Objective To observe the impact of an injection of botulinum toxin type A combined with rehabilitation on the quality of life (QOL) of patients with spasmodic torticollis.Methods Thirty-eight patients with spasmodic torticollis were randomly divided into a combined treatment group and control group.Both groups were given a local muscular injection of botulinum toxin type A.One week later the combined group was given rehabilitation training.Both groups were assessed using the Toronto torticollis rating scale (TWSTRS),Tsui's scale and a health survey (SF-36) one week and eight weeks after the injection.Results Eight weeks after the injection,severity,disability,pain,physical functioning,vitality,mental health and Tsui scores had all increased significantly in the combined treatment group compared with before treatment.Physical functioning,pain,vitality,mental health and Tsui scores had also improved significantly compared with the control group.In the control group,only severity and Tsui scores were significantly improved compared with before treatment.Throughout the course of treatment there were no significant adverse reactions.Conclusions Combining botulinum toxin type A with rehabilitation has synergistic effects on spasmodic torticollis.It can significantly reduce disability scores,relieve pain and improve quality of life.

Objective To observe the effect of low-frequency, repetitive transcranial magnetic stimulation ( rTMS) at different frequencies on the cognitive function of traumatic brain injury patients with a history of epilepsy. Methods Sixty traumatic brain injury patients were randomly divided into a 0. 5 Hz group, a 1. 0 Hz group and a control group, each of 20. In addition to routine drug therapy and cognition training, the control group was given fake stimulation, the 0.5 Hz group was treated with 0.5 Hz rTMS, and the 1.0 Hz group was provided with 1.0 Hz rTMS for 4 weeks, eleven times per week. Before and after treatment, the cognitive function of all three groups was assessed using the Montreal cognitive assessment ( MOCA) , the Rivermead behavior memory test ( RBMT) and a symbol can-cellation test. The number of patients reporting headache or epilepsy during the treatment period was also counted. Results During the treatment, there was no headache case in any of the groups, and no significant difference was found in the occurrence of seizures. After the treatment, all of the measurements in all 3 groups had improved signifi-cantly. The average MOCA and RBMT scores in the 1.0 Hz group were all significantly better than those in the control group, but there was no significant difference between the 0.5 Hz group and the control group. The symbol cancella-tion test efficiency of the 1. 0 Hz group was not significantly better than that of the 0. 5 Hz and control groups. Conclusions Repeated 1.0 Hz transcranial magnetic stimulation can significantly improve cognition after traumatic brain injury among patients with a history of epilepsy without increasing the risk of seizures.

Objective To observe the influence of secondary spasmodic torticollis on the balance of hemiplegic stroke survivors and to compare the effects of different treatment protocols.Methods Fifty-six secondary spasmodic torticollis patients after stroke were randomly divided into three groups based on the type of treatment.The botulinum toxin (BTX) group received BTX-A injections and common support treatment plus rehabilitation training (n =19),the medication therapy group received oral baclofen and common support treatment plus rehabilitation training (n =18),and the routine rehabilitation group received only routine rehabilitation therapy (n =19).In addition,19 stroke cases without spasmodic torticollis served as a control group.They also were treated with routine rehabilitative treatment alone.Before and after 2 months of treatment,balance was assessed using Berg's balance scale,and spasmodic torticollis was evaluated using Tsui's scale.Results Before treatment the balance of the control group members was significantly better than that of the other three groups.After 2 months of therapy,balance function had improved significantly in all four groups.The balance of the botulinum toxin group was better than that of the medication and routine rehabilitation groups.After treatment,Tsui scale scores in the medication and botulinum toxin groups were significantly lower than before treatment,and the scores in the botulinum toxin group were significantly lower than in the medication and routine rehabilitation groups.There was no significant difference in Tsui scale scores before and after treatment in the control group.Conclusions Spasmodic torticollis inflaences the recovery of balance function in hemiplegic patients after stroke.Treating the spasmodic torticollis can improve their balance.Treatment with BTX-A combined with common support treatmcnt and rehabilitation training showed significant curativeeffect.

