Sensory changes, C-and A-fiber function, and shoulder-hand syndrome in hemiplegic patients after stroke

BACKGROUND： Clinical diagnosis of various neurological disorders involving the sensory nerves depends primarily on subjective description, which cannot be quantitatively evaluated, and is also less reproducible and specific. Quantitative sensory testing methods can overcome these shortcomings and is currently used to identify the function of the C- and A-fibers. OBJECTIVE： To apply the quantitative sensory testing method for analyzing changes in temperature sensation, cryalgesia, thermalgesia, and vibration sense on the skin surface of hemiplegic patients with post-stroke shoulder-hand syndrome, and to analyze the relationship between these changes and shoulder-hand syndrome. DESIGN, TIME AND SETTING： A non-randomized, concurrent, control study was performed at the Clinic and Inpatient Department of the Third Xiangya Hospital, Central South University, between June 2000 and April 2001. PARTICIPANTS： Thirty post-stroke, hemiplegic patients were divided into shoulder-hand syndrome and control groups, according to whether patients exhibited shoulder-hand syndrome, with 15 patients in each group. METHODS： A TSA2001 quantitative sensory testing device （Medoc, Israel） was used for quantitative sensory testing. All sensory testing employed limits, testing temperature sense on the palm thenar eminence and vibration sense on the thumb metacarpal. Cold threshold was ≤ 28 ℃, warmth threshold was ≥ 36 ℃, cold-evoked pain threshold was ≤ 5 ℃, heat-evoked pain threshold was ≥ 51 ℃, vibration threshold was ≥ 5 μm/s; if a patient met one of these items, he/she was considered to be hypoanesthesia. MAIN OUTCOME MEASURES： Cold, warm, cold-evoked pain, heat-evoked pain and vibration threshold changes on skin from the paralyzed upper extremity was measured in the shoulder-hand syndrome and control groups. RESULTS： Incidence of sensory disability in the shoulder-hand syndrome group increased more significantly than in the control group （P 〈 0.05）, with the primary manifestations being decreased cold threshold （P 〈 0.05） and increased warmth threshold （P 〈 0.05）. The value differences between cold and cold-evoked pain thresholds, as well as between warmth and heat-evoked pain thresholds, decreased significantly in the shoulder-hand syndrome group （P 〈 0.05）. There were no significant differences between the two groups in cold-evoked pain, heat-evoked pain, or vibration thresholds. CONCLUSION： The primary manifestations of sensory impairment in hemiplegic patients with post-stroke shoulder-hand syndrome were displayed as thermohypesthesia and hyperalgesia. Functional impairments of nerve fibers that control pain and temperature sense may play an important role in the pathogenesis of post-stroke shoulder-hand syndrome.

Research progress on the effect of the combination of Jing acupoints bloodletting therapy and Sangzhi (Mori Ramulus) on shoulder-hand syndrome after stroke

Shoulder-hand syndrome(SHS)is one of the common complications of ischemic stroke.The pathogenesis is not completely clear and the therapeutic effects are not very satisfactory.As one of the Five-Shu acupoints(the general terms of acupoints that the twelve meridians are located below the elbow and knee of the body),Jing acupoints is distributed at the end of fingers and toes where the twelve meridians of the human body pass by,and has the functions of stimulating the meridians and dredging the channels and collaterals.For the effects of discharging neurons,promoting cerebral blood flow and improving the brain micro-circulation,Jing acupoints bloodletting therapy can effectively relieve the clinical symptoms of the patients with SHS after stroke.Sangzhi(Mori Ramulus),with the ability of dredging the meridian and relieving the pain,is also has certain treatment functions to the SHS.In clinical practice,the combination of Jing acupoints bloodletting and Sangzhi(Mori Ramulus)have been widely used in the treatment of various diseases,and in terms of their mechanism of action,the combined treatment has a positive effect on post-stroke SHS,but there are few reports on this.Therefore,it is worth affirming the efficacy of combined treatment of SHS after stroke.This article elaborates the theoretical basis of Jing acupoints bloodletting on SHS after stroke,and the research progress of Sangzhi(Mori Ramulus)in treating SHS after stroke,which provide the theoretical guidance for the combination.

Delphi and Analytic hierarchy process for the construction of a risk assessment index system for post-stroke shoulder-hand syndrome

Background:Shoulder-hand syndrome(SHS)is one of the common complications after stroke,which is difficult to cure once it occurs.Early risk identification is an effective measure to prevent and treat SHS,but there is no effective tool to assess the risk assessment of SHS.Objective:To develop a validated tool to assess the risk of SHS occurrence after stroke.Methods:This was an observational study with a 3-step process:(1)Literature review to establish initial indicators;(2)Application of a modified Delphi method for two rounds of correspondence,with final indicators obtained by modifying each round based on expert opinion;(3)Application of hierarchical analysis to determine the weights of each indicator.Results:The initial literature review constructed4 primary indicators and 24 secondary indicators;after the first round of Delphi,a total of 10 secondary indicators were deleted and 6 secondary indicators were added,and the final indicators included 3 primary indicators and 15 secondary indicators,and in the second round,consensus was reached;by AHP analysis,the highest weight was given to existing risk factors(0.5584),followed by relevant medical history(0.3196);lastly,demographic factors(0.1220),and the scores of other secondary indicators met the requirements.Conclusion:This study establishes and constructs a post-stroke SHS risk assessment tool,which provides a basis for early identification of SHS and early intervention.Meanwhile,this study provides a methodological reference for the development of other indicatorssets.

