电针夹廉泉穴治疗脑卒中后口咽期吞咽障碍的临床研究

目的观察电针夹廉泉穴对脑卒中后口咽期吞咽障碍(PSOD)的影响。方法选取符合标准的PSOD患者45例, 按随机数字表法分为电针组、神经肌肉电刺激(NMES)组和对照组, 每组患者15例。对照组患者给予常规吞咽康复训练, 电针组在此基础上增加电针夹廉泉穴治疗, NMES组在常规吞咽康复训练的基础上增加双侧颏下肌群NMES。电针和NMES均每日1次, 每次30 min, 每周治疗5 d, 连续治疗3周。于治疗前和治疗3周后(治疗后)对3组患者进行吞咽造影检查(VFSS), 采用功能性经口进食量表(FOIS)、标准吞咽功能评价量表(SSA)、渗漏-误吸量表(PAS)和改良式钡剂吞咽障碍量表(MBSImp)评估其吞咽功能, 另采用表面肌电图(sEMG)检测患者空吞咽和吞咽5 ml温水时颏下肌群的肌肉功能[包括波幅峰值、波幅均值和平均吞咽时程]。结果治疗后, 3组患者的SSA、FOIS、MBSImp、PAS评分以及空吞和吞咽5 ml温水时sEMG的波幅峰值、波幅均值、平均吞咽时程较组内治疗前均显著改善(P<0.05), 且电针组和NMES组上述指标均显著优于对照组治疗后(P<0.05...     

神经肌肉电刺激对脑卒中后吞咽障碍患者吞咽功能及其表面肌电图的影响

目的观察神经肌肉电刺激（NMES）治疗脑卒中恢复期吞咽障碍患者的临床疗效,并探讨表面肌电图在脑卒中患者吞咽障碍评估中的应用价值。 方法将脑卒中恢复期吞咽障碍患者40例按随机数字表法随机分为实验组（20例）和对照组（20例）,2组患者均给予神经内科常规药物治疗和常规吞咽训练,实验组患者在此基础上增加NMES治疗。2组患者均于治疗前和治疗2周后（治疗后）进行吞咽功能评定和sEMG检测。 结果治疗后,实验组患者的吞咽障碍评分为（7.65±0.88）分,与组内治疗前的（2.75±0.64）分和对照组治疗后的（6.10±0.85）分比较,差异均有统计学意义（P<0.05）。治疗后,2组患者舌骨上肌群的sEMG最大波幅和吞咽时程较组内治疗前显著改善（P<0.05）,且实验组治疗后的sEMG最大波幅和吞咽时程均显著优于对照组治疗后（P<0.05）。 结论NMES结合常规吞咽训练可显著改善脑卒中恢复期吞咽障碍患者的吞咽功能,且sEMG可作为评估脑卒中患者吞咽障碍的有效方法。     

神经肌肉电刺激治疗脑瘫患儿流涎症的临床观察

目的探讨神经肌肉电刺激（NMES）对脑瘫患儿流涎的影响。方法43例脑瘫流涎患儿分为NMES组（n=22）及对照组（n=21）,两组常规治疗相同,NMES组同时给予NMES治疗。分别于治疗前及治疗8周后采用教师流涎分级法(TDS)评定患儿流涎情况。结果NMES组与对照组有显著性差异（P<0.05）。结论NMES可以改善脑瘫患儿流涎,促进其吞咽功能。     

肌电生物反馈疗法联合神经肌肉电刺激对脑卒中后吞咽障碍患者吞咽功能及营养状况的影响

目的:探讨肌电生物反馈疗法联合神经肌肉电刺激(NMES)对脑卒中吞咽障碍患者吞咽功能及营养状况的影响。方法:60例脑卒中吞咽障碍患者随机分为常规组、NMES组、综合组各20例,常规组接受吞咽功能训练,NMES组接受神经肌肉电刺激,综合组接受肌电生物反馈治疗和神经肌肉电刺激。分别于治疗前及治疗1个月后采集3组患者的舌骨上肌群肌电积分值,进行营养指标测量,同时记录治疗前后3组患者胃管留置率的变化情况。结果:3组患者治疗后舌骨上肌群肌电积分值及各项营养指标均较治疗前改善(P0.05),治疗后综合组的改善幅度更优于NMES组和常规组(P0.05)。3组患者治疗后的胃管留置率均较治疗前有明显下降(P0.05),但3组间比较差异无统计学意义。结论:脑卒中吞咽障碍患者在神经肌肉电刺激基础上辅以肌电生物反馈治疗可以明显改善其吞咽功能及营养状况。     

