Recovery Of Limb Function Research Articles

JSU-Diagram: A Guideline for Treatment of the Upper Limb in Stroke Patients

Recovery of efficient, functional use of the upper limb post stroke can contribute to an increased quality of life. Early implementation of well-structured upper limb treatment after stroke may affect recovery of upper limb function and dexterity. The JSU (Jessa Sint-Ursula) diagram should be considered a guideline to work on the objectives needed to shape the rehabilitation of the upper limb at various stages of recovery. The diagram starts with upper limb rehabilitation from day one, even in the absence of sufficient trunk control and aims at offering a logical theoretical strategy for improving the recovery of function of the upper limb.

Improvements in neuroelectrophysiological and rear limb functions in rats with spinal cord injury after Schwann cell transplantation in combination with a C5a receptor antagonist.

We measured the effect of Schwann cell transplantation and complement factor 5a (C5a) receptor antagonist on nerve function recovery in rats with spinal cord injury. Experimental spinal cord injury was induced in eighty Wistar rats and these were randomly divided into four treatment groups: culture medium and saline injection (control group), Schwann cell injection (cell transplantation group), C5a receptor antagonist injection (C5a receptor antagonist group), and both Schwann cell and C5a receptor antagonist injections (combination group). Rear limb functional recovery was assessed 1, 2, 4, 6, and 8 weeks after the spinal cord injury with the tilt table test and the Basso, Beattie, Bresnahan scale. Sex-determining region Y (SRY) gene expression was measured at week 4 and horseradish peroxidase (HRP) labeling was used at week 8 to further assess the recovery of neuroelectrophysiological functions. The rear limb functional assessment showed that the combination group had better outcomes than the cell transplantation and C5a receptor antagonist groups. All treatment groups had better outcomes than control. Only the cell transplantation and combination groups showed SRY expression. The number of HRP-positive nerve fibers in the different groups ranked as follows: combination group > cell transplantation and C5a receptor antagonist > control. The refractory period and amplitude of the induced potential in the combination group were significantly greater than in the other three groups. These results suggest that the combination of Schwann cell transplantation and the C5a receptor antagonist enhances the regeneration of injured synapses and improves limb function and electrophysiology.

Effect of California Tri-Pull Taping Method on Shoulder Subluxation, Pain, Active Range of Motion and Upper Limb Functional Recovery After Stroke – A Pretest Post Test Design

Objective: The primary objective of the study was to evaluate the effect of California tri-pull taping (CTPT) method on post stroke shoulder subluxation, pain, active range of motion and upper limb functional recovery. Design: Pretest post test design. Setting: Study was conducted ininpatient and outpatient department of MM hospital Mullana- Ambala. Participants: 10 subjects with post stroke shoulder subluxation were included into the study. (7 male , 3 female). Intervention: For taping, two types of tape was used, cotton pre-tape and rigid post-tape. Tape was applied to subjects for thrice a week, for six weeks and conventional neuro rehabilitation programmewas also given to the subjects, five days a week for six weeks. Main outcome measures: Pre, and post assessment scores were taken from each subject by using, Digital Vernier caliper, visual analogue scale (VAS), Goniometer, and Fuglmeyer scale (FUG). Results: The CTPT method produced significant reduction on inferior subluxation from pre intervention to post intervention, pain. There was also significant improvement of AROM, and FUG. Conclusion: This intervention is a promising adjunct to the management of the hemiplegic subluxed shoulder. The main limitation of the study was, small sample size and no control group was used.

Transplantation of human bone marrow stromal cell-derived neuroregenrative cells promotes functional recovery after spinal cord injury in mice.

