Fugl-Meyer Motor Function Assessment Research Articles

Effect of task-oriented training assisted by force feedback hand rehabilitation robot on finger grasping function in stroke patients with hemiplegia: a randomised controlled trial

BackgroundOver 80% of patients with stroke experience finger grasping dysfunction, affecting independence in activities of daily living and quality of life. In routine training, task-oriented training is usually used for functional hand training, which may improve finger grasping performance after stroke, while augmented therapy may lead to a better treatment outcome. As a new technology-supported training, the hand rehabilitation robot provides opportunities to improve the therapeutic effect by increasing the training intensity. However, most hand rehabilitation robots commonly applied in clinics are based on a passive training mode and lack the sensory feedback function of fingers, which is not conducive to patients completing more accurate grasping movements. A force feedback hand rehabilitation robot can compensate for these defects. However, its clinical efficacy in patients with stroke remains unknown. This study aimed to investigate the effectiveness and added value of a force feedback hand rehabilitation robot combined with task-oriented training in stroke patients with hemiplegia.MethodsIn this single-blinded randomised controlled trial, 44 stroke patients with hemiplegia were randomly divided into experimental (n = 22) and control (n = 22) groups. Both groups received 40 min/day of conventional upper limb rehabilitation training. The experimental group received 20 min/day of task-oriented training assisted by a force feedback rehabilitation robot, and the control group received 20 min/day of task-oriented training assisted by therapists. Training was provided for 4 weeks, 5 times/week. The Fugl-Meyer motor function assessment of the hand part (FMA-Hand), Action Research Arm Test (ARAT), grip strength, Modified Ashworth scale (MAS), range of motion (ROM), Brunnstrom recovery stages of the hand (BRS-H), and Barthel index (BI) were used to evaluate the effect of two groups before and after treatment.ResultsIntra-group comparison: In both groups, the FMA-Hand, ARAT, grip strength, AROM, BRS-H, and BI scores after 4 weeks of treatment were significantly higher than those before treatment (p < 0.05), whereas there was no significant difference in finger flexor MAS scores before and after treatment (p > 0.05). Inter-group comparison: After 4 weeks of treatment, the experimental group’s FMA-Hand total score, ARAT, grip strength, and AROM were significantly better than those of the control group (p < 0.05). However, there were no statistically significant differences in the scores of each sub-item of the FMA-Hand after Bonferroni correction (p > 0.007). In addition, there were no statistically significant differences in MAS, BRS-H, and BI scores (p > 0.05).ConclusionHand performance improved in patients with stroke after 4 weeks of task-oriented training. The use of a force feedback hand rehabilitation robot to support task-oriented training showed additional value over conventional task-oriented training in stroke patients with hand dysfunction.Clinical trial registration informationNCT05841108

Scalp acupuncture for post-stroke spastic hemiparesis: A systematic review and meta-analysis.

Spastic paralysis is one of the most common sequelae of stroke, severely affecting patients' limb function and reducing their quality of life. Scalp acupuncture (SA) has been shown to significantly improve cerebral blood supply and reduce the severity of limb spasticity. This meta-analysis aims to systematically evaluate the clinical efficacy of SA in the treatment of post-stroke spastic paralysis, providing evidence-based medicine for clinical management of this condition. We comprehensively searched databases including China National Knowledge Infrastructure, Wanfang Data, VIP Chinese Science and Technology Periodical Database, China Biomedical Literature Database, PubMed, Embase, and Cochrane Library. Randomized controlled trials investigating the efficacy of SA in post-stroke spastic paralysis were identified until July 28, 2023. Meta-analysis was conducted using RevMan 5.4 and Stata17.0. A total of 16 studies were included. Meta-analysis showed that the modified Ashworth spasticity assessment scale in the SA group was significantly higher than that in the rehabilitation group (mean difference [MD] = -0.56, 95% confidence interval [CI] [-0.75, -0.37], Z = 5.67, P < .00001). The simplified Fugl-Meyer motor function assessment scale in the SA group was significantly higher than that in the rehabilitation group (MD = 5.86, 95% CI [3.26, 8.46], Z = 4.41, P < .0001). The modified Barthel index assessment scale in the SA group was significantly higher than that in the rehabilitation group (MD = 5.79, 95% CI [4.73, 6.84], Z = 10.77, P < .00001). Additionally, the clinical effective rate in the SA group was significantly higher than that in the rehabilitation group (relative risk = 1.25, 95% CI [1.16, 1.36], Z = 5.42, P < .00001). SA combined with rehabilitation therapy has certain advantages in reducing limb spasticity, improving limb function, and enhancing activities of daily living in patients with post-stroke spastic paralysis. This study provides reference and theoretical support for the promotion of SA in the treatment of this condition.

