Objective To evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in treating stroke patients with motor dysfunction. Methods The Cochrane Library, MEDLINE, EMbase, CBM, CNKI and WanFang Data were searched from inception to January 2012, and the references of the included studies were also retrieved to collect the randomized controlled trials (RCTs) on rTMS in treating stroke patients with motor dysfunction. Two reviewers independently screened articles according to the inclusion and exclusion criteria, extracted data and evaluated the quality of the included studies. Then meta-analysis was performed using RevMan 5.0.2 software, and evidence quality and recommendation level were assessed using the GRADE system. Results A total of 11 RCTs involving 376 patients were included. The results of meta-analysis (including 3 RCTs, low quality) showed that, compared with the routine rehabilitation treatment, 2 to 4 weeks of rTMS was much beneficial to stroke patients with motor dysfunction, with significant differences (WMD=11.02, 95%CI 2.56 to 19.47). The other 8 studies only adopted descriptive analysis accordingly. Conclusion It is still uncertain of the effectiveness of rTMS in improving motor dysfunction of stroke patients, so rTMS should be applied with caution in clinic.
Objective To investigate the effects of highly selective vagotomy plus mucosal antrectomy (HSVMA) and highly selective vagotomy (HSV) alone on the functions of the gastric antrum. MethodsEighteen dogs and 48 patients with chronic duodenal ulcer were tested. The time of gastric emptying, antral myoelectric activity, antral pressure were measured 4-6 months after operation in 18 dogs which were randomized into the control, HSV and HSVMA groups. The gastric evacuation, frequency and amplitude of electrogastrography (EGG) were observed 4-6 months after operation in 48 patients who were randomly divided into HSV (20 patients) and HSVMA (28 patients) group, their preoperative values were considered as control group. ResultsIt was found by barium meal examinations that the shape of the stomach and duodenum was normal and gastric peristalsis was clearly visible in all the animals and patients of two postoperative groups. The beginning and ending time of gastric emptying were (5.0±0.06) min and (4.0±0.4) h respectively in the dogs of HSVMA group, which were similar to those of the dogs of control and HSV group (Pgt;0.05). The frequency of the antral myoelectric action potential was (3.11±0.65 ) cycles/min in the dogs of HSVMA group, the frequency of EGG was (3.25±0.75) cycles/min in the patients of HSVMA group, which were significantly lower than that of the dogs or patients of control and HSV group (P＜0.05). Injection of pentagastrin in dogs or taking meal in patients significantly increased the antral pressure or amplitude of EGG. Conclusion The motor function of the reconstructed antrum in the HSVMA group approaches the normal level despite a lower antral myoelectric frequency. It is believed that HSVMA will be a choice for the treatment of duodenal ulcer.
【Abstract】 Objective To investigate the feasibility of transpositional anastomosis of C4 anterior trunk and accessory nerve for functional reconstruction of the trapezius muscle so as to provide theoretical basis of repairing accessory nerve defects. Methods Thirty-six adult male Sprague-Dawley rats (weighing 200-250 g) were randomly divided into the experimental group (n=18) and control group (n=18). The transpositional anastomosis of C4 anterior trunk and accessory nerve was performed in the left sides of experimental group; the accessory nerve was transected in the left sides of control group; and the right sides of both groups were not treated as within-subject controls. The electrophysiological and histological changes of the trapezius muscle were measured. The values of the latencies and amplitudes of compound muscle action potential (CMAP) were recorded in the experimental group at 1, 2, and 3 months; the latency delaying rate, amplitude recovery rate, and restoration rate of muscular tension were caculated. The counts of myelinated nerve fibers from distal to the anastomotic site were analyzed. The transverse area of the trapezius muscle was also measured and analyzed in 2 groups. Meanwhile, the muscles and nerves were harvested for transmission electron microscope observation in the experimental group at 1 and 3 months. Results As time passed by, the experimental group showed increased amplitudes of CMAP, shortened latencies of CMAP, and improved muscular tension. At 3 months, the amplitude recovery rates were 63.61% ± 9.29% in upper trapezius muscle and 73.13% ± 11.85% in lower trapezius muscle; the latency delaying rates were 130.45% ± 37.27% and 112.62% ± 19.57%, respectively; and the restoration rate of muscular tension were 77.27% ± 13.64% and 82.47% ± 22.94%, respectively. The passing rate of myelinated nerve fibers was 82.55% ± 5.00%. With the recovery of innervation, the transverse area of the trapezius muscle increased, showing significant differences between experimental group and control group at different time points (P lt; 0.05). The transmission electron microscope showed that the myotome arranged in disorder at 1 month and tended to order at 3 months. Conclusion Transpositional anastomosis of C4 anterior trunk and the accessory nerve can effectively reconstruct the function of the trapezius muscle of rats.
