Recovery Of Limb Function Research Articles

Impaired Limb Functional Outcome of Peripheral Nerve Regeneration Is Marked by Incomplete Recovery of Paw Muscle Atrophy and Brain Functional Connectivity in a Rat Forearm Nerve Repair Model.

Skilled sensorimotor deficit is an unsolved problem of peripheral nerve injury (PNI) led by limb trauma or malignancies, despite the improvements in surgical techniques of peripheral nerve anastomosis. It is now accepted that successful functional recovery of PNI relies tremendously on the multilevel neural plasticity from the muscle to the brain. However, animal models that recapitulate these processes are still lacking. In this report, we developed a rat model of PNI to longitudinally assess peripheral muscle reinnervation and brain functional reorganization using noninvasive imaging technology. Based on such model, we compared the longitudinal changes of the rat forepaw intrinsic muscle volume and the seed-based functional connectivity of the sensorimotor cortex after nerve repair. We found that the improvement of skilled limb function and the recovery of paw intrinsic muscle following nerve regeneration are incomplete, which correlated with the functional connectivity between the primary motor cortex and dorsal striatum. Our results were highly relevant to the clinical observations and provided a framework for future investigations that aim to study the peripheral central sensorimotor circuitry underlying skilled limb function recovery after PNI.

Effect of Self-Controlled Exercise on Antioxidant Activity of Red Blood Cells and Functional Recovery of Limbs in Patients with Breast Cancer after Rehabilitation.

Background:We aimed to investigate the effect of self-controlled exercise on the antioxidant activity of red blood cells and the recovery of limb function in patients with breast cancer after rehabilitation.Methods:Overall 130 breast cancer patients admitted to the First Affiliated Hospital of Zhengzhou University, China from Feb 2018 to Jan 2019 were divided into intervention group and control group. The control group received perioperative care and chemotherapy, the intervention group implemented a self-controlled exercise program. Indexes were compared between the two groups before intervention, 3 months and 6 months after intervention.Results:The activity of erythrocyte superoxide dismutase (SOD) in the intervention group was significantly increased in the first 3 months (P=0.030), and decreased from 3rd to 6th month (P=0.033). The glutathione peroxidase (GSH-Px) activity in the intervention group increased through the whole intervention period. The plasma malondialdehyde (MDA) in the intervention group was significantly decreased (P=0.029, 0.012). After intervention for 3 months and 6 months, the 6MND distances in the intervention group were significantly longer (P=0.001, 0.045). The average exercise time in the intervention group were significantly increased (P=0.004, 0.000).Conclusion:Self-controlled exercise can effectively improve the antioxidant ability of red blood cells in patients with breast cancer, improve the mobility of shoulder joints of the affected side and increase their exercise capacity, with good sustainability. It has positive effect on postoperative rehabilitation, could be used in long-term regular clinical work.

The results of polypropylene mesh application at anterior cruciate ligament reconstruction

Anterior cruciate ligament (ACL) repair remains one of the most common surgeries in orthopedics and traumatology. The evolution of the ACL repair technique continues, new fixators appear, and the position of the graft, its shape and size are modified. Semi-tendon and gracilis muscle (STG) grafts are the most common used due to low-trauma and technically simple method of obtaining. Its disadvantage is a long period of intratunnel incorporation, one of the ways of this acceleration is the implantation of a polypropylene mesh. In an experiment on rabbits, we proved its positive effect. Objective. To develop a method of improving the intratunnel incorporation of STG-graft at ACL repair of the knee joint using polypropylene mesh. Methods. Results of 75 patients were analyzed. The study group consisted of 35 patients who underwent surgery during 2018–2019 using polypropylene mesh, comparative group — 40 patients who had surgical treatment in 2017. Evaluated demographic data, pre-operation period, recovery functions, complications rate, data of KOOS and IKDC scales. Results. Non-specific data of the inflammatory process (CRP and ESR) did not change significantly in patients with inserted polypropylene mesh. They did not have more pronounced pain after surgery, there were less cases of reactive synovitis with significantly minimized the number of the knee joint punctures. Restorationof knee function was faster, and early weight bearing of the leg allowed up to 6 months. Better results by the KOOS and IKDC scales received after surgery. Conclusions. Implantation of polypropylene mesh around the intratunnel part of STG-graft at ACL repair surgery did not increase the complications rate and allowed to improve the dynamics of limb function recovery up to 6 months after surgery.

