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The effects of task-oriented training combined with electromyographic biofeedback on wrist/finger extension after stroke

Yunping REN ; Yueying LI ; Changjiang LI ; Daohai XIONG

Chinese Journal of Physical Medicine and Rehabilitation.2013;35(9):712-715. doi:10.3760/cma.j.issn.0254-1424.2013.09.010

Objective To study the effects of task-oriented training combined with electromyographic biofeedback on wrist and finger extension after stroke.Methods Thirty-eight stroke patients were assigned randomly into either an experimental group (18 cases) or a control group (18 cases).Both groups received routine rehabilitation treatment and electromyographic biofeedback training.In addition,the experimental group was given task-oriented training in wrist and finger extension.Myoelectricity values,the active range of wrist dorsiflexion and the FuglMeyer upper extremity assessment (FMA) were assessed before and after 8 weeks of training.Results All of the patients showed significant improvements after 8 weeks of training,but compared with the controls,the patients in the experimental group improved significantly more in terms of all of the measures.Conclusion Task-oriented training with electromyographic biofeedback can improve upper extremity function,particularly wrist extension,among hemiplegic stroke survivors.

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Influence of proprioceptive training of hemiplegic stroke patients on their visually-dependent compensatory strategy

Zhiqiang XU ; Junying WU ; Yawen WU ; Rong RONG ; Kui YUAN

Chinese Journal of Physical Medicine and Rehabilitation.2013;35(10):768-772. doi:10.3760/cma.j.issn.0254-1424.2013.10.005

Objective To investigate the influence of proprioceptive training of hemiplegic stroke patients on their visually compensatory dependence.Methods Twenty stroke patients without vestibular abnormalities were recruited.They were able to walk for 10 meters.All the patients underwent 4 weeks of rehabilitation training including proprioceptive training,treadmill exercises and isometric muscle strengthening.Static standing balance test was performed before and after 4 weeks of treatment.The parameters such as the anteroposterior and mediolateral sway of the center of gravity,center of gravity distribution were analyzed before and after the treatment,taking into consideration of visual feedback (eyes open or closed) by using t-test and multiple linear regression analysis.Results Visual feedback had significant no influence on the anteroposterior sway of center of gravity before and after training (P ＞ 0.05) ; Visual feedback had significant influence on mediolateral sway of center of gravity.Rehabilitation training significantly improved the mediolateral sway in opened-eye standing (P ＜ 0.05) but not closedeye standing (P ＞ 0.05).Visual feedback played significant role in center of gravity distribution after training (P ＜ 0.05).Conclusions Visual compensation is of significant influence on the mediolateral sway.Proprioceptive training can help decrease the patient's dependence on visual feedback and enhance the patient's balance ability.

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The kinematic analysis of Dorsiflexion Ankle Foot Orthotics on pelvic control of hemiplegic patients

Hui FENG ; Guangxu XU ; Yi ZHU

Chinese Journal of Physical Medicine and Rehabilitation.2013;35(10):773-776. doi:10.3760/cma.j.issn.0254-1424.2013.10.006

Objective To observe the effects of dorsiflexion ankle foot orthotics (d-AFO) on pelvic control of hemiplegic patients by analyzing the time-space gait parameters and 3D pelvic motion parameters.Methods Fifteen hemiplegic patients (14 male and 1 female) were enrolled in this study.The time-space gait parameters and pelvic 3D motion parameters were collecte with a Motion Analysis System while the patients were asked to walk under 3 conditions:wearing d-AFO (5°dorsiflexion),f-AFO (0°dorsiflexion) or barefoot.Results It was found that,while wearing d-AFO,the velocity,the paralyzed step length and the nonparalyzed step length were significantly increased,and the step width was significantly decreased when compared with those while walking barefoot (P ＜ 0.05).Comparison between wearing d-AFO and f-AFO showed that the sagittal and coronal plane inclinations,but not the transverse rotation of pelvis were significantly decreased when wearing the d-AFO (P ＜ 0.05).Conclusions d-AFO can significantly improve pelvis control and increase gait stability in hemiplegic patients.

