Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 51
Filtrar
1.
Sci Rep ; 11(1): 16940, 2021 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-34417481

RESUMO

Repetitive transcranial magnetic stimulation (rTMS) is an FDA-approved therapy in major depressive disorder. However, its treatment efficacy on depression after traumatic brain injury (TBI) remains inconclusive. We conducted a meta-analysis to assess the effectiveness of executing rTMS over dorsolateral prefrontal cortex (DLPFC) on depression, cognitive impairment and post-concussion syndrome in individuals with traumatic brain injury. This study contained seven randomized controlled trials that published before April 5, 2020 in PubMed, Embase, Scopus, Cochrane, and Web of Science databases. The rTMS had significant anti-depressant effect (SMD = 1.03, p = 0.02), but the effects dissipated at 1-month follow-up (SMD = 0.39, p = 0.62). In the subgroup analysis, only applying rTMS to left DLPFC area of post-TBI patients showed significant anti-depressant effect (SMD = 0.98, p = 0.04). Moreover, current data observed that rTMS on post-TBI patients possessed substantial improvement in visuospatial memory (SMD = 0.39, p < 0.0001), but wasn't in processing speed (SMD = - 0.18, p = 0.32) and selective attention (SMD = 0.21, p = 0.31). In addition, the effect of rTMS is not superior to sham on postconcussion syndrome. In conclusion, the short-term antidepressant effect of left DLPFC rTMS in patients with TBI was significant. However, the effectiveness of rTMS on cognition and postconcussion syndrome in patients with post-TBI depression was limited.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/fisiopatologia , Cognição/fisiologia , Depressão/complicações , Depressão/fisiopatologia , Estimulação Magnética Transcraniana , Adulto , Atenção/fisiologia , Feminino , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Síndrome Pós-Concussão/etiologia
2.
Artigo em Inglês | MEDLINE | ID: mdl-34242169

RESUMO

Paired associative nerve stimulation (PANS) was proposed as a potential nerve rehabilitation treatment strategy. However, few relevant documents are available regarding the strategy, and only a few clinical studies have involved healthy people. To determine the feasibility of the neurorehabilitation treatment and to estimate the effect of PANS on nerve plasticity for individuals with incomplete spinal cord injury (iSCI), a design combining repetitive transcranial magnetic stimulation (rTMS) with trans-spinal electrical stimulation was developed for treating individuals with iSCI in this pilot case study. First, a novel PANS system with multiple stimulation modes was designed and verified with resistors and a metal coil as load. Then, the system was applied to three individuals with iSCI, and five types of paired associative stimulation was performed to confirm the feasibility of the system and determine the most effective treatment strategy. The preliminary result showed that 20-Hz rTMS combined with cathodal trans-spinal direct current stimulation (tsDCS) had the greatest effect on corticospinal excitability. Next, stimulations of 20-Hz rTMS (brain) and sham (spine) as well as sham (brain) and cathode tsDCS (spine) were administered to individuals with iSCI, and the results revealed that paired associative stimulation of brain and spine was more effective than only 20-Hz rTMS brain stimulation or cathodal tsDCS stimulation for corticospinal plasticity.


Assuntos
Reabilitação Neurológica , Traumatismos da Medula Espinal , Potencial Evocado Motor , Humanos , Plasticidade Neuronal , Medula Espinal , Traumatismos da Medula Espinal/terapia , Estimulação Magnética Transcraniana
3.
J Neuroeng Rehabil ; 18(1): 106, 2021 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-34193179

RESUMO

BACKGROUND: Transcranial direct current stimulation (tDCS) and intermittent theta burst stimulation (iTBS) were both demonstrated to have therapeutic potentials to rapidly induce neuroplastic effects in various rehabilitation training regimens. Recently, we developed a novel transcranial electrostimulation device that can flexibly output an electrical current with combined tDCS and iTBS waveforms. However, limited studies have determined the therapeutic effects of this special waveform combination on clinical rehabilitation. Herein, we investigated brain stimulation effects of tDCS-iTBS on upper-limb motor function in chronic stroke patients. METHODS: Twenty-four subjects with a chronic stroke were randomly assigned to a real non-invasive brain stimulation (NIBS; who received the real tDCS + iTBS output) group or a sham NIBS (who received sham tDCS + iTBS output) group. All subjects underwent 18 treatment sessions of 1 h of a conventional rehabilitation program (3 days a week for 6 weeks), where a 20-min NIBS intervention was simultaneously applied during conventional rehabilitation. Outcome measures were assessed before and immediately after the intervention period: Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Jebsen-Taylor Hand Function Test (JTT), and Finger-to-Nose Test (FNT). RESULTS: Both groups showed improvements in FMA-UE, JTT, and FNT scores after the 6-week rehabilitation program. Notably, the real NIBS group had greater improvements in the JTT (p = 0. 016) and FNT (p = 0. 037) scores than the sham NIBS group, as determined by the Mann-Whitney rank-sum test. CONCLUSIONS: Patients who underwent the combined ipsilesional tDCS-iTBS stimulation with conventional rehabilitation exhibited greater impacts than did patients who underwent sham stimulation-conventional rehabilitation in statistically significant clinical responses of the total JTT time and FNT after the stroke. Preliminary results of upper-limb functional recovery suggest that tDCS-iTBS combined with a conventional rehabilitation intervention may be a promising strategy to enhance therapeutic benefits in future clinical settings. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04369235. Registered on 30 April 2020.

