Lower Limb Motor Function Research Articles

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.

Decoding Brain Signals to Classify Gait Direction Anticipation.

The use of brain-computer interface (BCI) technology has emerged as a promising rehabilitation approach for patients with motor function and motor-related disorders. BCIs provide an augmentative communication platform for controlling advanced assistive robots such as a lower-limb exoskeleton. Brain recordings collected by an electroencephalography (EEG) system have been employed in the BCI platform to command the exoskeleton. To date, the literature on this topic is limited to the prediction of gait intention and gait variations from EEG signals. This study, however, aims to predict the anticipated gait direction using a stream of EEG signals collected from the brain cortex. Three healthy participants (age range: 29-31, 2 female) were recruited. While wearing the EEG device, the participants were instructed to initiate gait movement toward the direction of the arrow triggers (pointing forward, backward, left, or right) being shown on a screen with a blank white background. Collected EEG data was then epoched around the trigger timepoints. These epochs were then converted to the time-frequency domain using event- related synchronization (ERS) and event-related desynchronization (ERD) methods. Finally, the classification pipeline was constructed using logistic regression (LR), support vector machine (SVM), and convolutional neural network (CNN). A ten-fold cross-validation scheme was used to evaluate the classification performance. The results revealed that the CNN classifier outperforms the other two classifiers with an accuracy of 0.75. Clinical Relevance - The outcome of this study has the potential to be ultimately used for interactive navigation of the lower-limb exoskeletons during robotic rehabilitation therapy and enhance neurodegeneration and neuroplasticity in a wide range of individuals with lower-limb motor function disabilities.

Catalpol as a Component of Rehmannia glutinosa Protects Spinal Cord Injury by Inhibiting Endoplasmic Reticulum Stress-Mediated Neuronal Apoptosis.

Disturbance of the internal environment in the spinal cord after spinal cord injury (SCI) is an important cause of the massive death of neurons in the injury area and one of the major problems that lead to the difficult recovery of motor function in patients. Rehmannia glutinosa, a famous traditional Chinese medicine, is commonly used in neurodegenerative diseases, whereas an iridoid glycoside extract of catalpol (CAT), with antioxidant, antiapoptotic, and neuroprotective pharmacological effects. However, the neuroprotective and anti-apoptosis mechanism of CAT in SCI remains unclear. In our study, we found that CAT has a restorative effect on the lower limb motor function of rats with SCI by establishing a rat model of SCI and treating CAT gavage for 30 days. Our study further found that CAT has the effect of inhibiting apoptosis and protecting neurons, and the action pathway may reduce endoplasmic reticulum (ER) stress by inhibiting CHOP and GRP78 expression and then reduce apoptosis and protect neurons through the Caspase3/Bax/Bcl-2 pathway. In conclusion, we demonstrated that CAT can treat SCI by inhibiting ER stress-mediated neuronal apoptosis and has the potential to be a clinical drug for the treatment of SCI.

Prediction of Motor Outcome of Stroke Patients Using a Deep Learning Algorithm with Brain MRI as Input Data

Background: Deep learning techniques can outperform traditional machine learning techniques and learn from unstructured and perceptual data, such as images and languages. We evaluated whether a convolutional neural network (CNN) model using whole axial brain T2-weighted magnetic resonance (MR) images as input data can help predict motor outcomes of the upper and lower limbs at the chronic stage in stroke patients. Methods: We collected MR images taken at the early stage of stroke in 1,233 consecutive stroke patients. We categorized modified Brunnstrom classification (MBC) scores of ≥5 and functional ambulatory category (FAC) scores of ≥4 at 6 months after stroke as favorable outcomes in the upper and lower limbs, respectively, and MBC scores of <5 and FAC scores of <4 as poor outcomes. We applied a CNN to train the image data. Of the 1,233 patients, 70% (863 patients) were randomly selected for the training set and the remaining 30% (370 patients) were assigned to the validation set. Results: In the prediction of upper limb motor function on the validation dataset, the area under the curve (AUC) was 0.768, and for lower limb motor function, the AUC was 0.828. Conclusion: We showed that a CNN model trained using whole-brain axial T2-weighted MR images of stroke patients would help predict upper and lower limb motor function at the chronic stage.

Intervention Effect of Rehabilitation Robotic Bed Under Machine Learning Combined With Intensive Motor Training on Stroke Patients With Hemiplegia.

