Lower Limb Motor Function Research Articles

Effect of Robot-Assisted Gait Training on Lower Limb Motor Function of Children with Cerebral Palsy： A Meta-Analysis

Effect of Robot-Assisted Gait Training on Lower Limb Motor Function of Children with Cerebral Palsy： A Meta-Analysis

A quantitative lower limb function assessment method based on fusion of surface EMG and inertial data in stroke patients during cycling task

ObjectiveQuantitative methods provide an accurate way to determine lower-limb motor function level that is essential for post-stroke rehabilitation protocol setup. Due to less requirement of postural stability and balance control, cycling task is more suitable for stroke patients in acute period compared to gait tasks. However, the feasibility of motor function assessment under cycling task has been rarely studied. In this study, we investigated the locomotor performance under cycling task with comparing to a lower-limb movement sequence task and developed a motor assessment framework based on fusion of surface electromyography (sEMG) and inertial features. MethodsTen post-stroke hemiparetic patients were enrolled where sEMG signals and inertial data were measured and derived in both tasks. The task effect was investigated using one-way analysis of variance and feature difference between the affected and unaffected limbs was furtherly statistically analyzed. Ratios of feature were calculated based on which a motor function assessment model was built using a K-nearest neighbor regression algorithm. ResultsResults showed that patients had more significant differences in bilateral muscle activations and ratios of features in the cycling task had higher correlation with Fugl-Meyer assessment scores. The proposed model obtained a high accuracy prediction with a significant correlation (R2 = 0.99, MAE = 0.15, p < 0.001) in lower-limb motor score prediction. ConclusionThe study provides a novel motor assessment framework that validates the usability and feasibility of cycling task and has great potential in practical clinical assessment.

The effect of whole-body vibration on lower extremity function in children with cerebral palsy: A meta-analysis.

The aim of this meta-analysis was to evaluate the effect of whole-body vibration training on lower limb motor function in children with cerebral palsy in randomized-controlled trials (RCTs). Two independent reviewers systematically searched the records of nine databases (PubMed, Cochrane, Web of Science, EMBASE, CNKI, etc.) from inception to December 2022. Tools from the Cochrane Collaboration were used to assess risk of bias. Standard meta-analyses were performed using Stata 16.0 and Revman 5.3. For continuous variables, the arms difference was calculated as the weighted mean difference (WMD) between the values before and after the intervention and its 95% confidence interval (95% CI). Of the 472 studies identified, 13 (total sample size 451 participants) met the inclusion criteria. Meta-analysis showed that WBV training could effectively improve GMFM88-D [WMD = 2.46, 95% CI (1.26, 3.67), P<0.01] and GMFM88-E [WMD = 3.44, 95% CI (1.21, 5.68), P = 0.003], TUG [WMD = -3.17, 95% CI (-5.11, -1.24), P = 0.001], BBS [WMD = 4.00,95% CI (3.29, 4.71), P<0. 01] and the range of motion of ankle joint and the angle of ankle joint during muscle reaction in children with cerebral palsy. The effect of WBV training on 6MWT walking speed [WMD = 47.64, 95% CI (-25.57, 120.85), p = 0.20] in children with cerebral palsy was not significantly improved. WBV training is more effective than other types of conventional physical therapy in improving the lower limb motor function of children with cerebral palsy. The results of this meta-analysis strengthen the evidence of previous individual studies, which can be applied to the clinical practice and decision-making of WBV training and rehabilitation in children with cerebral palsy.