4.
J Neuroeng Rehabil ; 18(1): 71, 2021 04 26.
Artigo em Inglês | MEDLINE | ID: mdl-33902646

RESUMO

BACKGROUND: Stroke survivors need continuing exercise intervention to maintain functional status. This study assessed the feasibility and efficacy of an interactive telerehabilitation exergaming system to improve balance in individuals with chronic stroke, compared to conventional one-on-one rehabilitation. METHODS: In this prospective case-control pilot study, 30 Taiwanese individuals with chronic stroke were enrolled and randomly allocated to an experimental group and a control group. All participants received intervention 3 times per week for 4 weeks in the study hospital. The experiment group underwent telerehabilitation using a Kinect camera-based interactive telerehabilitation system in an independent room to simulate home environment. In contrast, the control group received conventional one-on-one physiotherapy in a dedicated rehabilitation area. The effectiveness of interactive telerehabilitation in improving balance in stroke survivors was evaluated by comparing outcomes between the two groups. The primary outcome was Berg Balance Scale (BBS) scores. Secondary outcomes were performance of the Timed Up and Go (TUG) test, Modified Falls Efficacy Scale, Motricity Index, and Functional Ambulation Category. RESULTS: Comparison of outcomes between experimental and control groups revealed no significant differences between groups at baseline and post-intervention for all outcome measures. However, BBS scores improved significantly in both groups (control group: p = 0.01, effect size = 0.49; experimental group: p = 0.01, effect size = 0.70). Completion times of TUG tests also improved significantly in the experimental group (p = 0.005, effect size = 0.70). CONCLUSION: The Kinect camera-based interactive telerehabilitation system demonstrates superior or equal efficacy compared to conventional one-on-one physiotherapy for improving balance in individuals with chronic stroke. Trial registration ClinicalTrials.gov. NCT03698357. Registered October 4, 2018, retrospectively registered.


Assuntos
Equilíbrio Postural/fisiologia , Transtornos das Sensações/reabilitação , Reabilitação do Acidente Vascular Cerebral/métodos , Telerreabilitação/métodos , Idoso , Estudos de Casos e Controles , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Modalidades de Fisioterapia , Projetos Piloto , Estudos Prospectivos , Transtornos das Sensações/etiologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia , Jogos de Vídeo
5.
Medicine (Baltimore) ; 100(13): e25073, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33787589

RESUMO

RATIONALE: The incidence of Martin-Gruber anastomosis ranges from 5% to 34%, which is characterized by crossing over from the median to the ulnar nerve and innervating the first dorsal interosseous, thenar or hypothenar muscles. However, the reverse Martin-Gruber anastomosis, or Marinacci anastomosis, is far less discussed and appears in recent literature. PATIENT CONCERNS: A 56-year-old man presented to the clinic of a university hospital because of left neck soreness with numbness radiating to the left lateral shoulder. The neck discomfort was aggravated while the neck rotated or tilted to the right. DIAGNOSIS: Higher compound muscle action potential over the abductor pollicis brevis on elbow stimulation than on the wrist was found during upper limb nerve conduction velocity study. Ulnar to median anastomosis was identified. INTERVENTION: We performed cervical spine X-ray and electrophysiological examinations and monitored the patient. OUTCOMES: We identified that this patient had left C5 and C6 subacute radiculopathy with active denervation and left subclinical ulnar sensory neuropathy, and verified the existence of ulnar-to-median anastomosis. LESSONS: We demonstrated a pure motor ulnar-to-median anastomosis without sensory correspondence and higher CMAP over the abductor pollicis brevis on elbow stimulation of the ulnar nerve than on the wrist. The prevalence might be underestimated in a Chinese population-based published study.


