Objective:To explore the utility of applying low frequency transcranial magnetic stimulation (rTMS) in the acute stage of ischemic stroke in terms of improving upper limb motor function.Methods:Eighty ischemic stroke survivors in the acute stage were randomly divided into a control group and an experimental group, with 40 in each. In addition to routine rehabilitation, the experimental group was given low frequency rTMS, while the control group was provided with sham rTMS. Before and after 4-weeks of treatment, upper limb motor function was evaluated using the Fugl-Meyer rating scale (FMA), Wolf motor function tests (WMFTs), the modified Barthel index (MBI) and in terms of motor evoked potential (MEP) latency and amplitude.Results:There were no significant differences between the two groups before the treatment. Afterward, however, the average FMA, WMFT, MBI scores had improved significantly more in the experimental group, on average, as had the average MEP amplitude.Conclusion:Low frequency rTMS in the acute phase of ischemic stroke can improve upper limb motor function and ability in the activities of daily living.

ObjectiveTo explore the diagnostic value of fiberoptic endoscopic examination of swallowing (FEES) combined with dye test in patients with post-stroke dysphagia and silent aspiration. MethodsFrom December, 2021 to June, 2022, 50 stroke patients in the Rehabilitation Department of Xuzhou Central Hospital were selected. They were assessed with FEES and videofluoroscopic swallowing study (VFSS), and compared. ResultsThe detection rate of aspiration was higher with FEES than with VFSS (χ² = 7.000, P < 0.05), and especially for liquid food (χ² = 4.000, P < 0.05). There was a good consistency when consuming paste food (κ = 0.941, P < 0.001) and solid food (κ = 0.779, P < 0.001). There was a good consistency in the food residue site between two methods (κ = 0.818, P < 0.001), as well as for all the three food types (κ ≥ 0.862, P < 0.001). There was no significant difference in the scores of Penetration Aspiration Scale of three food types between two methods (Z < 0.667, P > 0.05). ConclusionFEES combined with dye test can be used for evaluating silent aspiration after stroke.

Objective To explore the effect of high-frequency repetitive transcranial magnetic stimulation (rTMS) on central facial paralysis after ischemic stroke. Methods From June, 2020 to June, 2021, 54 patients with central facial palsy after ischemic stroke who were hospitalized in the Rehabilitation Department of Xuzhou Central Hospital were randomly divided into control group (n = 27) and experimental group (n = 27). Both groups were given conventional rehabilitation treatment, including medication and facial muscle rehabilitation training. The experimental group was treated with 5 Hz rTMS on the affected primary motor cortex, and the control group was treated with the same parameters of sham stimulation at the same site. Before treatment and four weeks after treatment, the House-Brackmann Grading System 2.0 (HBGS-2), the Sunnybrook Facial Grading System, the horizontal distance difference between the bilateral mouth corners to the lower center of the philtrum at rest, the horizontal distance difference between the bilateral mouth corners to the intersection of the mandibular central incisor when showing the teeth at the best effort and the angle of the tongue midline deviating from the facial midline when the tongue was stretched out were used to evaluate the facial nerve function of the patient. Results One case dropped down in each group. Before treatment, there was no significant difference in the scores of HBGS-2 and Sunnybrook Facial Grading System, the horizontal distance difference between the bilateral mouth corners to the lower center of the philtrum at rest, the horizontal distance difference between the bilateral mouth corners to the intersection of the mandibular central incisor when showing the teeth at the best effort, and the angle of the tongue midline deviating from the facial midline when the tongue was stretched out between two groups (P > 0.05). After treatment, all the indexes significantly improved in both groups (|t| > 8.987, P < 0.001), and were better in the experimental group than in the control group (t > 2.939, P < 0.01). Conclusion 5 Hz rTMS on the affected primary motor cortex is effective on the facial nerve function of patients with central facial palsy after ischemic stroke.