Long-Term Lower Limb Motor Function Correlates with Middle Cerebellar Peduncle Structural Integrity in Sub-Acute Stroke: A ROI-Based MRI Cohort Study

Crossed cerebellar diaschisis (CCD) has been widely investigated in patients with supratentorial stroke. However, the role of CCD in lower limb recovery after stroke is still unknown. In this study, using a region-of-interest-based analysis of diffusion tensor imaging (DTI), a total of 44 cases of stroke within 3 months onset were enrolled for assessment of the cerebral peduncle (CP) and middle cerebellar peduncles (MCP) in CCD. Compared with the control group, the fractional anisotropy ratio (rFA) and laterality index (LI) of the CP and MCP in the stroke group significantly decreased. The rFA of the MCP (unaffected side/affected side) showed a more significant correlation with 1-year paresis grading (PG), lower extremity PG, upper extremity PG, National Institutes of Health Stroke Scale (NIHSS), and functional independence measure (FIM) motor item score, in comparison to the rFA of the CP (affected side/unaffected side) (r = -0.698 vs. r = -0.541, r = -0.651 vs. r = -0.386, r = -0.642 vs. r = -0.565, r = -0.519 vs. r = -0.403, and r = 0.487 vs. r = 0.435, respectively). Furthermore, the LI of the CP had a more significant association with 1-year Brunel Balance Assessment (BBA), upper extremity PG, and Modified Rankin Scale (mRS) as compared to the LI of the MCP (r = 0.573 vs. r = 0.452; r = -0.554 vs. r = -0.528; and r = -0.494 vs. r = -0.344, respectively). We set the cutoff point for the MCP rFA at 0.925 (sensitivity: 79% and specificity: 100%) for predicting lower extremity motor function prognosis and found the receiver operating characteristic (ROC) curve of MCP rFA was larger than that of CP rFA (0.893 vs. 0.737). These results reveal that the MCP may play a significant role in the recovery of walking ability after stroke.

Comparison of Mirror Therapy and Motor Relearning Program in improving the lower limb motor function of patients with stroke

Objective. The objective of the study was to compare the effectiveness of motor relearning programs and mirror therapy in improving the lower limb motor function of stroke patients.&#x0D; Methods. A randomized controlled trial was carried out at Al Noor hospital and Al Jannat Medicare of Rahim yar khan from January 2020 to July 2020. The data was collected after the ethical approval from Isra University. The sample consisted of 30 subjects with the age range of 40 to 65 years. Group A received MRP treatment while mirror therapy was given to Group B. Modified Fugl Meyer Assessment scale was used to measure the outcomes variables.SPSS 20 was used to analyze the research data. Non-parametric Friedman Test was used for intra-group comparison while Karuskal Wallis test was used for inter-group comparison. Three assessments were performed, pre-assessment at 0 weeks, mid-assessment at 3rd week, and post-assessment at 6th week.&#x0D; Results. Out of the total 30 participants in the study, males were 21 while females were 9. Patients with left hemiplegia were 22 while 8 were with right hemiplegia. The mean age was 53.80±7.66. The results showed that both treatments are effective in improving the motor function of stroke patients. But motor relearning program is more effective as a significant difference was found between the two treatments. (p&lt;.005)&#x0D; Conclusion. This study concluded that a motor relearning program is more effective than mirror therapy in improving the lower limb motor function of stroke patients. &#x0D; Keywords.Motor control, Mirror Therapy, Motor relearning, Stroke&#x0D; Trial Registration: IRCT20200316046791N1

INFLUÊNCIAS DA ENFERMAGEM NA RECUPERAÇÃO DA FUNÇÃO MOTORA EM PACIENTES COM HEMIPLEGIA PÓS-AVE

ABSTRACT Introduction: The motor function of the lower limbs is of great importance for the recovery of hemiplegics post stroke. Objective: Study the influence of nursing during motor rehabilitation on the recovery of lower limb motor function in patients with hemiplegia after stroke. Methods: In this study, the 28 patients were treated with nursing intervention for motor rehabilitation in the experimental group, while the control group was treated only with a conventional rehabilitation program, and the results were compared before and after the experiment. Results: After eight weeks of the experiment, the FMA-LE scale score in the experimental group increased from 19.65 to 30.51; the TUGT assessment score increased from 38.45s to 28.61s; the FAC rating test was upgraded from 1.86 to 2.98. The maximum weight percentage on the hemiplegic side increased from 27.54±10.14% to 79.51±7.52%; the fastest 5m return speed increased from 0.22±0.03m/s to 0.54±0.07m/s. The improvement effect was less evident in the control group. Conclusion: Rehabilitation nursing promotes a positive effect on improving lower limb motor function in hemiplegic patients. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

Double-target neural circuit-magnetic stimulation improves motor function in spinal cord injury by attenuating astrocyte activation.