Effect of Extended Care on Functional Rehabilitation of Stroke-Induced Hemiplegic Patients.

We aimed to observe the effect of extended care on improving motor function and activities of daily living of stroke-induced hemiplegic patients. Patients clinically diagnosed as stroke with hemiplegia and hospitalized in the Neurology Department at Tianjin Haibin People's Hospital, China from 2019 to 2020 were selected. One hundred twenty patients were enrolled and randomly divided into the intervention group (60 patients) and the control group (60 patients). The control group was given routine rehabilitation treatment and care. Based on routine rehabilitation treatment and care, the intervention group was given transitional care. After discharge, the patients were followed up. Barthel indexes (BIs) were collected to evaluate the activities of daily living of patients. The Fugl-Meyer Motor Function Assessment (FMA) was adopted to evaluate the patients' motor function. There was no statistically significant difference in the total BI scores between the two groups of patients at the two time points before intervention and at discharge. The total scores of the intervention group were higher than those of the control group after 1 month and 3 months of discharge, and the difference was statistically significant (P<0.05). There was no statistically significant difference in total FMA scores between the two groups of patients before intervention, indicating comparability. After 3 months of discharge, the total FMA score of the intervention group patients was higher than that of the control group, and the differences were statistically significant (P<0.05). Continuous care can effectively improve motor function and daily living ability of stroke patients with hemiplegia.

Utilizing fNIRS to investigate the impact of Baduanjin training on attentional function in post-stroke cognitive impairment patients: a study protocol for a randomized controlled trial

BackgroundPost-stroke cognitive impairment (PSCI) is a prevalent complication among stroke survivors. It not only directly impacts patients' cognitive abilities but also hampers their capacity to regain independence in daily activities, consequently diminishing their quality of life. Among the various cognitive deficits following stroke, impaired attention is the most frequently observed, influencing not only daily functioning but also higher cognitive functions like working memory, executive functioning, and language.Emerging evidence indicates that Baduanjin, a traditional Chinese exercise, may have a positive impact on enhancing attention in older adults with mild cognitive impairment and stroke survivors. However, the precise mechanisms behind this effect remain unclear. In this study, we employed Baduanjin training as an intervention to address attention decline in post-stroke cognitive impairment patients and to delve into the potential mechanisms through which Baduanjin training may enhance attention in individuals with PSCI.MethodsIn this prospective randomized controlled trial, we plan to recruit 72 participants diagnosed with post-stroke cognitive impairment (PSCI). These participants will be randomly assigned in a 1:1:1 ratio to one of three groups: Baduanjin training(left hemisphere stroke and right hemisphere stroke) and conventional treatment.The conventional treatment group will receive standard rehabilitation sessions. In addition to conventional treatment, participants in the octogenarian training groups will undergo octogenarian training sessions lasting 40 min, five times a week, over a total period of 12 weeks.The primary outcome measures will include the Montreal Cognitive Assessment (MoCA) scale and the Attentional Lateralization Index. These assessments will be conducted by a trained evaluator before the start of the intervention and at weeks 6 and 12 after the intervention begins.Secondary outcome measures will be assessed using the baseline Mandarin version of the Oxford Cognitive Screening (OCS-P) scale, the simplified Fugl-Meyer Motor Function Assessment (FMA) scale, the Pittsburgh Rehabilitation Participation (PRPS) scale, and the Activities of Daily Living (ADL) scale before and after the intervention, respectively.DiscussionThis trial aims to examine the impact of Baduanjin training on attentional lateralization among patients with post-stroke cognitive impairment (PSCI). Functional brain imaging utilizing near-infrared spectroscopy will be employed to investigate how Baduanjin exercise influences the structural and functional connectivity of distinct brain regions or brain networks.Trial registrationChictr.org.cn, ID: ChiCTR2300076533. Registered on 11 October 2023.

Application of cross-migration theory in limb rehabilitation of stroke patients with hemiplegia.