ObjectiveTo compare postoperative analgesic efficacy and motor function recovery between ultrasound guided adductor canal block (ACB) and Femoral nerve block (FNB) in patients after total knee arthroplasty (TKA). MethodsFrom March to April 2014, 40 patients chosen to receive TKA under general anesthesia were randomly allocated to FNB group and ACB group with 20 in each group. Opioids consumption during and after operation, pain score in rest and movement, the force of quadriceps femoris, activity of knee and complications after surgery were recorded. ResultsNo differences were found in opioids consumption during and after operation, pain score in rest and movement after operation. Patients of ACB group were superior to those of FNB group in motor function recovery. At hour 2, 4, 8, 12, 24, and 48 after operation, the force of quadriceps femoris was higher in patients of ACB group than those of FNB group (P<0.05). Activity of knee was higher in patients of ACB group than those of FNB group postoperatively. ConclusionACB and FNB have equal postoperative analgesic effect for TKA patients. But ACB has less influence on the force of quadriceps femoris than FNB. Therefore, patients of ACB group are superior to those of FNB group in motor function recovery, showing better activity of knee and early time of first straight leg raising.
Objective To evaluate whether respiratory training can improve motor function, exercise endurance, and activity of daily living (ADL) in stroke patients. Methods The randomized controlled trials of the effects of respiratory training on motor function, exercise endurance, and ADL in stroke patients were searched in PubMed, Embase, Google Scholar, China National Knowledge Infrastructure, Wanfang, and VIP Database. The search date was from the establishment of each database to December 2018. The control group received routine rehabilitation, medical treatment or other interventions, and the trial group added respiratory training on that basis. Outcome measures included the Fugl-Meyer Assessment (FMA), the 6-minute walk test (6MWT), and the modified Barthel Index (BI). The literature was independently screened by two investigators according to the inclusion and exclusion criteria, and the quality of the included articles was evaluated using the Physiotherapy Evidence Database scale and Cochrane Library systematic review criteria. Statistical analysis was performed using RevMan 5.3 software. Results A total of 11 articles with 741 stroke patients were included. Meta-analysis showed that in the trial group the exercise endurance [mean difference (MD)=41.50 m, 95% confidence interval (CI) (7.63, 75.37) m, P=0.02], ADL [MD=9.97, 95%CI (3.99, 15.96), P=0.001], and motor function [MD=8.00, 95%CI (1.29, 14.70), P=0.02] were improved compared with those in the control group. Subgroup analysis showed that after 8-10 weeks of intervention, BI of the trial group was higher than that of the control group [MD=25.37, 95%CI (16.49, 34.25), P<0.000 01]; after 8 weeks and 12 weeks to 3 months of intervention, FMA of the trial group was higher than that of the control group [ after 8 weeks: MD=20.40, 95%CI (9.72, 31.08), P=0.000 2; after 12 weeks to 3 months: MD=6.18, 95%CI (3.57, 8.79), P<0.000 01]. Conclusions The results of this study showed that respiratory training can improve exercise tolerance, ADL, and motor function in stroke patients. In consideration of the limited number of included articles as well as the heterogeneity among included articles in the current study, and the lack of long-term follow-up period, further studies could use more optimized respiratory training programs to conduct high-quality researches with bigger sample sizes.