Case series and finite element analysis of PFNA combined with cerclage wire for treatment of subtrochanteric fracture of femur

ObjectiveTo retrospectively analyze the clinical efficacy of PFNA combined with a cerclage wire in the treatment of 52 patients with unstable subtrochanteric fracture of the femur and to analyze the biomechanical effect of ligature on a fracture model.MethodsIn this study, 52 patients with unstable subtrochanteric fractures were treated in our orthopedic trauma center from June 2013 to July 2018. The Seinsheimer type IV fracture model was established using the patient’s CT data, and the joint surface of the distal femoral condyle and the external condyle were restrained. The femoral head was used as the loading point, and a force of 500 N was applied vertically along the long axis of the femoral shaft.ResultsAll 52 patients were followed up for 12 to 37 months, with an average of 18.07 ± 4.38 months. According to the Sanders hip function score, 28 cases were excellent (55–60 points), 22 cases were good (45–54 points), and 2 cases were poor (35–44 points), with an excellent and good rate of 96.15%. Postoperative deep vein thrombosis occurred in 3 cases, and fracture nonunion occurred in 1 case. No infection, loose fracture of internal fixation or hip varus deformity occurred. The finite element analysis indicated that the displacement of the whole model decreased slightly and the relative sliding of the fracture block decreased, but the maximum stress of the femur increased after the addition of the cerclage wire.ConclusionThe treatment of unstable subtrochanteric fracture of the femur with PFNA combined with cerclage wire has the advantages of simple operation, satisfactory reduction of fracture, stable fixation, and good recovery of limb function. The finite element analysis suggested that the biomechanical strength fixation was enhanced after the addition of cerclage wire. However, the local stress concentration of the tie may increase the risk of failure.

Impact of shoulder subluxation on peripheral nerve conduction and function of hemiplegic upper extremity in stroke patients: A retrospective, matched-pair study

ABSTRACT Purpose: To investigate the impact of shoulder subluxation (SS) on peripheral nerve conduction and function of the hemiplegic upper extremity (HUE) in poststroke patients. Methods: Thirty post-stroke patients were selected (SS group: 15 patients, non-SS group: 15 patients, respectively). Evaluation of nerve conduction in upper limbs: the compound muscle action potential (CMAP) amplitude and latency of suprascapular, axillary, musculocutaneous, radial, median, and ulnar nerves; the motor and sensory conduction velocity and the sensory nerve action potential (SNAP) amplitude of median, ulnar, and radial nerves. The Brunnstrom stage scale was used to evaluate the HUE motor function. Results: Compared with the healthy side, the CMAP and SNAP amplitudes of tested nerves on the HUE in both groups were lower, and the CMAP latency of the suprascapular, axillary and musculocutaneous nerves on the HUE in the SS group was longer (P < 0.05). Compared with the HUE in non-SS group, the CMAP amplitude of tested nerves (except ulnar) was decreased more (P < 0.05), the motor conduction velocity of the median nerve was lower (P < 0.05), and the Brunnstrom stage of the HUE was lower in SS group (P < 0.05). Conclusions: Stroke may lead to extensive abnormal nerve conduction on the HUE, and SS may aggravate the abnormality, which may disturb the recovery of upper limb function.

Влияние когнитивных нарушений на восстановление функции руки после лакунарного инсульта

The purpose of this study was to evaluate impact of cognitive impairments on the upper limb function recovery after acute lacunar stroke (LS). Material and methods. 139 patients (aged from 35 to 80 y. o.) with acute LS were examined. Along with the clinical and neurological examination, an upper limb function was evaluated by Action Research Arm Test and 9-Hole Peg Test, a study of cognitive status was made using the Montreal Cognitive Assessment (МоСа) and Frontal Assessment Battery (FAB). Results. Impaired upper limb function was revealed in 79% of patients with LS. After 2 weeks of acute period of LS, a significant improvement or the complete recovery of the upper limb function was observed in 81%. Moderate/severe executive dysfunction (FAB &lt; 15 points) was defined in 65% of patients with LS and upper limb dysfunction. Moderate/severe cognitive impairments (МоСа &lt; 26 points) were revealed in almost 55% of patients. In acute period of LS, the negative prognostic factor for complete recovery or significant improvement of the arm function was the presence of moderate/severe executive dysfunction (OR 3.89; 95% CI 1.07-14.19; p = 0.04) and general cognitive deficit (OR 3.27; 95% CI 1.10-9.70; p = 0.03). Conclusions. Cognitive impairments including executive disorders may affect the upper limb function recovery in acute period of LS. The data obtained can be used for the development of personalized rehabilitation programs for these patients.

