运动再学习对偏瘫患者下肢运动功能的影响

下肢运动功能障碍是偏瘫患者常见的后遗症之一.为探讨运动再学习训练方法对偏瘫患者下肢运动功能的影响,本文对20例偏瘫患者进行了运动再学习的训练及临床观察,取得较好效果,现报告如下:

感觉统合训练对痉挛型脑瘫患儿粗大运动功能的影响

脑性瘫痪是指自受孕开始至婴儿期非进行性脑损伤和发育缺陷所导致的综合征，主要表现为运动障碍及姿势异常［1］，综合康复训练［2］是目前主要的治疗方法。物理疗法（ physical thera-py，PT）是脑瘫治疗的基础，对于约占脑瘫60％～70％的痉挛型脑瘫，PT可不同程度地改善患儿的粗大运动功能［1］。但患儿能保持直立体位后，对平衡及协调能力的需求增加，故如何提高这部分患儿的立位平衡能力是随后临床工作中的重点［3］。感觉统合理论（ Sensory Integration Theory ）创立于1972年，多应用于感觉统合失常、自闭症、注意力缺陷、精神发育迟滞等患儿的康复训练［4-10］，但近几年也开始应用于脑瘫患儿的康复［11］，并不断研究其对脑瘫患儿的运动功能的影响。本研究将痉挛型脑瘫患儿分为对照组和治疗组，对照组用常规的综合康复训练进行治疗，治疗组则在综合康复训练的基础上进行感觉统合训练。并应用粗大运动功能测试量表（ Gross Motor Function Measure ， GMFM ）对两组脑瘫患儿治疗前后进行评价，分析比较两组患儿的粗大运动功能的改善情况有无显著性差异，观察感觉统合训练在痉挛型脑瘫患儿训练中起到的作用。

The purpose of this work was to investigate whether, by intranasal administration, the nerve growth factor bypasses the blood-brain barrier and turns over the spinal cord neurons and if such therapeutic approach could be of value in the treatment of spinal cord injury. Adult Sprague-Dawley rats with intact and injured spinal cord received daily intranasal nerve growth factor administration in both nostrils for 1 day or for 3 consecutive weeks. We found an in-creased content of nerve growth factor and enhanced expression of nerve growth factor receptor in the spinal cord 24 hours after a single intranasal administration of nerve growth factor in healthy rats, while daily treatment for 3 weeks in a model of spinal cord injury improved the deifcits in locomotor behaviour and increased spinal content of both nerve growth factor and nerve growth factor receptors. These outcomes suggest that the intranasal nerve growth factor bypasses blood-brain barrier and affects spinal cord neurons in spinal cord injury. They also suggest exploiting the possible therapeutic role of intranasally delivered nerve growth factor for the neuroprotection of damaged spinal nerve cells.

Clinical studies have shown that hyperbaric oxygen therapy improves motor function in patients with spinal cord injury. In the present study, we explored the mechanisms associated with the recovery of neurological function after hyperbaric oxygen therapy in a rat model of spinal cord injury. We established an acute spinal cord injury model using a modiifcation of the free-falling object method, and treated the animals with oxygen at 0.2 MPa for 45 minutes, 4 hours after injury. The treatment was administered four times per day, for 3 days. Compared with model rats that did not receive the treatment, rats exposed to hyperbaric oxygen had fewer apoptotic cells in spinal cord tissue, lower expression levels of aquaporin 4/9 mRNA and protein, and more NF-200 positive nerve ifbers. Furthermore, they had smaller spinal cord cavities, rapid recovery of somatosensory and motor evoked potentials, and notably better recovery of hindlimb motor function than model rats. Our ifndings indicate that hyperbaric oxygen therapy reduces apop-tosis, downregulates aquaporin 4/9 mRNA and protein expression in injured spinal cord tissue, improves the local microenvironment for nerve regeneration, and protects and repairs the spinal cord after injury.

