The Link between Psychomotor Disorders and Physical Therapy

The evolution of the individual in ontogenesis has been studied throughout life and on all sides of development. Studies in the field based on medical rehability performed by a full team such as doctors, physiotherapists and psychologists and not only have shown that the link between the patient’s psychological state and exercise are factors in full dependence and any imbalance can trigger irreparable effects. Psychology is the science that studies the laws of formation, development, functioning and deficiencies related to psychism;it includes a series of fundamental concepts that include: psychic processes, psychic phenomena, psychic attributes, psychic states or psychic activities. Psychic phenomena are the component elements of psychism. In a sense, the psychic phenomena are manifested by external facts, by our behavior, by the motor actions started, by gestures or verbal actions;in the other sense, psychic phenomena are manifested by inner deeds, as the form of ideas, images, feelings, and desires. The motor acts without psychism would be only simple automatisms, without human specifications of adaptation, while the psychism without motor acts would be deprived of the fundamentals of formation and functioning as well as of its production mechanisms. Objective: The objective of this study is to highlight the causal problems of delayed medical recovery in relation to the psychological and emotional factors. This desktop review aims to identify psychoemotional disorders in the case of subjects with operated lumbar disc herniation and aims to adapt a specialized physiotherapeutic protocol by adapting to CIF. The result of this study will be found in the percentage of socio-professional reintegration of the subjects with operated lumbar disc herniation and implicitly the increase in the quality of life. Conclusions: 1) For an effective functional recovery, a psycho-emotional balance is needed;2) A positive attitude actively influences medical rehabilitation;3) Regaining physical, cognitive and social activities depend on the degree of psycho-emotional impairment. .

Clinical Observation on Modified Huan'gan Lipi Decoction Combined with Acupuncture in Treating Spleen Deficiency and Liver Hyperactivity Type Tic Disorders

[Objectives]To observe the clinical efficacy of Modified Huan'gan Lipi Decoction combined with acupuncture in the treatment of spleen deficiency and liver hyperactivity type tic disorders(TD).[Methods]Sixty patients with spleen deficiency and liver hyperactivity type TD were randomly divided into a treatment group of 40 cases and a control group of 20 cases.The treatment group received Modified Huan'gan Lipi Decoction combined with acupuncture,and the control group received Haloperidol Tablets.After 4 weeks of treatment,the Yale Global Tic Severity Scale(YGTSS)score,the total score of TCM syndrome and the clinical efficacy were compared between the two groups before and after treatment.[Results]After treatment,the total effective rate of 87.5%in the treatment group was higher than 80.0%in the control group(P>0.05);the total score of YGTSS and the total score of TCM syndromes in the two groups were compared within groups,P﹤0.01;between groups,P﹤0.01.The recurrence rates of the treatment group and the control group were 11.1%and 71.4%,respectively.The difference between the two groups was statistically significant(P﹤0.01).[Conclusions]Modified Huan'gan Lipi Decoction combined with acupuncture in the treatment of spleen deficiency and liver hyperactivity type TD can significantly improve the patient's tic symptoms,and its long-term efficacy is stable.

Shaoma Zhijing granule for children with tic disorders: A rapid health technology assessment

Objective:To rapidly assess the effectiveness,safety,economy,and applicability of Shaoma Zhijing granule(SZG)for the treatment of children with tic disorders(TD),and provide currently available best evidence for decision-makers of health policies.Methods:We conducted a rapid health technology assessment(RHTA)to explore the value of SZG.A systematic literature search in eight literature databases and on three clinical trial registration platforms was performed.The literature was screened according to eligibility criteria.The screening process and data extraction were conducted by two reviewers,and the quality of the literature was also assessed.The results were summarized,analyzed,and presented in tables or figures.Results:A total of five randomized controlled trials(RCTs)were included in this study,of which one was published in English(in the Journal of Child Psychology and Psychiatry)and four in Chinese journals.The overall risk of bias for the five RCTs was evaluated as“some concerns.”SZG monotherapy or in combi-nation with tiapride was better than tiapride alone in improving traditional Chinese medicine(TCM)syndromes and tic symptoms,with a daily cost of¥67.50e107.22.Adverse events were mainly related to the digestive,respiratory,and neurological systems,but all were mild.Conclusion:Overall,the current RHTA of published,peer-reviewed literature has located a small body of evidence evaluating the use of SZG for the treatment of TD in children.SZG has effects on improving TCM syndromes and tic symptoms;the daily cost is¥67.50e107.22;and all adverse events are mild.High-quality studies with long-term follow-up should be conducted,so as to provide local evidence and consistently guide and improve scientific decision-making.

