Differences between flexion and extension synergy-driven coupling at the elbow,wrist, and fingers of individuals with chronic hemiparetic stroke

ObjectiveThe flexion and extension synergies were quantified at the paretic elbow, forearm, wrist, and finger joints within the same group of participants for the first time. Differences in synergy expression at each of the four joints were examined, as were the ways these differences varied across the joints.MethodsTwelve post-stroke individuals with chronic moderate-to-severe hemiparesis and six age-matched controls participated. Participants generated isometric shoulder abduction (SABD) and shoulder adduction (SADD) at four submaximal levels to progressively elicit the flexion and extension synergies, respectively. Isometric joint torques and EMG were recorded from shoulder, elbow, forearm (radio-ulnar), wrist, and finger joints and muscles.ResultsSABD elicited strong wrist and finger flexion torque that increased with shoulder torque level. SADD produced primarily wrist and finger flexion torque, but magnitudes at the wrist were less than during SABD. Findings contrasted with those at the elbow and forearm, where torques and EMG generated due to SABD and SADD were opposite in direction.ConclusionsFlexion and extension synergy expression are more similar at the hand than at the shoulder and elbow. Specific bulbospinal pathways that may underlie flexion and extension synergy expression are discussed.SignificanceWhole-limb behavior must be considered when examining paretic hand function in moderately-to-severely impaired individuals.     

注射用己酮可可碱联合奥扎格雷钠治疗急性脑梗死的临床研究

目的 分析注射用己酮可可碱联合奥扎格雷钠治疗急性脑梗死的临床疗效。方法 选取2015年3月—2020年10月北京市丰台中西医结合医院收治的112例急性脑梗死患者,按随机数字表法将患者分为对照组和治疗组,每组各56例。对照组静脉滴注注射用奥扎格雷钠,80 mg/次,溶于500 mL生理盐水中,2次/d。治疗组在对照组治疗基础上静脉滴注注射用己酮可可碱,0.2 g/次,溶于250 mL生理盐水中,1次/d,输注过程中患者平卧,2～3 h内滴注完成。两组疗程均为14 d。观察两组的临床疗效,比较两组治疗前后美国国立卫生研究院卒中量表（NIHSS）评分、简式Fugl-Meyer评定量表（FMA）评分、脑卒中专门化生存质量量表（SS-QOL）评分及血小板压积（PCT）、血小板聚集率（PAgT）、纤维蛋白原（FIB）和炎症相关指标[中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）]的变化。结果 治疗后,治疗组总有效率是94.64%,显著高于对照组的82.14%（P＜0.05）。治疗3、7、14 d后,两组NIHSS评分均较同组治疗前显著降低（P＜0.05）;治疗后,治疗组患者NIHSS评分显著低于对照组（P＜0.05）。治疗后,两组FMA、SS-QOL评分均较治疗前显著增加（P＜0.05）;治疗后,治疗组FMA、SS-QOL评分高于对照组（P＜0.05）。治疗后,两组PCT、PAgT、FIB、NLR、PLR均显著下降（P＜0.05）;治疗后,治疗组凝血及炎症相关指标显著低于对照组（P＜0.05）。结论 注射用己酮可可碱联合奥扎格雷钠治疗急性脑梗死的效果确切,能在较佳的安全性基础上,有效促进患者神经功能、运动功能恢复,改善凝血功能紊乱和机体炎症损害,利于患者生存状态提升。     

Comparison of Neuroplastic Responses to Cathodal Transcranial Direct Current Stimulation and Continuous Theta Burst Stimulation in Subacute Stroke

Objective

To investigate the effects of cathodal transcranial direct current stimulation (tDCS) and continuous theta burst stimulation (cTBS) on neural network connectivity and motor recovery in individuals with subacute stroke.

Comparative study of cephalometric measurements using 3 imaging modalities

Background

The authors conducted a study to compare 2-dimensional (2D) lateral cephalometric radiography (LCR), 2D cone-beam computer tomographic (CBCT)–generated cephalogram and 3-dimensional (3D) CBCT for assessing cephalometric measurements.

综合康复指导模式对脑卒中患者神经功能的影响

目的研究综合康复指导模式对脑卒中患者神经功能的影响。方法选择2018年1-12月天津医科大学第四中心医院收治的脑卒中患者共计80例,随机分为对照组和观察组,各40例。其中对照组给予常规治疗模式,观察组在此基础上给予综合康复指导。比较两组患者治疗后的康复效果及治疗前后NIHSS、FMA、ADL评分差异。结果治疗前,两组患者NIHSS、FMA、ADL各项评分差异无统计学意义(P>0.05);治疗后,观察组NIHSS、FMA、ADL各项评分情况均明显优于对照组,差异有统计学意义(P<0.05)。结论综合康复指导模式能有效提高脑卒中患者康复疗效,帮助患者提升生活质量,疗效明显,值得临床推广应用。     

