Recovery Of Limb Function Research Articles

Effects of non-invasive brain stimulation for upper limb rehabilitation in acute stroke patients - A controlled clinical trial

This study was conducted in Tuen Mun Hospital (TMH) to evaluate the effects of rTMS and tDCS on upper limb functional recovery in acute stroke patients. Patients with acute stroke were randomly assigned to rTMS, tDCS or control group. For rTMS group, patient received 1 Hz rTMS at 90% of resting motor threshold to M1 of the unaffected hemisphere for 1200 pulses. For tDCS group, patient received 1 mA anodal stimulation to hand area of the affected hemisphere for 20 minutes. Five consecutive sessions of rTMS or tDCS together with intensive physiotherapy upper limb training were given. For control group, only intensive physiotherapy upper limb training were given. The upper extremity section of Fugl–Meyer Scale (UE-FM) was used as outcome measure. Twenty-nine patients (17 female and 12 male) were assigned to the rTMS ( n = 9), tDCS ( n = 11) and control ( n = 9) group. The mean age was 62.7 ± 12.0 years old and the mean time between stroke onset and the first UE-FM assessment was 9.14 ± 3.30 days. There was no statistically significant difference in mean age, baseline UE-FM mean score, mean time between stroke onset and the first UE-FM assessment among three groups [X 2 (2) = 4.81, P = 0.09] [X 2 (2) = 1.56, P = 0.457] [X 2 (2) = 0.04, P = 0.98]. No adverse effects of rTMS or tDCS were reported. For between-group comparison, the changes in mean score of UE-FM in rTMS (20.8 ± 6.59) and tDCS group (16.1 ± 4.97) were statistically significantly larger than that in control group (10.6 ± 4.13) (U = −2.97, P = 0.002) (U = −2.29, P = 0.02). However, there was no significant difference between rTMS and tDCS group (U = −1.49, P = 0.152). Findings of the present study showed that both rTMS and tDCS could augment physiotherapy treatment in enhancing upper limb motor functional recovery in acute stroke patients. These positive findings warrant further investigation of the application of non-invasive brain stimulation techniques to neurorehabilitation.

Effects of robot-assisted training on upper limb functional recovery during the rehabilitation of poststroke patients.

The study aims to determine the effectiveness of robot-assisted training in the recovery of stroke-affected arms using an exoskeleton robot Armeo Spring. To identify the effect of robot training on functional recovery of the arm. A total of 34 stroke patients were divided into either an experimental group (EG; n= 17) or a control group (n= 17). EG was also trained to use the Armeo Spring during occupational therapy. Both groups were clinically assessed before and after treatment. Statistical comparison methods (i.e. one-tailed t-tests for differences between two independent means and the simplest test) were conducted to compare motor recovery using robot-assisted training or conventional therapy. Patients assigned to the EG showed a statistically significant improvement in upper extremity motor function when compared to the CG by FIM (P< 0.05) and ACER (P< 0.05). The calculated treatment effect in the EG and CG was meaningful for shoulder and elbow kinematic parameters. The findings show the benefits of robot therapy in two areas of functional recovery. Task-oriented robotic training in rehabilitation setting facilitates recovery not only of the motor function of the paretic arm but also of the cognitive abilities in stroke patients.

Using tDCS as an Add-On Treatment Prior to FES Therapy in Improving Upper Limb Function in Severe Chronic Stroke Patients: A Randomized Controlled Study.

Background: Upper limb function recovery is of vital importance for stroke patients. However, it is difficult to get ideal recovery, especially for patients with severe chronic stroke. As the first randomized controlled long-term trial combining bilateral transcranial direct current stimulation (tDCS) and functional electrical stimulation (FES) therapy, this study examined the efficacy of a novel protocol that included applying tDCS as an add-on treatment prior to FES therapy over the course of a 4-week program.Methods: Thirty subjects with severe chronic stroke were randomized to either Group A (active tDCS+FES) (N = 15) or Group B (sham tDCS+FES) (N = 15). Five assessments including 3 behavioral outcome measurement scales [the Fugl-Meyer scale (cFMA), the Wolf motor function test (WMFT) and the modified Ashworth scale (MAS)], the surface electromyography (sEMG) evaluation and the transcranial magnetic stimulation (TMS) assessment were performed to evaluate subjects before and after the overall therapy.Results: In Group A, the combined protocol was well tolerated by all patients and induced significant improvements in upper extremity motor abilities in terms of the assessments of cFMA [t(14) = −5.658, p < 0.05], WMFT [t(14) = −3.746, p < 0.05], MAS [t(14) = 5.236, p < 0.05], sEMG and TMS. The results of between-group comparisons showed there was a significant difference between Group A and Group B in terms of the assessments of cFMA [t(28) = 2.223, p < 0.05], WMFT [t(28) = −2.152, p < 0.05] and sEMG [F(1, 196) = 0.918, p < 0.05].Conclusion: The proposed protocol can facilitate improvements in upper extremity motor abilities in severe chronic stroke patients and is more beneficial than the protocol with FES therapy alone. Our results showed efficacy of the new paradigm with combined intervention in both the central nervous system and the peripheral nervous system.Trial registration: ChiCTR-ICR-15006108