Transplantation of bone marrow stromal cells (BMSCs) for spinal cord injury (SCI) has been shown to improve functional outcome. BMSCs can be easily obtained from bone marrow aspirate and have fewer problems in the clinical application for human SCI from the ethical and legal points of view. Recently, we produced cells with neural stem and/or progenitor cell property and neural regeneration supporting capacity from human bone marrow stromal cells (human bone marrow stromal cell-derived neuroregenerative cells: hBMSC-NRs). The aim of the present study was to clarify the effectiveness of transplantation of hBMSC-NRs to injured spinal cord of severe combined immunodeficiency (NOD/SCID) mice. Neurite outgrowth assay of PC-12 cells was performed. One week after a T9-level contusion SCI, hBMSCs or hBMSC-NRs were transplanted into the spinal cord. After the transplantation, functional and histological examinations were performed. Conditioned media of hBMSC-NRs significantly promoted the neurite outgrowth of PC-12 cells in vitro. Transplanted hBMSC-NRs survived in the injured spinal cord 8 weeks after SCI. Immunohistochemistry revealed that the density of serotonin-positive fibers of the transplanted group was significantly higher than that of the control group at the epicenter and caudal segment to the injured site. The recovery of hind limb function of the hBMSC-NRs group was significantly better than that of the control group. In conclusion, hBMSC-NRs can be one of the realistic candidates for cell transplantation therapy for human SCI.

The effect of visiting nursing on elderly hip fracture patients with postoperative re-covery of limb function

Objective To investigate the effect of visiting nursing on elderly hip fracture patients with postoperative recovery of limb function.Methods All the 40 patients who underwent the hip fracture were randomized to treatment group and control group with 20 patients in each group.The patients in treatment group was received the visiting nursing which guided the functional exercise of their affected limb at 1 week, 2 weeks, 4 weeks, 3 months, 6 months and 1 year after they left hospital.The patients of the control group were back to hospital to review their condition regularly.Results The total score and the scores of pain, activity, the ability to walk and the exercise of daily life including going upstairs, stocking were , sitting of treatment group were higer than those of control group.Conclusions Visiting nursing not only can ease the patients＇burden of visiting hospital outside, but also can correct the wrong functional exercise in time which can promote the effective functional exercise in proper order.Visiting nursing can promote the recovery of the elderly patient and improve their quality of life. Key words: Elderly hip fracture; Visiting nursing; Recovery of limb function

Effect of the comprehensive nursing intervention on clinical efficacy of lymphedema after breast cancer surgery

Objective To investigate effect of the comprehensive nursing intervention on clinical efficacy of lymphedema after breast cancer surgery.Methods In our hospital, 157 cases with breast cancer lymphedema appeared were randomly divided into control group （78 cases） and observation group （79 cases）, control group was given routine nursing intervention, observation group was given comprehensive nursing intervention.The upper limb perimeter, the limb function rehabilitation, infection between two groups patients before and after nursing intervention were compared.Results After nursing intervention, double upper limbs perimeter of the patients in observation group was significantly lower than that in the control group （ P〈0.05 ） .hand function recovery proficiency, excellent （ 82.3%, 100%） were significantly higher than those in the control group, infection rate （1.27%） were significantly lower than that in the control group （ P〈0.05, 0.01） .Conclusions Comprehensive nursing intervention can effectively alleviate after radical mastectomy lymphedema symptoms, lower limb skin infection rate, promote the recovery of upper limb function. Key words: Comprehensive nursing intervention; Upper limb function; Lymphedema; Breast cancer

Application of Calcium Phosphate Biological Material on Rehabilitation in Exercise-Induced Rotator Cuff Injury

Rotator cuff injury is one of the most common musculoskeletal system diseases in exercise-induced injury, self-setting calcium phosphate materials has a very good promoting role in the rotator cuff tendon bone interface in the repair process, it can effectively improve the maximum tensile strength of tendon bone interface and stiffness, and promote recovery of biomechanical properties. Therefore, the use of calcium phosphate artificial material can promote repair of the tendon bone interface in exercise-induced rotator cuff injury, and achieve early functional exercise, and early recovery of limb function and ability to live and work.

Does use of the optokinetic chart stimulation based OKCSIB protocol improve recovery of upper and lower limb movements, function and quality of life at 3 year follow up in dense strokes? A retrospective case control series.

