Botulinum toxin-A with and without rehabilitation for the treatment of spastic cerebral palsy.

OBJECTIVE: To determine the efficacy of botulinum toxin-A (BTX-A) nerve block, with and without rehabilitation, in the treatment of spastic cerebral palsy. METHODS: Patients (aged 1-23 years) with spastic cerebral palsy underwent nerve block with BTX-A, followed by ≥ 2 h/day rehabilitation (experimental group) or <2 h/day rehabilitation (control group). Muscle tension and motor function were evaluated pre-block using the Modified Ashworth Scale (MAS) and gross motor function measure (GMFM), respectively. MAS was assessed weekly to determine duration of action of BTX-A; GMFM was assessed at 1 year post-block. RESULTS: There were no significant differences between the experimental group (n = 120) and the control group (n = 124) in age, body weight, pre-block MAS or GMFM, or BTX-A duration of action. MAS was significantly improved in both groups at 1 month post-block. At 1 year post-block, GMFM was significantly improved in both groups, with a significantly greater improvement seen in the experimental group compared with the control group. CONCLUSION: BTX-A block improved muscle tension and motor function. Rehabilitation training, following the block, resulted in greater improvements to motor function than block alone.

Meta-analysis of branched chain amino acid-enriched nutrition to improve hepatic function in patients undergoing hepatic operation / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To perform a meta-analysis of randomized controlled trials (RCTs) assessing the benefit of providing branched chain amino acid (BCAA)-enriched nutrition to improve hepatic function in patients undergoing hepatic operation.</p><p><b>METHODS</b>The electronic databases of PubMed, Springerlink, the Chinese Biomedical Database (CBM), the Cochrane Library, and the China National Knowledge Infrastructure (CNKI) were searched for relevant RCTs using the following search terms: nutritional support, enteral nutrition, parenteral nutrition, hepatic/liver surgery, liver cirrhosis, cancer, hepatectomy, and liver transplantation. The quality of the retrieved RCTs was assessed according to the scale developed by the Cochrane Collaboration. The meta-analysis was conducted using RevMan software, version 5.2.</p><p><b>RESULTS</b>A total of 11 relevant RCTs, representing 510 patients, were included in the meta-analysis. Compared to patients in the control (normal nutrition) group, the patients in the BCAA group experienced an effective improvement in hepatic function, as evidenced by significant decreases in total bilirubin (by 0.07 mumol/L; 95% confidence interval (CI): -0.18 to 0.05, P more than 0.05]. In addition, the BCAA group showed improvements in plasma levels of albumin (weighted mean difference (WMD) = 0.07; 95% CI: 0.06, 0.24, P less than 0.05) and alanine aminotransferase (WMD = +5.61; 95% CI: -8.63 to 19.86, P more than 0.05] but neither of the changes reached the threshold of a statistically significant improvement. The BCAA group did however show significantly lower complication rate after operation (65%, 95% CI: 0.48, 0.87, P less than 0.01] and mean duration of hospital stay (4.61 days; 95% CI: -6.61, -2.61, P less than 0.01].</p><p><b>CONCLUSION</b>BCAA-enriched nutrition improves hepatic function in patients undergoing hepatic operation, thereby helping to reduce the complication risk, duration of hospital stay, and financial burden. BCAA-enriched nutrition is a safe and effective therapy and further clinical application may be beneficial.</p>

Effect of Botulinum Toxin Type A on Spastic Hamstring in Children with Cerebral Palsy / 中国康复理论与实践

@#Objective To observe the effect of Botulinum toxin type A (BTX-A) injection on spastic hamstring in the children with cerebral palsy. Methods 39 cerebral palsy children with spastic hamstring were divided into control group (n=20) and experimental group (n= 19). The control group accepted physical therapy, while the experimental group accepted BTX-A injection in affected hamstring in addition.They were assessed with modified Ashworth Scale (MAS), Gross Motor Fucntion Measure (GMFM-88) and flexion angle of knee joints before and after treatment. Results The scores of MAS and GMFM-88, and flexion angle of knee joints improved significantly 6 weeks after treatment in the experimental group (P<0.05), and improved more than that in the control group (P<0.05). Only the score of GMFM-88 improved significantly in the control group (P<0.05). Conclusion BTX-A injection can relieve hamstring spasticity in children with cerebral palsy, which may be helpful to correct abnormal gait and improve the motor function.