Stroke is a common cause of neurological dysfunction, often resulting in hemiplegia. Thus, rehabilitation of limb function in stroke patients is an important step towards accelerating recovery and improving quality of life. To investigate whether unilateral strength training in hemiplegic stroke patients could lead to cross-migration, an increase in bilateral muscle strength, and an improvement in lower limb motor function. We randomly divided 120 patients with hemiplegic stroke into two groups: Eexperimental and control groups, with 60 patients in each group. Both groups received routine rehabilitation treatment, while the experimental group additionally received ankle dorsiflexion resistance training on the healthy side for 6 wk. We measured the maximum voluntary contract (MVC), changes in surface electromyography (EMG), and the lower limb motor function using the simplified Fugl Meyer Motor Function Assessment Scale (FMA) before and within 1 wk after training. The FMA score in the experimental group improved significantly compared to both their pre-training score and the control group's post-training score (P < 0.05). The integrated EMG of the anterior tibialis muscle and pulmonary intestine muscle in the experimental group were significantly different after training than before (P < 0.05). Furthermore, the MVC of the anterior tibialis muscle on both the healthy and affected sides and the MVC of the pulmonary intestine muscle on both sides showed significant improvement compared with before training and the control group (P < 0.05). Our findings suggest that ankle dorsiflexion resistance training on the healthy side in hemiplegic stroke patients can increase strength in the opposite tibialis anterior muscle and antagonist's muscle, indicating a cross-migration phenomenon of strength training. Furthermore, this type of training can also improve lower limb motor function, providing a new exercise method for improving early ankle dorsiflexion dysfunction.

Relationship between temporal dynamics of intrinsic brain activity and motor function remodeling in patients with acute BGIS.

patients with acute basal ganglia ischemic stroke (BGIS) show changes in local brain activity represented by the amplitude of low-frequency fluctuation (ALFF), but the time-varying characteristics of this local nerve activity are still unclear. This study aimed to investigate the abnormal time-varying local brain activity of patients with acute BGIS by using the ALFF method combined with the sliding-window approach. In this study, 34 patients with acute BGIS with motor dysfunction and 44 healthy controls (HCs) were recruited. The dynamic amplitude of low-frequency fluctuation (dALFF) was employed to detect the alterations in brain activity induced by acute BGIS patients. A two-sample t-test comparison was performed to compare the dALFF value between the two groups and a Spearman correlation analysis was conducted to assess the relationship between the local brain activity abnormalities and clinical characteristics. Compared with HCs, the activity of neurons in the left temporal pole (TP), parahippocampal gyrus (paraHIP), middle occipital gyrus (MOG), dorsolateral superior frontal gyrus (SFGdl), medial cingulate cortex (MCC), right rectus, precuneus (PCu) and right cerebellum crus1 were significantly increased in patients with BGIS. In addition, we found that there was a negative correlation (r = -0.458, p = 0.007) between the dALFF value of the right rectus and the scores of the National Institutes of Health Stroke Scale (NIHSS), and a positive correlation (r = 0.488, 0.499, p < 0.05) with the scores of the Barthel Index scale (BI) and the Fugl Meyer motor function assessment (FMA). ROC analysis results demonstrated that the area under the curves (AUC) of the right rectus was 0.880, p<0.001. The pattern of intrinsic brain activity variability was altered in patients with acute BGIS compared with HCs. The abnormal dALFF variability might be a potential tool to assess motor function in patients with acute BGIS and potentially inform the diagnosis of this disease.

Effects of motor imagery based brain-computer interface on upper limb function and attention in stroke patients with hemiplegia: a randomized controlled trial

BackgroundSeeking positive and comprehensive rehabilitation methods after stroke is an urgent problem to be solved, which is very important to improve the dysfunction of stroke. The aim of this study was to investigate the effects of motor imagery-based brain-computer interface training (MI-BCI) on upper limb function and attention in stroke patients with hemiplegia.MethodsSixty stroke patients with impairment of upper extremity function and decreased attention were randomly assigned to the control group (CR group) or the experimental group (BCI group) in a 1:1 ratio. Patients in the CR group received conventional rehabilitation. Patients in the BCI group received 20 min of MI-BCI training five times a week for 3 weeks (15 sessions) in addition to conventional rehabilitation. The primary outcome measures were the changes in Fugl-Meyer Motor Function Assessment of Upper Extremities (FMA-UE) and Attention Network Test (ANT) from baseline to 3 weeks.ResultsAbout 93% of the patients completed the allocated training. Compared with the CR group, among those in the BCI group, FMA-UE was increased by 8.0 points (95%CI, 5.0 to 10.0; P < 0.001). Alert network response time (32.4ms; 95%CI, 58.4 to 85.6; P < 0.001), orienting network response (5.6ms; 95%CI, 29.8 to 55.8; P = 0.010), and corrects number (8.0; 95%CI, 17.0 to 28.0; P < 0.001) also increased in the BCI group compared with the CR group. Additionally, the executive control network response time (− 105.9ms; 95%CI, − 68.3 to − 23.6; P = 0.002), the total average response time (− 244.8ms; 95%CI, − 155.8 to − 66.2; P = 0.002), and total time (− 122.0ms; 95%CI, − 80.0 to − 35.0; P = 0.001) were reduced in the BCI group compared with the CR group.ConclusionMI-BCI combined with conventional rehabilitation training could better enhance upper limb motor function and attention in stroke patients. This training method may be feasible and suitable for individuals with stroke.Trial registration: This study was registered in the Chinese Clinical Trial Registry with Portal Number ChiCTR2100050430(27/08/2021).