Assuntos
Nervo Mediano/anormalidades , Malformações do Sistema Nervoso/diagnóstico , Radiculopatia/diagnóstico , Nervo Ulnar/anormalidades , Neuropatias Ulnares/diagnóstico , Vértebras Cervicais/inervação , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/inervação , Polegar/inervação , Punho/inervação
6.
J Neuroeng Rehabil ; 17(1): 91, 2020 07 13.
Artigo em Inglês | MEDLINE | ID: mdl-32660512

RESUMO

BACKGROUND: This study aimed to evaluate the effectiveness of a customized interactive video game-based (IVGB) training on balance in older adults with mild-to-moderate Parkinson's disease (PD). METHODS: In this 12-week crossover trial, PD patients ≥65 years of age were randomly divided into Group A (a 6-week intervention phase followed by a 6-week control phase) and Group B (a 6-week control phase followed by a 6-week intervention phase). Participants received IVGB exercise training during the intervention phase and no exercise during the control phase. Functional outcomes were measured using behavioral evaluation scales and questionnaires at baseline, week 6 and week 12. RESULTS: Twenty-four PD patients were included in this study, and were evenly divided into two groups. After Bonferroni adjustment, the changes in Modified Falls Efficacy Scale (MFES) and two subscales of Multi-Directional Reach Test were significantly different between two groups in the first 6-week period. In addition, the changes in Berg Balance Scale, MFES, and two subscales of Maximum Step Length were significantly different between two groups in the second 6-week period. Compared to controls, 6-week IVGB exercise intervention significantly improved different but overlapping functional outcomes in two groups of PD patients. CONCLUSIONS: The customized IVGB exercise training improves balance, postural stability and confidence in preventing falls in older adults with mild-to-moderate PD. However, this IVGB exercise doesn't have a significant impact on quality of life. TRIAL REGISTRATION: ClinicalTrials.gov. NCT03689764 . Registered 27 September 2018, retrospectively registered.


Assuntos
Terapia por Exercício/métodos , Doença de Parkinson/reabilitação , Equilíbrio Postural/fisiologia , Jogos de Vídeo , Acidentes por Quedas/prevenção & controle , Idoso , Estudos Cross-Over , Terapia por Exercício/instrumentação , Feminino , Humanos , Masculino , Doença de Parkinson/fisiopatologia , Qualidade de Vida
7.
Brain Sci ; 10(1)2020 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-31906559

RESUMO

The core objective of this study was to determine the neuroprotective properties of deep brain stimulation of the pedunculopontine tegmental nucleus on the apoptosis of the hippocampus. The pedunculopontine tegmental nucleus is a prime target for Parkinson's disease and is a crucial component in a feedback loop connected with the hippocampus. Deep brain stimulation was employed as a potential tool to evaluate the neuroprotective properties of hippocampal apoptosis. Deep brain stimulation was applied to the experimental animals for an hour. Henceforth, the activity of Caspase-3, myelin basic protein, Bcl-2, BAX level, lipid peroxidation, interleukin-6 levels, and brain-derived neurotrophic factor levels were evaluated at hours 1, 3 and 6 and compared with the sham group of animals. Herein, decreased levels of caspases activity and elevated levels of Bcl-2 expressions and inhibited BAX expressions were observed in experimental animals at the aforementioned time intervals. Furthermore, the ratio of Bcl-2/BAX was increased, and interleukin -6, lipid peroxidation levels were not affected by deep brain stimulation in the experimental animals. These affirmative results have explained the neuroprotection rendered by hippocampus apoptosis as a result of deep brain stimulation. Deep brain stimulation is widely used to manage neuro-motor disorders. Nevertheless, this novel study will be a revelation for a better understanding of neuromodulatory management and encourage further research with new dimensions in the field of neuroscience.

8.
Ann Phys Rehabil Med ; 63(6): 535-542, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31676456

RESUMO

BACKGROUND: Technology-assisted gait training (TAGT) with body weight support (BWS) has been designed to provide high numbers of repetitions during stepping practice, but its benefits have been inconclusive. OBJECTIVE: We evaluated the superiority of TAGT over conventional overground training (COT) to judge the clinical benefits. METHODS: We searched PubMed, Embase and Web of Science databases from their earliest record to July 1, 2019 and included randomized controlled trials of TAGT with BWS, such as robot-assisted gait training and body weight-supported treadmill training, for treating walking disability in patients within 6months after stroke. We conducted a meta-analysis of the outcomes motor impairment, mobility capacity, walking speed, endurance and fitness, balance, and activities of daily living as well as subgroup analyses of initial ambulatory ability and stroke duration. RESULTS: Among 14robotics and 10body weight-supported treadmill studies included for review, 23studies involving 1452participants contributed to the meta-analysis. We found no significant standardized mean differences between TAGT and COT (P>0.05) across all outcome categories in the robotics subgroup, the body weight-supported treadmill subgroup, or both subgroups combined, for both the short and long term. Further subgroup analyses also revealed non-significant standardized mean differences (P>0.05) across all outcomes in the subgroups initially ambulatory, non-ambulatory, or stroke duration less than 3 months. CONCLUSIONS: TAGT with BWS was not superior to COT in improving post-stroke recovery in patients with subacute stroke. Strategies other than simply increasing the repetitions by external assistance may be considered to augment the treatment effects of TAGT.


