Long-term effect of low-frequency repetitive transcranial magnetic stimulation over the unaffected posterior parietal cortex in patients with unilateral spatial neglect.

OBJECTIVE: To explore long-term effects on unilateral spatial neglect of low-frequency repetitive transcranial magnetic stimulation (rTMS) over the unaffected posterior parietal cortex. DESIGN: Uncontrolled pilot study. SUBJECTS: Two chronic-phase patients with left-sided unilateral spatial neglect from cerebral infarction. METHODS: Six rTMS sessions were undertaken for 2 weeks. Each session included 900 stimuli applied over P5 at an intensity of 95% motor thresholds and a frequency of 0.9 Hz. The Behavioural Inattention Test, either the Mini-Mental State Examination or the Revised Hasegawa Dementia Scale, Brunnstrom Recovery Stage, and Barthel Index were evaluated at 2-week intervals until 6 weeks after rTMS sessions. Single-photon emission computed tomography was performed 2 weeks before and after rTMS. RESULTS: Behavioural Inattention Test scores improved remarkably, especially from 2 to 4 weeks after rTMS sessions. At 6 weeks, Behavioural Inattention Test scores still remained above pre-rTMS levels. Other clinical evaluations as well as single-photon emission computed tomography showed no significant change during the study. CONCLUSION: In this small pilot study, low-frequency rTMS over the unaffected posterior parietal cortex decreased unilateral spatial neglect for at least 6 weeks.

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.

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.

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.

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.

Optimal Dose of Botulinum Toxin A to Release Spasticity of Triceps Surae in Children with Cerebral Palsy / 中国康复理论与实践

@#Objective To determine the coefficient in the formula of the optimal dose of botulinum toxin A(BTX-A) to treat spastic cerebral palsy(CP).Methods58 CP children(male 38,female 20,mean age 59.3±24.6 months,range 27 to 144 months) were divided into A,B,C,D and E five groups according to used coefficient and treated by BTX-A with different doses to release the spasticity.ResultsAccording to the improvement of motor function,the BTX-A dose of the group D was optimal.According to the effective endurance,the BTX-A dose of the group C was optimal.The optimal coefficient was 1.8.ConclusionThe formula of the optimal BTX-A dose injected in triceps surae is dose =(1+1.8×MAS score)×body weight.

Optimal Dose of Botulinum Toxin A to Release Spasticity of Triceps Surae in Children with Cerebral Palsy / 中国康复理论与实践

@#Objective To determine the coefficient in the formula of the optimal dose of botulinum toxin A(BTX-A) to treat spastic cerebral palsy(CP).Methods58 CP children(male 38,female 20,mean age 59.3±24.6 months,range 27 to 144 months) were divided into A,B,C,D and E five groups according to used coefficient and treated by BTX-A with different doses to release the spasticity.ResultsAccording to the improvement of motor function,the BTX-A dose of the group D was optimal.According to the effective endurance,the BTX-A dose of the group C was optimal.The optimal coefficient was 1.8.ConclusionThe formula of the optimal BTX-A dose injected in triceps surae is dose =(1+1.8×MAS score)×body weight.

Optimal Dose of Botulinum Toxic A in Treatment of Spastic Cerebral Palsy / 中国康复理论与实践

@#ObjectiveTo investigate the optimal dose of botulinum toxic A (BTX-A) block to relax spasticity in cerebral palsy.Methods61 children (27～144 months old) with spastic cerebral palsy were treated by BTX-A block and divided into A, B, C, D and E groups according to the dose coefficient. The dose of BTX-A block was 30～160 IU (average 69.0±32.4 IU) according to the weight and the score of Modified Ashworth Scale.Results55 BTX-A blocks were successful. The muscles tone turned below and the function were improved. The effective rate was 90.16%. The effective time ranged from 8 weeks to 32 weeks, average 17.56±8.30 weeks. The effective time of the group C (2≤dose-coefficient<3) was the longest in the five groups.ConclusionThe optimal dose of BTX-A block in triceps surae should be counted as follow: dose(IU)=(score of Modified Ashworth Scale+2.5)×weight(kg).

