Spasticity is a common problem in upper motor neuron lesions.Assessment of spasticity is extremely valuable in quantifying the effects of a therapeutic intervention.But it is,in other hand,a difficult and challenging problem.Objective:The present study was undertaken to determine the feasibility of quantifying spasticity by the pendulum test using the isokinetic dynamometric technique.We suggest that this machine can be used to perform pendulum test to quantify spasticity.Method:We studied the lower limb muscle tone in 34 spastic subjects,and in 9 flaccid paralysis control subjects,and 10 normal control subjects.Result:Typical pendulun test goniograms of each group were obtained and 5 parameters are extracted from the goniograms to evaluate the degree of spasticity. They are:Al(the flexion angle of the first drop)、R1(relaxation index)、R2(amplitude ratio)、T(time of swings)、F(frequency of swings).The correlation coefficients are calculated to determine the reliability of the parameters(>0.90 for three consecutive test;>0.80 for different days).The validity is determined by t test(p<0.01).Conclusion:The method of using isokinetic dynamometric technique combining pendulum test to quantify spasticity is a reliable,valid,accurate and convenient method of assessing spasticity.

BACKGROUND: The rehabilitation outcome varies in stroke patients,and there are differences in the literatures about the influence of factors on the functional recovery in such patients.,OBJECTIVE: To evaluate the pre-rehabilitative and post-rehabilitative effects of stroke patients by functional independence measure (FIM) that is widely used, and analyze the influence of gender, age, motor and cognitive functions at admission, time interval from stroke onset to arrival at rehabilitative admission, comorbidity occurrence, laterality of lesion on the functional recovery of stroke patients.DESIGN: Before-after control observationSETTING: Center of Rehabilitation Medicine, Shandong Provincial Hospital; Faculty of Rehabilitation Medicine, Capital University of Medical SciencesPARTICIPANTS: From March 2000 to December 2002, 55 stroke patients were selected from Shandong Provincial Hospital. They were all first episode, and patients whose bilateral cerebral hemisphere were involved were excluded.METHODS: After the vital signs were steady, the stroke patients got through risk phase (31-75 days) and were treated with medicine improving microcirculation and providing neurotrophic factor for nerves. In addition, they accepted comprehensive rehabilitation training of Bobath technique, PNF technique and Rood method mainly, with 1-2 hours per day and five times per week.MAIN OUTCOME MEASURES: The patients were evaluated within 7days after admission and reassessed 3 days before discharge using FIM,including 18 items of motor and cognitive functions and 126 total scores (108-126 as elementarily or completely independent, 72-107 as mildly dependent, 54-71 as moderately dependent, 36-53 as severely dependent,18-35 as extremely or completely dependent). Multiple stepwise regression equation was applied to analyze the relation of above factors and functional recovery (increased value of FIM total score).RESULTS: Totally 55 patients were involved into the result analysis.①FIM total score of patients was significantly higher at discharge than at admission (93.8±12.0, 68.8±11.6, P ＜ 0.001), and motor function and cognitive function at discharge also increased compare with at admission (P ＜ 0.001).②Mean value of FIM motor score increased everyday was identical with that of total score (0.56±0.21, 0.59±0.21), and higher than mean value of cognitive score (0.03±0.03).Multiple stepwise regression analysis showed,scores of motor and cognitive status at admission, age, time interval from stroke onset to arrival at rehabilitative admission all affected the increased value of FIM total scores. No significant association between gender, comorbidity, laterality lesion of paralysis and functional recovery was observed (P ＞ 0.05). The most influential factors were orderly motor function,cognitive function at admission, age and time interval from stroke onset to arrival at rehabilitation admission.CONCLUSION: Motor and cognitive function at admission, age and time interval from stroke onset to arrival at rehabilitative admission have a no table relationship with functional recovery of stroke patients, especially motor function at admission is positively related. Thus we should not neglect the influence of these factors when conducting rehabilitative treatment.

Objective To determine the effect of walking in water on patients with spinal cord injury~SCI). Methods Twenty SCI patients were recruited in this study, and these patients were randomly divided into a control group ~10 cases) and an experiment group~10 cases).The patients of the experiment group were administered aqua-walking and conventional physical therapy~PT),and the patients of control group were administered the conventional PT only. Results After 10 weeks of therapy, the muscle tone, motor index score and functional ambulation classification of experiment group were ameliorated significantly in comparison with the control group(P

Objective To explore the effect of early administration of alendronate (ALN) and pulsed electromagnetic fields (PEMFs) on bone mass of rats after spinal cord injury(SCI). Methods Sixty-two healthy female SD rats aged 3 months were randomly allocated into 5 groups: a Sham group, a SCI group, a SCI+ALN group, a SCI+PEMFs group and a SCI+PEMFs+ALN group. Rats in the Sham group underwent laminectomy, while the rats in the other 4 groups underwent complete spinal cord transection, and the remained 3 groups were treated with ALN and/or PEMFs 1 week after SCI. All rats were sacrificed 8 weeks after operation. The bone mineral density(BMD), biomechanical parameters of the femurs, and histomorphometric parameters of proximal tibias were mea-sured, respectively. The data were analyzed with one way-ANOVA and factorial design-ANOVA. Results After early treatment of ALN and/or PEMFs, the BMD of femur was significantly increased as compared with that of rats in the SCI group; the elastic load, maximal load of femur were significantly increased as compared with those of rats in the SCI group; the percent trabecular bone area and trabecular bone width of tibias were significantly increased when compared to those of rats in the SCI group. Conclusion Early treatments of ALN and PEMFs can reduce the loss of bone, improve biomechanical properties of the femur, and inhibit the decay of microstructure of upper part of tibia. The study suggests that ALN and PEMFs may help prevent osteoporosis after SCI.