Assuntos
Terapia por Exercício/métodos , Marcha/fisiologia , Robótica/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/fisiopatologia , Adulto , Idoso , Peso Corporal , Estudos de Equivalência como Asunto , Teste de Esforço , Terapia por Exercício/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aparelhos Ortopédicos , Ensaios Clínicos Controlados Aleatórios como Assunto , Robótica/instrumentação , Reabilitação do Acidente Vascular Cerebral/instrumentação , Resultado do Tratamento , Caminhada , Suporte de Carga
9.
J Neuroeng Rehabil ; 16(1): 101, 2019 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-31375122

RESUMO

BACKGROUND: Stroke can lead to movement disorders that affect interlimb coordination control of the bilateral upper extremities, especially the hands. However, few studies have investigated the influence of a stroke on bimanual force coordination control between the hands using a quantitative measurement tool, or the relationship of force coordination with paretic upper extremity motor and functional performance. We aimed to investigate these outcomes using a novel measurement device, and analyze the relationship of bimanual force coordination control deficits in both hands with motor and functional performances of the paretic upper extremity in stroke patients. METHODS: Sixteen healthy adults and 22 stroke patients were enrolled. A novel bilateral hand grip measurement device with two embedded dynamometers was used to evaluate the grip force during a bilateral hand grip-force coordination control task. The alternating time and force applied for coordination with the grip force of both hands were calculated to analyze control of bimanual grip force coordination. Motor and functional measurements included the upper-extremity portion of the Fugl-Meyer assessment (FMA-UE), Wolf Motor Function Test (WMFT), Motor Assessment Scale (MAS), and Barthel Index (BI). RESULTS: Compared with the healthy group, the alternating time from the non-paretic to the paretic hand was 27.6% shorter for stroke patients (p < 0.001). The grip force generated for coordination in the healthy group was significantly greater (30-59%) than that of the stroke group (p < 0.05), and the coefficients of variation of alternating time (p = 0.001) and force applied (p = 0.002) were significantly higher in the stroke group than the healthy group. The alternating time from the paretic to the non-paretic hand showed moderately significant correlations with the FMA-UE (r = - 0.533; p = 0.011), the WMFT (r = - 0.450; p = 0.036), and the BI (r = - 0.497; p = 0.019). CONCLUSIONS: Stroke results in a decline in bimanual grip force generation and increases the alternating time for coordinating the two hands. A shorter alternating time is moderately to highly associated with enhanced motor and functional performances.


Assuntos
Ataxia/etiologia , Ataxia/fisiopatologia , Dinamômetro de Força Muscular , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia , Adulto , Idoso , Feminino , Mãos/fisiopatologia , Força da Mão/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Desempenho Físico Funcional
10.
Am J Phys Med Rehabil ; 98(10): 921-930, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31206360

RESUMO

Fall prevention requires a multifaceted approach that should include individual risk assessment and intervention strategies. Exercise interventions may mitigate most risk factors for falls (eg, balance impairment, gait impairment, and muscle weakness). Numerous systematic reviews or meta-analyses have assessed the effectiveness of exercise interventions among people with various types of neurological disorders; however, the evidence obtained has not been synthesized into an overview. Therefore, the present systematic review assessed systematic reviews of exercise intervention for fall prevention among people with neurological disorders. The research sources were the Cochrane Database of Systematic Reviews, PubMed, and Embase. Eligible studies were selected, and data were extracted independently by two reviewers. A total of 15 studies (six systematic reviews and nine meta-analyses) were included. These systematic reviews examined in this study have demonstrated that exercise interventions reduced the number, frequency, and rate of falls among people with neurological disorders, including cognitive impairment, dementia, and Parkinson disease. Furthermore, the current study presented insufficient evidence regarding the effectiveness of exercise interventions for fall prevention among people with stroke, multiple sclerosis, and diabetes mellitus with polyneuropathy. Therefore, additional investigations are necessary to evaluate the effectiveness of exercise for fall prevention among people with multiple sclerosis, stroke, and diabetes mellitus with polyneuropathy.


Assuntos
Terapia por Exercício , Doenças do Sistema Nervoso/reabilitação , Acidentes por Quedas/prevenção & controle , Humanos , Doenças do Sistema Nervoso/complicações , Doenças do Sistema Nervoso/fisiopatologia
11.
Artigo em Inglês | MEDLINE | ID: mdl-30956680

RESUMO

Purpose. This study evaluated the effects of interactive video game-based (IVGB) exercise on balance in diabetic patients with peripheral neuropathy. Materials and Methods. Twenty-four patients were randomly assigned to two groups (12 participants per group). Group A received IVGB training for the first 6 weeks, with no exercise in the subsequent 6 weeks. Group B had no exercise for the first 6 weeks and then underwent IVGB training in the subsequent 6 weeks. For all participants, the Modified Falls Efficacy Scale (MFES), Time Up and Go (TUG) test, Berg Balance Scale (BBS), and Unipedal Stance Test (UST) were employed at weeks 0, 6, and 12 of the experiment. Results. BBS, right-leg UST, and TUG test scores significantly improved after IVGB intervention, whereas MFES and left-leg UST tended to improve after IVGB intervention. Conclusions. This study revealed that 6-week balance-based exercise training using the IVGB system exerted positive effects on functional balance in patients with diabetic peripheral neuropathy (DPN).