It was aimed to discuss the effect of bed-type rehabilitation robots under machine learning combined with intensive motor training on the motor function of lower limbs of stroke patients with hemiplegia. A total of 80 patients with stroke hemiplegia were taken as the subjects, who all had a course of treatment for less than 6 months in the Rehabilitation Medicine Department of Ganzhou Hospital. These patients were divided into the experimental group (40 cases) and the control group (40 cases) by random number method. For patients in the control group, conventional intensive motor training was adopted, whereas the conventional intensive motor training combined with the bed-type rehabilitation robot under machine learning was applied for patients in the experimental group. Fugl-Meyer Assessment of Lower Extremity (FMA-LE), Rivermead Mobility Index (RMI), and Modified Barthel Index (MBI) were used to evaluate the motor function and mobility of patients. The human–machine collaboration experiment system was constructed, and the software and hardware of the control system were designed. Then, the experimental platform for lower limb rehabilitation training robots was built, and the rehabilitation training methods for stroke patients with hemiplegia were determined by completing the contact force experiment. The results showed that the prediction effect of back-propagation neural network (BPNN) was better than that of the radial basis neural network (RBNN). The bed-type rehabilitation robot under machine learning combined with intensive motor training could significantly improve the motor function and mobility of the lower limbs of stroke patients with hemiplegia.

Effects of whole-body vibration training on lower limb motor function and neural plasticity in patients with stroke: protocol for a randomised controlled clinical trial

IntroductionLower limb motor dysfunction is common in patients with stroke, and usually caused by brain neural connectivity disorder. Previous studies have shown that the whole-body vibration training (WBVT) significantly improves...

Effect of Valproic Acid on NLR Family Pyrin Domain Containing 1/3 (NLRP1/3) Inflammasome in Rats with Acute Spinal Cord Injury

Our study assesses valproic acid’s effect on NLRP1/3 inflammasome in rats with acute spinal cord injury (SCI). SD rats were clamped by aneurysm clips to establish SCI model followed by analysis of functional recovery by BBB score, degree of inflammatory infiltration, by H&amp;E staining, NLRP1/NLRP3 and P2X7 level by western blot, IL-1β and IL-18 level by ELISA, blood spinal cord barrier by EVANS blue method. After SCI, the lower limb motor function of rats decreased and recovered after valproic acid treatment (P &lt; 0.05). Inflammatory cell infiltration of SCI group increased and decreased after treatment. After SCI, NLRP1/3 level increased and P2X7 protein level elevated which were reversed after valproic acid treatment (P &lt; 0.05). In rats with SCI, IL-1β level in spinal cord was higher than sham operation and lower after treatment (P &lt; 0.05) without difference of IL-18 between injury group and treatment group (P &gt; 0.05). In addition, fluorescence was higher in injury group than sham operation group and lower in valproic acid injection group than injury group. In conclusion, Valproic acid can promote motor function recovery in rats after SCI and inhibit inflammasome 1 and 3 expression, thereby inhibiting the maturation and release of IL-1β, and reducing P2X7 level after SCI.

Cervical Spinal Cord Injury Induces Distinct Changes in Gut Microbiome Composition Over Time in Rats

Nearly 60% of all spinal cord injuries (SCI) occur at the cervical level. These high‐level injuries can lead to quadriplegia, autonomic dysregulation, and interruption of the descending respiratory pathways required for breathing. As respiratory motor function is required for life, it is critical to restore breathing as soon as possible after cervical SCI. Indeed, therapeutic techniques in animal studies have been successful at restoring breathing function after SCI; however, these interventions appear to be more effective at chronic than acute timepoints post‐injury. One potential cause for this observation is the impact the injury has on the gastrointestinal (GI) tract and gut microbiome, which have previously been shown to have detrimental effects on recovery outcomes, including lower limb motor function and emotional affect as indicated by increased anxiety‐like behavior. However, the impact the gut microbiome has on the recovering spinal cord at different timepoints, levels, and injury severities still needs to be fully realized. We aimed to build upon these previous findings and investigate the impact of cervical SCI on the gut microbiome over time and up to chronic timepoints. We hypothesized that cervical SCI leads to transient changes in the gut microbiome, which are most severe acutely after injury impeding functional recovery of breathing, but resolve over time and thus eventually allow for more profound recovery. To test our hypotheses, we performed left C2 hemisections on adult female rats, collected fecal samples from injured, sham, and naïve animals, and assessed microbiome composition at various timepoints pre‐ and post‐injury. Preliminary results suggest that following cervical SCI (up to 12 weeks post injury), robust differences in gut microbiome are apparent compared to non‐injured animals. Future studies will classify bacterial identities and assess the impact of the post‐injury gut microbiome on respiratory motor function and plasticity, as well as inter‐institutional differences.

