奥拉西坦联合肌电生物反馈疗法治疗血管性痴呆疗效观察

目的:探讨奥拉西坦联合肌电生物反馈疗法治疗血管性痴呆(VD)的临床效果。方法:随机将2017年1月~2017年6月某院收治的104例VD患者随机分为A、B两组(A=52,B=52)。两组患者均给予奥拉西坦治疗,B组加用肌电生物反馈疗法,对比两组患者治疗前后MMSE、ADL和SF-36评分。结果:治疗后B组患者MMS、ADL和SF-36评分均高于A组(P<0.05)。结论:奥拉西坦联合肌电生物反馈疗法治疗可有效改善VD智力水平、自主生活能力和生活质量,具有较高的临床推广价值。     

Guidelines for Trials of Behavioral Treatments for Recurrent Headache, First Edition: American Headache Society Behavioral Clinical Trials Workgroup

Guidelines for design of clinical trials evaluating behavioral headache treatments were developed to facilitate production of quality research evaluating behavioral therapies for management of primary headache disorders. These guidelines were produced by a Workgroup of headache researchers under auspices of the American Headache Society. The guidelines are complementary to and modeled after guidelines for pharmacological trials published by the International Headache Society, but they address methodologic considerations unique to behavioral and other nonpharmacological treatments. Explicit guidelines for evaluating behavioral headache therapies are needed as the optimal methodology for behavioral (and other nonpharmacologic) trials necessarily differs from the preferred methodology for drug trials. In addition, trials comparing and integrating drug and behavioral therapies present methodological challenges not addressed by guidelines for pharmacologic research. These guidelines address patient selection, trial design for behavioral treatments and for comparisons across multiple treatment modalities (eg, behavioral vs pharmacologic), evaluation of results, and research ethics. Although developed specifically for behavioral therapies, the guidelines may apply to the design of clinical trials evaluating many forms of nonpharmacologic therapies for headache.     

Botulinum toxin and neuromotor rehabilitation: An integrated approach to idiopathic cervical dystonia.

Currently, the best treatment option for idiopathic cervical dystonia (ICD) is injection of botulinum toxin (BTX) into the affected muscles, whereas rehabilitative approaches have given disappointing results. We evaluated whether the association of an ad hoc rehabilitative program may improve the clinical efficacy of BTX treatment in a single-center, cross-over, controlled study. Forty patients with ICD were randomly assigned to two different treatment groups: (1) BTX type A (BTX-A) plus a specific program of physical therapy (BTX-PT) or (2) BTX-A alone (BTX-0). Patients in the BTX-PT group showed a longer duration of the clinical benefit (118.8 vs. 99.1 days) and needed a lower dose of BTX at reinjection (284.5 vs. 325.5 units). In addition, they showed more marked reductions in their disability in activities of daily living (-9.7 vs. -4.85 points) and subjective pain (-13.35 vs. 6.95 points) scores. Association of BTX-A therapy with a specific program of physical therapy may improve ICD treatment outcome.     

An effective treatment for functional urinary incoordination

Twenty women diagnosed with functional urinary incoordination were randomly assigned to one of two treatment groups: biofeedback or progressive muscle relaxation. Ten subjects who were placed on a waiting list prior to treatment allocation served as a comparison group. The biofeedback intervention focused specifically on retraining of pelvic floor musculature (PFM). Patients were assessed pretreatment, posttreatment, and at 2-month follow-up. Outcome measures included self-reported symptomatology, psychological functioning, psychophysiological assessment of the PFM, and urologist ratings of problem severity and treatment efficacy. Both treatment approaches proved effective in improving symptomatology and psychological state. Subjects on the waiting list demonstrated no change in urological difficulties. No differences were found between the two treatment groups on any of the outcome measures. Theoretical and practical implications of the results are discussed.     

Multiple Response Comparison of Parietal EEG and Frontalis EMG Biofeedback

In Study I parietal EEG and frontalis EMG were simultaneously recorded from 20 normal subjects while half of the subjects received 45 min of eyes-closed alpha EEG enhancement feedback and the other half received a similar amount of EMG suppression feedback. EMG feedback resulted in a significant reduction in frontalis EMG activity accompanied by a reliable increase in parietal alpha density, while EEG feedback produced only an increase in alpha without corresponding EMG reduction. In Study II, each of 8 subjects underwent four separate feedback contingencies in two 40-min sessions—one session with eyes open and the other with eyes closed. The four types of feedback were: a) alpha-up (alpha enhancement), b) alpha-down (alpha suppression), c) EMG-down (frontalis tension decrease), and d) EMG-up (frontalis tension increase). EMG feedback, up and down, resulted in the more consistent pattern of generalized arousal changes reflected in heart rate and respiratory rate as well as EEG and EMG activity. Within the constraints of a limited training period, the results suggest that frontalis EMG feedback is the more efficient procedure for producing a generalized relaxation response. However, since fingertip vasoconstriction accompanied all four types of feedback, caution must be exercised to avoid the oversimplification of generalized organism effects.     