Objective To explore the cognitive impairment of stroke survivors using magnetic resonance spectra (MRS) and the Loewenstein occupational therapy cognitive assessment (LOTCA),and to analyze their correlation and their clinical significance.Methods Thirty stroke survivors diagnosed with cognitive impairment using the mini-mental state examination formed a cognitive impairment group.Another 30 stroke survivors without cognitive impairment served as stroke controls,while a third group of 30 healthy counterparts were the normal controls.All were assessed using magnetic resonance imaging and the LOTCA and the results were correlated.Results The average LOTCA total score and sub-scores of the impaired group were significantly lower than those of the other two groups.The average LOTCA total scores and the orientation and spatial perception,apparent motion and thinking operation sub-scores of the stroke control group were also significantly lower than those of the normal control group,though their average visual perception and motor praxis scores were not.The average levels of N-acetyl aspartate and creatine (NAA and Cr) in the bilateral hippocampus of the cognitively impaired group were significantly lower than among the controls,while their choline and creatine (Cho/Cr) levels were significantly higher.The average NAA/Cr and Cho/Cr levels in the bilateral hippocampus of the stroke control group were similarly significantly lower and higher than among the healthy controls.The average NAA/Cr levels in the left and right hippocampus were weakly to moderately correlated with the total LOTCA scores and the LOTCA sub-score for attention (r=0.376-0.661 and r=0.396-0.691 respectively).The average value of Cho/Cr in the left hippocampus showed weak to moderate negative correlation with the LOTCA total scores (r=-0.368-0.619),but not with the attention scores.The value of Cho/Cr in the right hippocampus had weak to moderate negative correlation with the LOTCA total score and with the orientation,visual perception,visuo-motor organization and thinking operations sub-scores (r=-0.391-0.632),but no obvious correlation with the scores for spatial perception,motor praxis or attention.Conclusion MRS can be used to assess the cognitive impairment of stroke survivors.MRS and LOTCA scores are closely correlated.MRS combined with LOTCA can evaluate cognitive dysfunction more comprehensively and objectively.

Objective To explore the impact of low frequency repetitive transcranial magnetic stimula tion (rTMS) on executive dysfunction after stroke by magnetic resonance spectroscopy (MRS) and neuropsychological scale.Methods 60 stroke patients with executive dysfunction were recruited and randomly divided into a study group and a control group,with 30 in each.The study group was treated with rTMS in addition to routine treatment,while the control group received routine treatment only.Before and after treatment,the neuropsychological scale and MRS were measured in both groups.Results After treatment,the scores on the LOTCA and FAB of neuropsychological scale in the treatment group were (87.10 ± 3.16) and (11.97 ± 0.48),significantly better than before the baselines.NAA/Cr was (1.64 ± 0.08) and Cho/Cr was (1.17 ± 0.07),which were significantly better than the baselines.In the control group,significant differences were also observed in the scores of the neuropsychological scale and in the indicators of MRS before and after treatment.Conclusions rTMS can effectively improve executive function in patients with cerebral apoplexy by influencing the metabolites related with cognitive function in the brain.Magnetic resonance spectroscopy can show the therapeutic effect at molecular level.

Objective To quantify any therapeutic effect of cyclic movement training combined with functional electrical stimulation for improving lower limb motor function and ability in the activities of daily life after stroke.Methods Seventy stroke survivors were randomly divided into a control group and an experimental group,each of 35.Both groups were given conventional rehabilitation,including cyclic training,but the experimental group was additionally provided with functional electrical stimulation of the quadriceps,hamstrings,anterior tibialis and gastrocnemius at the affected side.Before and after four weeks of treatment the Fugl-Meyer lower limb (FMA-L) and balance (FMA-B) assessments were performed and a modified Barthel index (MBI) was assigned to each subject to quantify functioning.Results Before the treatment,no significant differences were observed between the two groups in any of the measurements.But after four weeks of treatment the average FMA-L,FMA-B and MBI scores of the experimental group were all significantly better than before the treatment and significantly better than the control group's averages.Conclusion Cyclic movement training combined with functional electrical stimulation can improve the lower limb motor function of stroke survivors and their ability in the activities of daily life.