重复经颅磁刺激对脑出血术后吞咽障碍伴颅骨缺损患者吞咽功能的影响

目的研究不同频率重复经颅磁刺激(rTMS)作用于健侧大脑半球下颌舌骨肌运动皮质功能区对脑出血后吞咽障碍伴颅骨缺损患者吞咽功能的影响。方法采用随机数字表法将49例脑出血后吞咽障碍伴颅骨缺损患者分为5 Hz组(13例)、3 Hz组(12例)、低频组(12例)及对照组(12例)。上述各组患者在常规吞咽功能训练前,分别对其健侧脑半球下颌舌骨肌运动皮质功能区给予5 Hz、3 Hz、1 Hz rTMS刺激或假磁刺激,各组患者均每天治疗2次,每周治疗6 d,共治疗2周。于治疗前、治疗2周后对上述患者进行疗效评定,采用吞咽功能量表(SSA)评定患者吞咽功能改善情况,同时检测患者吞咽时下颌舌骨肌表面肌电(sEMG)振幅及吞咽时程。结果治疗2周后5 Hz组、3 Hz组及低频组患者SSA评分及下颌舌骨肌sEMG振幅均较治疗前、对照组明显降低(P<0.05),吞咽时程均较治疗前、对照组明显缩短(P<0.05);两高频组SSA评分及下颌舌骨肌sEMG振幅均较低频组明显降低(P<0.05),吞咽时程均较低频组明显缩短(P<0.05);5 Hz组下颌舌骨肌sEMG振幅较3 Hz组明显降低,吞咽时程较3 Hz组明显缩短(P<0.05),但SSA评分两组间差异仍无统计学意义(P>0.05)。结论5 Hz、3 Hz、1 Hz rTMS刺激健侧脑半球下颌舌骨肌运动皮质功能区均可改善脑出血后吞咽障碍伴颅骨缺损患者吞咽功能,并以5 Hz rTMS的治疗效果相对较好。     

神经肌肉电刺激辅助治疗脑卒中后吞咽障碍的效果

目的 观察神经肌肉电刺激(NMES)辅助治疗脑卒中后吞咽障碍的效果.方法 将66例脑卒中后吞咽障碍患者按随机数字表法分为电刺激组、对照组各33例,均常规给予药物治疗和基本的康复训练,对照组同时采用吞咽训练,电刺激组同时采用NMES配合吞咽训练.治疗前、后采用藤岛一郎吞咽疗效评价标准对2组患者进行效果评估.结果治疗后,总有效率电刺激组为93.9%,对照组为72.7%,2组间差异有统计学意义(P＜0.05).结论 NMES配合吞咽训练改善脑卒中患者吞咽功能障碍的疗效优于单纯吞咽训练.     

不同频率高频重复经颅磁刺激治疗单侧脑卒中患者吞咽障碍的疗效观察

目的：研究不同频率高频重复经颅磁刺激（rTMS）作用于双侧大脑半球治疗单侧脑卒中患者吞咽障碍的疗效观察。方法：选取脑卒中后吞咽障碍患者36例,按照随机数字表法分为5Hz rTMS组12例、3Hz rTMS组12例和对照组12例。3组患者均给予常规吞咽训练,在此基础上3组患者在两侧大脑半球吞咽皮层代表区分别给予5Hz rTMS刺激、3Hz rTMS刺激和假性磁刺激。治疗前和治疗4周后分别对3组患者采用标准吞咽功能评价量表(SSA)评估患者吞咽功能、表面肌电（sEMG）记录下颌舌骨肌振幅及时程。结果：治疗4周后,3组患者SSA分值和sEMG振幅均较治疗前降低(P<0.05)、sEMG时程均较治疗前缩短(P<0.05);5Hz rTMS组和3Hz rTMS组患者相比对照组sEMG振幅和时程改善缩短(P<0.05),与3Hz rTMS组相比5Hz rTMS组sEMG振幅及时程改善更明显(P<0.05);5Hz rTMS组和3Hz rTMS组患者相比对照组SSA评分降低更明显（P<0.05）,但5Hz rTMS组和3Hz rTMS组SSA评分差异无统计学意义。结论：5Hz高频 rTMS作用于双侧大脑半球治疗单侧脑卒中患者吞咽障碍疗效较好。     