The aim was to compare follow up impairment, function and quality of life outcomes between dense parietal centred strokes treated by the optokinetic chart based OKCSIB protocol and those treated by conventional neuro-physiotherapy. Follow up retrospective case control series in the community. 643 persons with stroke were eligible for initial screening to see if they met inclusion criteria. Only 37 potential participants were eligible, with 18 of them still alive. From the 18 only 8 consented to participate in the follow up study. Sixteen mortalities that occurred post discharge were all from the conventional group. The OKCSIB group had statistically significant improved upper limb STREAM scores (p < 0.05). The OKCSIB group had statistically significant reduction in hand spasticity with none of the OKCSIB participants developing hand spasticity (p < 0.05). The OKCSIB group also had better lower limb STREAM scores although these were not statistically significant (p > 0.05). Barthel Index, and quality of Life improvements were non-significant (p > 0.05). The OKCSIB protocol led to better recovery of voluntary movements at 3 year follow up. However lack of randomisation and the small number of participants, necessitate further research to be carried out.

Effects of hypothermia combined with neural stem cell transplantation on recovery of neurological function in rats with spinal cord injury.

The microenvironment of the injured spinal cord is hypothesized to be involved in driving the differentiation and survival of engrafted neural stem cells (NSCs). Hypothermia is known to improve the microenvironment of the injured spinal cord in a number of ways. To investigate the effect of NSC transplantation in combination with hypothermia on the recovery of rat spinal cord injury, 60 Sprague-Dawley female rats were used to establish a spinal cord hemisection model. They were divided randomly into three groups: A, spinal cord injury group; B, NSC transplantation group; and C, NSC transplantation + hypothermia group. At 1, 2, 4, 6 and 8 weeks post-injury, the motor function of all animals was evaluated using the Basso, Beattie and Besnaham locomotor scoring system and the inclined plane test. At 4 weeks post-transplantation, histological analysis and immunocytochemistry were performed. At 8 weeks post-transplantation, horseradish peroxidase nerve tracing and transmission electron microscopy were conducted to observe axonal regeneration. The outcome of hind limb motor function recovery in group C significantly surpassed that in group B at 4 weeks post-injury (P<0.05). Recovery was also observed in group A, but to a lesser degree. For the pathological sections no neural axonal were observed in group A. A few axon-like structures were observed in group B and more in group C. Horseradish peroxidase-labeled neurofibers and bromodeoxyuridine-positive cells were observed in the spinal cords of group C. Fewer of these cells were found in group B and fewer still in group A. The differences among the three groups were significant (P<0.05). Using transmission electron microscopy, newly formed nerve fibers and myelinated nerve fibers were observed in the central transverse plane in groups B and C, although these nerve fibers were not evident in group A. In conclusion, NSC transplantation promoted the recovery of hind limb function in rats, and combination treatment with hypothermia produced synergistic effects.

Evidence-based nursing on functional exercise after breast cancer

Objective To apply the evidence-based nursing on the relationship between the functional exercise and drainage, subcutaneous effusion after breast cancer operation.Methods Sixty breast cancer patients which admitted from January 2012 to October 2013 were divided into control group （ twenty eight cases） and experimental group （ thirty two cases） .The control group just accepted routine care while the experimental group received evidence-based nursing care.The evidence related nursing plan making were collected from national and international literature and mainly focused on the relationship between functional excises and the value of drainage, subcutaneous effusion after breast cancer operation.After fortnight operation, the rate of swelling and the rate of subcutaneous effusion were observed, and the recovery of function had been assessed after the day of four weeks operation.Results The subcutaneous effusion of the experimental group （15.6%） were lower than that of control group （21.4%）, with a significant difference between two groups （χ^2=10.23;P〈0.05）.The rate of limb swelling of the experimental group was 31.3%,which was lower than that of the control group （32.1%）,the difference was not statically significant （χ^2=3.52,P〉0.05）.The recovery of affected limb function in the experimental group had better result than the control group （t=7.68,8.65,7.25, respectively;P〈0.05）.In the experimental group, the clinical curative effects had sixteen cases showed excellent, four cases （ fine） and two cases （ general） that had statistical significance comparing with control group （u=2.63,P〈0.05）.Conclusions When the breast cancer patients had the value of drainage over than 500 ml at the third of operation day or more than 30 ml at the fifth day, it is better to stop function exercise until the value of drainage lower than 10 ml daily.The above procedure can release swelling and subcutaneous effusion at fourteenth operation day’ s assessment, and benefit functional recovery after four weeks operation. Key words: Breast cancer; Postoperative period; Evidence-based nursing; Functional exercise