ObjectiveTo investigate the effect of anodal transcranial direct current stimulation (tDCS) combined with rehabilitation interventions on the patients suffering from motor dysfunction after traumatic spinal cord injury (SCI).MethodsTwo hundred and twenty-five patients with SCI from September 2015 to November 2018 were retrospectively included in this study. According to their accepted rehabilitation interventions, patients were divided into the intervention group and the control group. In the control group, the patients just accepted routine rehabilitation interventions, including movement therapy on limbs, physical therapy and acupuncture, while the patients in the intervention group accepted anodal tDCS combined with routine interventions (the same as the control group). The baseline between the two groups was similar. Moreover, subgroup analysis including trauma site and extent were carried out for further exploration for the positive effect of tDCS on motor function suffering from acute traumatic SCI. American Spinal Injury Association (ASIA) motor item, Functional IndependenceMeasure (FIM) and modified Barthel index (MBI), as well as motor evoked potential (MEP) were carried out for the evaluation of motor function ahead of and 30 days after intervention.ResultsAfter 30-day rehabilitation intervention, the scores of ASIA motor item (48.26±6.57), FIM (60.68±6.05) and MBI (68.73±7.57) were all significantly higher in the intervention group than those in the control group (all P<0.05). Besides, MEP latency of C7 [(9.20±0.42) ms], hand area [(17.81±0.56) ms], Pf [(3.24±0.47) ms] and leg area [(23.06±0.98) ms], as well as central motor conduction time of upper limbs [(6.08±0.50) ms] and lower limbs [(18.06±0.99) ms] were all significantly lower in the intervention group than those in the control group (P<0.05). In addition, the subgroup analyses based on injury site and injury extent also showed that anodal tDCS associated with better motor recovery, in that the scores of ASIA motor item, FIM and MBI were all significantly higher in the intervention group than those in the control group (P<0.05), while the MEP central motor conduction time of upper limbs and lower limbs were all significantly lower in the intervention group than those in the control group (P<0.05).ConclusionAnodal tDCS could distinctly promote the recovery of motor function in patients suffering from motor dysfunction after traumatic SCI, indicating that anodal tDCS may play an important role in the rehabilitation intervention for neurological dysfunction.
ObjectiveTo explore the correlation between the functional status of upper limb motor neurons and motor function in stroke patients, and provide guidance for rehabilitation assessment and functional prognosis.MethodsThe stroke patients who were hospitalized in Department of Rehabilitation Medicine of Zhongda Hospital of Southeast University between November 2020 and January 2021 were selected. Motor unit number estimation (MUNE) and F wave were examined to evaluate the functional status of motor neuron. The Fugl-Meyer Assessment (FMA) and Modified Ashworth Scale (MAS) were used to evaluate the upper limb motor function. The correlations of electrophysiological parameters with FMA score and MAS score were analyzed respectively.ResultsA total of 42 patients were enrolled, and 16 patients were complicated with carpal flexor spasm on the affected side. Among the 42 stroke patients, the MUNE of the abductor pollicis brevis on the affected side was lower than that on the unaffected side (t=−3.466, P=0.001), and the percentage of F waves with different shapes on the affected side was significantly lower than that on the unaffected side (Z=−5.583, P<0.001). Among the 16 stroke patients with carpal flexor spasm, the F wave amplitude was higher on the affected side than that on the unaffected side (t=2.764, P=0.014), while the F wave latency on the affected side was not statistically significant compared with the unaffected side (Z=−0.595, P=0.552). Among the 42 stroke patients, the affected/unaffected side ratio of the percentage of F waves with different shapes was positively correlated with FMA score (rs=0.377, P=0.014), while the correlation between the affected/unaffected side ratio of MUNE and FMA score was not statistically significant (rs=0.104, P=0.513). Among the 16 stroke patients with carpal flexor spasm, the affected/unaffected side ratio of the F wave amplitude was positively correlated with the MAS score of the carpi flexor muscle (rs=0.550, P=0.027).ConclusionStroke may result into the number of functional motor neurons of the upper limbs of the hemiplegic side decreased and the excitability of motor neurons increased simultaneously, and which were related to motor function and muscle tone.
In the process of robot-assisted training for upper limb rehabilitation, a passive training strategy is usually used for stroke patients with flaccid paralysis. In order to stimulate the patient’s active rehabilitation willingness, the rehabilitation therapist will use the robot-assisted training strategy for patients who gradually have the ability to generate active force. This study proposed a motor function assessment technology for human upper-limb based on fuzzy recognition on interaction force and human-robot interaction control strategy based on assistance-as-needed. A passive training mode based on the calculated torque controller and an assisted training mode combined with the potential energy field were designed, and then the interactive force information collected by the three-dimensional force sensor during the training process was imported into the fuzzy inference system, the degree of active participation σ was proposed, and the corresponding assisted strategy algorithms were designed to realize the adaptive adjustment of the two modes. The significant correlation between the degree of active participation σ and the surface electromyography signals (sEMG) was found through the experiments, and the method had a shorter response time compared to a control strategy that only adjusted the mode through the magnitude of interaction force, making the robot safer during the training process.