肌电生物反馈与电刺激治疗对急性出血性脑卒中后吞咽障碍患者临床疗效及吞咽功能的影响

目的探讨肌电生物反馈与电刺激治疗对急性出血性脑卒中(CVA)后吞咽障碍患者临床疗效及吞咽功能的影响。方法选取2018年2月至2022年2月我院收治的CVA后吞咽障碍患者91例,根据治疗方式不同分为对照组42例和观察组49例,对照组采取常规吞咽训练结合神经肌肉电刺激(NMES)疗法,观察组采取常规吞咽训练结合肌电生物反馈(EMGBF)疗法。比较两组治疗前后洼田饮水试验分级、临床疗效、表面肌电图(sEMG)检测结果、标准吞咽功能评定量表(SSA)及吞咽相关生活质量量表(SWAL-QOL)评分。结果与治疗前比较,两组洼田饮水试验法分级均明显改善,其中观察组改善效果更为显著(P<0.05);两组sEMG平均波幅均明显升高,吞咽时限缩短,其中观察组变化更为显著(P<0.05);观察组SSA评分低于对照组,SWAL-QOL评分高于对照组(P<0.05);观察组治疗后总有效率高于对照组(P<0.05)。结论EMGBF治疗急性出血性CVA后吞咽障碍患者临床疗效较NMES更明显,且能有效改善其吞咽功能,提高生活质量。     

神经肌肉电刺激联合吞咽训练治疗脑梗死后吞咽障碍疗效观察

目的探讨神经肌肉电刺激(NMES)联合吞咽训练对脑梗死后吞咽障碍患者的疗效。方法将50例脑梗死后吞咽障碍的患者随机分为对照组25例和治疗组25例,2组基线资料具有可比性。所有患者接受脑梗死常规治疗,对照组给予吞咽训练,治疗组加用V italStim电刺激治疗仪进行NMES治疗,治疗前后采用洼田饮水试验、吞咽障碍程度分级进行评定。结果 2组治疗前,在洼田饮水试验及吞咽障碍程度分级评定方面差异无统计学意义(P均>0.05),治疗后,2组洼田饮水试验及吞咽障碍程度分级评定均有所好转(P均<0.05),且治疗组洼田饮水试验分级(1.92±0.95vs2.56±1.12,P<0.05)及吞咽障碍程度分级(7.60±1.89vs6.40±2.27,P<0.05)均优于对照组。结论 NMES联合吞咽训练治疗脑梗死后吞咽障碍有明显疗效。     

针灸联合按摩治疗脑瘫合并吞咽障碍的临床研究

目的:观察针灸联合按摩治疗脑瘫合并吞咽障碍的临床疗效.方法:将符合纳入标准的61例脑瘫合并吞咽障碍的患儿随机分为治疗组和对照组,其中治疗组31例,对照组30例.治疗组采用针灸联合按摩治疗,对照组采用吞咽功能训练和吞咽治疗仪治疗.2组患儿疗程均为12周,分别于治疗前、后采用Sheppard的吞咽障碍调查问卷(DDS)、才藤荣一吞咽障碍7级评价方法和Kaup指数进行疗效评价.结果:治疗前2组患儿的DDS评分比较,差异无显著性意义(P＞0.05),治疗后2组患儿的DDS评分均有改善,治疗组优于对照组(P＜0.05);治疗前两组患儿才藤荣一吞咽障碍7级评价相互比较,差异无显著性意义(P＞0.05).治疗后才藤荣一吞咽障碍7级评价,两组患儿疗效相当(P＞0.05);两组患儿总体疗效比较,治疗组患儿总有效率为90.32％,对照组为83.33％,经统计学分析无显著性差异(P＞0.05),Kaup指数治疗组患儿的正常率优于对照组(P＜0.05).结论:针灸配合按摩疗法与吞咽功能训练和吞咽治疗仪疗法均能有效地改善脑瘫患儿的吞咽功能,且针灸按摩疗法能很好地改善患儿的营养状况,提高其生存质量,可作为一种有效的治疗方法应用于临床.     

Time Dependence of Unipolar Cathodal and Anodal Strength-Interval Curves

Following pacemaker electrode attachment, greater ventricular vulnerability to arrhythmias exists in an acutely ischemic ventricle with a unipolar anodal than cathodal stimulus falling on the T wave, due to the shorter refractory period exhibited by an anodal stimulus. In order to determine the relationship between anodal and cathodal refractory period at various times following endocardial electrode insertion, ventricular strength-interval curves were determined in nine dogs. With stable electrode position, serial measurements were made for a mean duration of 44 days. It was observed that during the first five days, the anodal refractory period was significantly shorter than cathodal, but within 15-20 days this relationship was reversed in all dogs. The longer anodal refractory period was observed up to the end of each study. These results suggest that due to shorter anodal refractory period, greater vulnerability to arrhythmias may occur with an anodal than cathodal stimulus in the initial 15-20 days following electrode insertion.     