Correlation between Current and Period in Effect of Block Myoelectricity Fixed Botulinum Toxin A Injection in Cerebral Palsy / 中国康复理论与实践

@#ObjectiveTo investigate the correlation between current and therapeutic effect of block myoelectricity fixed Botulinum Toxin A(BTX-A) injection in cerebral palsy.Methods15 children with spastic cerebral palsy were treated with BTX-A block injection under block myoelectricity fixing.The dose of BTX-A was identified with the weight of the child and the Modified Ashworth Scale.The correlation between current and period in effect was analyzed.ResultsThere was negative correlation between current and period in effect(r=-0.769,P=0.01).ConclusionThe BTX-A should be injected where the fixed current is less.

Evaluation of intelligence of children with cerebral palsy / 中国康复理论与实践

@#ObjectiveTo improve the assessment of the cerebral palsy (CP) children with mental retarded disability, develop their potentials and prevent further psycho-psychotics disability.Methods220 children with CP were assessed respectively before and after rehabilitation using IQ test, and diagnosed and received rehabilitation for one treating course (3 months).Results164 children had found with mental retarded among 220 cases, made up 74.5% of the total. 90% of the children with serious CP were also with mental retardation. The children had effect after rehabilitation was with a lower rate having mental retardation.ConclusionMany factors can influence the results of the intelligence assessment. Comprehensive judgment and analysis should be made in the intelligence assessment for the children with CP, a better and more reasonable assessment method is expected.

Preliminary study of the Gross Motor Function Classification System(GMFCS) for children with cerebral palsy / 中国康复理论与实践

@#ObjectiveTo test the reliability of Gross Motor Function Classification System(GMFCS) among different raters.MethodsUsing the Chinese translation vision of the GMFCS,5 doctors(raters) determined the level of each cerebral palsy(CP) child(aged 0～12) independently.After finishing classification of all the 23 CP children's level,the reasons of disparities among raters were discussed and analyzed,and the supplementary classification sentences were formulated.ResultsThere was no statistic significant difference in classifications among 5 raters,the GMFCS levels were correlated well with mobility and self-care domain scores in comprehensive function assessment,and higher degree of agreement could be achieved by referring to the supplementary classification sentences while classifying.ConclusionFor classifying the level of gross motor function of CP children,Chinese translation vision of the GMFCS has high degree of reliability.

Effect of SSY-B2 on regeneration of central nervous system of rats with bilateral fornix/fimbria transaction / 中国康复理论与实践

@#ObjectiveTo study the effect of SSY-B2 on regeneration of central nervous system of rats with bilateral fornix/fimbria transaction.MethodsMale adult SD rats were divided randomly into 6 groups as sham group,model group, positive control agent piracetam group, SSY-B2 low dosage(1.5g crude drug/kg) group, medium dosage(3g crude drug/kg) group and high dosage(6g crude drug/kg) group.The bilateral fornix/fimbria transection in the rats were carried out. After operation, drugs were fed introgastrically to each group respectively for 6 weeks. The immunoreactive products of growth-associated protein-43(GAP-43 )and chondroitin sulfate proteoglycans(CSPG) in defined areas were measured using immunohistochemical methods. ResultsThere was no difference in number of cells expressing GAP-43 between the model group and sham group (P>0.05),but that in low dosage group increased compared with the model group (P<0.001). The CSPG in parietal lobes after lesion expressed,which was in sham group and model group(sham group and model group respectively, 56.43±59.6,116.36±10.561), and SSY-B2 in low and medium dosage inhibited its expression compared with the model group (P<0.05,P<0.01). Conclusions SSY-B2 can enhance the expression of GAP-43 and inhibit the expression or deposition of CSPG, promote axonal regeneration in the CNS, and thus structural repair and functional restoration in certain degree.