Effect of Modified Constraint Induced Therapy on Upperlimb Functional Recovery in Young Stroke Subjects

Background : The aim of this study is to evaluate the effect of modified constraint induced therapy on upper limb functional recovery in young stroke subjects. Most of the stroke rehabilitation units following conventional rehabilitation methods for treatment of the stroke patients where these methods have been proved to be less useful especially in the young stroke subjects. Hence the purpose of this study is to see the effect of modified constraint induced therapy which is a task specific training method for upperlimb in young stroke subjects. Methods : Total of 40 young stroke subjects who is having minimal motor criterion and met other inclusion criteria were recruited from department of physiotherapy, g.s.l.general hospital. Pre and post intervention measures were taken using Wolf motor function test and Jebsen Taylor hand function test. Results : In this study had shown significant improvements in the modified constraint induced therapy group when compared to the conventional rehabilitation alone. P value between groups was < 0.05. Conclusion : In this study concludes that addition of 15 minutes modified constraint induced movement therapy to conventional physiotherapy is a useful adjunct in functional recovery of upper limb among young stroke subjects.

Influence of early rehabilitation nursing on the recovery of limb function for patients with stroke and hemiplegia

Objective To study the influence of early rehabilitation nursing on the recovery of limb function for patients with stroke .Methods Totals of 88 patients with stroke in our hospital during the period from February 2012 to February 2013 were divided into the control group （ routine nursing ） and the observation group （ early rehabilitation nursing ） , with 44 patients per group .The nerver motor function and activity of daily living （ ADL） recovery in the two groups were observed and compared according to the Fugl -Meyer score and Barthel index.Results The Fugl-Meyer was （68.0 ±20.0） of the observation group and （52.0 ±16.0） of the control group.The difference was statistically significant （ t =4.144, P 〈0.05）.The Barthel index was （66.0 ±25.0） of the observation group and （48.0 ±20.0） of the control group .The difference was statistically significant （t=3.729, P〈0.05）.Nerve function recovery and activities of daily life in the observation group were improved than those in the control group .The differences were statistically significant （Z=4.588,2.556;P〈0.05）.Conclusions The early rehabilitation nursing can significantly promote the recovery of limb function for patients with stroke and improve the prognosis quality . Key words: Rehabilitation nursing; Stroke; Hemiplegia; Daily life activity; Limb recovery

An update on predicting motor recovery after stroke

Being able to predict an individual's potential for recovery of motor function after stroke may facilitate the use of more effective targeted rehabilitation strategies, and management of patient expectations and goals. This review summarises developments since 2010 of approaches based on clinical, neurophysiological and neuroimaging measures for predicting individual patients’ potential for upper limb recovery. Clinical assessments alone have low prognostic accuracy. Transcranial magnetic stimulation can be used to assess the functional integrity of the corticomotor pathway, and has some predictive value but is not superior when used in isolation due to its low negative predictive value. Neuroimaging measures can be used to assess the structural integrity of descending white matter tracts. Recent studies indicate that the integrity of corticospinal and alternate motor tracts in both hemispheres may be useful predictors of motor recovery after stroke. The PREP algorithm is currently the only sequential algorithm that combines clinical, neurophysiological and neuroimaging measures at the sub-acute stage to predict the potential for subsequent recovery of upper limb function. Future research could determine if a similar algorithmic approach may be useful for predicting the recovery of gait after stroke.

Therapeutic effect of human adipose-derived stromal cells cluster in rat hind-limb ischemia.