Objective To explore the application of the model of team nursing in hospital nursing and continuing nursing in stroke patients with deglutition dysfunction.Methods A total of 78 stroke inpatients with deglutition dysfunction of department of rehabilitation from November 2014 to June 2015 were randomly divided into the intervention group and the control group. Patients in the control group received routine nursing method,while patients in the intervention group received team nursing method. The water-swallowing test and the investigation with Hamilton anxiety scale (HAMA) were carried out before admission and at discharge. The results of patients were compared between two groups. The changes of classification of water-swallowing test were compared between two groups 6 and 12 months after discharge.Results At discharge,the improvement rate of deglutition dysfunction in the intervention group (66.7%) was higher than that in the control group (35.9%) with a significant difference (P<0.05);the score of HAMA in the intervention group was better than that in the control group with a significant difference (P<0.05). There was no statistically significant difference in the classification of water-swallowing test and the improvement rate between two groups 6 months after discharge (P>0.05). There were significant differences in the classification of water-swallowing test and the improvement rate (the deterioration rate of the intervention group was lower than that of the control group) between two groups 12 months after discharge (P<0.05).Conclusions The application of team nursing model in stroke patients with deglutition dysfunction can strengthen the rehabilitation training effect and can improve the quality of life of patients after discharge.

Objective To explore the short-term mindfulness behavior training on movement function of stroke patients with hemiplegia. Methods A total of 60 stroke patients were divided into two groups randomly,observation group and control group. The patients of control group received conventional rehabilitation therapy, while the patients of observation group received mindfulness training besides this. Before treatment and after 60 days, all patients had accepted the assessment by the Fugl-Meyer motor function scale ( FMA ) , the Pittsburgh sleep quality index scale ( PSQI) and self-rating depression scale ( SDS) . Results After treatment, all patients′motor function and sleep quality were improved, and degree of depression lowered compared before;the improvement of observation group was better than control group′s (P<0. 05). Conclusions Mindfulness behavior training combined with behavioral rehabilitation for stroke patients with hemiplegia has strengthening effect on recover motor function, and provides a reference for exploring the comprehensive rehabilitation therapy.

Objective The application of International Classification of Functioning,Disability and Health (ICF)generic set in rehabilitation nursing of stroke patients with hemiplegia was evaluated,providing a theory basis for rehabilitation in stroke patients.Methods Fifty-three stroke in-patients with hemiplegia were treated in the department of rehabilitation medicine in Xuzhou Central Hospital from January to October in 2015. They were included in the investigation.After admitted to hospital the patients were evaluated with the generic set of ICF.According to the scores of seven categories in the evaluation of the patients,appropriate rehabilitation and nursing measures were made.After the intervention in hospitalization the patients were evaluated with the generic set of ICF again when they were discharged from hospital.The rehabilitation of the patients was compared based on the two scores evaluated before and after the intervention.Results In the seven categories of ICF generic set,no significant difference was found in the scores of b152,b280 and d850 before and after the intervention (P >0.05).Significant differences were found in the scores of b130,d230,d450,d455 and so on before and after the intervention (P <0.05).Conclusions The application of ICF generic set in the assessment of the status of hemiplegic patients and the corresponding reinforcement of rehabilitation nursing intervention can make body functions,movement and participation degrees of hemiplegic patients strong and promote their recovery.

Objective To investigate the association between chronotropic incompetence (CI)and motor ability in type 2 diabetic mellitus (T2DM) patients complicated with metabolic syndrome (MS).Methods One hundred and twenty patients with T2DM were enrolled in the study,including 66 cases with MS (MS group) and 54 without MS (non-MS group).The electrocardiographic exercise test was performed,the CI indexes including ratio of heart rate (rHR),heart rate reserve (HRR)were measured and the max metabolic equivalents(maxMETs) were calculated.Result The rHR(0.77 ±0.04 vs.0.81 ±0.06,t =3.41,P ＜ 0.05),HRR (0.62 ± 0.05 vs.0.70 ± 0.07,t =5.96,P ＜ 0.05) and maxMETs (8.8 ± 1.1 vs.9.7 ± 1.2,t =0.16,P ＜ 0.05) in patients of MS group all lower than those in non-MS group.The maxMETs were positively correlated with rHR (r =0.81,P ＜ 0.05) and HRR (r =0.78,P ＜ 0.05).Conclusion The results indicate that CI as well as maxMETs and rating of perceived exertion can be used as monitoring index in type 2 diabetic patients complicated with metabolic syndrome.