Function of the Upper Member in Stroke

Modern physical therapy is based on the idea that function governs the organ. This aspect can explain why the main activity of the hand is gripping and grasping and the main function of the foot is walking. The upper limbs use the movement in an open kinematic chain and have a very large representation at the central level, while the lower limbs work in a closed kinematic chain. We continue to face limitations in the recovery and interdisciplinary recovery of upper limb function in stroke, even though we currently have sufficient scientific evidence and therapeutic ways to stimulate healing. The research aims to identify whether a person suffering from an ischemic stroke can change the function of the affected upper limb three months after the accident by starting or continuing the recovery program until the patient leaves the acute phase.

Brachial plexus trauma: contralateral C7 transfer evaluation

Background and aim Root avulsion injury of brachial plexus is a serious injury. Many attempts have been made regarding contralateral transfer of C7 to restore hand function. We designed this work to evaluate efficacy of contralateral C7 (CC7) transfer in the management of avulsion root injury. Patients and methods Between 2015 and 2018, 11 patients with avulsion root injury were enrolled in the study. All of them were males. After the procedure, those patients were followed for at least 2 years to assess the effect of transfer on healthy limb function, sensory and motor recovery of the recipient nerves in the affected limb, and coordination between the healthy and affected limbs. Results It was noticed that three patients had finger and wrist flexion grade 3, whereas seven patients had flexion grade 2 and only one patient demonstrated grade 0. According to hand sensation recovery, nine patients of the group showed S2 recovery and two patients showed S1. All 11 patients included in this study have achieved good results by Elbow Mayo score system, in spite of only three patients achieving satisfactory result by Gilbert shoulder system score and eight patients had fair results. Conclusion Transfer of CC7 (total CC7 transfer) with direct repair for reconstructing limb function was? significantly better than CC7 transfer with graft.

Upper limb motor and functional recovery in patients with tetraplegia

To study the recovery of the upper limb motor function and functional independence in patients with cervical spinal cord injury. The study included 49 patients with subacute tetraplegia, mean age 33±14.8 years, 42 men and 7 women, admitted to the Preodolenie Rehabilitation Center. The follow-up was up to 2 years. The clinical and functional states were assessed after 3, 6, 12 and more than 12 months after spinal injury, using the ASIA neurological standard scale, the motor subscale of Functional Independence Scale (FIM) and short form of Van Lieshout Test (VLT). All patients received continuous rehabilitation courses that included physiotherapy, occupational therapy, social support, psychological rehabilitation. Upper limb motor recovery occurred in the first 6 months after spinal cord injury at 5±3.9 points (ASIA), while in 49% patients motor level decreased by one segment of the spinal cord, in 8% patients completeness of spinal cord injury improved. The improvement of functional independence was found during the first 12 months: according to FIM, in the period of 3-6 months by 18±11.1 points, in the period of 6-12 months by 8±8.1 points; according to VLT in the period of 3-6 months by 19±14.4 points, in the period of 6-12 months by 5.6±6.02 points. Upper limb motor recovery mostly occurs in the first 6 months while the functional independence improvement lasts during the first 12 months after a spinal cord injury.

Comparison of Repetitive Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation on Upper Limb Recovery Among Patients With Recent Stroke.

ObjectiveTo compare the efficacy of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) on upper limb function recovery among patients who recently had stroke.MethodsSubjects with recent stroke (within 1 month) were randomized to rTMS (n=25) and tDCS (n=26) applied over the non-lesioned hemisphere for three sessions per week, followed by tailored upper limb rehabilitation training for a total of 2 weeks. The primary outcomes were changes in the Motor Assessment Scale (MAS), Fugl-Meyer arm score test, Nine-Hole Peg Test (9HPT), hand grip strength, and modified Barthel Index at weeks 2 and 4. Both therapists responsible for training and assessment were blinded to the intervention allocated.ResultsThere was an improvement in all the motor performance scales among both groups (p<0.001). These improvements persisted at discharge. However, there was no significant difference in any of the assessment scales between the two groups. The rTMS group showed a statistically non-significant greater improvement in MAS, 9HPT, and handgrip strength than the tDCS group.ConclusionBoth interventions produce a statistically significant improvement in upper limb function. There was no statistically significant difference between the two intervention methods with respect to motor performance. It is suggested that a larger study may help to clarify the superiority of either methods.