Resting-state electroencephalography changes in poststroke patients with visuospatial neglect.

BackgroundThis study aimed to explore the electrophysiological characteristics of resting-state electroencephalography (rsEEG) in patients with visuospatial neglect (VSN) after stroke.MethodsA total of 44 first-event sub-acute strokes after right hemisphere damage (26 with VSN and 18 without VSN) were included. Besides, 18 age-matched healthy participants were used as healthy controls. The resting-state electroencephalography (EEG) of 64 electrodes was recorded to obtain the power of the spectral density of different frequency bands. The global delta/alpha ratio (DAR), DAR over the affected hemispheres (DARAH), DAR over the unaffected hemispheres (DARUH), and the pairwise-derived brain symmetry index (pdBSI; global and four bands) were compared between groups and receiver operating characteristic (ROC) curve analysis was conducted. The Barthel index (BI), Fugl-Meyer motor function assessment (FMA), and Berg balance scale (BBS) were used to assess the functional state of patients. Visuospatial neglect was assessed using a battery of standardized tests.ResultsWe found that patients with VSN performed poorly compared with those without VSN. Analysis of rsEEG revealed increased delta and theta power and decreased alpha and beta power in stroke patients with VSN. Compared to healthy controls and poststroke non-VSN patients, patients with VSN showed a higher DAR (P < 0.001), which was significantly positively correlated with the BBS (DAR: r = –0.522, P = 0.006; DARAH: r = –0.521, P = 0.006; DARUH: r = –0.494, P = 0.01). The line bisection task was positively correlated with DAR (r = 0.458, P = 0.019) and DARAH (r = 0.483, P = 0.012), while the star cancellation task was only positively correlated with DARAH (r = 0.428, P = 0.029). DARAH had the best discriminating value between VSN and non-VSN, with an area under the curve (AUC) of 0.865. Patients with VSN showed decreased alpha power in the parietal and occipital areas of the right hemisphere. A higher parieto-occipital pdBSIalpha was associated with a worse line bisection task (r = 0.442, P = 0.024).ConclusionrsEEG may be a useful tool for screening for stroke patients with visuospatial neglect, and DAR and parieto-occipital pdBSIalpha may be useful biomarkers for visuospatial neglect after stroke.

Design of Intelligent Rehabilitation Evaluation Scale for Stroke Patients Based on Genetic Algorithm and Extreme Learning Machine

The rehabilitation of stroke patients is a long-term process. To realize the automation and quantification of upper limb rehabilitation assessment of stroke patients, an automatic prediction model of rehabilitation evaluation scale was established by extreme learning machine (ELM) according to Fugl-Meyer motor function assessment (FMA). Four movements in the shoulder and elbow joints of FMA were selected. Two acceleration sensors fixed on the forearm and upper arm of the hemiplegic side were used to collect the motion data of 35 patients. After preprocessing and feature extraction, the feature selection was carried out based on genetic algorithm and ELM, and the single-action model and comprehensive prediction model were established, respectively. The results show that the model can accurately and automatically predict the shoulder and elbow score of FMA, and the root mean square error of prediction is 2.16. This method breaks through the limitations of subjectivity, time-consuming and dependence on rehabilitation doctors in the traditional evaluation. It can be easily used in the assessment of long-term rehabilitation.

Intermittent Theta Burst Stimulation Increases Natural Oscillatory Frequency in Ipsilesional Motor Cortex Post-Stroke: A Transcranial Magnetic Stimulation and Electroencephalography Study.