Review of the evidence for the management of co-morbid Tic disorders in children and adolescents with attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder(ADHD) is the most common neurodevelopmental disorder in children and adolescents, with prevalence ranging between 5% and 12% in the developed countries. Tic disorders(TD) are common co-morbidities in paediatric ADHD patients with or without pharmacotherapy treatment. There has been conflicting evidence of the role of psychostimulants in either precipitating or exacerbating TDs in ADHD patients. We carried out a literature review relating to the management of TDs in children and adolescents with ADHD through a comprehensive search of MEDLINE, EMBASE, CINAHL and Cochrane databases. No quantitative synthesis(meta-analysis) was deemed appropriate. Metaanalysis of controlled trials does not support an association between new onset or worsening of tics and normal doses of psychostimulant use. Supratherapeutic doses of dextroamphetamine have been shown to exacerbate TD. Most tics are mild or moderate and respond to psychoeducation and behavioural management. Level A evidence support the use of alpha adrenergic agonists, including Clonidine and Guanfacine, reuptake noradrenenaline inhibitors(Atomoxetine) and stimulants(Methylphenidate and Dexamphetamines) for the treatment of Tics and comorbid ADHD. Priority should be given to the management of co-morbid Tourette's syndrome(TS) or severely disabling tics in children and adolescents with ADHD. Severe TDs may require antipsychotic treatment. Antipsychotics, especially Aripiprazole, are safe and effective treatment for TS or severe Tics, but they only moderately control the co-occurring ADHD symptomatology. Short vignettes of different common clinical scenarios are presented to help clinicians determine the most appropriate treatment to consider in each patient presenting with ADHD and co-morbid TDs.

Acupuncture:a new method to treat tic disorders in children

Tic disorder is a common pediatric neurological disorder that severely affects children’s quality of life.But in fact,there is still a lack of a very effective treatment for tic disorder.Acupuncture as a flexible treatment time,treatment cycle control,easy to operate treatment method,widely used in the field of neurological disorder,widely praised by clinicians and patients.At the same time,tic disorder belongs to the category of chronic inflammatory convulsion in traditional Chinese medicine,and acupuncture has a good effect of relieving spasticity and fewer adverse reactions,which makes acupuncture have a good application prospect.Now,more and more studies about acupuncture treatment of tic disorder in children have been published.The main methods of treating tic disorder are acupuncture,electroacupuncture,scalp acupuncture and ear acupuncture.The efficacy of acupuncture alone or in combination with other drugs such as tiapride hydrochloride and haloperidol has been shown to be good.The safety of acupuncture is also commendable,and clinical trials showing that the combination of acupuncture and medication can reduce the incidence and severity of adverse drug reactions.According to the existing studies,acupuncture can promote the development and repair of the nervous system,regulate the secretion of neurotransmitters,and reduce the occurrence of local discomfort,which may be the main mechanism of acupuncture treatment of tic disorders.

Tourette syndrome associated with attention deficit hyperactivity disorder: The impact of tics and psychopharmacological treatment options

Tourette syndrome(TS) is a neurodevelopmental disorder characterized by multiple chronic motor and vocal tics beginning in childhood. Several studies describe the association between TS and attention deficit hyperactivity disorder(ADHD). Fifty percent of children diagnosed with ADHD have comorbid tic disorder. ADHD related symptoms have been reported in 35% to 90% of children with TS. Since ADHD is the most prevalent comorbid condition with TS and those with concomitant TS and ADHD present with considerable psychosocial and behavioral impairments, it is essential for clinicians to be familiar with these diagnoses and their management. This paper highlights the association between treating ADHD with stimulants and the development of tic disorders. The two cases discussed underscore the fact that children with TS may present with ADHD symptomatology prior to the appearance of any TS related symptoms. Appropriate management of TS in a patient diagnosed with ADHD can lead to quality of life improvements and a reduction in psychosocial impairments.