Relationship between lower limb function and functional connectivity assessed by EEG among motor-related areas after stroke

ABSTRACT Background: Neural connectivity in brain has been known as indicators for neural function and recovery of brain. Although previous studies reported that neural connectivity predicted the recovery of upper limb function after stroke, the relationship between neural connectivity and lower limb function has not been clear. Objectives: To clarify whether functional connectivity (FC) assessed by electroencephalographiy (EEG) with five electrodes placed on motor-related areas could be related to the functional motor recovery of the lower limbs in patients after stroke. Methods: Twenty-four patients with stroke during the recovery phase were recruited. Motor function of the lower limbs was assessed using Fugl-Meyer Assessment lower limb section (FMAL). EEG signals were recorded by five electrodes (C3, C4, FC3, FC4, and FCz) at rest and during ankle movement. Amplitude envelope correlations, as values for FC, were calculated in α (8–12 Hz), β (13–30 Hz), low-β (13–19 Hz), and high-β (20–30 Hz) frequency bands. The predictive regression equation of the FMAL score in the eighth week after stroke (8 W) was created by FCs in the fourth week (4 W). Results: The higher intra-hemispheric FC in both hemispheres in the resting state and during the ankle movement at 4 W was related to a higher lower limb function at 8 W. Additionally, the higher inter-hemispheric FC between M1 on both sides during the ankle movement was related to a higher function recovery. Conclusions: The intra- and inter-hemispheric FC among motor-related areas at 4 W after stroke might be related to the functional recovery of the lower limbs at 8 W.

Robot-assisted training compared with an enhanced upper limb therapy programme and with usual care for upper limb functional limitation after stroke: the RATULS three-group RCT.

Loss of arm function is common after stroke. Robot-assisted training may improve arm outcomes. The objectives were to determine the clinical effectiveness and cost-effectiveness of robot-assisted training, compared with an enhanced upper limb therapy programme and with usual care. This was a pragmatic, observer-blind, multicentre randomised controlled trial with embedded health economic and process evaluations. The trial was set in four NHS trial centres. Patients with moderate or severe upper limb functional limitation, between 1 week and 5 years following first stroke, were recruited. Robot-assisted training using the Massachusetts Institute of Technology-Manus robotic gym system (InMotion commercial version, Interactive Motion Technologies, Inc., Watertown, MA, USA), an enhanced upper limb therapy programme comprising repetitive functional task practice, and usual care. The primary outcome was upper limb functional recovery 'success' (assessed using the Action Research Arm Test) at 3 months. Secondary outcomes at 3 and 6 months were the Action Research Arm Test results, upper limb impairment (measured using the Fugl-Meyer Assessment), activities of daily living (measured using the Barthel Activities of Daily Living Index), quality of life (measured using the Stroke Impact Scale), resource use costs and quality-adjusted life-years. A total of 770 participants were randomised (robot-assisted training, n = 257; enhanced upper limb therapy, n = 259; usual care, n = 254). Upper limb functional recovery 'success' was achieved in the robot-assisted training [103/232 (44%)], enhanced upper limb therapy [118/234 (50%)] and usual care groups [85/203 (42%)]. These differences were not statistically significant; the adjusted odds ratios were as follows: robot-assisted training versus usual care, 1.2 (98.33% confidence interval 0.7 to 2.0); enhanced upper limb therapy versus usual care, 1.5 (98.33% confidence interval 0.9 to 2.5); and robot-assisted training versus enhanced upper limb therapy, 0.8 (98.33% confidence interval 0.5 to 1.3). The robot-assisted training group had less upper limb impairment (as measured by the Fugl-Meyer Assessment motor subscale) than the usual care group at 3 and 6 months. The enhanced upper limb therapy group had less upper limb impairment (as measured by the Fugl-Meyer Assessment motor subscale), better mobility (as measured by the Stroke Impact Scale mobility domain) and better performance in activities of daily living (as measured by the Stroke Impact Scale activities of daily living domain) than the usual care group, at 3 months. The robot-assisted training group performed less well in activities of daily living (as measured by the Stroke Impact Scale activities of daily living domain) than the enhanced upper limb therapy group at 3 months. No other differences were clinically important and statistically significant. Participants found the robot-assisted training and the enhanced upper limb therapy group programmes acceptable. Neither intervention, as provided in this trial, was cost-effective at current National Institute for Health and Care Excellence willingness-to-pay thresholds for a quality-adjusted life-year. Robot-assisted training did not improve upper limb function compared with usual care. Although robot-assisted training improved upper limb impairment, this did not translate into improvements in other outcomes. Enhanced upper limb therapy resulted in potentially important improvements on upper limb impairment, in performance of activities of daily living, and in mobility. Neither intervention was cost-effective. Further research is needed to find ways to translate the improvements in upper limb impairment seen with robot-assisted training into improvements in upper limb function and activities of daily living. Innovations to make rehabilitation programmes more cost-effective are required. Pragmatic inclusion criteria led to the recruitment of some participants with little prospect of recovery. The attrition rate was higher in the usual care group than in the robot-assisted training or enhanced upper limb therapy groups, and differential attrition is a potential source of bias. Obtaining accurate information about the usual care that participants were receiving was a challenge. Current Controlled Trials ISRCTN69371850. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 54. See the NIHR Journals Library website for further project information.