Synergistic effect of acupuncture and mirror therapy on post-stroke upper limb dysfunction: a study protocol for a randomized controlled trial

BackgroundUpper limb dysfunction is common after stroke, posing an important challenge for post-stroke rehabilitation. The clinical efficacy of acupuncture for the recovery of post-stroke upper limb function has been previously demonstrated. Mirror therapy (MT) has also been found to be effective. However, the effects of acupuncture and MT have not been systematically compared. This trial aims to elucidate the synergistic effects of acupuncture and MT on upper limb dysfunction after stroke.MethodsA 2 × 2 factorial randomized controlled trial will be conducted at the rehabilitation hospitals affiliated with Fujian University of Traditional Chinese Medicine. A total of 136 eligible subjects will be randomly divided into acupuncture treatment (AT), MT, combined treatment, and control groups in a 1:1:1:1 ratio. All subjects will receive conventional treatment. The interventions will be performed 5 days per week for 4 weeks. AT, MT, and combined treatment will be performed for 30 min per day (combined treatment: AT 15 min + MT 15 min). The primary outcomes in this study will be the mean change in scores on both the FMA and WMFT from baseline to 4 weeks intervention and at 12 weeks follow-up between the two groups and within groups. The secondary outcomes are the mean change in the scores on the Visual Analogue Scale, Stroke Impact Scale, and modified Barthel index. Medical abstraction of adverse events will be assessed at each visit.DiscussionThe results of this trial will demonstrate the synergistic effect of acupuncture and MT on upper limb motor dysfunction after stroke. In addition, whether AT and MT, either combined or alone, are more effective than the conventional treatment in the management of post-stroke upper limb dysfunction will also be determined.Trial registrationChinese Clinical Trial Registry: ChiCTR-IOR-17011118. Registered on April 11, 2017. Version number: 01.2016.09.1.

Treatment of multi-segment fracture of complex femoral shaft with instrument-assisted reduction combined with intramedullary interlocking nail fixation

To investigate the effect of minimally invasive mini-incision and instrumented reduction combined with interlocking intramedullary nailing in the treatment of patients with multi-segment fracture of complex femoral shaft. From January 2013 to January 2016, 32 patients with multiple fractures segments of femoral shaft were treated with instrumentation-assisted reduction combined with interlocking intramedullary nailing, including 22 males and 10 females with an average age of 45 years old ranging 17 to 68 years old. The time from injured to operation was 5 to 10 days with an average of 7 days. After admission, routine tibial tubercle or supracondylar bone traction was performed. The patient's general condition was evaluated, the operation time and intraoperative blood loss were recorded. According to Thorsen femoral fracture morphology evaluation criteria and Hohl knee function evaluation of postoperative efficacy, postoperative fracture healing, complications and postoperative recovery of limb function were observed. All patients were followed up for 6 to 24 months with an average of 12 months. The operative time ranged from 48 to 76 minutes with an average of 67 min. The intraoperative blood loss was 150 to 400 ml with an average of 220 ml. The surgical incisions all achieved grade A healing. The fractures reached the clinical standard of healing. The fracture healing time ranged from 4.2 to 10.8 months with an average of 5.7 months. There were no nonunion, incision infection and internal fixation fracture, failure and other complications. According to Thorsen femoral fracture morphology evaluation criteria, the result was excellent in 28 cases, good in 3 cases, fair in 1 case. According to Hohl knee function evaluation criteria, the result was excellent in 30 cases, good in 2 cases. Instrument-assisted reduction combined with interlocking intramedullary nail fixation is a safe and effective method for the treatment of complex femoral shaft fractures. It has advantages of small trauma, fixed fixation, quick recovery, early postoperative functional exercise.