Premonitory urges located in the tongue for tic disorder: Two case reports and review of literature

BACKGROUND Premonitory urges (PUs) was defined as the uncomfortable physical sensations of inner tension that can be relieved by producing movement responses. Nearly 70%-90% patients with Tourette syndrome reported experiences of PUs. CASE SUMMARY In this paper, we present two cases of young patients with PUs located in their tongue, which is very rare and easily misdiagnosed in clinical work. Both two young patients complained of an itchy tongue and cannot help biting their tongue. These two cases were worth reporting because it was rare that PUs was the initial symptom and located in the tongue. The results indicated that PUs seem to play an important role in the generation of tics. CONCLUSION Thus, PUs may be the first process, and an essential part, of the formation of tics.

Serum ferritin levels in children with attention deficit hyperactivity disorder and tic disorder

BACKGROUND Iron plays an important role in neurodevelopmental functions in the brain.Serum ferritin levels are different in children with attention deficit hyperactivity disorder and tic disorder than in healthy children.AIM To explore the current status of iron deficiency in children with neurodevelopmental disorders and its sex and age effects.METHODS A total of 1565 children with attention deficit hyperactivity disorder(ADHD),1694 children with tic disorder(TD),93 children with ASD and 1997 healthy control children were included between January 1,2020,and December 31,2021 at Beijing Children's Hospital.We describe the differences in age levels and ferritin levels between different disease groups and their sex differences.The differences between the sexes in each disease were analyzed using the t test.The incidence rate of low serum ferritin was used to describe the differences between different diseases and different age groups.A chi-square test was used to analyze the difference in the incidence of low serum ferritin between the disease group and the control group.Analysis of variance was used for comparisons between subgroups,and regression analysis was used for confounding factor control.RESULTS A total of 1565 ADHD patients aged 5-12 years were included in this study,and the average serum ferritin levels of male and female children were 36.82±20.64μg/L and 35.64±18.56μg/L,respectively.A total of 1694 TD patients aged 5-12 years were included in this study,and the average serum ferritin levels of male and female children were 35.72±20.15μg/L and 34.54±22.12μg/L,respectively.As age increased,the incidence of low serum ferritin in ADHD and TD first decreased and then increased,and 10 years old was the turning point of rising levels.The incidence of ADHD with low serum ferritin was 8.37%,the incidence of TD with low serum ferritin was 11.04%,and the incidence of the healthy control group with low serum ferritin was 8.61%,among which male children with TD accounted for 9.25%and female children with TD accounted for 11.62%.There was a significant difference among the three groups(P<0.05).In addition,there were 93 children with ASD with an average serum ferritin level of 30.99±18.11μg/L and a serum ferritin incidence of 15.05%.CONCLUSION In conclusion,low serum ferritin is not a risk factor for ADHD or TD.The incidence of low serum ferritin levels in children with ADHD and TD between 5 and 12 years old decreases first and then increases with age.

Research progress of Chinese and Western Medicine on tic disorder in children

Tic disorder is one of the common neuropsychiatric disorders that affect children’s physical and mental health.If it is not tested,diagnosed and treated early,it will have a serious impact on children themselves,their families,and even the whole society.Simple western medicine treatment methods include drugs,nerve regulation,psychological and behavioral therapy,but the results are not ideal.Traditional Chinese medicine takes systematic treatment based on syndrome differentiation and it uses methods of traditional Chinese medicine,massage and acupuncture to regulate five viscera and six bowels in order to harmonized Yin and Yang.These methods make up for the deficiencies of western treatment.In recent years,the clinical treatment of children with Tic disorders involving a variety of combined therapy has achieved significant results.As a result,the rehabilitation of children with Tic disorders has been significantly improved.By consulting the available literature at home and abroad in recent years,the author elaborates the etiology,pathogenesis and treatment of tic disorder in children,in order to further guide the clinical diagnosis and treatment.