12.
Clin Rehabil ; 33(7): 1102-1112, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30864462

RESUMO

OBJECTIVE: The aim of this study was to evaluate the effects of repetitive transcranial magnetic stimulation (rTMS) on the post-stroke recovery of lower limb motor function. DATA SOURCES: We searched the databases of PubMed, Cochrane Library, and Embase. The randomized controlled trials were published by 25 January 2019. REVIEW METHODS: We included randomized controlled trials that evaluated the effects of rTMS on lower limb motor recovery in patients with stroke. Two reviewers independently screened the searched records, extracted data, and assessed the risk of bias. The treatment effect sizes were pooled in a meta-analysis by using the RevMan 5.3 software. The internal validity was assessed using topics suggested by the Physiotherapy Evidence Database (PEDro). RESULTS: Eight studies with 169 participants were included in the meta-analysis. Pooled estimates demonstrated that rTMS significantly improved the body function of the lower limbs (standardized mean difference (SMD) = 0.66; P < 0.01), lower limb activity (SMD = 0.66; P < 0.01), and motor-evoked potential (SMD = 1.13; P < 0.01). The subgroup analyses results also revealed that rTMS improved walking speed (SMD = 1.13) and lower limb scores on the Fugl-Meyer Assessment scale (SMD = 0.63). We found no significant differences between the groups in different mean post-stroke time or stimulation mode over lower limb motor recovery. Only one study reported mild adverse effects. CONCLUSION: rTMS may have short-term therapeutic effects on the lower limbs of patients with stroke. Furthermore, the application of rTMS is safe. However, this evidence is limited by a potential risk of bias.


Assuntos
Extremidade Inferior , Atividade Motora/fisiologia , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/fisiopatologia , Estimulação Magnética Transcraniana , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/etiologia , Estimulação Magnética Transcraniana/métodos , Velocidade de Caminhada
13.
Int Urol Nephrol ; 51(1): 41-52, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30474784

RESUMO

OBJECTIVE: Traumatic brain injury (TBI) is a global scenario with high mortality and disability, which does not have an effectual and approved therapy till now. Bladder dysfunction is a major symptom after TBI, and this study deals with the alleviation of bladder function in TBI rats, with the aid of deep brain stimulations (DBS). METHODS: TBI was induced by weight drop model (WDM) and standardized with the experimental subjects with variable heights for weight dropping. The rats survived after TBI were considered for bladder dysfunction observations. DBS with variable stimulation parameters like cystometric analysis and MRI studies were also performed. RESULTS: After experimental studies, TBI 2-m-height crash was determined as suitable parameter due to minimal mortality rate and significant reduction in the voiding efficiency from 67 to 28%, whereas DBS significantly reversed the value of voiding efficiency to 65-84%. MRI studies revealed the severity of TBI impact and DBS localization. CONCLUSION: The results showed profound therapeutic effect of PnO-DBS on voiding functions and bladder control on TBI rats.


Assuntos
Lesões Encefálicas Traumáticas , Estimulação Encefálica Profunda/métodos , Doenças Urológicas , Animais , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/fisiopatologia , Modelos Animais de Doenças , Ratos , Resultado do Tratamento , Bexiga Urinária/fisiopatologia , Micção/fisiologia , Doenças Urológicas/etiologia , Doenças Urológicas/fisiopatologia , Doenças Urológicas/terapia
14.
Eur J Phys Rehabil Med ; 55(2): 162-168, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30156086

RESUMO

BACKGROUND: Intermittent theta burst stimulation (iTBS) was widely used in stroke rehabilitation and was more efficient than repetitive transcranial magnetic stimulation in terms of inducing larger motor evoked potential and producing longer effects. To our knowledge, the outcomes are not available combining rehabilitation and iTBS for improving motor function of lower extremities in patients with stroke. AIM: To evaluate the feasibility and effectiveness of intermittent theta burst stimulation aiming to stimulate bilateral leg motor cortex and promote functional improvements. DESIGN: A single blind, randomized controlled pilot study. SETTING: Rehabilitation ward. POPULATION: Twenty patients with chronic stroke finally enrolled for analyzed. METHODS: Participants were randomized into two groups to receive 10 sessions of iTBS group and sham group over a 5-week period. The iTBS was delivered over the midline of skull to stimulate bilateral leg motor cortex. The outcome measures included balance, mobility, and leg motor functions were measured before and after interventions. RESULTS: Within-group differences were significant in the Berg Balance Scale for both groups (Z=-2.442, P=0.015 in iTBS group; Z=-2.094, P=0.036 in sham group), in the Fugl-Meyer Assessment (Z=-2.264, P=0.024) and Overall Stability Index of Biodex Balance System of iTBS group (Z=-2.124, P=0.034). However, no significant between-group differences were found. CONCLUSIONS: There was no powerful evidence to support the effectiveness of iTBS group better than sham control group. Some essential technical issues should be considered for future studies applying iTBS to stimulate bilateral leg motor cortex. CLINICAL REHABILITATION IMPACT: iTBS combined with stroke rehabilitation are probably expected to be useful to promote brain plasticity and functional performance but some technical issues should be carefully considered.