Acute intermittent hypoxia and rehabilitative training following cervical spinal injury alters neuronal hypoxia- and plasticity-associated protein expression.

One of the most promising approaches to improve recovery after spinal cord injury (SCI) is the augmentation of spontaneously occurring plasticity in uninjured neural pathways. Acute intermittent hypoxia (AIH, brief exposures to reduced O2 levels alternating with normal O2 levels) initiates plasticity in respiratory systems and has been shown to improve recovery in respiratory and non-respiratory spinal systems after SCI in experimental animals and humans. Although the mechanism by which AIH elicits its effects after SCI are not well understood, AIH is known to alter protein expression in spinal neurons in uninjured animals. Here, we examine hypoxia- and plasticity-related protein expression using immunofluorescence in spinal neurons in SCI rats that were treated with AIH combined with motor training, a protocol which has been demonstrated to improve recovery of forelimb function in this lesion model. Specifically, we assessed protein expression in spinal neurons from animals with incomplete cervical SCI which were exposed to AIH treatment + motor training either for 1 or 7 days. AIH treatment consisted of 10 episodes of AIH: (5 min 11% O2: 5 min 21% O2) for 7 days beginning at 4 weeks post-SCI. Both 1 or 7 days of AIH treatment + motor training resulted in significantly increased expression of the transcription factor hypoxia-inducible factor-1α (HIF-1α) relative to normoxia-treated controls, in neurons both proximal (cervical) and remote (lumbar) to the SCI. All other markers examined were significantly elevated in the 7 day AIH + motor training group only, at both cervical and lumbar levels. These markers included vascular endothelial growth factor (VEGF), brain-derived neurotrophic factor (BDNF), and phosphorylated and nonphosphorylated forms of the BDNF receptor tropomyosin-related kinase B (TrkB). In summary, AIH induces plasticity at the cellular level after SCI by altering the expression of major plasticity- and hypoxia-related proteins at spinal regions proximal and remote to the SCI. These changes occur under the same AIH protocol which resulted in recovery of limb function in this animal model. Thus AIH, which induces plasticity in spinal circuitry, could also be an effective therapy to restore motor function after nervous system injury.

F69. Longitudinal follow-up of traumatic cauda equina/conus medullaris injuries – Neurological, neurophysiological and funsctional outcomes

Introduction Traumatic cauda equina/conus medullaris injuries lead to complex neurological syndromes that can compromise motor, sensory and autonomic functions of the lower limbs and pelvic organs. Some patients attain partial recovery of lower limb function and can accomplish independent ambulation. Standardized measures based on the neurological and functional evaluations are used to predict ambulation in spinal cord injuries. As distal spinal cord elements and cauda equina are composed mostly of peripheral nervous system structures, nerve conduction studies and electromyography (EMG), which are useful to quantify axonal loss, could help predict motor and functional outcomes. Methods 55 patients with trauma to the distal spinal cord due to thoracolumbar injuries, were submitted to a thoroughly evaluation in two distinct occasions - before the rehabilitation program (2–3 months after the injury) and after a long follow-up of at least 2 years. A longitudinal evaluation of neurological (ASIA/American Spinal Injury Association - Lower Extremity Motor Score-LEMS), functional (SCIM – Spinal Cord Independence Measure) and neurophysiological (EMG scores- EMGs) function was performed. The primary outcome was independent ambulation at the second year after the injury (SCIM item 12). A repeated-measures design with analysis of covariance (ANCOVA) was used to demonstrate the difference of pertinent parameters in the groups (complete X incomplete lesions) considering the baseline values, due to multiple confounders. Multiple regression and binary logistic regression analysis were used to determine the relevant importance of predictors. This work received local ethics board approval. Results From 55 patients (46 men, 18–53 years), 24 (43.6%) presented with an incomplete injury. Firearm injuries (63.6%) were the most frequent etiology, followed by motor vehicle accidents (20%) and falls (16.4%). There were no differences in demographic data between the groups (complete X incomplete injuries). All patients independently improved from motor function scores measured by LEMS and EMGs (p Conclusion The prognosis for neurological and functional recovery in traumatic cauda equina/conus medullaris injuries seems to be related to injury extension and to the initial improvement in motor function. The improvement in LEMS and EMGs, that were significantly correlated, suggests that the recovery of motor function might be related mostly to potential regrowth and regeneration of spinal roots.