ObjectiveIntermittent theta burst stimulation (iTBS) has been widely used as a neural modulation approach in stroke rehabilitation. Concurrent use of transcranial magnetic stimulation and electroencephalography (TMS-EEG) offers a chance to directly measure cortical reactivity and oscillatory dynamics and allows for investigating neural effects induced by iTBS in all stroke survivors including individuals without recordable MEPs. Here, we used TMS-EEG to investigate aftereffects of iTBS following stroke.MethodsWe studied 22 stroke survivors (age: 65.2 ± 11.4 years; chronicity: 4.1 ± 3.5 months) with upper limb motor deficits. Upper-extremity component of Fugl-Meyer motor function assessment and action research arm test were used to measure motor function of stroke survivors. Stroke survivors were randomly divided into two groups receiving either Active or Sham iTBS applied over the ipsilesional primary motor cortex. TMS-EEG recordings were performed at baseline and immediately after Active or Sham iTBS. Time and time-frequency domain analyses were performed for quantifying TMS-evoked EEG responses.ResultsAt baseline, natural frequency was slower in the ipsilesional compared with the contralesional hemisphere (P = 0.006). Baseline natural frequency in the ipsilesional hemisphere was positively correlated with upper limb motor function following stroke (P = 0.007). After iTBS, natural frequency in the ipsilesional hemisphere was significantly increased (P < 0.001).ConclusionsThis is the first study to investigate the acute neural adaptations after iTBS in stroke survivors using TMS-EEG. Our results revealed that natural frequency is altered following stroke which is related to motor impairments. iTBS increases natural frequency in the ipsilesional motor cortex in stroke survivors. Our findings implicate that iTBS holds the potential to normalize natural frequency in stroke survivors, which can be utilized in stroke rehabilitation.

Collaborative Care Model Based Telerehabilitation Exercise Training Program for Acute Stroke Patients in China: A Randomized Controlled Trial

BackgroundEarly rehabilitation has been proved very important for stroke patients. However, the effective model of transitioning from early in-hospital rehabilitation to discharge rehabilitation using the collaborative remote rehabilitation nursing model has not been thoroughly studied. ObjectiveTo explore the feasibility and effectiveness of collaborative care model based telerehabilitation exercise training for acute stroke patients. MethodsA randomized controlled clinical trial was conducted. Patients were recruited and randomly divided into intervention and control group. Both groups were given regular treatment and acute rehabilitation nursing instructions during hospitalization. The control group was followed by regular telephone follow-up after discharge. The intervention group received Internet-based remote rehabilitation project after discharge. Motor function, balance ability and quality of life were measured at the day of discharge, the 4th week, 8th week and 12th week after patients were discharged. The CONSORT checklist was used to check the procedure. ResultsA total of 61 patients completed the study, 30 cases in the intervention group and 31 cases in the control group. Both groups were significantly improved in terms of motor function and quality of life, but the intervention group showed greater improvement in Fugl-Meyer Motor Function Assessment (intervention group = 83.70 ± 4.44, control group = 75.29 ± 2.89), Berg Balance Scale (intervention group = 43.13 ± 2.32, control group = 38.29 ± 2.70) and Stroke-Specific Quality of Life Scale (intervention group = 190.57 ± 5.09, control group = 175.90 ± 5.78). Group-time interaction was significant in motor function and quality of life. ConclusionCollaborative care model based telerehabilitation exercise training program can safely and effectively improve the recovery of motor function and improve the quality of life in patients with stroke.

How does cross-education affects muscles of paretic upper extremity in subacute stroke survivors?

This study aimed to evaluate the benefits of adding electromuscular stimulation (EMS) to the flexors of wrist muscles on the nonparetic limb in conventional stroke training to strengthen homologous agonist and antagonist muscles on the paretic side in patients with subacute stroke. The EMS group patients (n = 15) received conventional therapy for 30 sessions for 6weeks (60min/session) with 30min of electrical stimulation to their nonparetic forearm using wrist flexors, with 5min of pre- and post-warm-up. The transcutaneous electrical nerve stimulation (TENS) group patients (n = 15) received the same conventional rehabilitation training with 30min of conventional antalgic TENS at a barely sensible level to their nonparetic forearm. The Fugl-Meyer motor function assessment for upper extremity (FMA-UE), functional independence measure (FIM), Brunnstrom staging of recovery for hand, maximum and mean wrist flexion force (flexionmax and flexionmean), and wrist extension force (extensionmax and extensionmean) of paretic untrained limb were evaluated before and after the treatment. EMS and TENS group patients improved similarly in terms of FMA-UE, FIM, and Brunnstrom staging for hand recovery. However, flexionmax and flexionmean of the paretic limb increased more in the EMS group than in the TENS group. Extensionmax and extensionmean on the paretic side increased in the EMS group but did not differ in the TENS group. Cross-education via EMS may have a beneficial effect as an adjunct to conventional treatment methods. This study is retrospectively registered and is available at www.clinicaltrials.gov (ID: NCT04113369).