Assuntos
Extremidade Inferior/fisiopatologia , Desempenho Físico Funcional , Reabilitação do Acidente Vascular Cerebral/métodos , Estimulação Magnética Transcraniana/métodos , Potencial Evocado Motor/fisiologia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Equilíbrio Postural/fisiologia , Método Simples-Cego , Ritmo Teta/fisiologia
15.
Disabil Rehabil ; 39(5): 419-427, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-26937553

RESUMO

Purpose This study investigated the relationship between peripheral nerve conduction velocity (NCV) and balance performance in older adults with diabetes. Methods Twenty older adults with diabetes were recruited to evaluate the NCV of their lower limbs and balance performance. The balance assessments comprised the timed up and go (TUG) test, Berg balance scale (BBS), unipedal stance test (UST), multidirectional reach test (MDRT), maximum step length (MSL) test and quiet standing with eyes open and closed. The relationship between NCV and balance performance was evaluated by Pearson's correlation coefficients, and the balance performances of the diabetic patients with and without peripheral neuropathy were compared by using Mann-Whitney U tests. Results The NCV in the lower limbs exhibited a moderate to strong correlation with most of the balance tests including the TUG (r = -0.435 to -0.520, p < 0.05), BBS (r = 0.406-0.554, p < 0.05), UST (r = 0.409-0.647, p < 0.05) and MSL (r = 0.399-0.585, P < 0.05). In addition, patients with diabetic peripheral neuropathy had a poorer TUG (p < 0.05), BBS (p < 0.01), UST (p < 0.05) and MSL performance (p < 0.05) compared with those without peripheral neuropathy (p < 0.05). Conclusion Our findings revealed that a decline in peripheral nerve conduction in the lower limb is not only an indication of nerve dysfunction, but may also be related to the impairment of balance performance in patients with diabetes. Implications for Rehabilitation Nerve conduction velocity in the lower limbs of diabetic older adults showed moderate to strong correlations with most of the results of balance tests, which are commonly used in clinics. Decline in nerve conduction velocity of the lower limbs may be related to the impairment of balance control in patients with diabetes. Diabetic older adults with peripheral neuropathy exhibited greater postural instability than those without peripheral neuropathy.


Assuntos
Neuropatias Diabéticas/fisiopatologia , Condução Nervosa/fisiologia , Nervos Periféricos/fisiopatologia , Equilíbrio Postural/fisiologia , Idoso , Idoso de 80 Anos ou mais , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
16.
Arch Phys Med Rehabil ; 98(2): 286-294, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27594516

RESUMO

OBJECTIVES: To describe the development of a participation measure that assesses 3 domains (productivity, social, and community) and 4 dimensions (frequency, diversity, desire for change, and perceived difficulty) of participation and to evaluate the initial psychometric properties in rehabilitation outpatients. DESIGN: A mixed-method approach included a literature review, item selection, expert reviews, cognitive interviews, and field testing with rehabilitation outpatients. Confirmatory factor analysis (CFA) and Rasch analysis were used to validate the construct validity of the difficulty dimension of the instrument. SETTING: Outpatient rehabilitation programs. PARTICIPANTS: An expert panel consisting of 12 rehabilitation and measurement experts contributed to measurement development; 20 rehabilitation outpatients participated in cognitive interviews; and a sample of rehabilitation outpatients (N=556) (average age, 61.36±23.62y; 53% men) participated in field testing. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The Participation Measure-3 Domains, 4 Dimensions (PM-3D4D). RESULTS: A scoring method for each dimension of the PM-3D4D was established. The instrument displayed good overall model fit in the CFA and unidimensionality across 3 domains after removing and collapsing locally dependent items identified from a principal component analysis. However, considering the poor personal reliability of the social subscale and its high correlation with the community subscale, we decided to merge the 2 subscales into 1. The combined subscale showed improved reliability and good construct validity by demonstrating a good model fit (comparative fit index, .985; Tucker-Lewis Index, .982, root mean square error of approximation, .061) and item fit. CONCLUSIONS: The PM-3D4D is a newly developed participation measure designed to assess multiple domains and dimensions of participation by rehabilitation patients. The psychometric analysis results supported the construct of the instrument and helped item revision. Further examination of the validity and reliability of the PM-3D4D will be conducted.