Multi-target neural circuit-magnetic stimulation has been clinically shown to improve rehabilitation of lower limb motor function after spinal cord injury. However, the precise underlying mechanism remains unclear. In this study, we performed double-target neural circuit-magnetic stimulation on the left motor cortex and bilateral L5 nerve root for 3 successive weeks in a rat model of incomplete spinal cord injury caused by compression at T10. Results showed that in the injured spinal cord, the expression of the astrocyte marker glial fibrillary acidic protein and inflammatory factors interleukin 1β, interleukin-6, and tumor necrosis factor-α had decreased, whereas that of neuronal survival marker microtubule-associated protein 2 and synaptic plasticity markers postsynaptic densification protein 95 and synaptophysin protein had increased. Additionally, neural signaling of the descending corticospinal tract was markedly improved and rat locomotor function recovered significantly. These findings suggest that double-target neural circuit-magnetic stimulation improves rat motor function by attenuating astrocyte activation, thus providing a theoretical basis for application of double-target neural circuit-magnetic stimulation in the clinical treatment of spinal cord injury.

Effect of whole-body vibration training on the recovery of lower limb function in people with stroke: a systematic review and meta-analysis

Purpose The purpose of this meta-analysis was to systematically evaluate the effects of whole-body vibration training (WBVT) on the recovery of lower limb function in people with stroke. Methods The literature search was made in the electronic databases PubMed, Web of Science, Scopus and Embase electronic databases. Only randomized controlled trials were included. Data extraction, quality assessment and meta-analysis were performed. The search was conducted on September 01, 2022. The data analysis software was RevMan 5.3. Results A total of 13 RCTs were included, including 687 patients. The results showed that compared with the control group, the overall difference in balance function was statistically significant [MD = 4.23, 95% CI 2.21 ∼ 6.26, p < 0.0001]. There was no significant difference in the evaluation indexes of lower limb motor function, including the TUG, 10MWT, 6MWT, and FMA - LE. The overall difference in lower limb muscle spasticity was statistically significant [MD = −0.53, 95% CI −0.81 ∼ 0.26, p = 0.0001]. Conclusions Compared with the control group, using WBVT treatment has a more obvious effect on the recovery of lower limb function and muscle spasticity, and there is no obvious advantage in motor function recovery. IMPLICATIONS FOR REHABILITATION This Systematic Review and meta-analysis of evidence suggest that whole-body vibration training is effective in the rehabilitation of lower limb function in patients with stroke. Whole body vibration training may be a better choice for improving balance and spasm in people with stroke. Currently it is not known which whole-body vibration training model with vibration intensity, stimulus type and duration is most effective and to design more targeted interventions.

Methodology for Selecting the Appropriate Electric Motor for Robotic Modular Systems for Lower Extremities.