头针结合热敏灸辅助治疗急性脑梗死后手软瘫33例临床观察

目的观察头针结合热敏灸辅助治疗急性脑梗死后手软瘫的临床疗效。方法将65例急性脑梗死后手软瘫患者采用随机数字表法分为治疗组33例和对照组32例。2组均给予西医常规治疗,在此基础上,对照组配合头针治疗,治疗组配合头针结合热敏灸治疗。2组均连续治疗6 d,间隔1 d,12次为1个疗程,共治疗1个疗程。1个疗程后比较2组的临床疗效、治疗前后Fugl-Meyer评定量表(FMA)评分及改良Barthel指数(MBI)评分。结果治疗后2组FMA评分及MBI评分均明显升高,与同组治疗前比较差异有统计学意义(P<0.05),且治疗组升高更明显,与对照组治疗后比较差异有统计学意义(P<0.05);治疗组总有效率为90.91%(30/33),对照组为81.25%(26/32),2组比较差异有统计学意义(P<0.05)。结论头针结合热敏灸辅助治疗急性脑梗死后手软瘫临床疗效显著,可明显改善患者运动功能并提高日常生活活动能力,值得临床推广应用。     

Development of a Computerized Adaptive Testing System of the Functional Assessment of Stroke

Objective

To develop a computerized adaptive testing system of the Functional Assessment of Stroke (CAT-FAS) to assess upper- and lower-extremity (UE/LE) motor function, postural control, and basic activities of daily living with optimal efficiency and without sacrificing psychometric properties in patients with stroke.

An analysis of FMA using structural self-bisimilarity

As ontologies are mostly manually created, they tend to contain errors and inconsistencies. In this paper, we present an automated computational method to audit symmetric concepts in ontologies by leveraging self-bisimilarity and linguistic structure in the concept names. Two concepts A and B are symmetric if concept B can be obtained from concept A by replacing a single modifier such as “left” with its symmetric modifier such as “right.” All possible local structural types for symmetric concept pairs are enumerated according to their local subsumption hierarchy, and the pairs are further classified into Non-Matches and Matches. To test the feasibility and validate the benefits of this method, we computed all the symmetric modifier pairs in the Foundational Model of Anatomy (FMA) and selected six of them for experimentation. 9893 Non-Matches and 221 abnormal Matches with potential errors were discovered by our algorithm. Manual evaluation by FMA domain experts on 176 selected Non-Matches and all the 221 abnormal Matches found 102 missing concepts and 40 misaligned concepts. Corrections for them have currently been implemented in the latest version of FMA. Our result demonstrates that self-bisimilarity can be a valuable method for ontology quality assurance, particularly in uncovering missing concepts and misaligned concepts. Our approach is computationally scalable and can be applied to other ontologies that are rich in symmetric concepts.     

Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS)

A group of European experts was commissioned by the European Chapter of the International Federation of Clinical Neurophysiology to gather knowledge about the state of the art of the therapeutic use of transcranial direct current stimulation (tDCS) from studies published up until September 2016, regarding pain, Parkinson’s disease, other movement disorders, motor stroke, poststroke aphasia, multiple sclerosis, epilepsy, consciousness disorders, Alzheimer’s disease, tinnitus, depression, schizophrenia, and craving/addiction. The evidence-based analysis included only studies based on repeated tDCS sessions with sham tDCS control procedure; 25 patients or more having received active treatment was required for Class I, while a lower number of 10–24 patients was accepted for Class II studies. Current evidence does not allow making any recommendation of Level A (definite efficacy) for any indication. Level B recommendation (probable efficacy) is proposed for: (i) anodal tDCS of the left primary motor cortex (M1) (with right orbitofrontal cathode) in fibromyalgia; (ii) anodal tDCS of the left dorsolateral prefrontal cortex (DLPFC) (with right orbitofrontal cathode) in major depressive episode without drug resistance; (iii) anodal tDCS of the right DLPFC (with left DLPFC cathode) in addiction/craving. Level C recommendation (possible efficacy) is proposed for anodal tDCS of the left M1 (or contralateral to pain side, with right orbitofrontal cathode) in chronic lower limb neuropathic pain secondary to spinal cord lesion. Conversely, Level B recommendation (probable inefficacy) is conferred on the absence of clinical effects of: (i) anodal tDCS of the left temporal cortex (with right orbitofrontal cathode) in tinnitus; (ii) anodal tDCS of the left DLPFC (with right orbitofrontal cathode) in drug-resistant major depressive episode. It remains to be clarified whether the probable or possible therapeutic effects of tDCS are clinically meaningful and how to optimally perform tDCS in a therapeutic setting. In addition, the easy management and low cost of tDCS devices allow at home use by the patient, but this might raise ethical and legal concerns with regard to potential misuse or overuse. We must be careful to avoid inappropriate applications of this technique by ensuring rigorous training of the professionals and education of the patients.