Assuntos
Avaliação da Deficiência , Modalidades de Fisioterapia/normas , Participação Social/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Psicometria , Reprodutibilidade dos Testes , Trabalho/psicologia
17.
Artigo em Inglês | MEDLINE | ID: mdl-28029125

RESUMO

In this study, we developed curcumin-encapsulated hyaluronic acid-polylactide nanoparticles (CEHPNPs) to be used for liver fibrosis amelioration. CD44, the hyaluronic acid (HA) receptor, is upregulated on the surface of cancer cells and on activated hepatic stellate cells (aHSCs) rather than normal cells. CEHPNPs could bind to CD44 and be internalized effectively through endocytosis to release curcumin, a poor water-soluble liver protective agent. Thus, CEHPNPs were potentially not only improving drug efficiency, but also targeting aHSCs. HA and polylactide (PLA) were crosslinked by adipic acid dihydrazide (ADH). The synthesis of HA-PLA was monitored by Fourier-transform infrared (FTIR) and Nuclear Magnetic Resonance (NMR). The average particle size was approximately 60-70 nm as determined by dynamic light scattering (DLS) and scanning electron microscope (SEM). Zeta potential was around -30 mV, which suggested a good stability of the particles. This drug delivery system induced significant aHSC cell death without affecting quiescent HSCs, hepatic epithelial, and parenchymal cells. This system reduced drug dosage without sacrificing therapeutic efficacy. The cytotoxicity IC50 (inhibitory concentration at 50%) value of CEHPNPs was approximately 1/30 to that of the free drug treated group in vitro. Additionally, the therapeutic effects of CEHPNPs were as effective as the group treated with the same curcumin dose intensity in vivo. CEHPNPs significantly reduced serum aspartate transaminase/alanine transaminase (ALT/AST) significantly, and attenuated tissue collagen production and cell proliferation as revealed by liver biopsy. Conclusively, the advantages of superior biosafety and satisfactory therapeutic effect mean that CEHPNPs hold great potential for treating hepatic fibrosis.


Assuntos
Curcumina/administração & dosagem , Sistemas de Liberação de Medicamentos , Ácido Hialurônico/administração & dosagem , Cirrose Hepática/tratamento farmacológico , Nanopartículas/administração & dosagem , Poliésteres/administração & dosagem , Alanina Transaminase/sangue , Animais , Aspartato Aminotransferases/sangue , Linhagem Celular Tumoral , Proliferação de Células/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Células Cultivadas , Curcumina/química , Curcumina/uso terapêutico , Humanos , Receptores de Hialuronatos/metabolismo , Ácido Hialurônico/química , Ácido Hialurônico/uso terapêutico , Cirrose Hepática/sangue , Cirrose Hepática/induzido quimicamente , Masculino , Camundongos Endogâmicos BALB C , Nanopartículas/química , Nanopartículas/uso terapêutico , Poliésteres/química , Poliésteres/uso terapêutico , Substâncias Protetoras/administração & dosagem , Substâncias Protetoras/química , Substâncias Protetoras/uso terapêutico , Ratos , Tioacetamida
18.
Am J Physiol Renal Physiol ; 311(1): F166-75, 2016 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-27147676

RESUMO

The role of 5-HT1A receptors in regulating voiding functions remains unclear, particularly regarding the urine flow rate (UFR) during voiding. This study examined the effects of 5-HT1A receptors on regulating urethral functions in female rats and investigated underlying modulatory mechanisms. Intravesical pressure (IVP), external urethral sphincter-electromyography (EUS-EMG), and UFR were simultaneously recorded during continuous transvesical infusion to examine the effects of a 5-HT1A receptor agonist (8-OH-DPAT) and antagonist (WAY-100635) on bladder and urethral functions. In addition, this study evaluated the independent roles of urethral striated and smooth muscles in the UFR in rats after a neuromuscular blockade (NMB) treatment and bilateral hypogastric nerve transection. Our results revealed that 8-OH-DPAT significantly increased the maximal UFR but reduced the mean UFR. This discrepancy may be because 8-OH-DPAT markedly increased the maximal UFR during the initial segment of the flow duration and subsequently induced an approximately zero level of long oscillatory waves during the remaining flow duration. Thus the mean UFR was reduced because of the prolonged approximately zero level of the UFR. However, paralyzing the EUS with an NMB agent, 8-OH-DPAT, significantly increased the maximal and mean UFRs because the prolonged zero level of the oscillatory UFR did not continue. These results support the hypothesis that the increased UFR in female rats during voiding is due to the induction of urethral smooth muscle relaxation by 8-OH-DPAT. This paper provides a detailed understanding of the role of 5-HT1A receptors in controlling the UFR in female rats.