The Effectiveness of Mirror Therapy on Upper Limb Function in Stroke Patients: A Single Case Experimental Design

ObjectivesTo assess the effectiveness of mirror therapy (MT) on upper limb (UL) function of sub-acute stroke patients.MethodsThis study is a single case experimental design with two participants. Twenty minutes of MT were implemented four times a week over a period of four weeks. For baseline phase, repeated measurements were performed six times for one participant and four times for the other participant using Fugl-Meyer Motor Function Assessment (FMA), and it was applied twice a week during the intervention phase. Brunnstrom Recovery Stages (BRS) and Barthel Index (BI) were applied once before the baseline phase, as well as prior and after the intervention phase.ResultsBased on percentage of non-overlapping data (PND) for FMA subtests, MT had questionable effectiveness on UL for both participants, and MT was unreliable intervention on wrist function. For the hand, of the second participant, MT had questionable effectiveness, whereas for the first participant it was unreliable intervention. For coordination, MT was fairly effective for the first participant and had questionable effectiveness for the second participant. BRS-Arm scores indicated improvements for the second participant from 3 (out of 6) to 4. BRS-Hand scores indicated improvements for the first participant from 5 (out of 6) to 6. No changes were shown in BI.DiscussionThis study revealed that MT had positive effects on some sections of UL motor function and coordination, whereas no change in wrist motor function was observed. No functional improvements in BI and slight difference in BRS were noticed.

Clinical observation of the phased acupuncture for ischemic stroke hemiplegia

To compare the effect difference among the staged acupuncture combined with conventional rehabilitation, traditional acupuncture combined with conventional rehabilitation, and conventional rehabilitation in the patients with ischemic stroke hemiplegia. A total of 145 patients with ischemic stroke hemiplegia were randomly assigned into an observation group (49 cases), a control group A (49 cases) and a control group B (47 cases). All the patients were received aspirin tablets 100 mg orally, once a day. The staged acupuncture according to Brunnstrom's theory combined with conventional rehabilitation were used in the observation group, at the acupoints in the yangming meridian during the flaccid paralysis phase, at the acupoints in the antagonistic muscle and the tendon of spastic dominant muscle during the spasm stage, and at the acupoints in the yangming meridian and Taixi (KI 3), Guanyuan (CV 4) and Qihai (CV 6) during the sequela stage. Conventional traditional acupuncture at the acupoints in the yangming meridian combined with conventional rehabilitation were applied in the control group A. Simple conventional rehabilitation was used in the control group B. Patients in the observation group and the control group A were received acupuncture and rehabilitation once a day from Monday to Friday, 2 weeks as 1 course; patients in the control group B were received the same rehabilitation as the observation group. The indexes were observed before treatment and at the end of the 2nd, 4th, 6th and 8th weeks of treatment, including National Institutes of Health Stroke Scale (NIHSS), short form Fugl-Meyer motor function assessment (FMA) scale, Fugl-Meyer balance (FM-B) scale, comprehensive spasm scale (CSS) and modified Barthel index (MBI). Compared with those before treatment, except the MBI score in the control group B after 2 weeks' treatment, the NIHSS, FMA, FM-B and MBI scores were improved in all three groups at the end of the 2nd, 4th, 6th and 8th weeks of treatment (P<0.01, P<0.05). At the end of the 2nd week of treatment, the NIHSS and CSS scores were lower (P<0.05, P<0.01), the FMA, FM-B and MBI scores were higher (all P<0.05) in the observation group and the control group A than those in the control group B. After 4, 6 and 8 weeks' treatment, the FMA, FM-B and MBI scores were higher (P<0.05, P<0.01), the NIHSS and CSS scores were lower (all P<0.01) in the observation group than those of control group A and control group B; the FMA, FM-B and MBI scores in the control group A were higher than those in the control group B (P<0.05, P<0.01); the NIHSS and CSS scores in the control group A were lower than those in the control group B (P<0.05, P<0.01). Staged acupuncture combined with conventional rehabilitation are consistent with the rehabilitation rule of patients with hemiplegia. They can improve motor function and the ability of daily life. They achieve better effect than traditional acupuncture combined with rehabilitation.

Effect of Tiaoshen Kaiyu Acupuncture (Regulating Vitality and Dredging Stasis) Combined with Psychological Intervention on Patients of Mild Depression After Stroke

