Objective: To investigate the effect of intraarticular hemorrhage on extending knee joint contracture model in rats . Methods: 18 mature male SD rats were divided into 3 groups by random number table method . The control group ( group C) was not immobilized and was killed after 4 weeks of feeding . In the simple fixation group( M1 group) , the left lower limb knee joint was immobilized in straight position for 4 weeks . The blood fixationgroup (M2 group) was injected into the knee cavity with body blood and immobilized in a straight position for 4 weeks . The knee joint motion of each group was measured by the joint motion measuring instrument under a stand⁃ard torque . The contracture degree was calculated by the joint range of motion of the knee joint before and after muscles separation . HE staining and Masson staining were used to detect the number of cells and collagen deposi⁃tion in the anterior joint capsule . The protein expressions of transforming growth factor 1 (TGF⁃ β1) , wingless⁃type MMTV integration site family , member 1 ( Wnt1) and beta⁃catenin ( β⁃catenin) in the anterior articular capsule were detected by Western blotting . Results: Compared with group C , total knee contracture and arthrogenic con⁃tracture of rats in M1 and M2 groups increased , and the difference was statistically significant (P < 0. 05) . At the same time , the degree of total contracture and arthrogenic contracture in M2 group was higher than that in M1 group , and the difference was statistically significant (P < 0. 05) . Compared with group C , the number of anterior joint capsule cells and collagen deposition in M1 and M2 groups increased , and the difference was statistically sig⁃group were higher than those in M1 group , and the difference was statistically significant (P < 0. 05) . Compared with group C , the protein expressions of TGF⁃ β1 , Wnt1 and β ⁃catenin in the anterior articular capsule of rats in M1 expressions of TGF⁃ β1 , Wnt1 and β ⁃catenin in the anterior articular capsule of the knee joint in M2 group were sig⁃nificantly higher than those in M1 group , with statistical significance (P < 0. 05) . Conclusion Joint immobiliza⁃ tion can lead to joint contracture , and joint bleeding aggravates the degree of joint capsule fibrosis induced by im⁃mobilization .

Objective:To explore any myogenic effect of extracorporeal shock wave therapy (ESWT) on shoulder joint contracture.Methods:Sixty-eight patients with shoulder contracture were enrolled and randomly divided into a conventional therapy group ( n=34) and an ESWT group ( n=34) for this clinical trial. The conventional therapy group received standard rehabilitation treatment, while the ESWT group received additional extracorporeal shock wave therapy. In addition, 24 Sprague-Dawley rats were randomly assigned to a blank control group, a model group, a natural recovery group, or an ESWT animal group, each of 6. All of the groups except the blank control group had contracture modeled using plaster cast immobilization of the left shoulder joint. After successful modeling, the natural recovery group was routinely raised for two weeks, while the ESWT animal group received two weeks of extracorporeal shock wave intervention. In both the clinical and animal experiments, ESWT was administered twice weekly (every Tuesday and Friday) for two consecutive weeks. Before and after the treatment, the patient groups were assessed using a visual analog scale (VAS) for pain, shoulder range of motion (ROM), and the root mean square (RMS) values of the surface electromyographs of the peri-shoulder muscles. Shoulder ROM was assessed in all four of the rat groups after the ESWT treatment, and histological analysis of the supraspinatus muscle was performed. Results:After the treatment, both patient groups showed significant improvements in their average VAS scores, active and passive shoulder ROM, and RMS values. On average, the ESWT group demonstrated significantly greater improvements than the conventional therapy group in active forward flexion, passive forward flexion, active abduction, passive abduction, and the RMS values of the deltoid, biceps brachii, and triceps brachii muscles. After the treatment the left shoulder abduction angle had been reduced significantly in the model group (to 96.00±2.37)°, the natural recovery group (103.00±4.05)° and the ESWT animal group (121.33±4.89)° compared to the blank control group (154.50±2.35)°. Both the natural recovery group and the ESWT animal group had significantly greater shoulder abduction angles than the model group, and the ESWT animal group also demonstrated a significantly larger abduction angle than the natural recovery group. After the treatment, significant differences between the model group and the blank control group were observed in the cross-sectional area of left supraspinatus muscle fibers and the proportion of collagen. The ESWT animal group too exhibited significantly improved muscle fiber cross-sectional area and collagen proportion compared to the natural recovery group.Conclusions:Shoulder joint contracture is accompanied by significant myopathic changes (muscle atrophy and fibrosis). ESWT effectively ameliorates these problems while enhancing muscle strength and functional recovery.