Objective To observe the influence of spasmodic torticollis on the rehabilitation prognoses of patients with neurogenic dysphagia.Methods One hundred and three dysphagic patients were recruited,of which 82 had spasmodic torticollis and 21 did not.The subjects with spasmodic torticollis were divided randomly into a medication therapy group (21 cases) which accepted medication plus swallowing training,a common therapy group (20 cases) accepting common support treatment plus swallowing training,a combined therapy group (20 cases) accepting common support treatment,medication,plus swallowing training as well,and a group of 21 cases accepting only routine rehabilitation therapy ( the routine rehabilitation group).The 21 cases without spasmodic torticollis served as a control group,and they were treated with routine rehabilitative treatment.The swallowing function of all patients was evaluated before and after therapy using videofluoroscopic swallowing study techniques.Results There was no significant difference with regard to the swallowing function among the groups before treatment except that the swallowing function of the control group (without torticollis) was significantly better than that of the other 4 groups.After treatment,swallowing function had improved significantly in all 5 groups.The average improvement in the routine rehabilitation group was,however,significantly less than in the others.After treatment there was no significant difference between the combined therapy group and the no torticollis control group with regard to swallowing function.Conclusions Spasmodic torticollis influences the recovery of swallowing function in dysphagic patients.Therapy for spasmodic torticollis can improve swallowing among dysphagic patients with spasmodic torticollis.

Objective To observe the influence of transplanting neural stem cells (NSCs) on angiogenesis in rats with spinal cord injury (SCI).Methods The Allen's method was used to create SCI models in sixty adult Sprague-Dawley (SD) rats.They were then randomly classified into a control group which received injections of phosphate buffered solution (PBS) and an NSC group which received injections of NSCs via the tail vein,with 30 rats in each group.Another group of 30 similar rats without SCI received injections of NSCs via the tail vein as the normal group.Each rat was evaluated before transplantation and at days 7 and 14 post-transplantation using the Basso,Beattie and Bresnahan (BBB) scale for testing hindlimb function.After sacrifice,the distribution of yon Willebrand factor (vWF) in both groups was determined by immunofluorescence,and Western blotting was used to detect vascular endothelial growth factor (VEGF) protein.Results The average BBB score of the normal group was 21 at every time point.Before transplantation,the BBB scoresof the control and NSC groups were both 0,however they increased over time.At day 7 post-transplantation,the BBB scores showed no significant difference between the control group and the NSC group.At day 14 post-transplantation,the average BBB score of the NSC group was significantly higher than that in the control group.At days 7 and 14,the counts of vWF-positive cells in the normal group were significantly higher than in the control and NSC groups.VEGF protein expression in the normal group was significantly lower than in the NSC and control groups.Conclusions NSC transplantation may promote angiogenesis after spinal cord injury and improve motor function by inducing the expression of VEGF.

Objective To observe the movement patterns of the geniohyoid muscle in swallowing of healthy subjects by using the real-time B/M-mode ultrasound imaging.Methods Thirty healthy subjects were recruited and the movement patterns of their geniohyoid muscles in swallowing of 5 ml juice-like,thin liquid,honey-like and budding-like bolus.The parameters included the range and the duration of geniohyoid muscle movement.Each subject was measured for 3 times to get the average.Results The range of geniohyoid muscle movement in swallowing of the above bolus was (6.993 ± 1.776)mm,(7.463 ± 1.947)mm,(8.446 ±2.293)mm and (8.905 ±2.057)mm,respectively,with significant differences among them except that between juice-like and thin liquid bolus swallowing,as well as between honey-like and budding-like bolus swallowing.The duration of geniohyoid muscle movement was (0.899 ±0.129)s,(1.019 ±0.149)s,(1.119 ±0.111)s and (1.211 ±0.141)s in juice-like,thin liquid,honey-like and budding-like bolus swallowing,with significant differences among them.When swallowing the same bolus,the range and duration of geniohyoid muscle movement of males were significantly longer than those of females.Conclusions B/M-mode imaging provides a useful technique for assessment the movement of the geniohyoid muscle.The bolus viscosity has an impact on the movement of the geniohyoid muscle.Compared with the range of movement,the duration of geniohyoid muscle movement is a better index for evaluating the effect of bolus viscosity on the geniohyoid muscle movement.