We investigated whether transplantation of three-dimensional cell masses (3DCM) of human adipose-derived stromal cells (hASCs) cultured on a basic fibroblast growth factor-immobilized substrate improved hind limb functional recovery by stimulating angiogenesis in an immune-competent rat ischemic limb model. In vitro experiments confirmed that cells within 3DCMs differentiate toward the endothelial lineage one day after culture in normal medium. The therapeutic effect of 3DCMs was evaluated by transplanting hASCs, phosphate-buffered saline alone, and the 3DCM into rat ischemic hind limbs. Blood flow was enhanced in the ischemic hind limb in the 3DCM-injected group compared with the other groups. The ratio of human nuclear antigen (HNA) and hVEGF-positive cells was significantly higher in the 3DCM-injected group compared to hASC-injected group. Human VEGF was observed in most HNA-positive cells. Many hCD31 and hSMA-positive cells were observed in vessel-like structures in the 3DCM-injected group. The 3DCM transplantation improved cell retention and angiogenic effects compared with ASC transplantation. These findings suggest that transplantation of 3DCMs may be an effective stem cell therapy for hind limb ischemia.

Anti-inflammatory and anti-apoptotic effect of combined treatment with methylprednisolone and amniotic membrane mesenchymal stem cells after spinal cord injury in rats.

This study was undertaken to investigate the synergistic effects of methylprednisolone (MP) administration and transplantation of amniotic membrane mesenchymal stem cells (AM-MSCs) following T11 spinal cord clip compressive injury in rats. The combination treatment with MP (50mg/kg) and delayed transplantation of AM-MSCs after rat spinal cord injury, significantly reduced (1) myeloperoxidase activity, (2) the proinflammatory cytokines: tumor necrosis factor-α, interleukin (IL)-1β, IL-6, IL-17, interferon-γ and (3) the cell apoptosis [terminal deoxynucleotidyl transferase, dUTP nick end labeling (TUNEL) staining, and caspase-3, Bax and Bcl-2 expressions]; increased: (1) the levels of the anti-inflammatory cytokines (IL-10 and transforming growth factor-β1) and (2) the survival rate of AM-MSCs in the injury site. The combination therapy significantly ameliorated the recovery of limb function (evaluated by Basso, Beattie and Bresnahan score). Taken together, our results demonstrate that MP in combination with AM-MSCs transplantation is a potential strategy for reducing secondary damage and promoting functional recovery following spinal cord injury.

Primary composite anterolateral thigh perforator flap transfer for treatment of Gustilo type III C open fracture

Objective To investigate the procedure techniques and clinical effects for treatment of cases on the brink of amputation with composite anterolateral thigh perforator flap (ALTP) in primary surgery.Methods From July 2008 to December 2012,9 cases on the verge of amputation received primary composite ALTP transfer to perform limb salvage surgery.All cases were Gustilo type Ⅲ C open injuries resulted from traffic accidents which involved upper extremities in 3 cases and lower extremities in 6 cases.Emergent fracture fixation was done for 5 cases; primary external fixation followed by definitive bone grafting was done for 4 cases combined with bone defects.Types of flaps consisted of flow-through ALTPs in 4 cases,chimeric ALTPs in 2 cases,flow-through + chimeric ALTPs in 2 cases,flow-through + chimeric + polyfoliate ALTP in 1 case.Size of flaps ranged from 10 cm × 6 cm-22 cm × 9 cm.Donor sites were closed primarily.Results Limb salvage succeeded for all the 9 cases.Six flaps survived uneventfully,but another 3 flaps developed tension blisters and survived eventually after stitches removing and blood-letting.Postoperative follow-up was 5-36 months.All cases achieved bone union in 4.5-8 months (mean,6.3 months).Conclusion Emergent composite ALTP transfer can not only save the limb,but also reduce the recovery time and complications and contribute to the early recovery of limb function. Key words: Wounds and injuries; Extremities; Surgical flaps; Limb salvage

Efficiency of transplantation of human placental/umbilical blood cells to rats with severe spinal cord injury.

