保持。

基于鼓活动位置的关键链多项目缓冲确定方法研究

为了确定鼓活动位置对分配鼓资源的影响,进一步区分位于关键链和非关键链的鼓活动缓冲的差异性,本文基于鼓活动综合优先级对鼓活动位置的不同情况进行了讨论,确定了基于鼓活动位置的关键链多项目缓冲确定模型,考虑鼓活动在关键链和非关键链的不同位置对能力约束缓冲的影响进行分散式设置,进一步根据鼓活动位置权重因子实时滚动分配项目执行过程中剩余缓冲监控量的方法。最后,使用Matlab软件进行案例仿真,将本文方法与经典方法进行比较分析,对比结果证明本文所提方法具有有效性。