Objective To explore the change of the pre-swallow peak pressure of upper esophageal sphincter (UES) in patients with post-stroke cricopharyngeal achalasia,and investigate the effect of pre-swallowing peak UES pressure on swallowing function by quantitative analysis.Methods Fifty-seven stroke patients with cricopharyngeal achalasia were recruited and divided into balloon dilation group,combined training group and routine swallowing training group with 19 patients in eachp.All the three groups accepted routine swallowing training.In addtion,the routine swallowing training group and balloon dilation group accepted larynx elevation training and balloon dilation training,respectively,while the combined training group accepted larynx elevation training and balloon dilation training simultaneously.The pre-swallow peak UES pressure was measured by using PC polygraph high rate gastrointestinal dynamical detection system (PC Polygraf HR,CTD-synectics,Sweden) before and after 8 weeks of treatment.The swallowing function was assessed using swallowing function classification and water swallowing test.Results Before treatment,there was no significant difference among the 3 groups in terms of the pre-swallow peak UES pressure,swallowing function classification,water swallowing test and VFSS (P ＞ 0.05).After treatment,pre-swallow peak UES pressure,swallowing function classification,water swallowing test and VFSS of the balloon dilation group and combined training group improved significantly compared with those before treatment (P ＜ 0.05),and the improvement in the combined training group was to a significantly better extent than in the balloon dilation group(P ＜O.05).Conclusion Balloon dilation and larynx elevation training plus routine swallowing training can increase pre-swallow peak UES pressure,decrease the UES resting pressure of stroke patients with cricopharyngeal achalasia,which is of great importance for their recovery.

Objective To observe the effect of different ways of balloon catheter dilation techniques on cricopharyngeal achalasia and its mechanisms.Methods Thirty patients with deglutition disorder after brain stem infarction,whose cricopharyngeal achalasias were proven by videofluoroscopic swallowing study(VFSS),were randomly divided into three groups: No.14 conventional catheter group A,No.14 modified bicavitary silica-gel catheter group B and No.22 conventional catheter group C with 10 cases in each group,respectively.All the patients of 3 groups received multiple times corresponding balloon catheter dilatation per nasal or per os(No.22 conventional catheter group C only per os).Results After an average of 30 d of balloon catheter dilatation,the level of dysphagia and VFSS evaluation of all patients improved significantly(P ＜ 0.05).However,the No.14 conventional catheter group A and No.22 conventional catheter group C improved to a greater extent than No.14 modified bicavitary silica-gel catheter group B(P ＜ 0.05).The saccule perimeter,saccule diameter and saccule intracapsular pressure of No.14 conventional catheter group A and No.22 conventional catheter group C increased significantly(P ＜ 0.05)when compared to those of No.14 modified bicavitary silica-gel catheter group B,but there was no significant diffference beween No.14 conventional catheter group A and No.22 conventional catheter group C(P ＞ 0.05).Conclusions The balloon catheter dilation technique can significantly improve swallowing function of deglutition disorders patients with cricopharyngeal achalasia after brain stem infarction,which is related positively to saccule diameter and saccule intracapsular pressure.

Objective To observe the surface electromyographic characteristics of the bilateral submen-tal muscles in dysphagia secondary to unilateral brainstem stroke. Methods A total of 25 subjects were recrui-ted. There were 8 stroke patients with dysphagia secondary to a left brainstem stroke and 7 stroke patients with dysphagia secondary to a right brainstem stroke. There were also 10 healthy controls matched in age and gender. The duration and peak amplitude of the submental muscle when swallowing 5 ml of warm water were recorded u-sing a surface electromyograph. Results The average amplitude of the left submental muscle in patients with a left brainstem stroke was significantly longer than that of those with a right brainstem stroke, but no significant differences in average duration were observed. Conversely, the amplitude of the right submental muscle in pa-tients with a right brainstem stroke was significantly longer than that of those with left brainstem stroke, but again there were no significant differences in duration. No significant differences were observed among the healthy con-trols. The amplitude and duration of both the affected and healthy sides of the patients were of course significantly longer or stronger than those of the healthy controls. Conclusion The swallowing function of the bilateral sub-mental muscles may be impaired among unilateral stroke survivors with dysphagia. The damage on the affected side is more severe than on the opposite side.

Objective To explore the application of videofluoroscopic swallowing study (VFSS) in the treatment of dysphagia post-stroke. Methods Eighty patients were assigned into control and treatment groups. Both groups accepted routine drug treatments and physical therapy, and all patients underwent VFSS on the 1 st and 28th day of the study. The patients in the treatment group accepted weekly VFSS in addition, and their swal-lowing training schedules were formulated according to the VFSS assessment results. Water drinking tests and de-glutition disorders were adopted to assess the patients' swallowing function before and after therapy. Results In treatment group, where the therapy schedule was adjusted using VFSS every week, the adjustment proportion at the 2nd, 3rd and 4th week was 20.6% , 40.7% and 15.8% , respectively. Before treatment there was no difference between the two groups with regard to water drinking, deglutition or VFSS scores. After training the water drinking and deglutition results and the time for iodine to transit the oral cavity and pharynx all improved significantly in both groups. The improvements in the treatment group were significantly greater than in the con-trol group. Conclusions Swallowing training based on videofluoroscopic assessment can significantly alleviate post-stroke dysphagia.