Effect of EMG Biofeedback and Progressive Muscle Relaxation Training on Awareness of Frontalis Muscle Tension

Awareness of muscle tension, as estimated by a modification of the Kinsman et al. (1975) procedure for determining probability of correct estimation (P(c)) of absolute differences in muscle tension between adjacent trials, was examined before and after volunteer subjects underwent 4 sessions of either: 1) EMG biofeedback (BF) training, 2) progressive muscle relaxation (PMR) training, or 3) a placebo-control (MC) procedure which involved listening to music as an alleged guide for relaxation. The subjects were 30 females (mean age = 28.3 yrs) responding to an offering of experimental treatment for anxiety and tension. Measurements of frontalis muscle tension (EMG) and P(c) were made before and after training. The results showed that EMG was significantly reduced by BF and PMR training but not by the MC procedure. Increases in P(c) after training were significantly greater for BF than for PMR or MC training. There were no group differences for subjective report of tension. Correlations between pre- to post-training EMG and P(c) change scores were significant only for the BF group and the combined group of BF and PMR subjects. These results suggest that: 1) both BF and PMR training were effective in producing frontalis EMG reductions, 2) the following relationship may exist among training groups in terms of relative influence upon awareness of tension—BF training > PMR training > MC training, and 3) awareness of tension appears to be related to the ability to reduce EMG although the exact nature of this relationship remains unclear.     

共患抽动障碍的ADHD儿童的脑电生物反馈治疗研究

目的:探讨脑电生物反馈治疗共患抽动障碍的注意缺陷多动障碍(ADHD)患儿的疗效。方法:对14例符合美国精神障碍诊断与统计手册第4版(DSM-IV)诊断标准,年龄7～14岁的共患抽动障碍的ADHD患儿进行平均为34次的脑电反馈治疗,治疗前后分别采用Conner父母问卷、Achenbach 量表和Rutter问卷评定行为水平,并测试中国韦氏记忆量表、韦氏儿童智力量表(C-WISC)、持续操作性测试(CPT)等项。抽动障碍严重程度采用耶鲁全面抽动严重程度量表(Yale Global Tic Severity Scale,YGTSS)进行评定。结果:治疗后Conner父母问卷多动指数(10.6±5.6)和Rutter问卷总分(11.5±8.6)较治疗前明显下降,分别为15.7±6.0和17.2±10.5,P<0.01。Achenbach 量表多动因子分治疗后较治疗前明显下降,治疗前后分别为13.2±7.4 和7.5±3.7, P<0.05。Conner父母问卷多动分数有所下降,但差异未达显著性(P>0.05)。治疗后,患儿韦氏记忆量表的记忆商(97.8±11.7)及C-WISC中注意/不分心因子分(106.3±10.6)均高于治疗前(分别为91.3±16.3和95.5±13.0),差异具有显著性(分别为P<0 .05,P<0.01)。在CPT测试中,平均反应时下降(治疗前后分别为523.3±86.7和464.3±68.2毫秒,P<0.05),正确率提高(治疗前后分别为90%和95%,P<0.05)。14例患儿运动抽动和发声抽动在     

Comparison of Frontal EMG Biofeedback and Several Types of Relaxation Instructions in Reducing Multiple Indices of Arousal

During the training phase, 96 subjects were given one of four types of relaxation instructions (single instructions, repeated instructions, relaxation training, no instructions) and in addition either did or did not receive frontal EMG biofeedback training. Results indicated that each of the instructions and biofeedback procedures were equally effective in reducing frontal EMG, but that none of these procedures had any effect on subjective anxiety or autonomic indices of arousal (pulse rate, skin temperature, and finger pulse volume). During the generalization/stress phase, subjects were threatened with electric shock and were told to apply the relaxation techniques they learned during the training phase even though no additional instructions and/ or biofeedback training would be provided. To assess the effectiveness of the shock manipulation, a no-threat control group was included. Results indicated that: a) the shock manipulation was effective in increasing arousal, b) previous instructions and/or biofeedback were equally effective in reducing frontal EMG levels, but that c) only relaxation training was consistently effective in reducing subjective and autonomic indices of arousal. These findings: a) suggest that in stressful situations, relaxation training may be more effective than either EMG biofeedback or simple relaxation instructions in producing a general relaxation effect as opposed to a specific EMG effect; and b) indicate the importance of assessing the effectiveness of relaxation procedures during stressful situations during which subjects’ levels of arousal are elevated above resting baseline levels.     

Effects of a second bout of maximal eccentric exercise on muscle damage and electromyographic activity

This study examined whether a second bout of maximal eccentric exercise performed 3 days after the first exercise bout would produce further changes in muscle damage and electromyographic activity (EMG). Male students (n=26) were randomly assigned to experimental 70 (EX70; n=9), experimental 30 (EX30; n=8), and control (CON; n=9) groups. The initial exercise was 30 maximal voluntary isokinetic eccentric contractions (MAX1) on non-dominant elbow flexors at 60° s⁻¹ (1.05 rad s^-1). The EX70 and EX30 groups performed a second bout of 70 and 30 eccentric contractions (MAX2), respectively, 3 days after MAX1. Upper arm circumference , range of motion , strength, integrated EMG (IEMG), and mean power frequency (MPF) were measured before, immediately after, and once a day for 9 days after MAX1. Plasma creatine kinase (CK) activity and muscle soreness were assessed before and for 9 days after MAX1. Total work, work per contraction, IEMG, and MPF were also recorded during MAX1 and MAX2. All indicators of muscle damage changed following MAX1 for each group (P<0.05), but no indicators of additional damage (P>0.05) were apparent after MAX2 for either the EX70 or EX30 groups. IEMG (P=0.03) and MPF (P=0.04) were lower for MAX2 compared with MAX1 for both the EX30 and EX70 groups. It is concluded that performing a second bout of eccentric exercise with damaged muscles 3 days after the initial bout does not produce further damage or retard recovery, even when the second bout of exercise is more strenuous. EMG findings were consistent with reduced activation of fast-twitch motor units during the second eccentric bout. These results may be interpreted as evidence of a neural protective mechanism. Electronic Publication