抽动障碍患儿共患ADHD的影响因素及中介效应分析

目的分析抽动障碍(tic disorders,TD)患儿共患注意缺陷与多动障碍(attention deficit hyperactivity disorder,ADHD)的影响因素及路径关系中的中介效应。方法调查收集363例TD患儿的临床资料及人口学和家庭环境信息,采用多因素Logistic回归分析、路径分析及中介效应分析相结合的方法进行研究。结果放纵型家庭教养方式(OR=2.59)、TD病情中重度(OR=25.92)、合并行为问题(OR=3.72)是TD患儿共患ADHD的危险因素。中介效应分析结果显示,TD病情严重程度在TD诊断类型和合并行为问题之间起部分中介作用,中介效应大小为14.34%;TD合并行为问题在TD病情严重程度和共患ADHD之间起部分中介作用,中介效应大小为6.49%;TD合并行为问题在家庭教养方式和共患ADHD之间起部分中介作用,中介效应大小为24.14%。结论TD患儿共患ADHD与家庭环境、临床因素关系密切,在TD诊疗过程中应充分考虑到疾病本身、共患病以及中介变量的影响。

儿童抽动障碍与肠道菌群及炎症反应、免疫指标相关性研究

目的探究儿童抽动障碍与肠道菌群及炎症反应、免疫指标相关性研究。方法选取连云港市第二人民医院2022年1月至2023年6月收治的69例儿童抽动障碍病儿作为试验组,并选取69例同期在该院体检的健康儿童作为对照组。对比两组小儿肠道菌群及炎症反应[白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)]、免疫指标[分化抗原(CD)3^(+)、CD4^(+)、CD8^(+)],同时分析试验组病儿美国耶鲁综合抽动严重程度量表(YGTSS)评分与肠道菌群、炎症反应和免疫指标的相关性。结果试验组病儿双歧杆菌水平低于对照组[(7.15±0.98)IgCFU/g比(9.24±0.85)IgCFU/g],大肠埃希菌水平高于对照组[(7.19±0.77)IgCFU/g比(6.29±0.81)IgCFU/g](均P<0.05);试验组病儿血清IL-6[(3.45±0.39)ng/L比(1.44±0.31)ng/L]和TNF-α[(10.24±1.31)ng/L比(5.43±1.29)ng/L]水平显著高于对照组(均P<0.05);试验组病儿CD3^(+)[(57.99±1.32)%比(62.08±1.27)%]和CD4^(+)[(41.87±1.23)%比(48.25±1.18)%]水平低于对照组,CD8^(+)[(36.77±1.39)%比(31.85±1.27)%]水平高于对照组(P<0.05);Pearson分析结果显示双歧杆菌水平、CD3^(+)和CD4^(+)水平与YGTSS评分呈负相关(r=−0.57、−0.66、−0.67,均P<0.05),大肠埃希菌水平、IL-6、TNF-α和CD8^(+)水平与YGTSS评分呈正相关(r=0.68、0.68、0.62、0.59,均P<0.05)。结论儿童抽动障碍病儿存在明显的肠道菌群及炎症反应、免疫指标异常,其病情程度与肠道菌群及炎症反应、免疫指标存在明显的相关性。

铁缺乏与抽动障碍关系研究进展

抽动障碍是一种常见于儿童的神经发育障碍性疾病,患病率高,患者个体间临床表现差异大,常常合并其他神经精神疾病,给患者心理和生理健康带来极大的负担。抽动障碍的病因尚未明确,可能与遗传、免疫、环境及心理等多种因素有关,病理机制涉及皮质-纹状体-丘脑-皮质通路障碍及多巴胺的异常。铁在神经系统发育过程中具有重要的生物学功能。研究显示,铁缺乏可能引起大脑发育障碍、多巴胺功能受损进而导致抽动障碍的发生发展。改善机体铁营养状况、对抽动障碍患儿适当补充铁剂可能是防治抽动障碍的新思路。

健脾宁神颗粒对抽动障碍小鼠脑组织单胺类神经递质的影响

目的:研究健脾宁神颗粒对抽动障碍小鼠脑组织单胺类神经递质的影响,以探讨健脾宁神颗粒可能的作用机制。方法:60只雄性ICR小鼠,除10只作为正常对照组外,其余各组均建立抽动障碍模型。造模成功后,将其随机分为模型对照组,健脾宁神颗粒高、中、低剂量组,硫必利阳性对照组;连续给药4周后,酶联免疫法(ELISA)检测脑组织多巴胺(DA)、5-羟色胺(5-HT)、去甲肾上腺素(NE)含量。结果:与正常对照组比较,模型对照组小鼠脑组织5-HT含量明显增加(P<0.05),DA、NE含量明显减少(P<0.05,P<0.01)。与模型对照组比较,健脾宁神颗粒高剂量组小鼠脑组织5-HT含量明显减少(P<0.05),DA、NE含量明显增加(P<0.05)。结论:调节脑组织单胺类神经递质DA、5-HT、NE水平是健脾宁神颗粒治疗抽动障碍的可能的作用机制之一。