Assuntos
Receptor 5-HT1A de Serotonina/efeitos dos fármacos , Agonistas do Receptor 5-HT1 de Serotonina/uso terapêutico , Urodinâmica/efeitos dos fármacos , 8-Hidroxi-2-(di-n-propilamino)tetralina/farmacologia , Animais , Denervação , Eletromiografia , Feminino , Plexo Hipogástrico/fisiologia , Bloqueadores Neuromusculares/farmacologia , Piperazinas/farmacologia , Piridinas/farmacologia , Ratos , Ratos Sprague-Dawley , Antagonistas do Receptor 5-HT1 de Serotonina/farmacologia , Antagonistas da Serotonina/farmacologia , Uretra/fisiopatologia , Micção/efeitos dos fármacos
19.
J Cardiopulm Rehabil Prev ; 36(4): 250-7, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26959494

RESUMO

PURPOSE: To evaluate the effects of cardiac rehabilitation (CR) provided within the first 3 months of revascularization on reducing recurrent revascularization in patients with coronary heart disease in Taiwan. METHODS: In this population-based cohort study, we used the claims data of 1 million beneficiaries who were randomly selected from all beneficiaries enrolled in Taiwan's National Health Insurance program from 1996 to 2000. Between 2000 and 2007, 2838 patients underwent a first-event revascularization. Of these patients, 442 (15.6%) underwent CR within the first 3 months of admission for revascularization. The remaining 84.4% (n = 2396) served as the non-CR group. All the study patients were followed-up until the end of 2008 for any recurrent revascularization. A propensity score-adjusted Cox proportional hazard model was used to estimate the relative risk of recurrent revascularization associated with CR. RESULTS: During the 1- to 9-year follow-up, 69 patients (15.6%) in the CR group and 840 (35.1%) patients in the non-CR group experienced recurrent revascularization. The results of the propensity score-adjusted Cox proportional hazard regression analysis showed that CR was significantly associated with a reduced risk of recurrent revascularization with a hazard ratio of 0.48 (95% CI, 0.37 to -0.62). CONCLUSIONS: Cardiac rehabilitation within the first 3 months of revascularization is significantly associated with a reduced risk of recurrent revascularization. This preventive effect was more pronounced in men compared with other subgroups of patients.


Assuntos
Reabilitação Cardíaca , Doença das Coronárias/reabilitação , Doença das Coronárias/cirurgia , Reoperação/estatística & dados numéricos , Demandas Administrativas em Assistência à Saúde , Adulto , Idoso , Ponte de Artéria Coronária , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea , Modelos de Riscos Proporcionais , Fatores de Proteção , Medição de Risco , Taiwan
20.
J Formos Med Assoc ; 115(9): 703-13, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26386674

RESUMO

BACKGROUND/PURPOSE: Few studies have investigated the feasibility of using pudendal neuromodulation to regulate bladder function in spinal cord-injured (SCI) animals. The present study aimed to determine the effects of electrical activation of the pudendal sensory branch on improving voiding functions in rats 6 weeks after a spinal cord injury and to explore the underlying neuromodulatory mechanisms. METHODS: Two urodynamic measurements were used to assess the effects of electrical stimulation (ES) on bladder and urethral functions: simultaneous recordings of the intravesical pressure (IVP) during continuous isotonic transvesical infusion (i.e., isotonic IVP) and external urethral sphincter (EUS) electromyography (EUS-EMG), and simultaneous recordings of transvesical pressure under isovolumetric conditions (i.e., isovolumetric IVP) and urethral perfusion pressure (UPP). RESULTS: Six weeks after the SCI, the rats showed voiding dysfunction, as indicated by abnormal cystometric measurements (e.g., increased volume threshold, increased contraction amplitude, and increased residual volume, and decreased voided volume). The voiding efficiency (VE) decreased to 13% after the SCI, but increased to 22-34% after applying pudendal afferent stimulation. In addition, pudendal stimulation significantly increased the EUS burst period and increased the difference between the UPP and the high-frequency oscillation (HFO) baselines, and changed the time offset between bladder and EUS activities. These findings suggest that pudendal afferent stimulation improved the VE by prolonging the micturition interval, decreased the urethral resistance, and recovered detrusor-sphincter dyssynergia during the voiding phase. CONCLUSION: This study demonstrates the feasibility of using pudendal neuromodulation in chronic SCI rats. These results could aid in developing an advanced neural prosthesis to restore bladder function in clinical settings.


Assuntos
Terapia por Estimulação Elétrica , Nervo Pudendo/fisiologia , Traumatismos da Medula Espinal/complicações , Uretra/patologia , Transtornos Urinários/terapia , Animais , Modelos Animais de Doenças , Eletromiografia , Feminino , Ratos , Ratos Sprague-Dawley , Micção , Urodinâmica
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...