脑白质高信号与上下肢运动功能障碍的相关性研究

目的 脑白质高信号(white matter hyperintensities, WMH)作为脑小血管病(cerebral small vessel disease, cSVD)的影像学特征之一,已经被证明与步态障碍相关,而针对其对上肢运动功能影响的研究较少。本研究旨在探究WMH与上肢及下肢运动功能障碍的相关性。方法 本研究连续入组首都医科大学附属北京朝阳医院神经内科查体的受试者,收集其临床资料并对其进行头部磁共振成像(magnetic resonance imaging, MRI)检查。根据Fazekas评分将受试者分为WMH低负担组(0~2分)和WMH中-高负担组(3~6分)。通过4米步行、起立行走(Timed Up and Go, TUG)测试、简易体能测试量表(Short Physical Performance Battery, SPPB)以及Tinetti平衡与步态量表评估下肢功能;用 10次双手轮替、10次手指捏合以及10次双手握拳时间评估上肢功能。采用单因素以及多因素线性回归探究WMH和上下肢运动功能之间的相关性。结果 入选的256名受试者平均年龄为(61.6±10.1)岁。其中WMH低负担组172人(67.2%),中-高负担组84人(32.8%)。多因素线性回归分析在校正年龄、性别、身高、血管危险因素以及其他cSVD分型后,WMH中-高负担组受试者的步宽增宽(β=1.174,P=0.021)和步频增加(β=0.533,P=0.022),与步长和步速无关(β=-1.550,P=0.228;β=0.062,P=0.429)。WMH中-高负担组的受试者Tinetti得分以及SPPB试验得分明显低于低负担组(β=-1.127,P=0.000;β=-0.844,P=0.000),TUG试验用时也明显增加(β=1.518,P=0.000)。10次双手轮替、捏合以及手运动用时WMH中-高负担组也明显增加(β=0.635,P=0.021;β=0.962,P=0.000;β=0.518,P=0.020)。结论 严重WMH会造成上肢以及下肢运动功能的障碍,导致运动功能下降。对于探究WMH导致运动功能障碍的机制有一定价值。     

步态训练矫正仪对脑卒中足下垂患者步态改善的效果分析

目的：探讨步态训练矫正仪对脑卒中足下垂患者的步态改善情况。方法收集符合本研究标准的脑卒中足下垂患者共30例,按随机数字表法随机分为对照组和观察组,每组各15例。两组患者均给予常规的药物治疗及功能康复训练,在此基础上观察组加用步态训练矫正仪治疗,1天2次,每次10~15 min。治疗前及治疗4周后,分别对两组患者下肢运动功能评定量表（FMA 评分）、异常步态模式评定量表及步态时空参数的结果进行分析比较。结果治疗4周后,两组患者的 FMA 评分、异常步态模式评分及步行参数均较治疗前改善（P ﹤0.05）,且观察组优于对照组（P ﹤0.05）。结论步态训练矫正仪可改善脑卒中患者足下垂步态。     

Intentional on-line adaptation of stride length in human walking

The intentional control of stride length is a fundamental basis for the adaptation of the stride to environmental constraints (obstacle avoidance, for example). Controlling the propulsive forces during the stance and/or controlling the pendular movement of the oscillating leg constitute the two potential and non-exclusive mechanisms underlying intentional stride length modulation. The present experiment was conducted in order to determine if these two mechanisms contribute to voluntary length modulation and, if so, how they cooperate according to whether the subject has to lengthen or shorten a stride and how these mechanisms are implemented at the neuromuscular level. Subjects had to produce a temporarily modulated stride of the same length, but originating from two different initial steady-states: one from shorter stride length and one from longer stride length. We found that the shortening was essentially realized by a swing-duration decrease (an increased activity in the hip extensor--biceps femoris--during the swing of the ipsilaterally shortened stride stopped the pendular leg movement earlier). The lengthening was realized by two mechanisms: (1) an increase in the propulsive forces (via an increased activity of the ankle extensor muscles--soleus--and the hip extensors--biceps femoris--from the stance of the ipsilaterally modulated stride, which was prolonged during the following stance of the contralateral leg), and (2) an increase in swing duration on the ipsilateral leg (an increased activity in hip and ankle flexors--rectus femoris and tibialis anterior--maintained the ipsilateral leg in flexion during the lengthened swing so that the foot landed later). In this experiment, the subjects were faced with a spatial constraint of the same magnitude in the direction of stride lengthening and stride shortening. However, under these conditions, subjects used a different balance between swing control (that directly modifies the foot trajectory without affecting the trajectory of the head-arm-trunk system) and/or the control of propulsive forces (that indirectly influences foot trajectory by modifying the trajectory of the head-arm-trunk system). In the first case, this concerns a voluntary control of gesture produced by the legs and usually implicated in the locomotor pointing; in the second case, this concerns a voluntary control of propulsive forces.     

Clinical features, laboratory findings and differential diagnosis of benign acute childhood myositis

We report clinical and laboratory data from 32 children with benign acute childhood myositis (BACM), children who presented with calf tenderness and gait abnormality. Laboratory evidence of a viral infection was evident in 23 patients, while serum creatine phosphokinase was uniformly increased (558 to 6800 U/L). Twenty-five patients (78.1%) were given a diagnosis other than BACM by their general practitioner or paediatrician. All patients made a rapid recovery within one week. We conclude that BACM should be encountered among the main causes of sudden-onset gait abnormality in young children.     

Motor and cognitive performances in pre-lingual cochlear implant adolescents,related with vestibular function and auditory input

Background: Information about the role of auditory input and motor control is limited.

Objectives: Assessment the relationship between auditory and vestibular information with specific motor and cognitive functions.

Methods: Posturography in 17 Pre-lingual Cochlear Implant Adolescents, (PCIA) age 14.06?±?3.05 in four sensory conditions was analyzed: (A) eyes open, cochlear implant (CI) on, (B) eyes open, CI off, (C) eyes closed standing on a foam over a platform (ECFP) with CI on, and (D) ECFP, CI off. Gait velocity (GV) was registered by inertial sensors using a 10-meter test. Vestibulo-ocular reflex (VOR) was evaluated with the video head impulse test (VHIT) and visual spatial skill (VS) assessed with the WISC-V test.

Results: SV had no significant difference between conditions A and B (p?=?.2461). Comparing C and D, SV values decreased when CI was turned on (p?=?.0036). A significant linear relationship between VOR and GV (p?=?.0064) generating the VOR gain loss lower gait. Relationship between VOR and VS scores was no significant (p?=?.685).

Conclusions and significance: Auditory information is a relevant cue when somatosensory and visual inputs are modified and range of vestibular function influence in a dynamic motor activity as gait, facts which must be considered in the neurodevelopment control.