Because of their strong proliferative capacity and multi-potency, placenta-derived mesenchymal stem cells have gained interest as a cell source in the ifeld of nerve damage repair. In the present study, human placenta-derived mesenchymal stem cells were induced to differentiate into neural stem cells, which were then transplanted into the spinal cord after local spinal cord injury in rats. The motor functional recovery and pathological changes in the injured spinal cord were observed for 3 successive weeks. The results showed that human placenta-derived mesenchymal stem cells can differentiate into neuron-like cells and that induced neural stem cells contribute to the resto-ration of injured spinal cord without causing transplant rejection. Thus, these cells promote the recovery of motor and sensory functions in a rat model of spinal cord injury. Therefore, human placenta-derived mesenchymal stem cells may be useful as seed cells during the repair of spinal cord injury.

microRNAs (miRNAs) play an important regulatory role in the self-renewal and differentiation of stem cells. In this study, we examined the effects of miRNA-124 (miR-124) overexpression in bone marrow-derived mesenchymal stem cells. In particular, we focused on the effect of overexpression on the differentiation of bone marrow-derived mesenchymal stem cells into neurons. First, we used GeneChip technology to analyze the expression of miRNAs inbone marrow-derived mesen-chymal stem cells, neural stem cells and neurons. miR-124 expression was substantially reduced inbone marrow-derived mesenchymal stem cells compared with the other cell types. We con-structed a lentiviral vector overexpressing miR-124 and transfected it intobone marrow-derived mesenchymal stem cells. Intracellular expression levels of the neuronal early markersβ-III tu-bulin and microtubule-associated protein-2 were signiifcantly increased, and apoptosis induced by oxygen and glucose deprivation was reduced in transfected cells. After miR-124-transfected bone marrow-derived mesenchymal stem cells were transplanted into the injured rat spinal cord, a large number of cells positive for the neuronal marker neurofilament-200 were observed in the transplanted region. The Basso-Beattie-Bresnahan locomotion scores showed that the motor function of the hind limb of rats with spinal cord injury was substantially improved. These re-sults suggest that miR-124 plays an important role in the differentiation ofbone marrow-derived mesenchymal stem cells into neurons. Our ifndings should facilitate the development of novel strategies for enhancing the therapeutic efifcacy ofbone marrow-derived mesenchymal stem cell transplantation for spinal cord injury.

The Kinect-based virtual reality system for the Xbox 360 enables users to control and interact with the game console without the need to touch a game control er, and provides rehabilitation training for stroke patients with lower limb dysfunctions. However, the underlying mechanism remains un-clear. In this study, 18 healthy subjects and five patients after subacute stroke were included. The five patients were scanned using functional MRI prior to training, 3 weeks after training and at a 12-week fol ow-up, and then compared with healthy subjects. The Fugl-Meyer Assessment and Wolf Motor Function Test scores of the hemiplegic upper limbs of stroke patients were significantly increased 3 weeks after training and at the 12-week fol ow-up. Functional MRI results showed that contralateral primary sensorimotor cortex was activated after Kinect-based virtual reality training in the stroke patients compared with the healthy subjects. Contralateral primary sensorimotor cortex, the bilateral supplementary motor area and the ipsilateral cerebel um were also activated during hand-clenching in al 18 healthy subjects. Our findings indicate that Kinect-based virtual reality training could promote the recovery of upper limb motor function in subacute stroke patients, and brain reorganization by Kinect-based virtual reality training may be linked to the contralateral sen-sorimotor cortex.

Most studies on spinal cord neuronal injury have focused on spinal cord tissue histology and the expression of nerve cell damage and repair-related genes. The importance of the microcirculation is often ignored in spinal cord injury and repair research. Therefore, in this study, we established a rat model of intervertebral disc extrusion by inserting a silica gel pad into the left ventral sur-face of T13. Electroacupuncture was used to stimulate the bilateralZusanlipoint (ST36) and Neiting point (ST44) for 14 days. Compared with control animals, blood lfow in the ifrst lumbar vertebra (L1) was noticeably increased in rats given electroacupuncture. Microvessel density in the T13 segment of the spinal cord was increased significantly as well. The number of normal neurons was higher in the ventral horn of the spinal cord. In addition, vacuolation in the white matter was lessened. No obvious glial cell proliferation was visible. Furthermore, hindlimb motor function was improved signiifcantly. Collectively, our results suggest that electroacupuncture can improve neuronal morphology and microcirculation, and promote the recovery of neurological functions in a rat model of intervertebral disc extrusion.