肠道菌群情况与发声和多种运动联合抽动障碍患儿神经递质、神经功能及T细胞亚群的相关性分析

目的探讨发声和多种运动联合抽动障碍(又称抽动症)患儿肠道菌群分布情况与其神经递质、神经功能及T细胞亚群的相关性。方法以2020年5月—2023年5月南京中医药大学附属南京市中西医结合医院收治的97例抽动症患儿作为研究对象,通过耶鲁抽动症整体严重度量表(YGTSS)将所有患儿分为轻度组23例、中度组42例和重度组32例。采集所有患儿粪便样本,采用16S rRNA测序技术和Qiime软件进行肠道菌群α多样性分析[Chao1指数、observed species(Sobs)指数、Shannon指数、Simpson指数];测定T淋巴细胞亚群(CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))和神经递质[5-羟色胺(5-HT)、多巴胺(DA)、γ-氨基丁酸(GABA)、去甲肾上腺素(NE)]水平;评估两组儿童神经功能;采用Pearson相关性分析探讨患儿肠道菌群与神经递质、神经功能及T细胞亚群的关系。结果与轻度组相比,中度组和重度组的YGTSS评分的运动性抽动、发声性抽动、总分更高(P<0.05);轻度组、中度组和重度组患儿的Chao1、Sobs、Shannon和Simpson指数比较,经方差分析,差异均有统计学意义(P<0.05);与轻度组相比,中度组和重度组的α多样性更低(P<0.05);轻度组、中度组和重度组患儿的CD4^(+)、CD8^(+)和CD4^(+)/CD8^(+)比较,经方差分析,差异均有统计学意义(P<0.05);与轻度组相比,中度组和重度组的CD4^(+)和CD4^(+)/CD8^(+)更低,CD8^(+)更高(P<0.05);与轻度组相比,中度组和重度组的5-HT和DA更高,GABA、NE、神经功能评分更低(P<0.05)。根据Pearson相关性分析结果,患儿Chao1、Sobs、Shannon和Simpson指数与5-HT、DA呈负相关(P<0.05),与CD4^(+)、GABA、NE和神经功能评分呈正相关(P<0.05)。结论肠道菌群与抽动症患儿的神经递质、神经功能和T细胞亚群密切相关。

常克从风、火、痰、虚、瘀论治抽动障碍之经验

抽动障碍发病率逐年升高,病情反复且常以多发性、共患病为其临床特点。儿童抽动障碍之病因病机,虽系于外感之所为,然本乎于风火痰虚瘀耳,其病因之杂,症状之变,非一脏之所为,常多涉及五脏。常克教授从风、火、痰、虚、瘀认识儿童抽动障碍,针对其病机之要,采用常用方及自拟方进行论治,临床疗效甚好,现将其治验总结如下,并附验案一则。