Mechanical loading provides an anabolic stimulus for bone. Low frequency vibration is a kind of mechanic stimulus, which can promote osteogenesis in certain frequency, mode and intensity. The osteogenesis promotion of low frequency vibration may be associated with the membrane ion channels, integrin-cytoskeleton complex triggering mitogen activated protein kinase (MAPK) signal and second messengers regulating RANK-RANKL-OPG axals.

Objective To observe the effect of low frequency vibration (LFV) on bone metabolism, bone mass density (BMD), bone histomorphometric and biomechanical characterization in rats with secondary osteoporosis (OP) after spinal cord injury (SCI).MethodsSCI model was established with 50 SD rats by transecting spinal cord completely at the level of tenth thoracic vertebra, and the animals were randomly divided into 5 groups: SCI 6-week control group, SCI 12-week control group, vibration 6-week (Vi 6w) group, vibration 12-week (Vi 12w) group and vibration 6-12 week (Vi 6-12w) group. All rats of vibration groups accepted LFV (frequency=20 Hz, acceleration=0.15 g) with 10 minutes once, twice per day, and 6 days per week. The LFV was given from the forth day postoperation to the end of the sixth week in Vi 6w group, and to the end of twelfth week in Vi 12w group, while from the seventh week postoperation to the end of twelfth week in Vi 6-12w group. All animals were sacrificed when LFV test finishied. The serum alkaline phosphatase (ALP), bone glaprotein (BGP) and serum calcium (Ca2+)/BMD of femur and the fifth lumbar vertebra (L5)/bone histomorphometric characterization of tibia/bone biomechanical characterization of femur and L5 were measured.ResultsCompared with control groups, the serum Ca2+ and BMD of promixal femur improved significantly in rats of Vi 6w group ( P<0.05), while the maximal load of L5 increased significantly in rats of Vi 12 group ( P<0.05). There were no changes in rats of Vi 6-12w group ( P>0.05).ConclusionThe early treatment of LFV may improve the secondary OP of rats with SCI, but the effect is different in different sites of rats' body. The late treatment of LFV can't improve the secondary OP, but may keep rats with SCI from deteriorating.

Skeletal muscle contractile properties are determined by their myosin heavy chain (MHC) expression profiles partly. Spinal cord injury induced the adaptation change in MHC isoform mRNAs and protein expression of skeletal muscle below the injured level, leading to the increased expression of fast and decreased expression of slow MHC isoforms. The adaptations in the MHC-mRNAs preceded the changes in proteins. The degree and velocity of MHC isoform adaptation were dependent on differenrt muscle and animal species. Short-term training could not induce the significant change of the transformation of MHC isoform, whereas long-term stepping training which emphasized load bearing could attenuate the MHC shift from slow toward faster isoforms.

ObjectiveTo observe the effect of aerobic exercise training on plasma apolipoprotein in severe simple obese children.Methods7 severe simple obese children had 10 week exercise training and plasma apolipoprotein AⅠ(ApoAI) and B (ApoB) were tested before and after training. ResultsComparing with the control group, the ApoB in obese children increased significantly <0.01) and reduced after aerobic exercise training (P<0.05). The ApoAⅠ in obese children showed a decreasing intendcy (P>0.05). ConclusionThe aerobic exercise training may improve the plasma apolipoprotein.

ObjectiveTo observe the effect of early administration of alendronate on bone mineral density and biomechanical properties of the femur of spinal cord injuried rats.Methods36 3-month-old female SD rats were randomly divided into the Sham group, SCI group and SCI+ALN group. Rats in the Sham group underwent a sham procedure. Rats in the SCI group and in SCI+ALN group underwent spinal cord transection at the level of the tenth thoracic vertebra. Rats in the SCI+ALN group were injected with alendronate intraperitoneally 1 week after SCI, three times a week. All rats were sacrificed 8 week after operation. Bone mineral density and biomechanical properties of the femur were measured, respectively.ResultsBone mineral density and biomechanical properties of the femur changed significantly after spinal cord transection. After the treatment of alendronate injection, bone mineral density of the femur in the SCI+ALN group was significantly increased compared with that of the SCI group(P<0.01). Elastic loading and maximal loading of the femur in the SCI+ALN group was significantly increased compared with that of the SCI group(P<0.01). Maximal stress was significantly increased compared with that of the SCI group(P<0.05). ConclusionThe rats 8 week after spinal cord transection can be used in osteoporotic research following SCI. Early administration of ALN after SCI can inhibit bone resorption, improve biomechanical properties of the femur of spinal cord injured rats so as to prevent the development of osteoporosis and osteoporotic fracture.

ObjectiveTo discuss the causes, preventions and treatments of fractures after spinal cord injury (SCI).MethodsA retrospective survey was carried out in the clinical data of 22 patients who suffered fractures after SCI in China Rehabilitation Research Center (CRRC) during 1988-2001.ResultsAll the patients showed osteoporosis or osteopenia in different degrees,fractures occured unconsciously or during minor force,without symptoms after fractures.It was difficult to discover and often was neglected. 15 patients were cured by surgical operation.Conclusions Osteoporosis is the pathological base of fractures after SCI, excess loading stress in the diaphysis is the main cause during joint movement passively, it is important to emphasize preventions and treatments of osteoporosis on early stage and the health propaganda and education is needed.