The effect of motor point blocking on spasticity in children with cerebral palsy / 中华物理医学与康复杂志

Objective To compare the advantages and disadvantages of botulinum toxin A (BTX-A) and phenol block in the treatment of spasticity in children with cerebral palsy. Methods Four hundred and twenty children with spastic cerebral palsy were divided into an experimental group (375 cases) and a control group (45 cases).The children were aged from 1 to 22 years ( average age 6 years).The children in the experimental group were treated with BTX-A block at a dosage of 55 to 350 IU (average 130.5 IU).The children in the control group were treated with a 5％ phenol solution block at a dosage of 0.5 to 4.6 ml ( average 2.2 ml).Children of both groups were given systematic functional rehabilitation training. All the children were evaluated with a physician rating scale (PRS) and the modified Ashworth scale (MAS) before and after the blocking.Effectiveness rates,effectiveness durations and side effects rates were calculated. Results Before treatment there was no significant difference in terms of motor disorder or spasticity between the 2 groups.After treatment,spasticity had been significantly reduced in both groups.The effectiveness rate was 98.4％ in the experimental group and 95.6％ in the control group,a difference which was not significant.The average effectiveness duration was ( 24.9 ± 5.76 ) weeks in the experimental group and ( 69.2 ± 13.76) weeks in the control group,significantly longer.The side effects rate was 5.33 ％ in the experimental group and 15.56％ in the control group,also a significant difference. Conclusion BTX-A could be more widely used because of its safety and credibility.

Application of Community Extremity Impairment Assessment Schedule in Community Rehabilitation for Stroke / 中国康复理论与实践

@#Objective To evaluate the validity of Community Extremity Disability Assessment Schedule (CEDA) in community rehabilitation. Methods 313 patients with hemiplegia after stroke were divided into rehabilitation group and control group. The rehabilitation group received community-based rehabilitation (CBR) for 3 months, and was assessed with Community Extremity Disability Assessment Schedule before and 1 month, 2 months and 3 months after rehabilitation respectively. And it was compared with Fugl-Meyer Assessment (FMA). The control group received the same evaluation only. Results The scores of CEDA and FMA improved more in the rehabilitation group than in the control group 2 months after rehabilitation (P<0.01). The score of CEDA positively correlated with the FMA (r=0.643, P<0.01). Conclusion CEDA can be used to evaluate the efficacy of community rehabilitation.

Effect of Rehabilitation on Long-term Efficacy of Botulinum Toxin Type A on Spastic Cerebral Palsy / 中国康复理论与实践

@# Objective To investigate the long-term efficacy of Botulinum toxin type A (BTX-A) on spasticity in cerebral palsy, and theeffect of rehabilitation on it. Methods 230 children with spastic cerebral palsy were treated with BTX-A block. The dose of BTX-A wasidentified with the weight of the children and the Modified Ashworth Scale (MAS). They were divided into group A who exercised morethan 2 h/d, and group B who exercised less than 2 h/d or not. They were assessed with Gross Motor Function Measure (GMFM) 1 year aftertreatment. Results There was no significant difference between group A and B with ages, weight, MAS, GMFM before block (P>0.05), norwith BTX-A effect time (P>0.05). The GMFM improved significantly in both group A and B 1 year after block (P<0.05), and it improvedmore in group A than group B (P<0.01). Conclusion The long-term efficacy of BTX-A block is positive. The rehabilitation training afterblock can help children to improve their gross motor function.

Drug Resistance and Pathogens in General Surgery Department:Analysis of 158 Cases / 中华医院感染学杂志

OBJECTIVE To understand the pathogens and their drugs resistance in general surgery department and provide rational suggestion of antibiotics use for clinic treatment.METHODS A total of 158 cases with nosocomial infection among the general surgery department inpatients from Jun 2006 to Oct 2008 were retrospectively analyzed and summarized.RESULTS The common nosocomial infection sites were the lower respiratory tract,gastrointestinal tract,urinary tract and surgical sites.The G-bacilli of nosocomial infections in turn were Escherichia coli(18.02%),Acinetobacter baumannii(11.26%),Pseudomonas aeruginosa(7.66%),and Klebsiella pneumoniae(4.50%).The main G+cocci were Staphylococcus aureus(21.62%),Enterococcus faecium(5.86%)and E.faecalis(3.15%)in turn.In G-bacilli,the sensitivity to imipenem was the highest from 58.82% to 100.00%.The sensitivity to amikacin were more than 70.00% except A.baumannii,and to sulbactam/cefoperazone were more than 50.00% except Pseudomonas aeruginosa.In G+ cocci,the sensitivity to vancomycin of S.aureus and E.faecium was 100.00% and 84.62%.CONCLUSIONS Investigating the pathogens and their drug resistance in general surgery department is very important to prevent and control nosocomial infections.