Torque calculation is essential for selecting the appropriate motor to achieve the required torque at each joint of a hybrid exoskeleton. In recent years, the combined use of functional electrical stimulation (FES) and robotic devices, called hybrid robotic rehabilitation systems, has emerged as a promising approach for the rehabilitating of lower limb motor functions. Specifically, the implementation strategy of functional electrical stimulation walking aid combined with the design of the exoskeleton part is the main focus of our research team. This work copes with issues of the design process of a robotic exoskeleton. The importance of robotic exoskeletons for providing walking aid to people with mobility disorders or the elderly is discussed. Furthermore, the approaches to calculating the joint torques are investigated, and the mathematical models and parameters of interest are identified. This further includes the comparative data for servo motors: robotic exoskeleton characteristics and actuator analysis in the robotic exoskeleton. The aforementioned is used to propose a mathematical model based on previous models (Zatsiorsky BSP and Dempster BSP body segment parameters models, forward kinematics models), which was extended to include added adjustable parameters such as length, area, volume, mass, density, the centre of mass, human body characteristics, and considering both static and dynamic parameter extraction. Then, an analytic method is presented, exploiting the results from the mathematical model to select the appropriate motor for each joint of the lower extremities. The detailed description of the method is followed by examples, experimental measurements, and statistical analysis of qualitative and quantitative characteristics. The results showed deviations from typical calculation methods, offering a better understanding of the motor requirements for each joint of the exoskeleton and avoiding selections of marginal functionality features of the motors. In addition, researchers are offered a tool for replicating the results of this work, allowing them to configure the parameters associated with the servo motor features. The researcher can either use the embedded library developed for this work or enter new data into it, affecting the calculated torques of the model joints. The extracted results assist the researcher in choosing the appropriate motor among commercially available brushed and brushless motors based on the torques applied at each joint in robotic articulated systems.

Effect of combination of botulinum toxin and electromyographic biofeedback therapy on post-stroke patients with lower limb muscle spasticity

Purpose: To investigate the clinical effect of combined use of botulinum toxin type A and electromyographic biofeedback therapy (EMGBFT) on post-stroke patients with lower limb muscle spasticity.&#x0D; Methods: The data of 91 post-stroke patients with lower limb muscle spasticity who were admitted to Shanghai Seventh People’s Hospital (January 2020 -January 2021) were retrospectively analyzed, and they were divided into control group (COG, n = 45) and study group (STG, n = 46) based on the treatments given. All patients received conventional rehabilitation and training. Patients in COG were treated with EMGBFT, whereas those in STG received botulinum toxin type A as well as EMGBFT. The parameters determined in the two groups were degree of spasticity, lower limb motor function [3m-Timed Up and Go (3m - TUG) and 10m - Walk Test (10 m - WT)], active range of motion (AROM) of ankle dorsiflexion, ability of daily living (based on Barthel Index, BI), and adverse reactions before and after treatment.&#x0D; Results: The effectiveness of the treatments on spasticity was higher in STG than in COG (p &lt; 0.05). After treatment, the times taken for 3m-TUG and 10m-WT were significantly shorter in STG than in COG (p &lt; 0.05). The AROM of patients in both groups was expanded, but the expansion was significantly greater in STG than in COG (p &lt; 0.05).&#x0D; Conclusion: Combined therapy using botulinum toxin and EMGBFT effectively relieved lower limb muscle spasticity of post-stroke patients, and also improved their lower limb motion function and daily living ability. Thus, the combined therapy provided better management of lower limb spasticity. However, further clinical trials are required prior to its adoption in clinical practice.

Effect of &amp;quot;Tong Du Tiao Shen&amp;quot; Acupuncture Therapy Combined with Rehabilitation Training on the Recovery of Lower Limb Motor Function after Ischemic Stroke

Effect of &amp;quot;Tong Du Tiao Shen&amp;quot; Acupuncture Therapy Combined with Rehabilitation Training on the Recovery of Lower Limb Motor Function after Ischemic Stroke