The Effect of High Frequency Repetitive Transcranial Magnetic Stimulation Combined with Treadmill Training on the Recovery of Lower Limb Function in Chronic Stroke Patients: A Randomized Controlled Trial

This study was conducted to investigate the effects of high frequency repetitive transcranial magnetic stimulation (rTMS) combined with treadmill training on recovery of lower limb function in chronic stroke patients. 13 subjects were randomly assigned to 7 in the experimental group and 6 in the control group. The experimental group was applied 5 Hz high frequency rTMS of 15 minutes and treadmill training of 20 minutes, and the control group was applied sham rTMS of 15 minutes and treadmill training of 20 minutes per day, 5 times a week for a total of 4 weeks. The subjects were assessed for gait speed by 10-meter walk test (10MWT), gait endurance by 6-minute walk test (6MWT) and ability of dynamic stability by Timed up and go test (TUG). A significant improvement in 10MWT, 6MWT and TUG was observed after intervention in the experimental group (p 0.05), and there was a significant improvement in all evaluation items compared to the control group (p 0.05). The results of this study suggest that high frequency rTMS applied to primary motor cortex (M1) combined with treadmill training has a positive effect on the recovery of lower limb function in chronic stroke patients.

Ruptura isolada de menisco lateral em cão –relato de caso

Menisci are important intra-articular structures whose main function is attributed to load transmission and impact absorption, reducing biomechanical stress and providing greater osteoarticular stability. In dogs, knee-related disorders are described as the main causes of claudication. This report aims to describe a case of lateral meniscal lesion in a canine without signs of femorotibiopatellar instability, whose main change was claudication. The diagnosis was confirmed through orthopedic evaluation and magnetic resonance imaging, in which an anechogenic line of dissolution of meniscal continuity and intact ligament structures was visualized. As a treatment, the technique of total meniscectomy was chosen, which allowed the recovery of limb function and absence of clinical manifestations. &nbsp

Application and Effect of the Gymnastic Exercise Mode during Chemotherapy for Breast Cancer Patients

Breast cancer is one of the most common malignant tumors in women, which seriously threatens the health of women. With the improvement of living standards, the incidence rate of breast cancer is also rising. In the past ten years, the incidence rate of breast cancer in China’s major cities has increased by 37%, far higher than that in Europe and America. At present, chemotherapy and radiotherapy are the main treatment methods for breast cancer, but many patients will have cancer-related fatigue after surgery. Some studies believe that appropriate sports can improve cancer-related fatigue, but there is no specific research in this area. In view of this problem, this paper puts forward a rehabilitation training method based on gymnastics for breast cancer surgery. This paper is divided into three parts. The first part is the basic theory and core concept of breast cancer and cancer-related fatigue. Through the in-depth study of the theory, this paper believes that breast cancer patients paying attention to rehabilitation training can effectively improve cancer-related fatigue and affect the final therapeutic effect. The second part is the rehabilitation training program based on the way of gymnastics. The corresponding experimental model is established by using real cases as samples. In order to ensure the quality of the experiment, this paper gives the treatment plan in detail and establishes a unified evaluation system. In the third part of this paper, the relevant experiments and results analysis are given, and through data analysis, this paper believes that gymnastics can effectively help breast cancer patients with postoperative rehabilitation and continuous recovery of the upper limb function and improve cancer-related fatigue and other issues.