Osteossíntese com placa óssea em u ma macaca bugio-preto (Alouatta caraya)

The surgical treatment for the correction of fractures in wild animals requires the correct selection of the osteosynthesis method to be used, in such a way as to achieve the reduction and stabilization of the fracture focus, and an adequate evolution during the postoperative period. The purpose of this report was to describe and monitor bone healing in a tibiofibular oblique proximal diaphyseal fracture with a 2.7 mm bone plate implant in a female black howler monkey of the Alouatta caraya species. In the follow-up of the patient’s evolution, the radiographic images showed evidence of consolidation of both bones and stable fixation of the plate, providing early ambulation and complete recovery of limb function.

Effects of fixed-foot stance YunShou combine with raising handclasp of Bobath on the recovery of upper extremity function in post-stroke: a randomized controlled trial

Objective To explore the influence of fixed-foot stance Yunshou combined with raising handclasp of Bobath on the recovery of upper extremity in post- stroke patients with hemiplegia. Methods Meeting the criteria 59 cases of stroke patients with hemiplegia were randomly divided into experimental group (29 cases) and control group(30 cases) according to random number table.All the patients in both groups were received routine therapy and nursing,besides,the patients in the control group were given raising handclasp of Bobath,while the patients in experimental group were treated with fixed-foot stance Yunshou combined with raising handclasp of Bobath.The intervention were once a day,five days a week, lasting eight weeks. The Fugl-Meyer Assessment of Upper Extremity(FMA-UE) and Modified Barthel Index(MBI) as well as Simple Test for Evaluating Hand Function(STEF) were used to assess the patients′ condition before, 8 weeks after treatment respectively. Results After 8weeks intervention, the scores of FMA-UE, MBI, STEF were 40.69±8.67, 76.89±1.79, 59.31±7.89 and before intervention were 24.17±11.98,57.14±13.93,31.83±5.41, the difference between the experimental group before and after intervention was statistically significant (t=13.222,8.755,18.311, P 0.05). Conclusion Compared with training on raising handclasp of Bobath alone,fixed-foot stance Yunshou combined with raising handclasp of Bobath is more effective On the recovery of upper limb function in stroke patients with hemiplegia. Key words: Stroke; Tai Chi Yunshou; Bobath technology; Upper-extremity

Efficacy of reconstruction of thumb skin defect with dorsal index finger flap pedicled with radial digital proper artery

Objective To investigate the effect of dorsal index finger flap pedicled with radial digital proper artery for reconstruction of thumb skin defect. Methods A retrospective case series study was conducted on the clinical data of 78 patients with thumb skin defect admitted from August 2009 through September 2015. According to the treatment method, the patients were divided into Group A which adopted dorsal index finger flap pedicled with radial digital proper artery and Group B which adopted the conventional dorsal index finger flap for the reconstruction of thumb skin defect. Group A (n=47) comprised of 31 males and 16 females, aged averagely 29.6 years (range, 20-54 years), and Group B (n=31) comprised of 22 males and nine females, aged averagely 27.3 years (range, 19-55 years). The dimensions of skin defect were (9.02±0.45)cm2 in Group A and (7.15±0.72)cm2 in Group B. The cut flap area, operation time, postoperative visual analogue score (VAS), flap survival rate, two point discrimination recovery, and evaluation criteria of the upper limb function of the Chinese Medical Association (joint activity, shape, muscle strength, sensory recovery, sequelae, and work ability) were compared between Groups A and B. Results The cut flap area was (9.25±0.78)cm2 in Group A and (7.25±0.61)cm2 in Group B (P 0.05). The VAS was (7.40±0.36)points in Group A, and (6.33±0.47)in Group B (P>0.05). All flaps of Group A survived without any epidermal necrosis or bister, with the survival rate of 100%; while four cases of Group B had partial or total necrosis, with the survival rate of 87% (P<0.05). The two point discrimination was (6.33±1.41)mm in Group A, and (8.80±1.43)mm in Group B (P<0.05). According to the evaluation criteria of the upper limb function of the Chinese Medical Association, the results of Group A were excellent in 21 cases, good in 22, and poor in four, with the excellent and good rate of 92%; while the results of Group B were excellent in 14 cases, good in 8, poor in 5, and worst in 4, with the excellent and good rate of 71% (P<0.05). Conclusion Dorsal index finger flap pedicled with radial digital proper artery for the reconstruction of thumb skin defect is worthy of clinical practices, for the advantages of larger cut flap area, improved flap survival rate and quality, and better recovery of upper limb function. Key words: Hand injuries; Surgical flaps; Thumb