To observe the effect of Tiaoshen Kaiyu acupuncture (regulating vitality and dredging stasis) combined with psychological intervention for treating mild depression after stroke. Ninety-four patients were enrolled and were randomly divided into acupuncture (48 cases) and control (46 cases) groups. Patients in the control group were given standard treatment plus psychological intervention, while patients in the acupuncture group were treated with Tiaoshen Kaiyu acupuncture plus standard treatment and psychological intervention. Acupoints of Sishencong(EX-HN 1), Baihui(GV 20), and Yintang(EX-HN 3) were selected in the acupuncture group. Each group received treatment once daily, five times weekly, for a total of 6 weeks. A self-rating depression scale (SDS), Hamilton depression scale (HAMD), simplified Fugl-Meyer motor function assessment (FMA), and modified Barthel index (MBI) were used before and after treatment to evaluate the efficacy. After the treatment the four indexes were improved significantly compared with those before treatment in the acupuncture and control groups (P<0.01). The FMA and MBI scores in the acupuncture group were higher than those in the control group (P<0.05). The HAMD and SDS scores were significantly lower in the acupuncture group than in the control group (P<0.01). In both the acupuncture and control groups, the differences before and after treatment of the HAMD and FMA scores (rs＝0.332, P<0.01) and the HAMD and MBI scores (rs＝0.356, P<0.01) were positively correlated. Tiaoshen Kaiyu acupuncture combined with psychological intervention is more effective than psychological intervention therapy alone. The efficacy is correlated with motor function and mild depression scores of patients after stroke.

Total hip arthroplasty in treating elderly femoral neck fracture with hemiplegia

Objective To investigate the clinical effects of high restrictive anti-dislocation prosthesis total hip arthroplasty (THA) in treating elderly femoral neck fracture patients with hemiplegia. Methods From June 2015 to January 2017, Forty-three elderly femoral neck fracture patients with hemiplegia were treated with CombiCup THA system. There were 15 males and 28 females with an average age of 71.5±5.6 years (60-84 years). The left side was involved in 20 cases, while the right side in 23 cases. There were 15 cases with Garden III type and 28 cases with type IV. Lower limb muscle strength grade were 20 cases in grade 3, 19 cases in grade 4, and 5 cases in grade 5. Sixteen cases walked independently before injury, while 27 of them walked with the aid of crutches. The duration between injuries to operation ranged from 2 days to 5 days. The size of the prosthesis and off-set distance were recorded by template technique pre-operation. The appropriate type of prosthesis was selected to restore the offset and to reconstruct the abductor muscle arm, according to the actual measurement in the operation and the preoperative plan. Based on the bone mineral density and medullary cavity morphology, biological or cemented femoral stem prosthesis was selected. The quality of the implant and the length of both lower limbs were evaluated by pelvic X-ray immediately after operation. The patients were followed-up at 2 weeks, 1 months, 2 months, 3 months, 6 months, 1 and 2 years. Functional exercise guidance and complications were recorded at the follow-up duration. At the last follow-up, the hip function and limb function were evaluated according to the Harris score and Fugl-Meyer motor function assessment respectively. Results Based on pelvic X-ray evaluation after operation, all prosthesis position were favorable with the average angle of acetabular abduction 45.1±2.3 degrees and the length difference of both limbs less than 5 mm (average 2.2±0.8 mm). The follow-up duration ranged from 6 to 24 months with an average of 11.2±3.5 months. There was no complication such as prosthesis dislocation and infection. Deep venous thrombosis in calf occurred in 3 patients at 2 days after operation, who underwent recanalization after thrombolysis. At the last follow-up, the average score of Harris hip function and Fugl-Meyer were 90.2±3.8 (77 to 96) and 97.1±2.5 (83 to 100), respectively. No dislocation, infection, loosening, subsidence and osteolysis phenomenon was found during the follow-up. Conclusion The elderly patients with Garden type III or IV femoral neck fractures accompanied with hemiplegia can be treated with anti-dislocation prosthesis THA. It does have the advantages of low dislocation rate and improved hemiplegic limb function. Key words: Femoral neck fractures; Hemiplegia; Aged; Arthroplasty, replacement, hip

Post-stroke unilateral spatial neglect treated with acupuncture and rehabilitation: a randomized controlled trial

To observe the impacts on post-stroke unilateral spatial neglect treated with acupuncture for "regaining consciousness, benefiting marrow and opening orifices" and rehabilitation. Forty patients of post-stroke unilateral spatial neglect were randomized into an observation group and a control group, 20 cases in each one. In the observation group, acupuncture was applied to the acupoints for "regaining consciousness, benefiting marrow and opening orifices", named Baihui (GV 20), Sishencong (EX-HN 1), Benshen (GB 13), Shenting (GV 24), and the bilateral yuan-primary points and luo-connecting points of the heart meridian, pericardium meridian and kidney meridian, as well as the acupoints along the affected meridians. Additionally, the rehabilitation was provided. In the control group, acupuncture at the acupoints along the affected meridians and rehabilitation were adopted. The treatment was given once a day, 5 times a week. After 8 weeks of treatment the evaluation was made. the indexes of unilateral spatial neglect such as line bisection test, the score of the mini-mental state examination (MMSE), the score of simple Fugl-Meyer motor function assessment and the modified Barthel indexes were adopted for the assessment of the severity of unilateral spatial neglect, cognitive function, motor function, and the activities of daily living. After treatment, the indexes of unilateral spatial neglect (line bisection test, line cancellation test, clock-drawing test and copying drawing test), MMSE score, the simple Fugl-Meyer motor function assessment and modified Barthel indexes were all improved as compared with those before treatment in the two groups (all P<0.01). The improvements in the observation group were more obvious than those in the control group (P<0.05, P<0.01). The combination of acupuncture treatment for "regaining consciousness, benefiting marrow and opening orifices" and rehabilitation much more effectively alleviates the severity of post-stroke unilateral spatial neglect and improves the motor function and the activities of daily living in the patients.