Effect of SSY-B2 on loss of neurons and enhancing the expression of nerve growth factor of rats with bilateral fornix/fimbria transection / 中国康复理论与实践

@#ObjectiveTo evaluate the possible effect of SSY-B2 on reducing the loss of neurons and enhancing the expression of nerve growth factor(NGF).MethodsMale adult SD rats were divided randomly into 6 groups as sham group,model group,positive control agent piracetam group, SSY-B2 low(1.5g crude drug/kg), medium(3g crude drug/kg)and high dosage (6g crude drug/kg)group.Bilateral fornix/fimbria transection was carried out in the rats' septohippocampal pathway and 6 weeks' drug treatment was administered with different doses of SSY-B2 and positive control agent piracetam. After behavioral tests, the numbers of neurons in medial septum and immunoreactive products of NGF in different areas were measured, using Nissle staining and immunohistochemical methods.ResultsThere was neural loss in medial septum after fornix /fimbria transection, but SSY-B2 at each dosage markedly reduced the loss(59.13±22.02,50.60±23.18,63.93±18.35,the number of neurons for three SSY-B2 dosage groups,P<0.005 for all compared with the model group 20.33±14.01).The number of NGF positive cells decreased in model group, but did not show significant statistic difference compared with the sham group (P>0.05) in the medial septum, polymorph layer of dentate gyrus and entorhinal cortex/Subiculum area. In the medial septum, all three dosage enhanced the expression of NGF positive cells(145.1±57.7,161.3±08.2,200.6±58.2,the number of neurons for three SSY-B2 dosage group,P<0.005 for all compared with the model group 50.2±48.6). SSY-B2 at low and medium dosage group also increased the number in both entorhinal cortex/Subiculum and polymorph layer of dentate gyrus.Conclusions SSY-B2 can reduce the loss of neurons in the medial septum, which may be involve in increasing expression of NGF;NGF expression in dentate gyrus, subiculum of hippocampal formation and entorhinal cortex increased by SSY-B2 may play a role in the compensation of these area for learning/memory.

Effect of SSY-B2 on microglial cells in rats after bilateral fornix/fimbria transection / 中国康复理论与实践

@# ObjectiveTo observe the effect of SSY-B2 on microglial cells in rats after bilateral fornix/fimbria transection.MethodsMale adult SD rats were divided randomly into 6 groups as sham group,model group,positive control agent piracetam group, SSY-B2 low(1.5g crude drug/kg), medium(3g crude drug/kg)and high dosage (6g crude drug/kg)groups. Half to 1 hour before operation, water or drugs were fed introgastrically to each group respectively and continued for 6 weeks.The tissues of brain was gained and the immunoreactive products of BS-I B4 (Isolectin B4 from Bandeiraea Simplifolia, a marker for microglia) in the perilesion area was measured using immunohistochemical methods.ResultsThe number of microglia of the sham and model groups was (30.3±21.8) and (114.5±102.3) respectively, P<0.05. That of three different dosage of SSY-B2 groups was(249.7±149.4), (252.0±191.7)and (244.2±154.9), P<0.05 for each group compared with the model group.ConclusionMicroglia number in the perilesion area can be increased by SSY-B2, which may contribute to the nerve repair and functional improvement after injury.

Effect of SSY-B2 on improvement of learning/memory function of rats with bilateral fornix/fimbria transection / 中国康复理论与实践

@#ObjectiveTo study the effect of SSY-B2 on improvement of learning/memory function of rats with bilateral fornix/fimbria transection.MethodsMale adult SD rats were divided randomly into 6 groups as sham group,model group,positive control agent piracetam group, SSY-B2 low(1.5g crude drug/kg), medium(3g crude drug/kg)and high dosage (6g crude drug/kg)group. Half to 1 hour before operation, water or drugs were fed introgastrically to each group respectively. From the fourth week, Morris water maze and tunnel water maze tests were used. Escape latency of rats in Morris test, escape latency and errors in tunnel test were recorded.ResultsIn both Morris test and tunnel water maze test, low dosage and medium of SSY-B2 markedly shorten the escape latency or reduced the errors.ConclusionsSSY-B2 can ameliorate spatial learning/memory dysfunction produced by fornix/fimbria transection. Functional compensation in other neural structure other than regeneration of the septohippocampal pathway is considered to be responsible for the effects.