EFEITOS DO BANHO MEDICINAL CHINÊS NA FADIGA MUSCULAR ESPORTIVA DOS ATLETAS

ABSTRACT Introduction: The Fifth International Conference on Sports Biochemistry defines sports fatigue as the physiological process of dysfunction at a certain level or inability to maintain predetermined exercise intensity. When left untreated, it can cause adverse effects to the musculoskeletal system. Natural alternatives for controlling sports fatigue exist in Chinese culture, but scientific research is needed to determine the effectiveness of these treatments. Objective: This study aimed to verify the effect of traditional Chinese medicinal baths on athletes’ muscle fatigue. Methods: 100 athletes with exercise-induced muscle fatigue were randomly divided into two groups. The control group received ganglioside injection combined with therapeutic exercise protocols, while the experimental group received the medicinal bath based on traditional Chinese medicine. Tonus of adductors, ischiotibials, gastrocnemius, in addition to lower limb motor function, was evaluated. Results: The total effective rate (90.8%) of the observation group was higher than that of the control group (72.3%), and the difference was statistically significant (P&lt;0.05). After treatment, adductor, hamstring, and gastrocnemius muscle tension in the observation group were lower than the control group (P&lt;0.05). Gross motor function assessment score (GMFM-88), Berg Balance Scale (BBS), 10m walking speed on a 20cm wide walkway (MWS) in the observation group were higher than those in the control group (P&lt;0.05). Conclusion: Chinese herbal lavender lotion combined with suspension exercise can effectively improve the body's muscle strength after exercises, accelerate the recovery of muscle strength, and significantly reduce exercise-induced muscle fatigue. Evidence Level II; Therapeutic Studies - Investigating the result.

Effects of Motor Imagery Training for Lower Limb Dysfunction in Patients With Stroke: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

The aim of the study is to determine the effects of motor imagery training associated with conventional rehabilitation therapies on lower limb motor function recovery in poststroke patients. Comprehensive literature searches were performed to identify studies published before June 5, 2022. RevMan 5.3 software was used for meta-analysis. The quality of the included studies was assessed using the Cochrane risk-of-bias tool and the modified Jadad scale. The certainty of the evidence was evaluated with the Grading of Recommendations, Assessment, Development and Evaluations system. Twenty-three trials and/or 1109 participants with motor imagery training ability were included in this review. Motor imagery training combined with conventional rehabilitation therapies versus conventional rehabilitation therapies demonstrated significant benefits in motor function, balance function, temporospatial gait variables (walking speed, stride length, and cadence) and activities of daily living. Subgroup analysis demonstrated that motor imagery training-conventional rehabilitation therapies had a better effect on improvement in motor function and activities of daily living in the acute phase and had a greater benefit on walking speed in the chronic phase. In addition, motor imagery training-conventional rehabilitation therapies resulted in greater improvements in stride length, cadence, walking ability, and balance function in the subacute phase. Motor imagery training-conventional rehabilitation therapies have better effects on the recovery of lower limb motor function in poststroke patients than conventional rehabilitation therapies, which may be most beneficial for lower extremity motor function recovery in the first 7 days to 6 mos.

Design and evaluation of a double rope rehabilitation robot for sit-to-stand training

A double rope rehabilitation robot for sit-to-stand training is developed for human lower limb rehabilitations. Two kinds of training methods are used to ensure the safety control of rehabilitation activities. During the sit-to-stand training, the robot sensor system measures the ground reaction force, center of pressure, tension of ropes, motion track of body trunk, and the rotation angle of each body segment, and then the control system calculates the joint torques of hip, knee and ankle in real time. Six volunteers are involved in the experiment, and the results verify that the rehabilitation robot can ensure the completion of natural track in sit-to-stand training and improve the joint torque. In addition, the user’s motor intention can be identified by the control system, and the lower limb motor function can be trained effectively by encouraging users to exert strength by themselves. Therefore, the developed rehabilitation robot can be used to evaluate human body dynamics parameters and may improve rehabilitation activities in clinical environment.

Identifying different cognitive phenotypes and their relationship with disability in neuromyelitis optica spectrum disorder.