An experimental study of neuronal activation through body-weight-supposed treadmill training after spinal cord injury using laser confocal microscopy / 中华物理医学与康复杂志

Objective To investigate the effects of locomotor training on improving locomotor function after spinal cord injury(SCI)and the mechanism of spinal cord plasticity.Methods A model of complete thoracic cord transection was established using 84 adult female rats divided into sham,SCI and treadmill training(BWSTT) groups.The hind limb locomotor function of all the rats was evaluated.The fluorescence intensities due to (EphA4),vesicular glutamate transporter 2(VGluT2)and EphA4/VGluT2 double-positive neurons in the ventromedial area of the anterior horn of the lumbar COrd were detected using immunofluorescence double labeling and laser confocal microscopy.Results The rats in the BWSTT group showed better functional recovery in their hind limbs than those in the SCI group.BWSTT was correlated with markedly increased EphA4.VGIuT2 and EphA4/VGluT2 intensities in the ventromedial area.Conclusion BWSTT improves hind limb locomotor function in rats with thoracic cord transections by elevating the expression of EphA4/VGluT2,promoting neuronal plasticity in the lumbar anterior horn.

Serum osteocalcin in patients with spinal cord injury / 中华物理医学与康复杂志

Objective To explore the correlation between the time course of disease and bone metabolism changes in patients with spinal cord injury. Methods Data on serum osteocalcin(SO)measured by radioimmunoassay(RIA)from a database on 167 patients with spinal cord injury(SCI)were analyzed retrospectively.The patients were divided into four groups according to the time post-injury:group A(＜3 months post-injury,n=44),group B(3-6 months post-injury,n=42),group C(7-12 months post-injury,n=37)and group D(＞12 months post-injury,n=44). Results The mean SO value in all 4 groups of patients was significantly higher than normal.The mean SO value of group B was significantly higher than that of group A,but not significantly different from that of group C.The mean SO value of group D was significantly lower than that of group C,but not significantly different from that of group A.Conclusion Serum osteocalcin is elevated in the early stages of SCI,and its subsequent de-cline is closely correlated with the time post-injury.

Influencing factors of functional recovery of stroke patients / 中国组织工程研究

BACKGROUND: The rehabilitation outcome varies in stroke patients,and there are differences in the literatures about the influence of factors on the functional recovery in such patients.,OBJECTIVE: To evaluate the pre-rehabilitative and post-rehabilitative effects of stroke patients by functional independence measure (FIM) that is widely used, and analyze the influence of gender, age, motor and cognitive functions at admission, time interval from stroke onset to arrival at rehabilitative admission, comorbidity occurrence, laterality of lesion on the functional recovery of stroke patients.DESIGN: Before-after control observationSETTING: Center of Rehabilitation Medicine, Shandong Provincial Hospital; Faculty of Rehabilitation Medicine, Capital University of Medical SciencesPARTICIPANTS: From March 2000 to December 2002, 55 stroke patients were selected from Shandong Provincial Hospital. They were all first episode, and patients whose bilateral cerebral hemisphere were involved were excluded.METHODS: After the vital signs were steady, the stroke patients got through risk phase (31-75 days) and were treated with medicine improving microcirculation and providing neurotrophic factor for nerves. In addition, they accepted comprehensive rehabilitation training of Bobath technique, PNF technique and Rood method mainly, with 1-2 hours per day and five times per week.MAIN OUTCOME MEASURES: The patients were evaluated within 7days after admission and reassessed 3 days before discharge using FIM,including 18 items of motor and cognitive functions and 126 total scores (108-126 as elementarily or completely independent, 72-107 as mildly dependent, 54-71 as moderately dependent, 36-53 as severely dependent,18-35 as extremely or completely dependent). Multiple stepwise regression equation was applied to analyze the relation of above factors and functional recovery (increased value of FIM total score).RESULTS: Totally 55 patients were involved into the result analysis.①FIM total score of patients was significantly higher at discharge than at admission (93.8±12.0, 68.8±11.6, P ＜ 0.001), and motor function and cognitive function at discharge also increased compare with at admission (P ＜ 0.001).②Mean value of FIM motor score increased everyday was identical with that of total score (0.56±0.21, 0.59±0.21), and higher than mean value of cognitive score (0.03±0.03).Multiple stepwise regression analysis showed,scores of motor and cognitive status at admission, age, time interval from stroke onset to arrival at rehabilitative admission all affected the increased value of FIM total scores. No significant association between gender, comorbidity, laterality lesion of paralysis and functional recovery was observed (P ＞ 0.05). The most influential factors were orderly motor function,cognitive function at admission, age and time interval from stroke onset to arrival at rehabilitation admission.CONCLUSION: Motor and cognitive function at admission, age and time interval from stroke onset to arrival at rehabilitative admission have a no table relationship with functional recovery of stroke patients, especially motor function at admission is positively related. Thus we should not neglect the influence of these factors when conducting rehabilitative treatment.