Objective:To explore any myogenic effect of extracorporeal shock wave therapy (ESWT) on shoulder joint contracture.Methods:Sixty-eight patients with shoulder contracture were enrolled and randomly divided into a conventional therapy group ( n=34) and an ESWT group ( n=34) for this clinical trial. The conventional therapy group received standard rehabilitation treatment, while the ESWT group received additional extracorporeal shock wave therapy. In addition, 24 Sprague-Dawley rats were randomly assigned to a blank control group, a model group, a natural recovery group, or an ESWT animal group, each of 6. All of the groups except the blank control group had contracture modeled using plaster cast immobilization of the left shoulder joint. After successful modeling, the natural recovery group was routinely raised for two weeks, while the ESWT animal group received two weeks of extracorporeal shock wave intervention. In both the clinical and animal experiments, ESWT was administered twice weekly (every Tuesday and Friday) for two consecutive weeks. Before and after the treatment, the patient groups were assessed using a visual analog scale (VAS) for pain, shoulder range of motion (ROM), and the root mean square (RMS) values of the surface electromyographs of the peri-shoulder muscles. Shoulder ROM was assessed in all four of the rat groups after the ESWT treatment, and histological analysis of the supraspinatus muscle was performed. Results:After the treatment, both patient groups showed significant improvements in their average VAS scores, active and passive shoulder ROM, and RMS values. On average, the ESWT group demonstrated significantly greater improvements than the conventional therapy group in active forward flexion, passive forward flexion, active abduction, passive abduction, and the RMS values of the deltoid, biceps brachii, and triceps brachii muscles. After the treatment the left shoulder abduction angle had been reduced significantly in the model group (to 96.00±2.37)°, the natural recovery group (103.00±4.05)° and the ESWT animal group (121.33±4.89)° compared to the blank control group (154.50±2.35)°. Both the natural recovery group and the ESWT animal group had significantly greater shoulder abduction angles than the model group, and the ESWT animal group also demonstrated a significantly larger abduction angle than the natural recovery group. After the treatment, significant differences between the model group and the blank control group were observed in the cross-sectional area of left supraspinatus muscle fibers and the proportion of collagen. The ESWT animal group too exhibited significantly improved muscle fiber cross-sectional area and collagen proportion compared to the natural recovery group.Conclusions:Shoulder joint contracture is accompanied by significant myopathic changes (muscle atrophy and fibrosis). ESWT effectively ameliorates these problems while enhancing muscle strength and functional recovery.

Objective To demonstrate the changes in flexor digitorum and extensor digitorum tension in the affected hands with shear-wave elastography (SWE) before and after manual digitorum sensory stimulation (MDSS) in hemiplegic patients with stroke. Methods A total of 51 hemiplegic post-stroke inpatients in the Department of Rehabilitation Medicine in Second Hospital of Anhui Medical University from April to June, 2020, underwent MDSS completed by a researcher who used a bare thumb and index finger to squeeze each nail bed as well as the sides of each fingertip in the affected hand. The stimulation intensity was the minimum that could cause finger extension without obvious pain, and the interval between two stimulations was five to ten seconds. Muscular tension of the flexor digitorum superficialis, flexor digitorum profundus, flexor pollicis longus and extensor digitorum were assessed with modified Ashworth Scale (MAS) and shear-wave velocity (SWV) of SWE on the affected side before and immediately after MDSS. MAS score was -1 as low muscular tension. Results The MAS scores of all the muscles significantly reduced after MDSS (|Z| > 2.843, P < 0.001); while the changes of SWV were not significantly in all the muscles with initially MAS score of 0 or -1 (t < 1.052, P > 0.05), and it reduced in those muscles with initial MAS scores of one to three (t > 2.672, P < 0.05). The SWV were positively correlated with the MAS scores both before and after MDSS (r > 0.334, P < 0.05). Conclusion MDSS can effectively, immediately, and safely relieves muscle spasms of the flexor digitorum and facilitate active finger extension in the affected hand for hemiplegic patients with stroke. SWE is useful for quantitatively and objectively evaluating muscular tension in the affected hand for hemiplegic patients with stroke.

ObjectiveTo investigate the changes of surface electromyography (sEMG) of the flexors and extensors of the affected fingers after manual digitorum sensory stimulation (MDSS) in the hemiplegic patients after stroke. MethodsFrom April to August, 2020, 50 stroke patients in Department of Rehabilitation Medicine, the Second Hospital of Anhui Medical University accepted MDSS on the nail beds and the third knuckles of affected fingers, until the fingers extended actively. The tension of affected flexor pollicis brevis, flexor digitorum superficialis and extensor digitorum were assessed with modified Ashworth Scale (MAS) before and immediately after stimulation; while the root mean square (RMS) of sEMG of bilateral flexor pollicis brevis, flexor digitorum superficialis and extensor digitorum were recorded. ResultsThe MAS score of all the muscles decreased after stimulation (|Z| > 2.699, P < 0.01), while the RMS of affected extensor digitorum increased (t = -2.069, P < 0.05). Compared with the unaffected ones, RMS of affected flexor pollicis brevis and extensor digitorum decreased before and after stimulation (t > 2.450, P < 0.05). ConclusionMDSS may immediately relieve the spasm of flexors of hemiplegic fingers after stroke, which associates with the promoting muscle strength of the extensors.