BackgroundThe existence, frequency, and features of cognitive impairment (CI) in patients with neuromyelitis optica spectrum disorder (NMOSD) are still debated. A precise classification and characterization of cognitive phenotypes in patients with NMOSD are lacking.MethodsA total of 66 patients with NMOSD and 22 healthy controls (HCs) underwent a neuropsychological assessment. Latent profile analysis (LPA) on cognitive test z scores was used to identify cognitive phenotypes, and ANOVA was used to define the clinical features of each phenotype. Univariate and multivariate analyses were used to explore the predictors of severe CI, and a corresponding nomogram was created to visualize the predictive model.ResultsLPA results suggested four distinct meaningful cognitive phenotypes in NMOSD: preserved cognition (n = 20, 30.3%), mild-attention (n = 21, 31.8%), mild-multidomain (n = 18, 27.3%), and severe-multidomain (n = 7, 10.6%). Patients with the last three phenotypes were perceived to have CI, which accounts for 67.6% of patients with NMOSD. Patients with NMOSD and worse cognitive function were older (p < 0.001) and had lower educational levels (p < 0.001), later clinical onset (p = 0.01), worse Expanded Disability Status Scale scores (p = 0.001), and poorer lower-limb motor function (Timed 25-Foot Walk, p = 0.029; 12-item Multiple Sclerosis Walking Scale [MSWS-12], p < 0.001). Deterioration of Nine-Hole Peg Test (odds ratio, OR: 1.115 [1, 1.243], p = 0.05) and MSWS-12 (OR: 1.069 [1.003, 1.139], p = 0.04) were the independent risk factors for severe cognitive dysfunction. Finally, a nomogram was built based on the entire cohort and the above factors to serve as a useful tool for clinicians to evaluate the risk of severe cognitive dysfunction.ConclusionsWe introduced a classification scheme for CI and highlighted that the deterioration of upper- and lower-limb motor disability potentially predicts cognitive phenotypes in NMOSD.

Analysis of Risk Factors for Postoperative Lower Extremity Deep Venous Thrombosis and its Treatment and Nursing.

Objective To explore the risk factors of lower extremity deep venous thrombosis (LEDVT) after surgery and discuss the treatment and nursing countermeasures. Methods A retrospective analysis was conducted on 268 surgical patients admitted between July to December 2021. The factors associated with LEDVT were analyzed using the Logistic regression model. Further, LEDVT patients were assigned to a research group treated with targeted nursing to prevent LEDVT and a control group that used routine care. Coagulation function and inflammatory cytokines before and after nursing intervention were compared between groups. The assessment of patients' mobility employed the lower limb motor function part of the Fugel–Meyer Assessment (FMA), Harris Hip Score (HHS), and Barthel index (BI), and their psychological status was evaluated using the Kolcaba's General Comfort Questionnaire (GCQ) and Self-rating Anxiety/Depression Scale (SAS/SDS). Finally, patient satisfaction with the treatment service was investigated. Results Logistic regression analysis showed that hypertension, limb paralysis, central venous catheterization of lower limbs, and bedridden time affect postoperative LEDVT in an independent way (P < 0.05). After the intervention, the coagulation function and inflammatory reaction were improved in both groups, with more significant improvement in the research group (P < 0.05). The research group also showed higher FMA, Harris, GCQ, and BI scores while lower SAS and SDS scores than the control group postnursing intervention (P < 0.05). Finally, a higher satisfaction rate was identified in the research group as compared to the control group (P < 0.05). Conclusion Hypertension, limb paralysis, CVC of lower limbs, and bedridden time are all independent risk factors for LEDVT after surgery. The implementation of targeted nursing strategies for the above factors can effectively alleviate the hypercoagulable state of patients after operation, reduce inflammatory responses, and improve patient comfort, which is of great significance for preventing the occurrence of LEDVT.