基于数据挖掘和网络药理学探讨杨丽新治疗抽动障碍用药规律和作用机制

目的 探讨杨丽新教授治疗抽动障碍的用药规律及作用机制。方法 搜集杨丽新教授2016年于广东省中医院儿科门诊治疗抽动障碍的病历资料,运用“中医传承辅助平台(V2.5)”对中药数据进行频数分析和关联度分析,获取核心组方,并根据结果进行网络药理学分析。用TCMSP、ETCM、TCMID、Batman等数据库筛选核心处方中药活性成分,利用Genecard、Drugbank等数据库获取抽动障碍相关疾病靶点并生成韦恩图,得到药物-疾病交集靶点并上传至STRING,使用Cytoscape 3.7.2构建核心网络。运用Metascape数据库对共同靶点进行GO功能及KEGG通路富集分析。运用AutoDock vina和Pyrx软件进行分子对接,进一步筛选核心处方治疗抽动障碍的核心靶点。结果 共录入3 443个病例,处方涉及77味中药,高频药物10味,寒性药物运用最多,多归肺经、脾经,性味以辛、甘、苦多见;关联规则得到32条数据,聚类分析得到4组核心组合。7种核心药物(陈皮、甘草、法半夏、竹茹、茯苓、牡蛎及钩藤)中的核心活性成分145个,靶点基因220个,疾病靶点1 290个,药物-疾病共同靶点共58个。GO功能富集条目422条,生物过程304条,细胞过程44条,分子功能74条,生物功能186条,KEGG富集通路68条。主要活性成分有山柰酚、7-甲氧基-2-甲基异黄酮、刺芒柄花素、β-豆甾醇等,作用于SLC6A4、SLC6A3、HTR2A、HTR2C等靶点,通过神经活性配体-受体相互作用、血清素神经突触、cGMP-PKG等关键信号通路进行调节实现。分子对接结果显示主要活性成分与核心靶点有强烈的结合活性。结论 通过数据挖掘、网络药理学分析和分子对接得出杨丽新教授治疗抽动障碍组方用药规律及作用机制,可为治疗抽动障碍的新方组合提供思路。

基于肝与小儿少阳体质探究抽动障碍中医机制

抽动障碍病起病于儿童和青少年时期,现代医学属于神经精神障碍性疾病。随着社会的发展,外界刺激的增加,本病病例亦有逐年上涨的趋势。当儿童发育处于生长时期,无不体现肝之特性,小儿体质符合肝的特性,肝气平和,肝血充足则正常发育;肝阳过亢、肝阴不足或肝肾不相协调易使得肝风内动则可见抽动的症状表现。另外,对于外部刺激的处理失当,肝气郁滞,亦生内动之变。基于此,抓住肝的生理特性和小儿体质特点,探究二者之间的关系,以及肝与其他脏腑的联系,从肝和少阳体质关系的角度分析抽动障碍,以肝为主,五脏平调,内外并治,对于初发和久治不愈的疑难性抽动障碍治疗均具有一定的指导意义。

儿童抽动障碍中医外治专家共识(2024)

儿童抽动障碍是临床最常见的神经精神疾病之一,对儿童身心健康有较大危害。以针灸、推拿为代表的中医外治疗法在儿童抽动障碍治疗中具有一定特色优势,但规范化程度有待提高。本共识内容涵盖儿童抽动障碍的术语与定义、诊断、病因病机、辨证、中医外治技术规范等,总结了本病的现代医家经验和循证医学进展。本共识突出临床实用性,体现了最新研究进展,从而帮助提高儿童抽动障碍中医外治临床规范化水平。

基于复杂网络分析吴力群治疗抽动障碍用药规律

目的探究吴力群教授治疗小儿抽动障碍的用药规律。方法收集吴力群教授2016年9月-2022年10月诊治抽动障碍患儿病案,建立数据库,使用SPSS Statistics 23进行频数统计,使用Liquorice软件进行多尺度骨干网络分析及多层核心网络分析,总结用药规律。结果共纳入病案709则,涉及处方834首,中药203味。药物类别多为补虚药、清热药、平肝熄风药,药性以温、寒、平性为主,归经多归肺经、肝经、脾经。复杂网络分析显示核心处方由当归、白芍、川芎、党参、等20味中药组成,得到30组常用药对,以及不同症状及共患病常用药物。结论吴力群教授治疗小儿抽动障碍重在从“肝风”论治,疏散外风截断病程,平肝潜阳以熄内风,并重视调达肝气,滋阴柔肝,养血熄风。

韩雪教授分症论治儿童抽动障碍经验

总结韩雪教授治疗儿童抽动障碍(Tic disorder,TD)的临证经验。认为儿童TD以脏腑失和,肝失条达,内风妄动为总病机。TD临床病症多变,提出分症论治的观点,将TD常见的五类临床症状及共患病进行分类辨治,以小柴胡汤为基础方,并根据不同症状的病机特点与半夏厚朴汤、葛根汤、麻黄附子细辛汤、苓桂术甘汤、防己地黄汤、柴胡加龙骨牡蛎汤、四逆散合方组方施药。并附验案1则,以资佐证。