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Experimental study of proliferation and differentiation of peripheral blood stem cells into Schwann cells induced by low frequency electrical stimulation

Xudong GU ; Jing BAI ; Chengwen ZHANG ; Jianming FU ; Jing WANG ; Wenping PAN

Chinese Journal of Physical Medicine and Rehabilitation.2013;35(9):673-676. doi:10.3760/cma.j.issn.0254-1424.2013.09.001

Objective To investigate in vitro possible mechanisms by which low frequency electrical stimulation may stimulate peripheral blood stem cells' proliferation and differentiation into Schwann cells (SCs).Methods The original generation of peripheral blood stem cells was cultured using Sprague-Dawley (SD) rats.The third passage stem cells were divided into a low frequency stimulation group,an extracellular signal-regulated kinase (ERK) group,a combination group and a control group.All 4 groups were cultured in DMEM containing 2％ fetal bovine serum by adding the SC supernatant.The low frequency electrical stimulation group was given 1 h of continuous low frequency stimulation.For the ERK group 50 mmol/L of the inhibitor PD98059 was added.The combination group was given the inhibitor plus 1h of sustained low frequency electrical stimulation.The control group received no special intervention.Before and after induction the 3-(4,5-dimethyl-thiazol-2)-2,5-diphenyl tetrazolium bromide (MTT) assay was used to detect the absorbance value A of 4 cells at 570 nm (A750),and after induction Western blotting was used to determine cyclin D1 (cyclin D1) and cyclin-dependent kinases (CDK4).Results Before the intervention peripheral blood stem cells in each group had no significant differences in their A750 values.After the intervention,the A750 values of the low frequency electrical stimulation,the ERK group,the combination group and the control group were (1.051 ±0.058),(0.363 ±0.343),(0.894 ±0.343) and (0.758 ±0.047),respectively.This showed a statistically significant increase for all groups except the ERK group.The differences among the groups were also statistically significant.The expression of S-100,glial fibrillary acidic protein (GFAP) and P75 was highest in the low frequency electrical stimulation group,and in the ERK group they were the lowest.S-100,GFAP and P75 protein expression also was highest in the low frequency electrical stimulation group and lowest in the ERK group,and the inter-group differences were statistically significant.ERK expression showed no significant difference among the groups.Compared with the control group,the expression of phosphorylated extracellular signal-regulated kinase 1/2 (p-ERK1/2),cyclin D1 and CDK4 protein in the low frequency electrical stimulation group and the combination group were all significantly higher and the protein expression in the ERK group was significantly lower.The p-ERK1/2,cyclin D1 and CDK4 protein levels in the combination group were significantly lower than in the low frequency electrical stimulation group and higher than in the ERK group.Conclusions Low frequency electrical stimulation can promote peripheral blood stem cell proliferation and induce cell differentiation into Schwann cells,at least in vitro.The ERK signaling pathways are part of the signaling pathways of the proliferation and differentiation.

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Normal conduction values for the posterior antebrachial cutaneous nerve

Jingfei XU ; Jinsong WANG ; Huiyan ZONG ; Chengqi HE

Chinese Journal of Physical Medicine and Rehabilitation.2013;35(9):696-699. doi:10.3760/cma.j.issn.0254-1424.2013.09.006

Objective To determine normal reference values for conduction in the posterior antebrachial cutaneous nerve.Methods Antidromic sensory conduction examinations of the bilateral posterior antebrachial cutaneous nerve were conducted with fifty-eight healthy subjects.The onset latency,peak latency,peak-to-peak amplitude and conduction velocity of the sensory nerve action potentials (SNAPs) were recorded and the inter-side ratios of the peak-to-peak amplitudes were calculated.Results The observed means (and standard deviations) of the onset time,the peak latency,the amplitude and the conduction velocity were 1.96 (0.12) ms,2.48 (0.14) ms,7.39 (2.36) μV and 61.39 (3.69) m/s,respectively.The side-to-side amplitude ratio (smaller/larger) was 0.88 ± 0.09,and no significant difference was observed between the left and right side.The average peak latency and amplitude were significantly different for different age groups.There was no statistically significant difference among the age groups with regard to onset latency or conduction velocity.Conclusion Conduction in the posterior antebrachial cutaneous nerve is easy to study.The peak latency is prolonged and the amplitude decreases with age,suggesting that different normal reference values should be established for different age groups.