22. Early vs (

<h3>BACKGROUND CONTEXT</h3> The optimal clinical management of central cord syndrome (CCS) remains unclear; yet this is becoming an increasingly relevant public health problem in the face of the global aging population. <h3>PURPOSE</h3> To provide a head-to-head comparison of the neurological and functional outcomes of early (<24 hrs) vs late (24 hrs) surgical decompression for CCS. <h3>STUDY DESIGN/SETTING</h3> Propensity, score-matched analysis cohort study. <h3>PATIENT SAMPLE</h3> Participants were included if they had a documented baseline American Spinal Injury Association (ASIA) / International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) neurological examination performed within 14 days of injury. Participants were eligible if they underwent surgical decompression for CCS, as defined by apoint difference of five or more between baseline ASIA lower extremity motor score (LEMS) and upper extremity motor score (UEMS), in favor of the lower limbs (LEMS - UEMS 5). <h3>OUTCOME MEASURES</h3> The primary endpoint was motor recovery (upper extremity motor score (UEMS); lower extremity motor score (LEMS); AMS) at one year. Secondary endpoints were Functional Independence Measure (FIM) motor score and complete independence in each FIM motor domain at one year. <h3>METHODS</h3> This study identified CCS patients from three international, multicentre studies examining the timing of surgical decompression in spinal cord injury. Patients who underwent surgery for CCS (LEMS-UEMS5) were identified from three spinal cord injury (SCI) datasets (NACTN; STASCIS; NASCIS III). Propensity scores were calculated as the probability of undergoing early (< 24 hrs) compared to late (24 hrs) surgery using the logit method and adjusting for data source, age, injury mechanism, and baseline ASIA motor score (AMS), AIS grade, and neurological level. Propensity score matching was performed in a one-to-one ratio by an "optimal matching" technique. Effect sizes for outcomes were summarized by mean differences (MDs) or odds ratios (ORs) and associated 95% confidence intervals. <h3>RESULTS</h3> The final study cohort consisted of 186 patients with CCS. Baseline characteristics were balanced between matched early (N=93) and late (N=93) surgery groups. Early surgical decompression resulted in significantly improved recovery in upper limb (MD 2.3, P=0.047), but not lower limb (MD 1.1, P=0.256), motor function, as compared with late surgery. More patients in the early surgery group appeared to achieve complete independence in various functional activities, particularly those involving upper limb function; however, these associations did not reach statistical significance, and there was no difference in one-year FIM motor score (MD 4.4, P=0.182). On subgroup analysis, outcomes were comparable with early or late decompressive surgery in AIS grade D patients. However, in patients with AIS grade C injury, early surgery resulted in significantly greater recovery in overall motor score (MD 9.5, P=0.038), owing to gains in both upper and lower limb motor function. <h3>CONCLUSIONS</h3> This study found early (<24 hrs) compared to late (24 hrs) surgical decompression to result in improved recovery in upper limb motor function at one year in patients with central cord syndrome. The benefit of early surgery was especially realized in patients with AIS grade C injury. Treatment paradigms for central cord syndrome should be redefined to encompass early surgical decompression as a neuroprotective therapy. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Effect and mechanism of mirror therapy on lower limb rehabilitation after ischemic stroke: A fMRI study.

Mirror therapy has been gradually adopted for lower limb rehabilitation, but its efficacy and neural mechanism are not well understood. This study aims to investigate the effect and neural mechanism of mirror therapy on lower limb rehabilitation after ischemic stroke by using resting state functional magnetic resonance imaging (rs-fMRI). A single-blind and randomized controlled pilot study was conducted. 32 patients with ischemic stroke were included in this study and randomly divided into two groups - the control group (CT, n = 16) and the mirror therapy group (MT, n = 16). Both the CT and MT groups received medication and routine rehabilitation training. In addition, mirror therapy was added to the MT group 5 times a week for 30 minutes each time over a period of 3 weeks. Patients' motor functions, functional connectivity (FC), regional homogeneity (ReHo), and fractional amplitude of low-frequency fluctuations (fALFF) were analyzed both before and immediately after the treatment. Patients' motor functions showed significant improvement in both groups compared to those before treatment (p < 0.01). Moreover, the MT group showed significantly better improvement than the CT group after the treatment (p < 0.05). FC, ReHo and fALFF indicated enhanced neuronal activities in motor function-related brain regions in the MT group compared to the CT group. Mirror therapy promotes the recovery of lower limb motor functions in patients with ischemic stroke. Through the comparative rs-fMRI analysis, it is found that the mirror therapy promotes the functional reorganization of the injured brain.