Practical Machine Learning Model to Predict the Recovery of Motor Function in Patients with Stroke

Background: Machine learning (ML) is an artificial intelligence technique in which a system learns patterns and rules from a given data. Objectives: The objective of the study was to investigate the potential of ML for predicting motor recovery in stroke patients. Methods: We analyzed data from 833 consecutive stroke patients using 3 ML algorithms: deep neural network (DNN), random forest, and logistic regression. We created a practical ML model using the most common data measured in almost all rehabilitation hospitals as input data. Demographic and clinical data, including modified Brunnstrom classification (MBC) and functional ambulation classification (FAC), were collected when patients were transferred to the rehabilitation unit (8–30 days) and 6 months after stroke onset and were used as input data. Motor outcomes at 6 months after stroke onset of the affected upper and lower extremities were classified according to MBC and FAC, respectively. Patients with an MBC of <5 and an FAC of <4 at 6 months after stroke onset were considered to have a “poor” outcome, whereas those with MBC ≥5 and FAC ≥4 were considered to have a “good” outcome. Results: The area under the curve (AUC) for the DNN model for predicting motor function was 0.836 for the upper and lower limb motor functions. For the random forest and logistic regression models, the AUCs were 0.736 and 0.790 for the upper and lower limb motor functions, respectively. The AUCs for the random forest and logistic regression models were 0.741 and 0.795 for the upper and lower limb motor functions, respectively. Conclusion: Although we used simple and common data that can be obtained in clinical practice as variables, our DNN algorithm was useful for predicting motor recovery of the upper and lower extremities in stroke patients during the recovery phase.

Effect of Virtual Reality Combined with Intelligent Exercise Rehabilitation Machine on the Nursing Recovery of Lower Limb Motor Function of Patients with Hypertensive Stroke.

The lower limbs of the human body are stable and flexible weight-bearing joints. They usually perform a variety of complex and subtle jobs whose functions directly affect people's daily lives. The most common type of stroke patients is limb movement dysfunction. 50% to 70% of survivors still have hemiplegic lower limb dysfunction within 2 to 4 years after stroke, which seriously affects their daily life, social participation, functional role, and independence of leisure activities and increases the heavy burden on family and society In order to understand the pathological conditions of ischemic stroke and the role of intelligent sports rehabilitation machines in the diagnosis and treatment of patients with hypertensive stroke, this article collects relevant information through case investigations of patients and interviews with professionals. Using a controlled experiment, the patients were treated in groups, and different treatment plans were used to compare the recovery of the patients' lower extremity movement ability, so as to provide some reference for the subsequent researchers. The results of the study found that stroke patients are more common in the elderly, the incidence rate of the elderly is 6 times that of young adults, and the recurrence rate of hypertensive stroke patients is 10%, which is extremely harmful. The intelligent exercise rehabilitation machine can play a great role in the treatment of patients. It can greatly improve the motor function of the patient's lower limbs. The effect is about 30% higher than that of general treatment methods, and it can also play a certain role in the prognosis of rehabilitation and effectively prevent related postoperative complications. This shows that the intelligent sports rehabilitation machine should raise people's attention in the diagnosis and treatment of patients with hypertensive stroke and increase research and development efforts and promotion efforts, and it can play a greater role in the diagnosis and treatment of patients with hypertensive stroke.