Therapeutic Effects of Diagonal-Transcranial Direct Current Stimulation on Functional Recovery in Acute Stroke: A Pilot Study

Background: Peak neurologic recovery from acute stroke occurs within the first 3 months, and continues at a slower pace for 6 months. Objective/Hypothesis: The aim of this pilot study is to clarify the safety and feasibility of multiple diagonal-transcranial direct current stimulation (d-tDCS) sessions up to 3 months with electrodes placed diagonally over the lesional dorsolateral prefrontal cortex and contralesional primary motor cortex for upper limb hemiparesis in acute stroke. Methods: Five patients with acute stroke (2 with intracerebral hemorrhage and 3 with cerebral infarction) with upper limb paresis participated. d-tDCS (1 mA, 20 min per day) combined with conventional rehabilitation was given starting 7–21 days after stroke onset. Each session consisted of 10 d-tDCS over 2 weeks and patients received 2 sessions in the acute phase and 2 sessions in the subacute phase for a total 40 treatments. Motor function was assessed using Fugl-Meyer Assessment for upper extremity (FMA-UE) before and after each session, and the period to achieve 70% of maximal potential recovery in FMA-UE was evaluated. Results: All 5 patients completed the intervention and showed no adverse effects throughout the protocol. Of these, 3 (60%) achieved 70% predicted scores within 2 months. Regarding therapeutic gains of FMA-UE in each of the 10 sessions in the acute phase, 4 sessions showed great recovery, 3 sessions showed moderate recovery, and 3 sessions showed poor recovery. Conclusion: These findings suggest that d-tDCS over 3 months may be safe and feasible for acute stroke patients in the acute to subacute phases and have therapeutic potential to promote recovery of upper limb function, although further randomized, double-blind, sham-controlled trial is warranted with larger sample size.

Effects of Virtual Reality Based Rehabilitation Therapy with Postural Correction Feedback on Recovery of Upper Limb Function and non Use in Patients with Chronic Stroke

Effects of Virtual Reality Based Rehabilitation Therapy with Postural Correction Feedback on Recovery of Upper Limb Function and non Use in Patients with Chronic Stroke

The Promotoer, a brain-computer interface-assisted intervention to promote upper limb functional motor recovery after stroke: a study protocol for a randomized controlled trial to test early and long-term efficacy and to identify determinants of response

BackgroundStroke is a leading cause of long-term disability. Cost-effective post-stroke rehabilitation programs for upper limb are critically needed. Brain-Computer Interfaces (BCIs) which enable the modulation of Electroencephalography (EEG) sensorimotor rhythms are promising tools to promote post-stroke recovery of upper limb motor function. The “Promotoer” study intends to boost the application of the EEG-based BCIs in clinical practice providing evidence for a short/long-term efficacy in enhancing post-stroke hand functional motor recovery and quantifiable indices of the participants response to a BCI-based intervention. To these aims, a longitudinal study will be performed in which subacute stroke participants will undergo a hand motor imagery (MI) training assisted by the Promotoer system, an EEG-based BCI system fully compliant with rehabilitation requirements.MethodsThis longitudinal 2-arm randomized controlled superiority trial will include 48 first ever, unilateral, subacute stroke participants, randomly assigned to 2 intervention groups: the BCI-assisted hand MI training and a hand MI training not supported by BCI. Both interventions are delivered (3 weekly session; 6 weeks) as add-on regimen to standard intensive rehabilitation. A multidimensional assessment will be performed at: randomization/pre-intervention, 48 h post-intervention, and at 1, 3 and 6 month/s after end of intervention. Primary outcome measure is the Fugl-Meyer Assessment (FMA, upper extremity) at 48 h post-intervention. Secondary outcome measures include: the upper extremity FMA at follow-up, the Modified Ashworth Scale, the Numeric Rating Scale for pain, the Action Research Arm Test, the National Institute of Health Stroke Scale, the Manual Muscle Test, all collected at the different timepoints as well as neurophysiological and neuroimaging measures.DiscussionWe expect the BCI-based rewarding of hand MI practice to promote long-lasting retention of the early induced improvement in hand motor outcome and also, this clinical improvement to be sustained by a long-lasting neuroplasticity changes harnessed by the BCI-based intervention. Furthermore, the longitudinal multidimensional assessment will address the selection of those stroke participants who best benefit of a BCI-assisted therapy, consistently advancing the transfer of BCIs to a best clinical practice.Trial registrationName of registry: BCI-assisted MI Intervention in Subacute Stroke (Promotoer).Trial registration number: NCT04353297; registration date on the ClinicalTrial.gov platform: April, 15/2020.