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The posterior parietal cortex in visuospatial attention:study with continuous theta burst stimulation

Guangqing XU ; Yue LAN ; Zhenghong CHEN ; Jiangli ZHAO ; Dongfeng HUANG

Chinese Journal of Physical Medicine and Rehabilitation.2013;35(9):687-690. doi:10.3760/cma.j.issn.0254-1424.2013.09.004

Objective To seek more direct evidence of the role of the posterior parietal cortex (PPC) in controlling visuospatial attention.Methods Forty healthy subjects took the Attention Network Test following continuous theta burst stimulation (cTBS) applied over the left or right PPC or sham stimulation.The Attention Network Test measures the alerting,orienting and executive control components of visual attention separately.Results Subjects responded to spatial cues significantly slower after cTBS.Alerting and orienting showed deficits after cTBS over the right PPC.cTBS over the left PPC resulted in significant improvements in alerting,but not in the orienting.Furthermore,there were significant differences in the alerting and orienting indices between cTBS over the left and right PPC,but not in the executive control index.Conclusions The results suggest that the right PPC is associated with spatial orienting and the alerting function.The findings supported the theory of inter-hemispheric competition for visuospatial attention.Visuospatial attention bias might be selectively modulated through cTBS.

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Changes in the functional activity and connectivity of the insular cortex in patients with low back pain

Shanshan ZHANG ; Wen WU ; Ziping LIU ; Shigui GUO ; Jianming YANG

Chinese Journal of Physical Medicine and Rehabilitation.2013;35(9):691-695. doi:10.3760/cma.j.issn.0254-1424.2013.09.005

Objective To investigate the functional activity and connectivity of the insular cortex at rest in persons with low back pain (LBP).Methods Twelve healthy subjects (male 6,female 6 ; age 24.8 ± 3.3 years) were given fMRI 3.0T scans at rest.Back muscle pain was then induced with an intramuscular injection of 3％ hypertonic saline solution and a second scan was performed.The pain-free and in-pain fMRI data were compared using paired t-tests to highlight any changes in the functional connectivity of the anterior and posterior insular cortex on both sides.Pain severity was quantified using a visual analogue scale (VAS).Results Ratings of LBP severity peaked at 6.02 ± 1.96 on the VAS.The functional connectivity of the inferior insular cortex with the frontal cortex,the thalamus and the parahippocampal gyrus was enhanced when the subjects were in pain,but connectivity with the posterior cingulate cortex,the precuneus,the temporal cortex,the paracentral lobule and the cerebellar tonsil was reduced.The inferior parietal lobule exhibited significantly enhanced connectivity with the anterior insular cortex,but reduced connectivity with the posterior insular cortex.In addition,the medial cingulate cortex displayed decreased functional connectivity with the anterior insular cortex,but increased functional connectivity with the posterior insular cortex when the subjects were in pain.Conclusion This study has revealed impeded functional connectivity of the insular cortex when experiencing LBP at rest.This may possibly be related to pain's disruption of cognition and emotion.

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The effects of cognitive function training on motor and executive functions after basal ganglia stroke

Liang TIAN ; Xiangming YE ; Juebao LI ; Liang ZHOU ; Wanshun WEN ; Genying ZHU ; Ting YANG

Chinese Journal of Physical Medicine and Rehabilitation.2013;35(9):708-711. doi:10.3760/cma.j.issn.0254-1424.2013.09.009

Objective To observe the effect of cognition training on the motor and executive functioning of patients after a basal ganglia stroke.Methods Thirty patients with basal ganglia stroke were randomly divided into a treatment group and a control group.The control group received standard stroke rehabilitation training,while the treatment group received in addition 2 months of cognitive function training.The executive and motor functions of all of the subjects and their facility in the activities of daily living (ADL) were tested using the Tower of Hanoi,the Wisconsin card sorting test,a Stroop-3 test and the Fugl-Meyer assessment,the Berg balance scale and the modified Barthel index before and at the end of treatment.Results After two months of training,both within-group and between group comparisons showed that the treatment group had improved significantly more in executive function,cognition and motor function.Conclusion Cognition training can improve executive function,motor function and ADL performance after a basal ganglia stroke.