The effects of a single intravenous injection of human umbilical blood were studied on the model of severe spinal cord contusion injury in rats. Rats receiving no umbilical blood (spontaneous recovery) served as the control. All rats exhibited pronounced hind limb paraplegia and autonomic dysfunction of pelvic organs after the injury. Recovery of the hind limb function was evaluated by loading tests and locomotor activity testing in the open field using BBB score for open-field testing. Testing was carried out weekly for 8 weeks after the injury. Open-field testing showed a significant (p < 0.05) increase of the rate and volume of the hind limb motor activity recovery in the groups receiving umbilical blood infusions.

Effects of the combination of methylprednisolone with aminoguanidine on functional recovery in rats following spinal cord injury.

Methylprednisolone (MP), a synthetic glucocorticoid, has been widely used as a standard therapeutic agent for the treatment of spinal cord injury (SCI). The combination of MP and other pharmacological agents aimed at enhancing functional recovery is desirable as the beneficial effects of MP are controversial, due to a variety of side-effects. Aminoguanidine (AG), a small water-soluble compound, is potentially useful in the treatment of acute SCI. The aim of the present study was to determine the effects of MP and AG, administered in combination, following SCI in adult rats. In rats with SCI, the combination therapy group treated with AG (75 mg/kg) and MP (0.75 mg/kg) exhibited significantly reduced levels of cytokine expression and cell apoptosis compared with those in the control group. In addition, the data demonstrated that the combination therapy significantly enhanced the recovery of limb function. These data clearly suggest that treatment with a combination of MP and AG represents a promising strategy of clinically applicable pharmacological therapy for the rapid initiation of neuroprotection following SCI.

Effect of three-grade rehabilitation nursing on the limb function and life quality in patients with hemiplegia after stroke

Objective To investigate the therapeutic effect of three-grade rehabilitation nursing on stroke patients with hemiplegia.Methods Totaled of 100 cases of stroke patients with hemiplegia in our hospital were divided into the observation group and the control group according to the different training methods,the control group was given routine rehabilitation training,the observation group was given three-grade rehabilitation nursing,rehabilitation effects were compared between the two groups.Results Barthel index and NDF score after 6 months in the observation group were significantly higher than those in the control group (P ＜ 0.05),FMA score Ⅲ ～ Ⅳ of upper and lower limbs was significantly higher than that in control group (P ＜ 0.05).Life quality score of household activities,mental state,work and economic aspects in the observation group were significantly higher than those in the control group (P ＜ 0.05).Conclusions The three-grade rehabilitation nursing can effectively promote the recovery of limb function in the stroke patients with hemiplegia,and improve the life quality of the patients. Key words: Three-grade rehabilitation nursing; Stroke patients with hemiplegia; Limb function; Life quality

Repair of segmental load-bearing bone defect by autologous mesenchymal stem cells and plasma-derived fibrin impregnated ceramic block results in early recovery of limb function.

Calcium phosphate-based bone substitutes have not been used to repair load-bearing bone defects due to their weak mechanical property. In this study, we reevaluated the functional outcomes of combining ceramic block with osteogenic-induced mesenchymal stem cells and platelet-rich plasma (TEB) to repair critical-sized segmental tibial defect. Comparisons were made with fresh marrow-impregnated ceramic block (MIC) and partially demineralized allogeneic bone block (ALLO). Six New Zealand White female rabbits were used in each study group and three rabbits with no implants were used as negative controls. By Day 90, 4/6 rabbits in TEB group and 2/6 in ALLO and MIC groups resumed normal gait pattern. Union was achieved significantly faster in TEB group with a radiological score of 4.50 ± 0.78 versus ALLO (1.06 ± 0.32), MIC (1.28 ± 0.24), and negative controls (0). Histologically, TEB group scored the highest percentage of new bone (82% ± 5.1%) compared to ALLO (5% ± 2.5%) and MIC (26% ± 5.2%). Biomechanically, TEB-treated tibiae achieved the highest compressive strength (43.50 ± 12.72 MPa) compared to those treated with ALLO (15.15 ± 3.57 MPa) and MIC (23.28 ± 6.14 MPa). In conclusion, TEB can repair critical-sized segmental load-bearing bone defects and restore limb function.