High frequency transcranial magnetic stimulation combined with mirror therapy improves upper limb motor function post-stroke

Objective To investigate the effect of repetitive transcranial magnetic stimulation (rTMS) combined with the mirror therapy (MT) on the recovery of upper limb function recovery 3 to 6 months after a stroke. Methods Forty-five male patients were randomly assigned to an MT (A) group, an rTMS+ MT (B) group or an MT+ rTMS group (C ), each of 15. All received conventional medical treatment and stroke rehabilitation. In addition, group A received 60 min of MT daily, 5 days a week for 4 weeks. Group B received 10 min of rTMS over the M1 area of the affected hemisphere followed by 50 min of MT treatment, and group C received 50 min of MT treatment followed by 10 min of rTMS. rTMS was delivered at a frequency of 10 Hz and an intensity of 90% resting motor threshold. The latency of motor evoked potential (MEP) for the affected abductor pollicis brevis muscle and its central motor conduction time (CMCT) were observed before and after the treatment. The upper extremity portion of the Fugl-Meyer assessment (FMA) was performed along with a functional test for the hemiplegic upper extremity (FTHUE). The motricity index (MI) was also quantified. Results Average MEP latency and CMCT had decreased significantly in all three groups after the treatments. The average MEP latency of group B was significantly shorter than that of group A, and CMCT was also significantly shorter than for groups A and C. Moreover, after the intervention, all of the groups had significantly improved their average FMA, MI and FTHUE scores, with the average FMA score of group B significantly better than those of groups A and C. The average FTHUE score of group B was also significantly better than that of group A. Conclusions MT either alone or in combination with rTMS can improve cerebral motor cortex excitability and motor recovery after a stroke. Ten minute rTMS sessions followed by 50 min of MT have the best effect. Key words: Transcranial magnetic stimulation; Mirror therapy; Upper limb motor function; Stroke

Effects of patterned peripheral nerve stimulation on soleus spinal motor neuron excitability.

Spinal plasticity is thought to contribute to sensorimotor recovery of limb function in several neurological disorders and can be experimentally induced in animals and humans using different stimulation protocols. In healthy individuals, electrical continuous Theta Burst Stimulation (TBS) of the median nerve has been shown to change spinal motoneuron excitability in the cervical spinal cord as indexed by a change in mean H-reflex amplitude in the flexor carpi radialis muscle. It is unknown whether continuous TBS of a peripheral nerve can also shift motoneuron excitability in the lower limb. In 26 healthy subjects, we examined the effects of electrical TBS given to the tibial nerve in the popliteal fossa on the excitability of lumbar spinal motoneurons as measured by H-reflex amplitude of the soleus muscle evoked by tibial nerve stimulation. Continuous TBS was given at 110% of H-reflex threshold intensity and compared to non-patterned regular electrical stimulation at 15 Hz. To disclose any pain-induced effects, we also tested the effects of TBS at individual sensory threshold. Moreover, in a subgroup of subjects we evaluated paired-pulse inhibition of H-reflex. Continuous TBS at 110% of H-reflex threshold intensity induced a short-term reduction of H-reflex amplitude. The other stimulation conditions produced no after effects. Paired-pulse H-reflex inhibition was not modulated by continuous TBS or non-patterned repetitive stimulation at 15 Hz. An effect of pain on the results obtained was discarded, since non-patterned 15 Hz stimulation at 110% HT led to pain scores similar to those induced by EcTBS at 110% HT, but was not able to induce any modulation of the H reflex amplitude. Together, the results provide first time evidence that peripheral continuous TBS induces a short-lasting change in the excitability of spinal motoneurons in lower limb circuitries. Future studies need to investigate how the TBS protocol can be optimized to produce a larger and longer effect on spinal cord physiology and whether this might be a useful intervention in patients with excessive excitability of the spinal motorneurons.