Many studies have examined motor impairments using voxel-based lesion symptom mapping, but few are reported regarding the corresponding relationship between cerebral cortex injury and lower limb motor impairment analyzed using this technique. This study correlated neuro-nal injury in the cerebral cortex of 16 patients with chronic stroke based on a voxel-based lesion symptom mapping analysis. Neuronal injury in the corona radiata, caudate nucleus and putamen of patients with chronic stroke could predict walking speed. The behavioral measure scores were consistent with motor deifcits expected after damage to the cortical motor system due to stroke. These ifndings suggest that voxel-based lesion symptom mapping may provide a more accurate prognosis of motor recovery from chronic stroke according to neuronal injury in cerebral motor cortex.

Detailed knowledge of motor outcomes enables to establish proper goals and rehabilitation strate-gies for stroke patients. Several previous studies have reported functional or motor outcomes in patients with a middle cerebral artery territory infarct. However, little is known about motor outcome in patients with a complete middle cerebral artery territory infarct. In this study, we investigated the motor outcomes in 23 patients with a complete middle cerebral artery territory infarct. Al of these patients received comprehensive rehabilitative management, including movement therapy and neuromuscular electrical stimulation of the affected finger extensors and ankle dorsiflexors, for more than 3 months. Motor outcomes were measured at 6 months after stroke onset using the Medical Research Council, Motricity Index, the modified Brunnstrom Classification, and Functional Ambula-tion Category scores. The motor function of the lower extremities was found to be better than that of the upper extremities. After receiving rehabilitation treatments for 3-6 months, about 70%of these patients were able to walk independently (Functional Ambulation Category scores>3), but no pa-tient achieved functional hand recovery.

Our previous studies have histomorphological y confirmed that nanofibrous poly(3-hydroxybutyrate-co-3-hydroxyvalerate) conduit can be used to repair 30-mm-long sciatic nerve defects. However, the repair effects on rat behaviors remain poorly understood. In this study, we used nanofibrous poly(3-hydroxybutyrate-co-3-hydroxyvalerate) conduit and autologous sciatic nerve to bridge 30-mm-long rat sciatic nerve gaps. Within 4 months after surgery, rat sciatic nerve functional re-covery was evaluated per month by behavioral analyses, including toe out angle, toe spread anal-ysis, walking track analysis, extensor postural thrust, swimming test, open-field analysis and noci-ceptive function. Results showed that rat sciatic nerve functional recovery was similar after nanofibrous poly(3-hydroxybutyrate-co-3-hydroxyvalerate) conduit and autologous nerve grafting. These findings suggest that nanofibrous poly(3-hydroxybutyrate-co-3-hydroxyvalerate) conduit is suitable in use for repair of long-segment sciatic nerve defects.

Hemiparesis is one of the most common consequences of stroke. Advanced rehabilitation tech-niques are essential for restoring motor function in hemiplegic patients. Functional electrical stimulation applied to the affected limb based on myoelectric signal from the unaffected limb is a promising therapy for hemiplegia. In this study, we developed a prototype system for evaluating this novel functional electrical stimulation-control strategy. Based on surface electromyography and a vector machine model, a self-administered, multi-movement, force-modulation functional electrical stimulation-prototype system for hemiplegia was implemented. This paper discusses the hardware design, the algorithm of the system, and key points of the self-oscillation-prone system. The experimental results demonstrate the feasibility of the prototype system for further clinical trials, which is being conducted to evaluate the efifcacy of the proposed rehabilitation technique.

卒中单元早期康复护理对急性脑卒中病人运动功能的影响

卒中单元是指为卒中病人提供药物治疗肢体康复、语言训练和健康教育的一种新的病房管理模式,强调多专业协作,有机整合临床医生、护士、康复师等资源来促进病人的康复.在目前所有缺血性卒中的治疗中,为有效的方法是卒中单元,治疗和康复的有效性明显[1].我科从2005年3月正式启动卒中单元,此研究重点探讨早期肢体康复护理在卒中单元中所起到的作用,对神经功能、生活自理能力及社会功能恢复有重要影响.

中药外洗治疗小儿脑性瘫痪肌张力增高

BACKGROUND:Muscular tension of children with cerebral paralysis enhances and motor range of joint is limited,which directly affect motor function of children.Traditional Chinese medicine affirms the cause of cerebral paralysis is because of congenital feebleness,deficiency of liver yin and kidney yin and lack of proper care after birth.Deficiency of liver yin and kidney yin leads to lack of proper care of muscles and stagnancy of qi blood,marked by spasm of muscles and disadvantage of joint movement.