The application of aqua-walking in patients with spinal cord injury / 中华物理医学与康复杂志

Objective To determine the effect of walking in water on patients with spinal cord injury~SCI). Methods Twenty SCI patients were recruited in this study, and these patients were randomly divided into a control group ~10 cases) and an experiment group~10 cases).The patients of the experiment group were administered aqua-walking and conventional physical therapy~PT),and the patients of control group were administered the conventional PT only. Results After 10 weeks of therapy, the muscle tone, motor index score and functional ambulation classification of experiment group were ameliorated significantly in comparison with the control group(P

Effect of early intervention on bone mass and biomechanical properties of femur in rats after spinal cord injury / 中华物理医学与康复杂志

Objective To explore the effect of early administration of alendronate (ALN) and pulsed electromagnetic fields (PEMFs) on bone mass of rats after spinal cord injury(SCI). Methods Sixty-two healthy female SD rats aged 3 months were randomly allocated into 5 groups: a Sham group, a SCI group, a SCI+ALN group, a SCI+PEMFs group and a SCI+PEMFs+ALN group. Rats in the Sham group underwent laminectomy, while the rats in the other 4 groups underwent complete spinal cord transection, and the remained 3 groups were treated with ALN and/or PEMFs 1 week after SCI. All rats were sacrificed 8 weeks after operation. The bone mineral density(BMD), biomechanical parameters of the femurs, and histomorphometric parameters of proximal tibias were mea-sured, respectively. The data were analyzed with one way-ANOVA and factorial design-ANOVA. Results After early treatment of ALN and/or PEMFs, the BMD of femur was significantly increased as compared with that of rats in the SCI group; the elastic load, maximal load of femur were significantly increased as compared with those of rats in the SCI group; the percent trabecular bone area and trabecular bone width of tibias were significantly increased when compared to those of rats in the SCI group. Conclusion Early treatments of ALN and PEMFs can reduce the loss of bone, improve biomechanical properties of the femur, and inhibit the decay of microstructure of upper part of tibia. The study suggests that ALN and PEMFs may help prevent osteoporosis after SCI.

Application of Problem Based Learning in the Course of Assessment & Evaluation of Physical Therapy / 中国康复理论与实践

@# Objective To investigate the effect of problem based learning (PBL) applied in the course of Assessment & Evaluation of Physical Therapy. Methods PBL and traditional teaching were applied in different classes. Their scores of the final examination were compared, and the students were investigated with the questionnaire. Results The scores of final examination were higher in the PBL class than that in the traditional teaching (P<0.001). A lot of the students accepted the PBL in the course. Conclusion PBL can improved the teaching quality of the course of Assessment & Evaluation of Physical Therapy.

The effect of treatment of spastic cerebral palsy by BTX-A block / 中华物理医学与康复杂志

Objective To investigate the effect of B TX -A block by insulative needle to release the spasticity in cerebral palsy. MethodsFrom June 2000 to November 2002, 47 children wit h spastic cerebral palsy aged 2 to 15 years old, averaged( 6.32?2.52) years o ld were divided into an experiment group and a control group. The 33 children in the experiment group were blocked with BTX-A by insulative needles. The other 14 children in the control group were blocked with BTX-A by use of the convent ional syringe. ResultsThe spasticity in the experim ent group reduced to a larger extend than that in the control group, and the th erapeutic effect lasted longer in the experiment group. Conclusi onUsing insulative needle can improve the effect of BTX-A block.

Rehabilitation for Problem after Total Hip Replacement / 中国康复理论与实践

@#To introduce a rehabilitation program for total hip replacement (THR), including muscle strength training; rehabilitation for scar and adhesion, scoliosis, hip control, etc. The principle and the cautions were discussed.