Mirror therapy combined with acupuncture can improve the upper extremity function of stroke survivors

Objective To explore the effects of mirror therapy combined with Tongdu Xingshen acupuncture on the upper extremity function of stroke survivors. Methods Sixty stroke survivors were randomly divided into a mirror group (n=20), an acupuncture group (n=20) and a combined group (n=20). In addition to routine rehabilitation treatment, those in each group received mirror therapy, acupuncture or both for 4 weeks. Before the treatment and after 2 and 4 weeks of treatment, all of the patients were assessed using the Fugl-Meyer motor function assessment (FMA), Brunnstrom upper limb and hand staging (BSULH), the Barthel Index (BI) and in terms of the active range of motion in the wrist contralateral to their hemiplegia (AROM). The combined group was also evaluated using functional magnetic resonance imaging (fMRI) before treatment and after the 4 weeks. Results After 2 and 4 weeks of the treatment, the average BI, AROM, FMA and BSULH results had improved significantly compared with before the treatment. The improvements in the combined group were significantly greater than in the other groups after 2 and 4 weeks. The fMRI demonstrated that there were high-intensity signals in the primary motor area, the premotor area and the supplementary motor area on the affected side after 4 weeks of treatment. Conclusions Mirror therapy combined with Tungdu Xingshen acupuncture can improve the functional performance of the upper extremities of stroke survivors. Key words: Mirror therapy; Acupuncture; Stroke; Upper extremities

Diaphragm muscle training for reducing post-stroke fatigue

Objective To investigate the effect of diaphragm training on respiratory function and the activities of daily living after cerebral apoplexy. Methods Seventy-eight patients with post-stroke fatigue were randomly divided into a treatment group and a routine therapy group, each of 39. Both groups were given conventional rehabilitation treatment, while the treatment group was additionally provided with diaphragm muscle training. Before and after 4 weeks of treatment, both groups were evaluated using pulmonary function tests, a fatigue severity scale (FSS), Fugl-Meyer motor function assessment (FMA) and the modified Barthel index (MBI). Results Vital capacity, forced vital capacity, forced vital capacity during the first second, and especially the maximum ventilatory volume of the treatment group were all significantly improved after the treatment. There was also significant improvement in that group′s average FSS score, but not in that of the control group. The average FMA and MBI scores for both groups had improved significantly after the intervention, with the average FMA score of the treatment group significantly higher than that of the control group. However, no significant differences in the average MBI score were observed after the treatment. Conclusion Diaphragm training can significantly improve motor function and the daily life of stroke survivors. The mechanism may be related to improved respiratory function and decreased severity of fatigue. Key words: Post-stroke fatigue; Respiratory function; Diaphragm muscle training; Daily life ability

Efficacy of Mirror Therapy Containing Functional Tasks in Poststroke Patients.

ObjectiveTo investigate the effect of mirror therapy containing functional tasks on upper extremity function and activities of daily living in patients with subacute stroke.MethodsThe subjects were randomly divided into two groups: the mirror therapy group (30 patients) and the sham therapy group (30 patients). The mirror therapy group underwent a mirror therapy program together with conventional therapy for 20 minutes per day on 5 days per week for 4 weeks. The control group received a sham conventional therapy program under the same schedule as the mirror therapy group. The Fugl-Meyer Motor Function Assessment (FMA), Brunnstrom motor recovery stage, and Modified Barthel Index (MBI) were evaluated 4 weeks after the treatment.ResultsThe upper extremity function on the affected side and ability to perform daily life activities after the intervention were significantly improved in both groups. After 4 weeks of intervention, improvements in the FMA (p=0.027) and MBI (p=0.041) were significantly greater in the mirror therapy group than the sham therapy group.ConclusionIn this study, we found that the mirror therapy containing functional task was effective in terms of improving the upper extremity functions and activities of daily living in patients with subacute stroke.