Cognitive Multisensory Rehabilitation for Sensory and Motor Function in Adults with Spinal Cord Injury: Proof of Concept

<h3>Research Objectives</h3> About 296,000 Americans have a spinal cord injury (SCI) resulting in reduced or complete loss of motor and sensory function, including loss of body awareness. The objective is to establish the proof of concept of using Cognitive Multisensory Rehabilitation (CMR), for sensory and motor improvement in adults with SCI. <h3>Design</h3> Single group, pre-post design. <h3>Setting</h3> Brain Body Mind Lab, University of Minnesota. <h3>Participants</h3> We recruited 3 men and 3 women, mean age of 52.00±12.22 years, 2-16 years after a complete (n=3) or incomplete (n=3) SCI injury, ranging from T6 to L2, with resulting paraplegia and neuropathic pain. Recruitment methods included fliers, recruitment letters, and posting of the study on ClinicalTrials.gov. <h3>Interventions</h3> A physical therapist, specialized in CMR treated the participants for 6 weeks (3x/week, 45min/session). CMR tasks help restore awareness of where the body is in space and restore sensory function through texture discrimination and discrimination of sponges that have varying resistance. <h3>Main Outcome Measures</h3> Outcome measures were recorded pre-therapy, post-therapy, and at 6 weeks follow-up. Sensory (pinprick, touch) and lower limb motor function were tested using the American Spinal Cord Injury Association (ASIA) Impairment Scale. <h3>Results</h3> Touch sensation (average change score of 4.50±3.75, effect size Cohen's d=0.71, moderate effect size); pinprick sensation (4.08±2.81, d=0.68, moderate effect size) and lower limb motor function (5.58±3.40, d=1.23, large effect size) improved after CMR compared to baseline. Both sensory function and motor function were maintained at the 6-week follow-up testing (average change score baseline to follow-up: touch=7.58±4.42, d=1.11, large effect size; pinprick=5.00±2.34, d=0.81, large effect size; lower limb motor function=6.50±3.29, d=1.56, large effect size). <h3>Conclusions</h3> The pilot study confirms the proof of concept that CMR can improve sensory and motor function. Further validation is needed. <h3>Author(s) Disclosures</h3> No conflict of interests.

Effect of acupuncture at Huatuo Jiaji (EX-B2) combined with core muscle training on motor function of lower limbs in patients with hemiplegia after stroke

To observe the effect of acupuncture at Huatuo Jiaji (EX-B2) combined with core muscle training on motor function of lower limbs, balance function and core muscle in patients with hemiplegia after stroke. A total of ninety-six patients with hemiplegia after stroke were randomly and equally divided into acupuncture, training and combination groups (n=32 cases in each). Patients of the acupuncture group were given acupuncture at the 5th, 7th, 9th and 11th chest vertebrae, and the 1st to 5th lumbar vertebrae of EX-B2. Patients in the training group received core muscle training. In the combination group, both acupuncture treatment and core muscle training were given to the patients. The treatment was conducted once daily, 5 times a week for 4 weeks. The Fugl-Meyer lower limb motor function score (FMA), Berg balance function scale (BBS), Barthel index (BI) and surface electromyography (sEMG) of the erector spinae and rectus abdominis were evaluated before and after treatment and during the follow-up period. Compared with the scores before the treatment, the FMA, BBS and BI scores were obviously increased after the treatment and during the follow-up period in the three groups respectively (P<0.05). After treatment and during the follow-up period, the root mean square (RMS) of erector spinae and rectus abdominis in the sitting position flexed 45° and extended 30° on the healthy and affected side were higher than those of the same side before treatment in the three groups (P<0.05). The therapeutic effect of combination of acupuncture at EX-B2 and core muscle training was obviously superior to that of single acupuncture or single training (P<0.05). Before the treatment, the RMS of erector spinae and rectus abdominis in the sitting position flexed 45° and extended 30° on the affected side were lower than those of the healthy side in the three groups (P<0.05), while there was no significant difference between the RMS of the erector spinae and rectus abdominis of the affected side and the healthy side in the comprehensive group after treatment and during the follow-up period (P＞0.05). Acupuncture at EX-B2 combined with core muscle training can significantly improve the balance function and lower limb motor function of patients with hemiplegia after stroke.

Application of Data Mining in the Effect of Traditional Chinese Medicine on the Rehabilitation of Cerebral Spasticity of Lower Extremity Exercise Energy.