Related Factors Influencing the Prognosis of Upper Limb Function of Stroke Patients with Left Side Hemiplegia / 中国康复理论与实践

@#Objective To explore the associated factors influencing the prognosis of upper limb function and ability of activities daily living(ADL)in stroke patients with left side hemiplegia.Methods 64 stroke patients with left side hemiplegia were treated regularly last for 1 month.At admission,the assessment procedure for cognitive function were performed with scales of Mini-Mental State Examination(MMSE),Loewenstein Occupational Therapy Cognitive Assessment(LOTCA),Motor Impersistence(MI),Schenkenberg Line Bisection Test.Brunnstrom stage,Modified Barthel Index(MBI),Ueda,Bin Hemiplegic Finger Function Assessment Scale,Upper Limb Function Assessment Scale were graded for the upper limb function and ADL ability before and after training.The multinominal logistic regression analysis was used to analyze the relationship between those factors and the upper limb function and ADL ability.Results The extent of resumption of upper limb function of patients was positively correlated with the ability of formal operational thinking(P<0.01)in LOTCA score before training.However,the extent of resumption of hand was negatively correlated with MI score before training(P<0.01).The extent of resumption of the hand practicability was positively correlated with the ability of operational thinking and score of ADL in LOTCA before training(P<0.01).The extent of the resumption of ADL was positively correlated with the ability score of operational thinking in LOTCA and diseased region.It was negatively correlated with the score of Schenkenberg line bisection(P<0.01).Conclusion The ability of operational thinking in LOTCA before training and the scores of Schenkenberg line bisection,ADL and MI are helpful in prognosis for the upper limb function in stroke patients with left side hemiplegia.

Releasing Spasticity of Triceps Surae Muscle of Children with Spastic Cerebral Palsy by Botulinum Toxic A Block with Dose Calculated According to Certain Formula / 中国康复理论与实践

@#Objective To investigate whether the curative effect of Botulinum Toxic A(BTX-A) block increased and prolonged when the dose calculated according to certain formula.Methods 15 children with cerebral palsy(CP) were appointed as the trial group and the dose of BTX-A was calculated according to the designed formula.The other 58 CP children were appointed as the control group and the BTX-A dose was determined by routine method.Results After treatment,the motor function of the children in trial group was superior to that in the control group(P<0.05) and the duration of therapeutic effect of the trial group was significantly longer than the control group(P<0.001).Conclusion BTX-A dose calculated according to the formula can increase effect and prolong the duration.

Effects of Body-weight Support Treadmill Training on Lower Extremity Muscle Atrophy and Ambulatory Capacity in Complete Spinal Cord Injured Patients / 中国康复理论与实践

@#Objective To explore the effect of body-weight support treadmill training(BWSTT)on lower extremity muscle atrophy and ambulatory capacity in complete spinal cord injured(SCI)patients.Methods 20 patients with complete SCI at the thoracic level were divided into control and BWSTT group.They all received comprehensive rehabilitation,and patients in BWSTT group also received BWSTT for 3 months when the physical condition was permitted.They were assessed before and after treatment with measurement of thigh girth,ambulatory capacity measure of Functional Independence Measure(FIM),10 meters ambulatory velocity and activity of daily living(ADL)evaluation.Patients in BWSTT group also received middle thigh MRI examination before and after BWSTT.Results The muscles at the mid-thigh of the BWSTT group looked larger after BWSTT than before.The scores of FIM ambulatory function,the 10 miters ambulatory velocity of BWSTT group improved significantly when compared with that of the control group(P<0.05).The thigh girth and the scores of ADL were no different between these two groups before and after treatment(P<0.05).Conclusion BWSTT may ameliorate lower extremities skeletal muscle atrophy and improve ambulatory capacity for SCI patients.

Suitable Dose and Correlation Factors in Treatment of Spastic Cerebral Palsy by Botulinum Toxic A Block / 中国康复理论与实践

@#Objective To investigate the optimal dose of botulinum toxic A(BTX-A)for releasing spasticity of cerebral palsy(CP)and related factors.Methods 39 children with CP was treated by BTX-A injected in local muscles to release the spasticity.Results After treatment,23 children had good curative effect.In them,15 cases were male,8 cases were female,the mean age was 60.7±26.9 months(range 33 to 145 months).There was no correlation between the optimal unit dose of BTX-A and those including sex,age,body weight,diagnosis type,degree of Gross Motor Function Classification System(GMFCS),etiological factor and the injections.There was a linear positive correlation between the optimal unit dose of BTX-A and the score of Modified Ashworth Scale(MAS).Conclusion BTX-A can release the spasticity of CP children,the injecting dose is correlated with MAS score.

Application of Low Frequency Vibration in Osteogenesis / 中国康复理论与实践

@#Mechanical loading provides an anabolic stimulus for bone. Low frequency vibration is a kind of mechanic stimulus, which can promote osteogenesis in certain frequency, mode and intensity. The osteogenesis promotion of low frequency vibration may be associated with the membrane ion channels, integrin-cytoskeleton complex triggering mitogen activated protein kinase (MAPK) signal and second messengers regulating RANK-RANKL-OPG axals.