Timeliness of the analgesic effect of superficial needling on shoulder-hand syndrome after stroke

Objective To observe the correlation between analgesic effect and duration of analgesic effect of superficial needling for shoulder pain of shoulderhand syndrome（SHS） after stroke, so as to screen the best time period of analgesia. Methods A total of 120 patients with SHS after stroke（stage I） were recruited and superficial needling therapy was applied. Two obvious tenderness points on the affected shoulder of patients were found out. The site 80–100 mm down each tenderness point was selected for superficial needling. Bimanual needling technique was applied after inserting needles. The surrounding of tenderness points was pinched and grasped by left hand above the needling, and the technique of green dragon swaying tail was applied by right hand. The needles at each acupoint were manipulated for3 min and retained for 30 min. The analgesic effect was evaluated dynamically by visual analogue scale（VAS） in 120 patients before treatment, immediately after treatment, 30 min after treatment, 1 h after treatment and 24 h after treatment. The analgesic effects at different time were statistically analyzed by generalized estimating equation. Results The mean values of VAS were 7.483, 3.950, 4.767, 5.917 and 7.217, respectively, before treatment, immediately after treatment, 30 min after treatment, 1 h after treatment and 24 h after treatment. The difference of analgesic effect at different time was statistically significant（P〈0.01）; the difference of analgesic effect of superficial needling in treatment of SHS after stroke was significant between immediately after treatment and 30 min after treatment（both P〈0.05）, while there was no significant difference between 1 h after treatment and 24 h after treatment（both P〈0.05）. Conclusion Analgesic effect of superficial needling for shoulder pain of SHS after stroke was different at different time points and decreased over time; analgesic effect was the most significant immediately after treatment and the optimal duration of analgesic effect was from immediately to 30 min after superficial needling therapy.

Therapeutic effect of acupuncture and massage for shoulder-hand syndrome in hemiplegia patients:a clinical two-center randomized controlled trial

OBJECTIVE:To evaluate the therapeutic effects of acupuncture and massage for shoulder-hand syndrome in hemiplegia patients.METHODS:One hundred and twenty hemiplegia patients with stage I shoulder-hand syndrome were randomly divided into a group treated with standardized electric acupuncture and massage,and a group treated with rehabilitation therapy for 6 weeks.The primary indices evaluated were pain on passive movement of the shoulder using the numeric pain rating scale(NPRS),and the number of patients with shoulder-hand syndrome at Steinbrocker stage II or III after treatment.The secondary indices were Fugl-Meyer evaluation of functional movement of the upper limb and hand using the modified rankin scale(MRS).RESULTS:At post-treatment evaluation and a 12-week follow-up visit,NPRS score,number of patients with stage II or III shoulder-hand syndrome,and MRS score were all improved in the acupuncture-massage group compared with the rehabilitation group(P<0.05).On Fugl-Meyer evaluation,functional movement of the upper limb was also improved in the acupuncture-massage group compared with the rehabilitation group(P<0.05).CONCLUSION:Standardized acupuncture-massage therapy may have curative effects on shoulder-hand syndrome in hemiplegia patients.

择时中药热奄包循经熨烫治疗对缺血性脑卒中后肩手综合征的影响

目的:观察择时中药热奄包偱经熨烫治疗对缺血性脑卒中后肩手综合征(shoulder-hand syndrome,SHS)患者的影响。方法:选取2021年8月—2022年8月泉州市中医院收治的74例缺血性脑卒中后SHS患者作为研究对象。根据随机数表法将其分为观察组和对照组,各37例。对照组给予常规治疗,观察组在对照组基础上给予择时中药热奄包循经熨烫治疗。比较两组治疗前后的疼痛程度、上肢运动功能、生活自理能力、手部肿胀程度。结果:治疗后,观察组视觉模拟评分法(visual analogue scale,VAS)、手部肿胀程度评分均低于对照组,Fugl-Meyer评测法(Fugl-Meyer assessment,FMA)、改良Barthel指数评定量表(modified Barthel index rating scale,MBI)评分均高于对照组,差异有统计学意义(P<0.05)。结论:择时中药热奄包偱经熨烫治疗可减轻缺血性脑卒中后SHS患者患侧上肢疼痛、肿胀程度,提高患侧上肢运动功能及生活自理能力。

Clinical Observation on Electroacupuncture Treatment of Shoulder-Hand Syndrome in Apoplectic Hemiplegia

Objective： To investigate the therapeutic effect of electroacupuncture on shoulder-hand syndrome in apoplectic hemiplegia. Methods： One hundred and sixty patients were randomly divided into two groups. 80 cases in the control group was treated by conventional acupuncture by filiform needles and 80 cases in the treatment group were treated by electroacupuncture. The therapeutic effects were evaluated after two courses of treatment. Results： After two courses of treatment, the therapeutic effect for edema on back of the hand and hand pain in digital flexion and the total effective rate were better in the treatment group than in the control group （P〈0.05）. Conclusion： Electroacupuncture is of significant importance for relieving pain on back of hand, preventing the muscular atrophy of hand and promoting recovery from apoplexy.