In this article, we have examined the effect of acupoint injection of mecobalamin on the nerve function of the lower limbs of stroke patients by giving acupoint injection of mecobalamin for 2 weeks in patients with stroke, effectively fusing acupuncture, acupoints, and drugs in traditional Chinese medicine to rehabilitate the effect of motor function and activities of daily living. For this purpose, a total of 60 study cases will be screened in the study. They are randomly divided into experimental group and control group: the control group will be treated with conventional stroke treatment and nursing, and the experimental group will be treated with bilateral acupoint injection of mecobalamin; once a day, after 14 days of continuous injection, we observed and intervened the lower limb nerve function, motor function, and activities of daily living of the two groups before and after the treatment and statistically analyzed the data so as to obtain the clinical effect of the treatment on the lower limb rehabilitation of stroke patients. Before the intervention, the general information and basic clinical data of the two groups of subjects were collected for baseline comparison, and the differences between the two groups of subjects' lower limb nerve function, motor function and activities of daily living before the intervention were compared. Comparison of lower limb neurological deficits mainly include comparison between groups and comparison within groups. Comparison of lower limb motor function mainly include comparison between groups and comparison within groups. (1) Acupoint injection of mecobalamin therapy and simple stroke rehabilitation therapy have good results. (2) Acupoint injection of mecobalamin can improve the neurological deficits of the lower limbs of stroke patients more than simple conventional stroke therapy, and it also has a rehabilitation effect in nourishing the nerves, improving circulation, and protecting the brain. (3) Point-injection mecobalamin therapy is more effective than conventional stroke therapy in improving the motor function of the lower limbs and promoting the rehabilitation of the lower limbs of patients with ischemic stroke. (4) Acupoint injection of mecobalamin therapy can improve the activities of daily living of patients with ischemic stroke and improve the quality of life of patients compared with conventional stroke therapy alone.

Effects of Health Qigong Exercise on Lower Limb Motor Function in Parkinson's Disease.

PurposeThis study explored the effects of Health Qigong exercise on lower limb motor function in patients with Parkinson's disease (PD).Patients and MethodsA total of 40 patients with PD were recruited and randomly allocated into the experimental group and the control group. The experimental group completed an intervention of Health Qigong exercise over 12 weeks, while the control group did not perform any regular physical activity. Data relating to gait, lower-limb joint range of motion, Timed Up and Go, as well as scores for motor function scale from the Unified Parkinson's Comprehensive Rating Scale III (UPCRS III) before and after the intervention were collected for Repeated Measure ANOVA.ResultsCompared to the control group, Health Qigong exercise improved the constant- and high-speed stride length and gait velocity of patients, but not constant- and high-speed stride frequency. Left and right hip flexion and extension range were improved as well as left and right knee flexion range. Finally, Timed Up and Go time became significantly slower and UPCRS III score significantly decreased.ConclusionHealth Qigong exercise can improve walking ability and lower limb joint range of motion in patients with PD, lessen motor difficulties, and improve the quality of life. This non-pharmacological exercise intervention may be a useful adjustment treatment for PD.

CT image findings of spinal gout.

Spinal gout is uncommon. The clinical manifestations of spinal gout are not characteristic. Huge tophi can invade the vertebral joints and protrude into the spinal canal, even causing spinal canal stenosis, which may result in irreparable spinal cord injury. Therefore, early diagnosis and treatment is very important. Summarizing the imaging features of spinal gout may help clinicians with an early diagnosis and promptly intervention. Retrospective case series. To describe the findings from computed tomography (CT) images of spinal gout, including the tophi location, growth pattern, involvement of adjacent joints, and differentiation from other spinal lesions. We analyzed CT images from the atlantoaxial joint and lumbar spine in 17 cases with spinal gout. 17 cases had tophi as high-density masses. 14 (82.4%) cases involved lumbar facet joints, including 7(41.2%)cases involving single vertebral facet joints and 7(41.2%) cases involving multiple vertebral facets. CT imaging showed bone resorption and erosion of the facet joints, as well as narrowing of the joint space. The other three cases (17.6%) involved the atlantoaxial joint, showing a high-density mass around the odontoid process with bone resorption and invasion under the articular surface. One case was secondary to a pathological fracture. Four cases (23.6%) showed a huge mass protruding into the spinal canal where the nerve root was compressed, and even spinal cord injury, leading to serious lower back pain symptomatic of brachial plexus or sciatic nerve compression, and even affected the motor function of lower limbs. In cases with gouty arthritis involving the axial spine, the lower lumbar spine is mainly involved, high-density tophi grow forward and backward around the facet joints, CT image shows bone resorption, erosion of facet joints, and narrowing of the joint space. With atlantoaxial joint involvement, there was evidence of bone resorption combined with joint.