Beneficial Effects of Intrathecal Injection of Methylprednisolone Against Spinal Cord Injury in Rats

Background: High dose intravenous (i.t.) injection of methylprednisolone (MPSS) for spinal cord injury (SCI) is clinically controversial. Objectives: This study aimed to investigate whether i.t. MPSS would have a beneficial effect on SCI and whether or not it is a safe operation for SCI patients. Methods: An animal experiment was conducted to explore the safety and feasibility of i.t. Administration of MPSS. Male Sprague-Dawley rats were randomly divided into four groups: (1) sham group, i.t. injection of normal saline (NS) (n = 25); (2) control group, SCI surgery (created using the Infinite Horizon IH-400 impactor) with i.t. injection of NS (n = 25); (3) i.t. MPSS1 group, SCI with i.t. injection of MPSS by a pulse therapy (n = 25); (4) i.t. MPSS2 group, SCI with i.t. injection of MPSS intermittently (n = 25). Malondialdehyde (MDA), superoxide dismutase (SOD), and inflammatory cytokines in serum were measured at 6h, 24h, 48h, 7d, and 14d after surgery with commercial assay kits. Glial fibrillary acidic protein (GFAP) level was observed at 14 days after surgery by immunohistochemistry. Motor evoked potentials (MEP) and somatosensory evoked potential (SEP) were monitored and recorded separately before surgery and 1, 7, and 14 days after surgery. Also, locomotor function was evaluated using the Basso, Beattie, and Bresnahan (BBB) locomotor rating scale. Results: The results showed that the levels of MDA and SOD, and three inflammatory cytokines, including IL-1b, IL-6, and TNF-α were reduced in i.t. MPSS groups than that of the control group (all P &lt; 0.05). The expression of GFAP was inhibited after i.t. MPSS treatment. The amplitude was reduced, and the latency period of SEP and MEP recovery was prolonged (all P &lt; 0.05) after MPSS administration. In addition, the recovery of limb function (BBB score) was significantly ameliorated (P &lt; 0.05) in SCI rats treated with MPSS compared with the control group. Conclusions: Our results demonstrated that i.t. MPSS was a potential strategy for reducing the secondary damage after SCI, especially the MPSS pulse therapy.

Significance of Recovery of Limb Function After Surgical Revascularization in Chronic Limb-Threatening Ischemia

Wound healing and ambulation could be pivotal goals in treatment of chronic limb-threatening ischemia (CLTI). To show the impact these limb functions have on the patient’s prognosis, the wound-free ambulation (WFA) rate was evaluated as a new end point. Based on clinical outcomes of 187 patients (225 limbs) who underwent surgical revascularization for CLTI between January 2012 and December 2017 in a single center (74% diabetes and 50% dialysis), WFA, which was the end point to complete wound healing and achievement of ambulation after revascularization, was assessed. Significance of WFA in patients’ prognosis and factors associated with WFA were analyzed by the Cox proportional hazards model. WFA rate reached 52% at 3 months and 65% at 6 months after surgery. Wound, Ischemia, and foot Infection (WIfI) clinical stage did not alter patients’ survival rate in this series; however, WFA clearly stratified patients’ prognosis in CLTI. There was significant difference in 2-year survival rate between patients who achieved WFA and patients who did not (73% and 40%; P < .01). In particular, WFA was the strongest factor associated with postoperative patients’ prognosis. Multivariate analysis demonstrated four statistically significant predictors of WFA: heart failure (hazard ratio [HR], 0.48; 95% confidence interval [CI], 0.32-0.70), low nutrition (serum albumin concentration <3.0 g/dL; HR, 0.64; 95% CI, 0.42-0.98), limb severity expressed by WIfI classification (HR, 0.16; 95% CI, 0.09-0.26), and loss of ambulation on CLTI onset (HR, 0.25; 95% CI, 0.16-0.40). Thus, WFA was a comprehensive factor including these multiple factors associated with patients’ survival rate in CLTI. Limb function expressed by WFA was related to postoperative patients’ prognosis after revascularization. Recovery of limb function after revascularization might be an important end point to extend a life prognosis of CLTI patients.