ObjectiveTo explore the effect of early individualized rehabilitation on patients with severe mechanical ventilation. MethodsA total of 36 patients on mechanical ventilation admitted to the ICU of the Second Affiliated Hospital of Anhui Medical University from March, 2019 to February, 2020 were randomly divided into control group (n = 18) and rehabilitation group (n = 18). All the patients completed a rehabilitation assessment within 24 hours of admission, including clinical assessment, state of consciousness and muscle strength assessment. The control group was treated with intensive care routine treatment, including symptomatic treatment of primary disease, nutritional support, placement of normal limbs, active and passive movement of limbs. The rehabilitation group received early individualized rehabilitation in addition., including active and passive limb movements, transfer training, physical factor therapy, and respiratory muscle training after the specific evaluation. The mechanical ventilation duration and ICU length of stay, the hospitalization cost, Richmond Agitation and Sedation Scale (RASS), acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ), and the content of tumor necrosis factor (TNF)-α, interleukin (IL)-6 and IL-8 were compared. ResultsThere was no significant difference in the weaning rate and hospitalization cost between two groups (P > 0.05). The mechanical ventilation duration and ICU length of stay were less in the rehabilitation group than in the control group (t > 2.067, P < 0.05). After treatment, the score of APACHEⅡ and the content of TNF-α and IL-6 decreased in the control group (t > 2.040, P < 0.05); the score of APACHEⅡ and the content of TNF-α, IL-6 and IL-8 decreased in the rehabilitation group (t > 4.141, P < 0.001); the content of TNF-α, IL-6 and IL-8 was less in the rehabilitation group than in the control group (t > 2.217, P < 0.05). The improvement of all the indexes was better in the rehabilitation group than in the control group (|Z| > 2.104, P < 0.05). ConclusionFor patients on mechanical ventilation, early individualized rehabilitation could improve the sedation, relieve the inflammatory reaction, accelerate the process of weaning, and reduce the length of stay with no extra cost.

Objective To explore the effects of rehabilitation starting at different stages on the gross motor function of infants with high risk of cerebral palsy.Methods 214 neonates (117 boys and 97 girls) at least 14 days old and with a neonatal behavioral neurological assessment scale (NBNA) score of less than 35 were randomly divided into four groups.They received 2 to 3 weeks of rehabilitation in the hospital,followed by 4 to 6 weeks of family rehabilitation and then another 2 to 3 weeks of hospital rehabilitation.The three groups started this course of treatment at different times:beginning when the babies were not older than 3 months for group Ⅰ,3 to 6 months for group Ⅱ,6 to 12 months for group Ⅲ and 12 to 24 months for group Ⅳ.In each individual case the rehabilitation in hospital was replaced by family rehabilitation only when the baby's overall development was normal or almost normal.Another 63 infants with high risk of cerebral palsy composed group Ⅴ.They received only the family rehabilitation.The rehabilitation in hospital included taking neurotrophic drugs,receiving physical treatment,hand manipulation,kinesiotherapy,cognitive training,conductive education,and using orthoses.Family rehabilitation was implemented by the parents once or twice a day,for 35 to 45 minutes each time following detailed,individualized exercise plans made up jointly by the rehabilitation doctors and therapists.Moreover,a clinical checkup was required every 1 to 2 months.At 3,6,12 and 24 months old,all of the subjects' gross motor ability was quantified using the gross motor function measure (GMFM) scale.The hospital stays and the number of subjects diagnosed with cerebral palsy and motor retardation were recorded.Results At 3 months old,the average GMFM scores of the groups were 5.00± 1.89 for group Ⅰ,6.80± 1.55 for group Ⅱ,8.44±1.26 for group Ⅲ,11.10±1.72 for group Ⅳ and 12.70±1.64 for group Ⅴ,the controls.All of the intergroup differences were significant.At 6 months old the average GMFM scores of groups Ⅰ to Ⅳ were not significantly different,but all were significantly lower than the group Ⅳ average.At 12 months old the average GMFM scores of groups Ⅰ,Ⅱ and Ⅴ were significantly higher than the group Ⅲl and Ⅳ averages.At 24 months old the groups' average scores decreased consistently from Ⅰ to Ⅴ,with significant differences between one group and the next.Group Ⅲ had the longest hospital stays,followed by groups Ⅰ,Ⅱ and Ⅳ.Those inter-group differences were significant except for between groups Ⅰ and Ⅱ.The incidence of cerebral palsy in groups Ⅰ and Ⅱ (38.10％ and 29.79％) was significantly higher than in group Ⅲ (21.62％),Ⅳ (12.00％) or Ⅴ (3.17％).Moreover,the incidence of motor retardation in groups Ⅰ and Ⅱ (7.14％ and 10.64％) was also significantly lower than in group Ⅲ(56.76％),Ⅳ (68.00％) or Ⅴ (36.51％),but the differences between groups Ⅰ and Ⅱ and between groups Ⅲ and Ⅳ were not significant.The incidence of excellent gross motor performance ratings at 24mo decreased significantly from group Ⅰ to group Ⅴ,with all of the inter-group differences significant.Conclusion Early and formal rehabilitation is of great importance for infants with a high risk of cerebral palsy.The earlier formal rehabilitation starts,the better is its effect.