Integrated bioinformatics analysis identifies the effects of Sema3A/NRP1 signaling in oligodendrocytes after spinal cord injury in rats.

ObjectiveTo investigate the effect of Sema3A/NRP1 signaling in oligodendrocytes (OLs) after spinal cord injury.MethodsThree analysis strategies, namely differential expression gene analysis, Gene Ontology (GO) enrichment, and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis, were applied. The protein-protein interaction (PPI) network was constructed using the STRING website to explore the correlation between Sema3A/NRP1 and oligodendrocytes. Then, the T10 spinal cord segment of rats was injured by the Allen method to establish a spinal cord injury (SCI) model. Real-time quantitative PCR, Western blotting, Nissl staining and immunofluorescence staining were used to detect the effect of Sema3A/NRP1 signaling on oligodendrocytes in vivo.ResultsAfter the SCI model was established, significantly fewer oligodendrocytes were observed. At the same time, R software was used to analyze the expression of related genes, and NRP1 expression was increased. PCR also demonstrated similar results, and NRP1 ligand Sema3A was also upregulated. KEGG and GO functional enrichment analysis indicated that the SCI model was mainly related to cytokine interaction, cell proliferation, differentiation and maturation. Interestingly, we found that NRP1 was involved in semaphorin-plexin signaling pathway neuronal projection guidance and axon guidance, mediating cell growth and migration. Moreover, Sema3A/NRP1 signaling was closely associated with platelet-derived growth factor receptor α (PDGFRα) in the PPI network. When Sema3A/NRP1 signaling was specifically blocked at early stages, PDGFRα expression was effectively inhibited, and the expression of OLs was promoted. Furthermore, inhibition of Sema3A/NRP1 signaling increased the Basso-Beattie-Bresnahan (BBB) score of lower limb motor function in SCI rats and promoted the survival of motor neurons in the ventral horn of the injured spinal cord.ConclusionOur data suggest that Sema3A/NRP1 signaling may regulate the development of OPCs and OLs after SCI, thereby affecting functional recovery.

What are the relevant categories, modalities, and outcome measures for assessing lower limb somatosensory function in children with upper motor neuron lesions? A Delphi study

Purpose Somatosensory function of the lower limbs is rarely assessed in children with upper motor neuron lesions despite its potential relevance for motor function. We explored consensus regarding somatosensory categories (exteroception, proprioception, interoception, and body awareness), modalities, and outcome measures relevant to lower limb motor function. Methods Fifteen international experts with experience of somatosensory function assessment participated in this Delphi study. Surveys of four rounds, conducted online, included questions on the relevance of somatosensory categories and modalities for motor function and on the use of potential outcome measures in clinical practice. Results The experts reached consensus on the relevance of six modalities of the categories exteroception, proprioception, and body awareness. Based on their feedback, we formulated three core criteria for somatosensory outcome measures, namely suitability for clinical practice, child-friendliness, and relevance for motor function. None of the nine available outcome measures fulfilled each criterion. The experts also highlighted the importance of using and interpreting the tests in relation to the child’s activity and participation. Conclusion There was expert consensus on three categories and six modalities of somatosensory function relevant for lower limb motor function. However, existing outcome measures will need to be adapted for use in paediatric clinical practice. IMPLICATION FOR REHABILITATION Consensus was established for the categories and modalities of somatosensory function relevant for lower limb motor function of children with UMN lesion. Outcome measures should cover tactile function, joint movement and joint position and dynamic position sense, and spatial and structural body representation. None of the nine existing outcome measures fulfilled the core criteria: feasibility for clinical practice, child-friendliness, and relevance to motor function.