Clinical application of tibial composite saphenous nervetissue flap for the treatment of traumatic bone-skin defect of leg

To investigate the effect of tibial composite saphenous nerve tissue flap in repairing traumatic bone-skin defect of leg. From February 2009 to May 2015, 23 patients with focile skin defect caused by trauma were treated, including 18 males and 5 females, aged from 8 to 59 years old with an average age of 35.6 years old. Length of tibia bone cortex defect ranged from 4 to 12 cm, width ranged from 2 to 2.5cm, skin defect ranged from 8 cm× 3 cm to 18 cm× 11 cm, all the wound surfaces had purulent exudation. Cross shift and ipsilateral shift methods of tibial composite saphenous nerve tissue flap were used to reconstruct continuity of the injured limb tibial brace and repair wound surface. Cutting flap ranged from 9 cm× 4 cm to 20 cm × 12 cm, bone flap length was 6 to 15 cm, width was 1.5 to 2.5 cm. Fracture healing time and recovery of limb function were observed. At 3 to 5 months after operation, bone flap and area of affected area were healed with an average of 4.7 months. Twenty-three cases were followed up for 6 months to 5 years with an average of 30.3 months. Thirteen patients were able to walk without abnormal gait and could be engaged into original work. According to Enneking evaluation systems, 13 patients obtained excellent results, 8 moderate and 2 poor. With tibial composite saphenous nerve tissue flap transplantation at stage one to repair tibia and skin defects according to specific condition of affected limbs has a high rate of success and creates less damage to region of limb injury, which is an ideal method to repair skin defect of focile.

One-Step Prepectoral Breast Reconstruction With Dermal Matrix–Covered Implant Compared to Submuscular Implantation: Functional and Cost Evaluation

BackgroundThe breast reconstructive subpectoral technique commonly leads to functional consequences. Recently, a new conservative prepectoral breast reconstruction (PPBR) technique was proposed and its surgical safety and aesthetic effectiveness proved. The aim of this prospective nonrandomized study was to compare the functional and economical outcomes of the PPBR procedure versus the subpectoral one. Patients and MethodsFrom February 2015 to September 2016, 86 patients underwent mastectomy with immediate implant-based reconstruction. Thirty-nine patients were assigned to group 1 and received prepectoral acellular dermal matrix–wrapped implant reconstruction. The remaining 45 patients were assigned to group 2 and received a subpectoral implant or tissue expander. We recorded the operating time, length of hospital stay, analgesic consumption, postoperative pain, upper limb function, esthetic satisfaction, and quality of life. Additional surgical procedures for reconstruction completion or contralateral operation for symmetrization were also recorded. ResultsCompared to group 2 patients, group 1 patients showed less postoperative pain and faster upper limb functional recovery. Patients in group 1 also recorded a lower analgesic consumption and an earlier return to usual work. Moreover, the muscle-sparing technique improved aesthetic outcomes and largely reduced the need for symmetrization. ConclusionImmediate breast reconstruction by using prepectoral muscle-sparing acellular dermal matrix–wrapped implant resulted in lower pain intensity and significant upper limb functional advantages compared to submuscular implant placement. Furthermore, when considering a series of ascertained benefits, PPBR is also economically advantageous, although future studies should better define its cost-effectiveness.

Neonatal spinal injury induces de novo projections of primary afferents to the lumbosacral intermediolateral nucleus in rats

Complete spinal transection in adult rats results in poor recovery of hind limb function and severe urinary bladder dysfunction. Neonatal rats with spinal cord transection, however, exhibit spontaneous and significant recovery of micturition control. A previous study in which biotinylated-dextran amine (BDA) was used as an anterograde tracer demonstrated that primary afferent fibers from the fifth lumbar dorsal root ganglion (DRG) project more strongly and make more terminals in the ventral horn after neonatal spinal cord transection at the mid-thoracic level. In the present study, we injected BDA into the sixth lumbar (L6) DRG of neonatally spinalized rats to label primary afferent fibers that include visceral afferents. The labeled fibers projected to the intermediolateral nucleus (IML) in the intermediate zone on ipsilateral side of the L6 spinal segment, whereas no projections to the IML were observed in sham-operated or intact rats. The BDA-labeled fibers of neonatally spinalized rats formed varicose terminals on parasympathetic preganglionic neurons in the IML. These findings suggest that some primary afferent projections from the L6 DRG to the IML appear after neonatal spinal cord transection, and these de novo projections might contribute to the recovery of autonomic function such as micturition following spinal cord injury in the neonatal stage.