电针配合高压氧治疗脑卒中偏瘫患者50例

BACKGROUND:Motor obstacle of limbs directly resulted from hemiplegia after stroke seriously affect patients′ daily work and living.Conventional medicine treatment can improve the function of hemiplegic limbs at some degree, but more and more studies confirm that conventional acupuncture therapy is an effective method to improve motor function of limbs.By point stimulating channel system, acupuncture therapy can regulate qi and smooth channel system, thus regulate whole body to achieve the goal of curing hemiplegia. Acupuncture combined with hyperbaric oxygen therapy can accelerate regeneration of cerebral cells, and promote the recovery of motor function of paralyzed limbs.

脑通对急性脑梗死患者运动功能的康复意义:前瞻性、随机、单盲对照研究

Objective To evaluate recovered effect of sermior treatment on motor function of patients with acute cerebral infarction. Methods Prospect, random, single blind and control study on sermior, citicoline and cerebrolysin, using volume of low dense in CT (CTV), glutamate content in cerebral spinal fluid (CSF) and total fraction of Fugl Meyer motor function score as evaluating index to study inpatient patients. Result Decrease of CTV and glutamate content in CSF and increase of total fraction of Fugl Meyer motor function score in sermior treatment group, in citicoline treatment group, in sermior and cerebrolysin treatment group were significant compared with those of citicoline treatment group, cerebrolysin treatment group (P< 0.05). Conclusion Unite long term sermior therapy can decrease cerebral infarction volume and improve synthesize motor function apparently.

早期康复训练对脑卒中患者运动功能恢复的疗效观察

Objective To observe the effect of early recovery training on motor function in stroke patients.Method 118 cases suffering from cerebral apoplexy were randomly divided into two groups: rehabilitation group(59 cases),contrast group(59 cases).The former took the early recovery training,and the latter took the routine treatment.Result After the treatment,the former 's curative effect was better than the latter,and their dyskinesia turned for the better obviously.Conclusion The early recovery training can decrease the crippling rate in stroke patients.

早期康复介入对急性脑卒中重度偏瘫患者运动功能恢复的影响

Objective To observe influence of early rehabilitation intervention on motor function of acute stroke patients with severe hemiplegia.Method We evaluate 58 cases of acute stroke with severe hemiplegia with FMA method and Barthel index,observe influence of early rehabilitation intervention on recovery of motor function.Result Motor function after treatment was promoted apparently compared with control group(P< 0.05).Conclusion Early rehabilitation intervention can promote motor function recovery of acute stroke patients with severe hemiplegia.

脑性瘫痪患儿运动障碍的系统康复管理(一)

脑性瘫痪(脑瘫)是导致儿童残障的主要疾病,近10年来脑瘫研究取得了一系列成果,主要有:①发育神经学的重要研究成果,发现了0～3个月婴儿的自发性全身运动规律,实现了在超早期阶段诊断脑瘫[1,2];②以粗大运动功能测试量表(gross motor function measure,GMFM)为代表的脑瘫标准化评估量表的诞生,为脑瘫研究提供了良好的功能研究工具[3,4];③影像学技术不断进步,功能性MRI可以提供更为直接的脑部功能性证据[5,6];④肉毒毒素注射可以缓解脑瘫患儿的肌肉痉挛,早期控制由于痉挛所导致的二次损害[7,8];⑤证实了肌力训练的有效性[9,10];⑥认知训练正在不断地推广,但仍需更多的疗效证据[11];⑦在新型运动发育理论[12]的指导下,使得对脑瘫的管理更为科学合理.以这些研究成果为背景,对脑瘫疾病的认识也在不断地深入,2005年国际脑瘫新定义[13]认为脑瘫是指一组运动和姿势发育障碍的症候群,这种导致活动受限的症候群是由于发育中的胎儿或婴儿脑部受到非进行性损伤而引起的.

缺血性脑卒中后神经可塑性与运动功能恢复研究进展

卒中是导致死亡的第1位原因,也是导致成人致残的首要原因[1].在既往报道的大量缺血性脑卒中病例中,仅少数患者完全恢复,大多数患者残留有不同程度的永久性缺陷[2].然而,尽管卒中造成的功能损害很严重,但由于受损神经的重塑及相应部位的功能重组,受损功能仍能得以不断的恢复.本综述旨在介绍缺血性脑卒中后神经可塑性与运动功能的恢复的关系及其可能机制,为康复治疗提供有价值的资料.