Effects of Sheng-wu Capsule on learning-memory ability and hippocampal histology in aged rats / 中国康复理论与实践

@#ObjectiveTo investigate the effects of Chinese compound Sheng-wu Capsule on learning-memory ability and histology including the neurons, astrocytes and expression of nerve growth factor(NGF) and its receptor (TrkA) in hippocampus CA1 of aged rats. MethodsSheng-wu Capsule consists of 6 kinds of Chinese medicinal herbs such as polygonum multiflorum,ginseng, and Rhizoma Acori Tatarinowii.The water-soluble component of polygonum multiflorum,2,3,5,4'- tetrahydroxystibane-2-O-β-D-glucoside was the quality standard of Sheng-wu Capsule.Aged Wistar rats(22 months old) were orally administrated with Sheng-wu Capsule(1.8g/kg and 0.9g/kg) for 2 months. Positive control drug was Piracetam(0.56g/kg). The learning and memory ability was tested by passageway water maze; the number and morphology of neurons was detected by HE staining; the proliferation of astrocytes was detected by immuno-histochemistry for glial fibrillary acidic protein(GFAP); the expression of neurotrophic substance was detected by immuno-histochemistry for NGF and TrkA receptor by ABC method. Image analysis to determine average cell number, size(area) and staining density in hippocampal CA1 region was achieved by VISILOG 5.0 image pattern analyser.ResultsBoth NGF and TrkA-immunoreactive neurons in aged rats significantly decreased as well as cell number, size and staining density in CA1 region of hippocampus(P<0.01). Aged rats showed damage of neurons and increase of GFAP positive cells in the same area,model rats indicated learning-memory deficit too. In Sheng-wu Capsule administrated groups,the significant little decrease in cell number, size and staining density of NGF and TrkA-immunoreactive neurons in CA1 region of hippocampus was observed(P<0.01-0.05). The loss of Neurons and proliferation of astrocytes were inhibited and learning-memory ability was also improved in Sheng-wu groups.Conclusions Chinese compound Sheng-wu Capsule significantly promotes the expression of NGF and TrkA in aged rats and it relieves the damage of hippocampus.This may be the mechanism by which Sheng-wu Capsule improves the learning and memory ability. Enhancing endogenous neurotrophic substance plays an important role in the treatment of Alzheimer's disease.

Clinical rehabilitation research on 90 infants with cerebral palsy / 中国康复理论与实践

@#ObjectiveTo investigate the effect of rehabilitative treatment on different groups of infants with cerebral palsy in different age, sickness extent and rehabilitative period.MethodsBy the prospective method, 90 patients from 3 to 36 months old were randomly divided into three groups including 3 to 12 months, 13 to 24 months and 25 to 36 months with 30 cases each. Every 10 cases in light, moderate and severe degrees were given rehabilitative care for 2 months and 3 months respectively. The personal ADL of every case was evaluated at the initial and the final state. The compared score was analyzed with T test.ResultsComparing the groups of different ages, there were prominent differences of treatment under the same sickness, among the light, moderate and severe degrees(P<0.01). The rehabilitative treatment effect of 3 months was better than that of 2 months. Furthermore the effect of the group of 3-12 months was better than that of 25-36 months.ConclusionsThe rehabilitative care is prominently effective in the light and moderate groups , the former is better and within 3 months is better than 2 months. The younger infant is, the better the rehabilitative treatment is.

Research on the Clinical Usage of Orthosis / 中国康复理论与实践

@#This research focused on the rehabilitation effect of orthosis for cerebral palsy(CP) children.46 CP children with physical dysfunction used the orthosis as an auxiliary therapy.The gait analysis,equilibrium,and comprehensive ADL measurement had been administrated pretherapy and post-therapy.The results show that 94.25% of CP children had improved their functions.The conclusions of this study indicated that it is important to use orthosis as an auxiliary therapy for CP children.Some important items of therapy had been discussed and the experiences of making plastic AFO had been introduced.

Short period Clinical Observations of Cerebral Palsied Children with Athetosis Treated with Madopar / 中国康复理论与实践

@# In this paper,we studied the clinical effects,side effects,doses ,dosing interval,relations between doses and effects of using Madopar in 61 children with athetoid cerebral palsy.Taking ADL Evaluation Scheme for Cerebral Palsied Children as main efficacy value,very marked statistic difference exists when two groups with or without Madopar were assessed on the third evaluation in our study,and it shows the effects of Madopar while its adverse events are mild and transient.The average and maximal initial dose is 9mg/kg/d and 26mg/kg/d respectively,and the average titration interval is one week while the shortest inetrval is a day.It can be titrated to 20mg/kg/d on average and 38mg/kg/d on maximal dose.There was no correlation between doses and effects.Suggestion was made for further investigation.