Effect of narrative nursing on disease adaptation outcome of patients with breast cancer

Objective To explore the effect of narrative nursing on disease adaptation outcome of patients with breast cancer such as posttraumatic growth, cancer-related fatigue, psychosocial adaptation, limb function and lymphedema. Methods From August 2015 to February 2016, 76 breast cancer patients of the First Affiliated Hospital of Harbin Medical University were selected as the research objects by convenient sampling method. All patients were divided into observation group and control group by random number table, 38 cases with each group. Patients in the control group were given routine breast cancer treatment and psychological care. On the basis of control group, patients in the observation group received the narrative nursing intervention. The posttraumatic growth rating scale (PTGI) , short fatigue scale (BFI) and disease psychosocial adaptation scale (PAIS-SR) were used to evaluate the disease adaptation condition of patients. The upper limb lymphedema and functional recovery were compared between two groups after intervention. Results The scores of interpersonal relationship, personal strength, mental change, appreciation of life and posttraumatic growth score were higher in the observation group than that in the control group after 1-month intervention (P<0.05) ; the scores of physical fatigue, cognitive fatigue and total score of fatigue in the observation group were higher than those in the control group, the differencs were statistically significant (P<0.05) ; except the family environment and social environment dimensions, the scores of each dimension and total scores of disease psychosocial adaptation in the observation group were higher than those in the control group, the differencs were statistically significant (P<0.05) ; The function of upper limb in the observation group was better than that in the control group, and the incidence of lymphedema was lower than that in the control group, the differencs were statistically significant (P<0.05) . Conclusions Narrative nursing can improve the disease adaptation outcome in breast cancer patients in the aspects of posttraumatic growth, cancer-related fatigue, psychosocial adaptation, limb functional recovery and lymphatic edema disease. It is worth spreading among breast cancer or more disease group. Key words: Breast neoplasms; Narrative nursing; Post-traumatic growth; Carcinogenic fatigue; Maladaptive outcome

Neuroprotective effect of local hypothermia in a computer-controlled compression model in minipig: Correlation of tissue sparing along the rostro-caudal axis with neurological outcome.

This study investigated the neuroprotective efficacy of local hypothermia in a minipig model of spinal cord injury (SCI) induced by a computer-controlled impactor device. The tissue integrity observed at the injury epicenter, and up to 3 cm cranially and caudally from the lesion site correlated with motor function. A computer-controlled device produced contusion lesions at L3 level with two different degrees of tissue sparing, depending upon pre-set impact parameters (8N- and 15N-force impact). Hypothermia with cold (4°C) saline or Dulbecco's modified Eagle's medium (DMEM)/F12 culture medium was applied 30 min after SCI (for 5 h) via a perfusion chamber (flow 2 ml/min). After saline hypothermia, the 8N-SCI group achieved faster recovery of hind limb function and the ability to walk from one to three steps at nine weeks in comparison with non-treated animals. Such improvements were not observed in saline-treated animals subjected to more severe 15N-SCI or in the group treated with DMEM/F12 medium. It was demonstrated that the tissue preservation in the cranial and caudal segments immediately adjacent to the lesion, and neurofilament protection in the lateral columns may be essential for modulation of the key spinal microcircuits leading to a functional outcome. Tissue sparing observed only in the caudal sections, even though significant, was not sufficient for functional improvement in the 15N-SCI model.

An analysis of the effect of artificial lengthening femoral head replacement in elderly patients with stage I of unstable femoral intertrochanteric fracture

Objective To analyze of the effect of artificial lengthening femoral head replacement in elderly patients with stage I of unstable femoral intertrochanteric fracture. Methods 203 patients with stage I of unstable femoral intertrochanteric fracture were selected as the research object, and they were taken artificial lengthening femoral head replacement, among which 65caese were male, female in 138 cases.The Harris scoring, SF-36, VAS pain scores on admission, 2 weeks after operation, postoperative follow-up limb were counted, and the pain of the affected limb and the hip scores were compared amond 3 time periods. Results All 203 cases of senile patients with follow-up, average operation time was 83.64 minutes, the intraoperative blood loss was 355.41mL.The curative effect was evaluated according to the Harris score, SF-36 and VAS pain scoring criteria, and the Harris scores of the affected limbs at admission, at 2 weeks after the operation and after the follow-up were (28.26±5.50)points, (68.26±5.50)points, (93.13±5.31)points, respectively, the differences were statistically significant(t=-71.27, -1 397.55, -46.07, all P<0.01); The VAS pain scores were (8.19±0.48)points, (3.53±0.71)points, (0.23±0.42)points, respectively, the differences were statistically significant (t=88.06, 324.17, 60.84, all P<0.01). The sf-36 scores: physiological[(8.35±1.24)points, (15.23±2.17)points, (19.21±2.12)points], social/family[(7.01±1.13)points, (14.12±2.12)points, (19.85±2.24)points], emotional[(4.83±1.01)points, (10.12±1.22)points, (14.87±1.32)points], function[(6.35±1.21)points, (13.67±1.87)points, (16.81±2.12)points], additional focus[(8.85±1.45)points, (16.38±2.12)points, (20.21±2.42)points], total quality of life [(47.35±4.76)points, (74.69±5.87)points, (89.21±6.12)points], the differences were statistically significant(-39.77, -62.92, -20.21, -44.87, -71.89, -26.79, -45.04, -89.01, -38.25, -45.79, -63.41, -15.29, -45.20, -60.39, -17.54, -52.12, -76.49, -22.58, all P<0.01). Conclusion Artificial lengthening femoral head replacement in elderly patients with stage I of unstable femoral intertrochanteric fracture has good clinical effect, intraoperative high safety, less postoperative complications, postoperative limb functional recovery is good, and it is worthy of clinical promotion and application. Key words: Femoral fractures; Arthroplasty, replacement, hip; Aged