Effects of Water Weight-Loss Walking Training on Lower Limb Motor Function and Gait in Stroke Patients

Background: Water weight-loss walking training is an emerging physical therapy technique, which provides new ideas for improving the motor function of stroke patients and improving the quality of life of patients. However, the rehabilitation effect of water weight-loss training in stroke patients is currently unclear. Objective: To analyze the effect of water weight loss walking training in stroke patients. Methods: A total of 180 stroke patients admitted to our hospital from January 2019 to December 2021 were selected and randomly divided into two groups. The control group received routine walking training, and the research group performed weight loss walking training in water on this basis. The lower limb motor function, muscle tone grade, daily living ability, gait and balance ability were compared between the two groups before and after treatment. Results: Compared with the control group, the FMA-LE score (Fugl-Meyer motor assessment of Lower Extremity), MBI score (Modified Barthel Index) and BBS score (berg balance scale) of the study group were higher after treatment, and the muscle tone was lower (P < 0.05). After treatment, the stride length, stride speed and stride width in the two groups were increased compared with those before treatment, and the stride length, stride speed and stride width in the study group after treatment were higher than those in the control group (P < 0.05). Comparison of the maximum angle of flexion and extension of hip and knee between the two groups, P < 0.05. Conclusion: Water weight loss walking training can enhance patients’ muscle tension, correct patients’ abnormal gait, improve patients’ balance and walking ability, and contribute to patients’ motor function recovery and self-care ability improvement.

Effects of paired associative magnetic stimulation between nerve root and cortex on motor function of lower limbs after spinal cord injury: study protocol for a randomized controlled trial.

Classic paired associative stimulation can improve synaptic plasticity, as demonstrated by animal experiments and human clinical trials in spinal cord injury patients. Paired associative magnetic stimulation (dual-target peripheral and central magnetic stimulation) has been shown to promote neurologic recovery after stroke. However, it remains unclear whether paired associative magnetic stimulation can promote recovery of lower limb motor dysfunction after spinal cord injury. We hypothesize that the current caused by central and peripheral magnetic stimulation will converge at the synapse, which will promote synapse function and improve the motor function of the relevant muscles. Therefore, this study aimed to examine the effects of paired associative magnetic stimulation on neural circuit activation by measuring changes in motor evoked and somatosensory evoked potentials, motor and sensory function of the lower limbs, functional health and activities of daily living, and depression in patients with spinal cord injury. We will recruit 110 thoracic spinal trauma patients treated in the Department of Spinal Cord Injury, China Rehabilitation Hospital and randomly assign them to experimental and control groups in a 1:1 ratio. The trial group (n = 55) will be treated with paired associative magnetic stimulation and conventional rehabilitation treatment. The control group (n = 55) will be treated with sham stimulation and conventional rehabilitation treatment. Outcomes will be measured at four time points: baseline and 4, 12, and 24 weeks after the start of intervention (active or sham paired associative magnetic stimulation). The primary outcome measure of this trial is change in lower limb American Spinal Injury Association Impairment Scale motor function score from baseline to last follow-up. Secondary outcome measures include changes in lower limb American Spinal Injury Association sensory function score, motor evoked potentials, sensory evoked potentials, modified Ashworth scale score, Maslach Burnout Inventory score, and Hamilton Depression Scale score over time. Motor evoked potential latency reflects corticospinal tract transmission time, while amplitude reflects recruitment ability; both measures can help elucidate the mechanism underlying the effect of paired associative magnetic stimulation on synaptic efficiency. Adverse events will be recorded. Findings from this trial will help to indicate whether paired associative magnetic stimulation (1) promotes recovery of lower limb sensory and motor function, reduces spasticity, and improves quality of life; (2) promotes neurologic recovery by increasing excitability of spinal cord motor neurons and stimulating synaptic plasticity; and (3) improves rehabilitation outcome in patients with spinal cord injury. Recruitment for this trial began in April 2021 and is currently ongoing. It was approved by the Ethics Committee of Yangzhi Affiliated Rehabilitation Hospital of Tongji University, China (approval No. YZ2020-018) on May 18, 2020. The study protocol was registered in the Chinese Clinical Trial Registry (registration number: ChiCTR2100044794) on March 27, 2021 (protocol version 1.0). This trial will be completed in April 2022.