Broad Applicability of Ultrarapid Train Stimulation as an Efficient Alternative to Conventional Programmed Electrical Stimulation

FISHER, J.D., et al.: Broad Applicability of Ultrarapid Train Stimulation as an Efficient Alternative to Conventional Programmed Electrical Stimulation. Background and study objective:Conventional programmed electrical stimulation (PES) is useful for establishing inducibility or noninducibility of clinical ventricular arrhythmias (VA), but is complex and time-consuming. This study compared a standard PES protocol with ultrarapid train stimulation (UTS) in a broad range of patients with and without a history of ventricular arrhythmias or structural heart disease. Methods: Patients prospectively underwent electrophysiologic testing with both UTS and conventional PES protocols in a randomized, crossover design. Results: The results were concordant in 79% of 150 matched pairs of comparisons in 104 patients (NS). There were no differences related to underlying heart disease or arrhythmia, or antiarrhythmic treatment. Induction of nonclinical arrhythmias with the two methods was similar   (P = 0.524)   . Inhibition phenomena were minor except in some patients receiving amiodarone. Fewer drive-extrastimuli sequences and less time were needed to complete the trains protocol   (P < 0.0001)   . Conclusions: In cases where the main intent is to induce ventricular arrhythmias, UTS yields results that are similar to those of conventional PES protocols in a shorter length of time. (PACE 2003; 26[Pt. II]:518–523)     

Spinal Cord Stimulation for Complex Pain: Initial Experience with a Dual Electrode, Programmable, Internal Pulse Generator

Abstract: The objective of this study was to engage in an 18‐month follow‐up of 20 chronic complex pain patients using a dual electrode, programmable, fully implantable internal pulse generator (IPG) for spinal cord stimulation (SCS). Implant status, stimulation mode, anode‐cathode configuration (array), cathode position, paresthesia overlap, complications, Visual Analog Scores (VAS), and overall satisfaction were prospectively examined in 20 patients implanted with dual 4 contact, staggered, percutaneous electrodes (Pisces 3487A, Medtronic, Minneapolis, Minnesota) internalized to a fully implantable, programmable IPG (Synergy 7466, Medtronic, Minneapolis, Minnesota). All patients had undergone initial implantation for chronic complex axial and extremity pain (eg, Failed Back Surgery Syndrome (FBSS), Complex Regional Pain Syndrome (CRPS)) with dual octapolar, radiofrequency (RF) SCS systems (Advanced Neuromodulation Systems 2098, Plano, Texas). 1 - 3 All patients required conversion to the current dual IPG systems due to RF system receiver sensitivity, preventing further antenna coupling). 1 Dual quadrupolar IPG SCS outcomes were compared to previous long‐term, dual octapolar RF SCS complex pain reports. 1 - 3 Data was collected and analyzed by a disinterested third party. At 18 months, all 20 patients remained implanted. All patients reported using 1 or 2 “best” guarded tripolar or bipolar arrays to maintain favorable paresthesia overlap (77.5%), VAS reduction (9.78 → 4.40), and overall patient satisfaction (80%). Eighty‐five percent of “best” anode‐cathode configurations were activated on both electrode columns about the physiologic midline of the C 3/4 vertebral segments for upper extremity pain, and the T 9/10 vertebral segments for low back and lower extremity pain. Sixty‐seven and one half percent of all electrodes were thoracic and 32.5% were cervical. “Best” arrays were activated as narrow (adjacent contact) guarded cathode tripoles (75%), extended (nonadjacent contact) bipoles/tripoles (15%), or as narrow bipoles (10%). The mean number of active contacts per “best” array was 5.6, with 3.75 anodes and 1.85 cathodes. All patients preferred the current IPG to the prior RF SCS implant, citing RF receiver site sensitivity, difficulty maintaining coupling of the RF antennae, and time intensive RF programming. Conversely, 13 patients (65%) reported IPG site sensitivity that did not affect overall satisfaction. That is, none would convert their current IPG to a smaller IPG to resolve this issue, unless it was of equal longevity. Sixteen patients (80%) were satisfied with the overall level of pain relief, and all (100%) would repeat the IPG SCS implant. This study demonstrates improved overall outcome and patient satisfaction after long‐term, dual octapolar RF SCS conversion to dual quadrupolar IPG SCS systems in the same patient population. It also validates prior dual SCS electrode reports of common array configuration, electrode positioning about the physiologic midline, and patient preference of single or dual programmability in the treatment of chronic complex pain. 1 , 4 , 5 Follow‐up of this initial experience with a multicenter study is warranted.     