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Clinical effects of botulinum toxin type A injection guided by electromyography and electrical stimulation for the treatment of upper limb spasticity after stroke

Bojun HAN ; Shanshan HONG ; Minzhi LU ; Zhigang SUN ; Feng HAN ; Dinghua LIU

Chinese Journal of Physical Medicine and Rehabilitation.2013;35(9):716-719. doi:10.3760/cma.j.issn.0254-1424.2013.09.011

Objective To investigate the clinical effect of botulinum toxin type A (BTX-A) injections guided by electromyography in combination with electrical stimulation in the treatment of upper limb spasticity poststroke.Methods Forty-five patients with upper limb spasticity following stroke were recruited.They received multiple intra-muscular BTX-A injections guided by electromyography and electrical stimulation.Rehabilitation training was administered after the BTX-A injections.The results were assessed using the modified Ashworth scale (MAS),the Fugl-Meyer upper limb assessment (FMA),active range of movement (AROM) and the modified Barthel index (MBI).All the assessments were performed at the baseline,and then 1 week,2 weeks,1 month,and 3 months after the injections.Results Compared with the baseline scores the MAS,FMA,AROM and MBI results had all obviously improved by 2 weeks after the BTX-A injections.Compared with 2 weeks after the injections,the FMA and AROM scores at 1 month were significantly higher and there were further significant improvements at 3 months.No patient demonstrated obvious side effects from the therapy.Conclusion BTX-A injection guided by electromyography and electrical stimulation is safe and has definite beneficial effects on upper limb spasticity after stroke.

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Effects of treadmill exercise training on biomechanical properties of bone in a rat model of type 2 diabetes

Zhixiang SHEN ; Meng MENG ; Cuixian LIU ; Jian ZHAO ; Yuchun LIU ; Shengying SUN

Chinese Journal of Physical Medicine and Rehabilitation.2013;35(10):753-756. doi:10.3760/cma.j.issn.0254-1424.2013.10.001

Objective To study the influence of different intensities of treadmill exercise training on bone biomechanical properties and the bone healing in type 2 diabetic model rats.Methods Fifty-two healthy 8-month-old male Sprague-Dawley rats were randomly divided into a control group (n =10) and a type 2 diabetic model group (n =42).Type 2 diabetes was modeled in rats of the model group by feeding feedstuff containing high glucose,fat and energy food for 4weeks,followed by a single intra-abdominal injection of streptozotocin.Thirty model rats were then randomized into 3 subgroups:type 2 diabetes group,a mild exercise group and a moderate exercise group.Different intensities of treadmill training protocols was administered accordingly for 8 weeks.The biomechanical indices of the femur bone including maximum load and stress,module and energy was measured with mechanical testing instrument.Results Compared with the control group,both maximum load and energy were decreased significantly in type2 diabetes group [(148.5±17.8)N vs (192.3±43.4)N] for maximum load,and (51.38 ±13.7)mJ vs (82.0 ± 30.8) mJ for maximum stress] (P ＜ 0.05,P ＜ 0.01).Compared with the type 2 diabetes group,maximum load and stress were increased significantly in the mild and moderate exercise groups(P ＜ 0.05,P ＜ 0.01).Maximum load and energy were improved more in the moderate exercise group than in the mild exercise group [(184.1 ± 26.6)N vs (165.4±21.5)N for maximum load and (83.59 ±29.96)mJ vs (62.33 ±14.32)mJ for maximum stress] (P ＜ 0.05).Conclusions A significant decrease of the bone biomechanical properties was observed in rats with experimental type 2 diabetes,which could be alleviated by treadmill exercise training.

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