Repetitive transcranial magnetic stimulation combined with respiratory muscle training for pulmonary rehabilitation after ischemic stroke-A randomized, case-control study.

Respiratory muscle weakness often occurs after stroke, which can lead to pulmonary dysfunction (PD). Pulmonary dysfunction prolongs the length of hospital stay and increases the risk of death. In a prospective, randomized, case-control study, we used musculoskeletal ultrasonography (MSUS), and pulmonary function tester to objectively evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) combined with respiratory muscle training (RMT) in the treatment of PD in patients with acute ischemic stroke. Sixty-two stroke patients with PD were recruited and eventually 60 patients participated in this study. The control group was treated with RMT, and the treatment group was treated with rTMS on the basis of RMT. Treatment occurred five times a week for 8 weeks. Before and after treatment, diaphragmatic thickness (DT), diaphragmatic thickening fraction (DTF) and diaphragmatic mobility (DM) in patients, bilateral chest wall were measured by MSUS. Meanwhile, FVC, FEV1, FEV1/FVC, PEF, and MVV tested by pulmonary function tester was used to evaluate the improvement of lung functional. activities of daily living (ADL) was used as an objective criterion to evaluate the overall functional recovery of patients before and after treatment. After treatment, DT, DTF, and DM values improved significantly in both the affected and unaffected sides. The FVC, FEV1, FEV1/FVC, PEF, MVV, and ADL were all increased after the treatment. Combined treatment showed a stronger increase than that by RMT treatment alone. The study preliminarily shows that rTMS and RMT could improve lung functional after acute ischemic stroke.

The effect of coupled inhibitory-facilitatory repetitive transcranial magnetic stimulation on shaping early reorganization of the motor network after stroke.

Neural plasticity is a major factor driving cortical reorganization after stroke. This study aimed to evaluate functional connectivity (FC) changes in the cortical motor network after coupled inhibitory-facilitatory repetitive transcranial magnetic stimulation (rTMS) treatment and to assess the correlation between FC changes and functional recovery, further characterizing the neural mechanisms underlying the beneficial effects of rTMS. We randomly divided 63 patients with acute stroke into four groups: (1) Group A received coupled inhibitory-facilitatory rTMS [1 Hz over the contralesional primary motor cortex (M1) and 10 Hz over ipsilesional M1]; (2) Group B received a contralesional sham stimulation and ipsilesional 10 Hz stimulation; (3) Group C received a contralesional 1 Hz rTMS and ipsilesional sham stimulation; and (4) Group D received bilateral sham stimulation only. Standardized rehabilitation therapy was performed immediately after rTMS, and each group was treated with their respective treatment modalities for 4 weeks. Twenty-four hours before and after the intervention, participants underwent resting-state functional magnetic resonance imaging. Additional functional assessments were conducted at baseline, after treatment, and at the 3 month follow-up. The rTMS treatment significantly changed the FCs of intra- and inter-hemispheric cortical motor networks in the rTMS groups (A and B) compared with the sham group (Group D). This effect was more pronounced in Group A, which displayed a changed FC between the contralesional postcentral gyrus and contralesional superior parietal gyrus, between the contralesional precentral gyrus and contralesional postcentral gyrus, and between the ipsilesional postcentral gyrus and contralesional superior parietal gyrus, when compared with Groups B and C. Importantly, FC changes were significantly correlated with improvement of motor function. In the early stages of ischemic stroke, coupled rTMS was more conducive to motor recovery by modulating the FCs of intra-hemispheric and inter-hemispheric motor networks. Our results suggested that FC changes were related to motor function recovery for early-stage cerebral stroke patients treated with coupled rTMS. These findings could help to understand the mechanism of coupled rTMS and further the use of this therapy as an adjunct rehabilitation technique in motor recovery.

The correlation between diffusion tensor imaging of the sacral cord and bladder contractility in people with tetraplegia.

STUDY DESIGN: Cross-sectional descriptive study. OBJECTIVES: To compare the diffusion tensor imaging (DTI) changes of the sacral cord in people with complete cervical spinal cord injury (SCI) and neurogenic bladder versus people without SCI, and to explore the relationship between sacral cord DTI changes and bladder contractility. SETTING: First Affiliated Hospital of Soochow University, Jiangsu Province, China. METHODS: Forty participants were included: 25 participants with complete cervical SCI and 15 without SCI. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were calculated by DTI for ventral horn and intermediate column of sacral cord at S2-S4 level. All participants underwent urodynamic examination. The urodynamic parameters (voiding efficiency (VE), and bladder contractility index (BCI)) and DTI parameters were compared between people with and without SCI. The correlations between DTI values (FA and ADC) and urodynamic parameters were analyzed. RESULTS: The FA values were significantly lower and the ADC values were significantly higher in the intermediate column and ventral horn at S2-S4 level of the participants with SCI compared with their able-bodied counterparts (p < 0.05). VE and BCI were significantly different between the two groups (p < 0.05). The FA values of intermediate column positively correlated with BCI (r = 0.749, p < 0.05) and the ADC values negatively correlated with BCI (r = -0.471, p < 0.05) in participants with SCI. The DTI values of sacral cord were not correlated with each urodynamic parameter in participants without SCI (p > 0.05). CONCLUSIONS: Complete cervical SCI might lead to microstructural changes of the sacral cord, which might further affect bladder contraction.

Reference values of gait using APDM movement monitoring inertial sensor system.

Normal gait data reported show variability depending on specific equipment and techniques. Reference values of initial contact angle (ICA) and toe-off angle (TOA) are still lacking. We present a normative gait database of 292 healthy adults using the APDM Movement Monitoring inertial sensor system across a large age span of adulthood. Data were collected as participants completed a walk test for 2 min. Normalization was conducted and two factors were extracted by a factor analysis. Six reference gait variables under each factor were presented and the impacts of age, gender and BMI were evaluated by MANOVA and ANCOVA. ICA and TOA were highly correlated with speed and stride length. ICA was significantly larger in men, whereas larger TOA could be observed in women in all age groups but could not achieve significant difference. Overweight and obese adults walked at significantly lower speed, shorter stride length, reduced cadence and longer gait cycle duration. TOA was smaller in the obese group. However, the differences in ICA were not significant. Reference gait values described herein were valuable for identifying and interpreting gait phenomena using APDM®, contributing to rehabilitation of gait dysfunction.