Pathways of Translation: Deep Brain Stimulation

Electrical stimulation of the brain has a 2000 year history. Deep brain stimulation (DBS), one form of neurostimulation, is a functional neurosurgical approach in which a high‐frequency electrical current stimulates targeted brain structures for therapeutic benefit. It is an effective treatment for certain neuropathologic movement disorders and an emerging therapy for psychiatric conditions and epilepsy. Its translational journey did not follow the typical bench‐to‐bedside path, but rather reversed the process. The shift from ancient and medieval folkloric remedy to accepted medical practice began with independent discoveries about electricity during the 19th century and was fostered by technological advances of the 20th. In this paper, we review that journey and discuss how the quest to expand its applications and improve outcomes is taking DBS from the bedside back to the bench.     

经颅磁刺激及局部直流电刺激对受损周围神经再生的影响

目的 分别从电生理学、组织学方面观察经颅磁刺激及局部直流电刺激对周围神经再生的影响，探讨其促进受损神经功能恢复的相关机制。方法共选取20只SD大鼠，将其制成周围神经损伤模型并随机分为经颅磁刺激组及局部直流电刺激组，分别采用电生理学及组织学方法观察磁刺激对周围神经潜伏期、波幅、神经传导速度及周围神经髓鞘结构、数量的影响，并与局部直流电刺激组进行比较。结果2组大鼠分别经20d相应处理后，发现经颅磁刺激组大鼠受损坐骨神经的波幅明显增高，与局部直流电刺激组间的差异有统计学意义；在组织学方面，可观察到经颅磁刺激组有大量新生神经髓鞘出现，其数量显著多于局部直流电刺激组，差异亦有统计学意义；另外经颅磁刺激组的髓鞘结构也较局部直流电刺激组清晰、完整。结论通过电生理学及组织学观察，发现经颅磁刺激在促进受损周围神经再生、修复方面，其疗效可能优于局部直流电刺激。     

Progress in sensorimotor rehabilitative physical therapy programs for stroke patients

Impaired motor and functional activity following stroke often has negative impacts on the patient, the family and society. The available rehabilitation programs for stroke patients are reviewed. Conventional rehabilitation strategies (Bobath, Brunnstrom, proprioception neuromuscular facilitation, motor relearning and function-based principles) are the mainstream tactics in clinical practices. Numerous advanced strategies for sensory-motor functional enhancement, including electrical stimulation, electromyographic biofeedback, constraint-induced movement therapy, robotics-aided systems, virtual reality, intermittent compression, partial body weight supported treadmill training and thermal stimulation, are being developed and incorporated into conventional rehabilitation programs. The concept of combining valuable rehabilitative procedures into “a training package”, based on the patient’s functional status during different recovery phases after stroke is proposed. Integrated sensorimotor rehabilitation programs with appropriate temporal arrangements might provide great functional benefits for stroke patients.     

咽部冰刺激联合低频脉冲电刺激在脑卒中后吞咽障碍患者中的应用效果

目的:观察咽部冰刺激联合低频脉冲电刺激在脑卒中后吞咽障碍患者康复治疗中的效果。方法:选择2017年4月至2018年4月在德阳市人民医院神经内科住院治疗的脑卒中后吞咽障碍的患者168例为研究对象,采用随机数字表法分为3组,每组各56例。对照组给予常规吞咽训练,电刺激组在对照组的基础上施加低频脉冲电刺激,联合刺激组在电刺激组基础上给予咽部冰刺激,干预时间为2周。对比分析3组患者治疗效果,包括洼田饮水试验、标准吞咽功能评分、吞咽障碍特异性生活质量评分和肺炎的发生率。结果:3组的治疗总有效率分别为76.4%(对照组)、96.4%(电刺激组)和98.1%(联合刺激组),差异有统计学意义(P<0.01);肺炎发生率分别为34.5%(对照组)、17.9%(电刺激组)和14.8%(联合刺激组),差异有统计学意义(P<0.01);干预后联合刺激组吞咽功能和生活质量评分均优于对照组,差异有统计学意义(P<0.01)。结论:咽部冰刺激联合低频脉冲电刺激能有效提高脑卒中后吞咽障碍患者的康复有效率,改善吞咽功能,并能够显著降低相关性肺炎发生率,从而提高患者的生活质量。