Epidemiological profile and treatment of substance losses by trauma to the lower limbs.

to evaluate the epidemiological profile, the surgical treatment and the postoperative results of patients with complex traumatic injuries to the lower limbs. we conducted a retrospective study of patients with traumatic complex injuries treated by the Plastic Surgery Service of a regional hospital in Brasília. We analyzed clinical-epidemiological data, type of surgical procedure and functional recovery of the limb after six months of treatment. 119 patients were treated, with a mean age of 29 years, predominantly men (76.4%). Motorcycle accident was responsible for most of the injuries, in 37.8% of cases. The most frequent surgical treatment was skin grafting (62.1%), followed by the fasciocutaneous flap (21.9%), muscular flap (12.6%) and microsurgical flap (3.4%). Six months after completion of the surgical treatment, 35.3% of the patients needed crutches to move, characterizing a delay in limb functional recovery that, however, was significantly related to the presence of fractures, external fixation or bone exposure in the preoperative period. the profile of the patient with complex traumatic lower limb injury was a male, motorcycle accident victim, and grafting was the most used treatment. Orthopedic trauma with bone fracture, bone exposure and the presence of external fixator were significantly associated with a higher risk of limb functional impairment, requiring locomotion crutches after six months of treatment.

Effects of non-invasive brain stimulation for upper limb rehabilitation in acute stroke patients – A controlled clinical trial

Introduction/Background This study was conducted in Tuen Mun Hospital (TMH) to evaluate the effects of rTMS and tDCS on upper limb functional recovery in acute stroke patients. Material and method Patients with acute stroke were randomly assigned to rTMS, tDCS or control group. For rTMS group, patient received 1 Hz rTMS at 90% of resting motor threshold to M1 of the unaffected hemisphere for 1200 pulses. For tDCS group, patient received 1 mA anodal stimulation to hand area of the affected hemisphere for 20 minutes. Five consecutive sessions of rTMS or tDCS together with intensive physiotherapy upper limb training were given. For control group, only intensive physiotherapy upper limb training were given. The upper extremity section of Fugl–Meyer Scale (UE-FM) was used as outcome measure. Results Twenty-nine patients (17 female and 12 male) were assigned to the rTMS ( n = 9), tDCS ( n = 11) and control ( n = 9) group. The mean age was 62.7 ± 12.0 years old and the mean time between stroke onset and the first UE-FM assessment was 9.14 ± 3.30 days. There was no statistically significant difference in mean age, baseline UE-FM mean score, mean time between stroke onset and the first UE-FM assessment among three groups [X 2 (2) = 4.81, P = 0.09] [X 2 (2) = 1.56, P = 0.457] [X 2 (2) = 0.04, P = 0.98]. No adverse effects of rTMS or tDCS were reported. For between-group comparison, the changes in mean score of UE-FM in rTMS (20.8 ± 6.59) and tDCS group (16.1 ± 4.97) were statistically significantly larger than that in control group (10.6 ± 4.13) (U = −2.97, P = 0.002) (U = −2.29, P = 0.02). However, there was no significant difference between rTMS and tDCS group (U = −1.49, P = 0.152). Conclusion Findings of the present study showed that both rTMS and tDCS could augment physiotherapy treatment in enhancing upper limb motor functional recovery in acute stroke patients. These positive findings warrant further investigation of the application of non-invasive brain stimulation techniques to neurorehabilitation.