针刺治疗脑卒中合并睡眠呼吸暂停低通气综合征随访分析

目的观察分析针刺廉泉对脑卒中合并睡眠呼吸暂停低通气综合征的近、远期临床疗效。方法符合诊断的30例患者采用针刺廉泉穴治疗,治疗前和治疗4星期后进行睡眠监测、ESS嗜睡量表、NIHSS卒中量表评价,治疗2年后进行ESS嗜睡量表评价以及相关临床症状随访,观察临床疗效。结果完成观察21例,9例脱落。21例脑卒中合并阻塞性睡眠呼吸暂停低通气综合征的患者,针刺加电针治疗后呼吸暂停指数明显下降(P<0.05),睡眠时最低血氧饱和度值明显上升(P<0.05),ESS嗜睡量表评价分数明显下降(P<0.05)。NIHSS卒中量表评价分数无明显改善(P>0.05)。2年后随访21例,完成16例,脱落5例,16例脑卒中合并阻塞性睡眠呼吸暂停低通气综合征的患者,2年后ESS嗜睡量表评价分数较之治疗前无明显改善(P>0.05),较之治疗后4星期也无明显改善(P>0.05)。结论针刺廉泉治疗脑卒中合并阻塞性睡眠呼吸暂停低通气综合征,可降低患者呼吸暂停AHI指数,提高睡眠时最低血氧饱和度,改善临床症状。2年后随访,远期疗效不明显。

中西医结合康复治疗中风后肩手综合征40例疗效观察

目的:观察中西医结合康复治疗中风后并发肩手综合征(SHS)的临床疗效。方法:将40例患者进行中西医结合康复治疗,治疗前后采用Fugl—Meyer运动功能量表(上肢部分)评定患侧上肢的运动功能,视觉模拟评分法(VAS)评定患侧肩痛,改良的Barthel指数评定日常生活活动能力。结果:治疗后Fugl—Meyer运动功能评分、改良的Barthel指数均较治疗前提高,视觉模拟类比评分(VAS)较治疗前降低,差异均有显著性意义。结论:中西医结合康复治疗SHS可有效缓解疼痛,促进患肢运动功能及日常生活能力的恢复。

锁骨下盗血综合征腔内介入治疗临床分析

目的总结锁骨下盗血综合征(subclavian steal syndrome,SSS)的临床特点,分析腔内介入治疗的安全性及有效性。方法回顾性分析2011-05—2015-04在阜阳市人民医院因锁骨下动脉狭窄行腔内介入治疗的18例患者的临床资料,评估术后责任血管狭窄程度及患者症状改善程度;随访1a后评估责任血管再狭窄程度。结果 18例患者共植入18枚支架,手术成功率100%,血管狭窄程度从治疗前的(73.5±12.0)%降至(10.2±7.5)%;临床症状明显改善,术后脉压差明显恢复(P<0.05);随访1a1例患者血管狭窄≤20%,其余未再发生狭窄。结论血管内支架成形术治疗锁骨下盗血综合征安全有效,长期随访结果显示能显著降低卒中发生率及残死率。

卒中后非痴呆患者5年认知功能变化与中医证候要素关系探讨

目的:通过对卒中后非痴呆患者的5年随访,分析其认知功能变化特点及其与中医证候要素的关系。方法:2011年10月至2013年9月在北京中医药大学东方医院纳入卒中后非痴呆患者233例,5年后随访,66例完成面对面访视。根据认知水平是否较入组时下降分为认知下降组(39例)和认知无下降组(27例),分析5年认知功能变化与中医证候要素之间的关系。结果:认知下降组气虚、痰浊证候要素较基线显著增加(P<0.05,P<0.01),证候虚实夹杂、多个证候要素组合的比例明显增加(P<0.05)。下降显著的认知域为视空间与执行功能、语言、延迟回忆。视空间与执行功能下降组,5年后气虚明显增加,但差异无统计学意义;在语言、延迟回忆下降组,5年后痰浊显著增加(P<0.01)。结论:在卒中后认知功能下降的长期病程中,证候要素倾向于虚实夹杂、相兼组合,证候及病机更加复杂;气虚、痰浊与卒中后认知障碍进展相关,气虚与视空间与执行功能下降之间存在关联,痰浊与语言、记忆功能下降之间存在关联。