Objective The study aimed to evaluate the impact of Botulinum toxin A (BoNT/A) on neuropsychiatric symptoms in Parkinson’s disease (PD) patients. Methods A total of 125 PD patients and an equal number of age- and gender-matched healthy controls were involved. Mental health status was assessed using the Cornell Medical Index (CMI) self-assessment questionnaire. Sixty-four PD patients exhibiting neuropsychiatric symptoms were selected for the controlled study and randomly grouped into treatment and control groups. The treatment group received BoNT/A injections, while the control group received a placebo. The primary outcome measures included depression scores from the CMI and the proportion of patients displaying improvement in neuropsychiatric symptoms at 8 weeks post-treatment. The secondary outcome was other CMI scores at 4, 8, and 12 weeks post-treatment. Results The outcomes revealed that PD patients had significantly higher scores in various neuropsychiatric factors compared to healthy controls. At 4 weeks post-treatment, the treatment group displayed improvements in depression and tension. At 8 weeks post-treatment, they exhibited significant reductions in depression, anxiety, sensitivity, and tension compared to the control group. Moreover, a notably higher percentage of patients in the treatment group showed improvement in neuropsychiatric symptoms compared to the control group. At 12 weeks post-treatment, the treatment group exhibited significant improvements in somatization, depression, sensitivity, and tension. Conclusion PD patients commonly experience multiple neuropsychiatric symptoms, and BoNT/A has demonstrated efficacy in alleviating these symptoms. Specifically, BoNT/A was found to effectively alleviate somatization, tension, anxiety, depression, and sensitivity in PD patients.
OBJECTIVE:Ultrasound-guided tibial nerve pulsed radiofrequency (US-guided TN PRF) and fluoroscopy-guided intralesional radiofrequency thermocoagulation (FL-guided intralesional RFT) adjacent to the painful calcaneal spur are two interventions for pain management in painful calcaneal spur and plantar fasciitis. This study aimed to compare the effectiveness of the two procedures. DESIGN:A prospective, randomized, single-blind study. SETTING:Single-center pain clinic. SUBJECTS:Forty-nine patients who met the inclusion criteria were randomized into two groups. METHODS:Group U (25 patients) received US-guided TN PRF at 42°C for 240 s, whereas Group F (24 patients) received FL-guided intralesional RFT at 80°C for 90 s. The most severe numeric rating scale (NRS) score during the first morning steps and the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were used to evaluate the effectiveness of the procedures. The study's primary outcome assessed treatment effectiveness via the NRS, whereas the secondary outcomes included changes in the AOFAS score and the incidence of procedure-related mild adverse events. RESULTS:NRS and AOFAS scores significantly improved in Groups U and F at 1 and 3 months compared with baseline (P < .05), and there was no significant difference between the groups. At month 1, 50% or greater pain relief was achieved in 72% of patients in Group U and 75% of patients in Group F. No significant difference was observed in the incidence of mild adverse events between the groups. CONCLUSIONS:US-guided TN PRF and FL-guided intralesional RFT have shown significant effectiveness in the treatment of painful calcaneal spur and plantar fasciitis. Larger randomized controlled trials are needed. CLINICAL TRIAL NUMBER:NCT06240507.
BACKGROUND:Although nonsurgical treatment of thumb carpometacarpal (CMC-1) osteoarthritis (OA) provides short-term improvement, the durability of these effects beyond 1 year is unknown. In this study, we investigated patient-reported pain and limitations in activities of daily living (ADL) at >5 years following nonsurgical treatment (i.e., exercise therapy and use of an orthosis) for CMC-1 OA. We hypothesized that pain and limitations in ADL would not worsen after 12 months. Secondary outcomes were satisfaction with treatment results and health-related quality of life at >5 years of follow-up and the rate of conversion to surgery. METHODS:This was a multicenter, prospective cohort study using 2 overlapping samples. The change in the Michigan Hand Outcomes Questionnaire (MHQ) subscales of pain and ADL between 12 months and >5 years was the primary outcome as measured in the first sample (n = 170), which consisted of patients who did not undergo conversion to surgery. Additional measurement time points included baseline and 3 months. We evaluated conversion to surgery in a second sample, which included all patients who responded to the invitation for this follow-up study (n = 217). RESULTS:At a median follow-up of 6.6 years (range, 5.1 to 8.7 years), the score on the MHQ pain subscale did not differ significantly from that at 12 months. The score on the MHQ ADL improved by 4.4 points (95% confidence interval [CI],1.5 to 7.2) compared with 12 months, but this was not clinically relevant. At >5 years, 5% of the patients rated their satisfaction as "poor," 14% as "moderate," 26% as "fair," 39% as "good," and 16% as "excellent." The median EuroQol-5 Dimensions-5 Levels (EQ-5D-5L) index score was 0.852 (range, 0.135 to 1). The rate of conversion to surgery was 22% (95% CI,16.4% to 27.7%) at a median follow-up of 7 years (range, 5.5 to 9.0 years). CONCLUSIONS:We found positive outcomes at >5 years of follow-up for nonsurgical treatment of CMC-1 OA, with no worsening of pain or of limitations in ADL after 12 months. Our findings support nonsurgical treatment as the first treatment choice and suggest that treatment effects are sustainable. LEVEL OF EVIDENCE:Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.
BACKGROUND:Greater occipital nerve (GON) blockade is a short-term preventive therapy for cluster headache (CH). We conducted a systematic review to evaluate the effectiveness and safety of GON blockade in patients with CH. METHODS:On 23 October 2020, we searched MEDLINE, Embase, Embase Classic, PsycINFO, CINAHL, CENTRAL and Web of Science databases from their inception date. Studies included participants with a CH diagnosis who received corticosteroid and local anaesthetic suboccipital region injections. Outcomes were change in the frequency/severity/duration of attacks; proportion of participants responding to treatment, time to attack freedom from an attack, change in attack bout length and/or the presence of adverse effects after GON blockade. Risk of bias was assessed with the Cochrane Risk of Bias V.2.0 (RoB2)/Risk of Bias in Non-randomized Studies - of Interventions (ROBINS- I) tools and a specific tool for case reports/series. RESULTS:Two RCTs, eight prospective and eight retrospective studies, and four case reports were included in the narrative synthesis. Every effectiveness study found a significant response in one or more of frequency/severity/duration of individual attacks or proportion of patients responding to treatment (47.8%-100.0%). There were five instances of potentially irreversible adverse effects. A higher injectate volume and use of concurrent prophylaxis may be associated with an increased likelihood of response. Methylprednisolone may have the best safety profile of available corticosteroids. DISCUSSION:GON blockade is safe and effective for CH prevention. Higher injectate volumes may improve likelihood of response, and the likelihood of serious adverse events may be reduced by using methylprednisolone. PROSPERO REGISTRATION NUMBER:CRD42020208435.
Background Tai Chi has shown beneficial effects on the motor and non-motor symptoms of Parkinson’s disease (PD), but no study has reported the effect of long-term Tai Chi training. Objective To examine whether long-term Tai Chi training can maintain improvement in patients with PD. Methods Cohorts of patients with PD with Tai Chi training (n=143) and patients with PD without exercise as a control group (n=187) were built from January 2016. All subjects were assessed at baseline and in November 2019, October 2020 and June 2021. A logarithmic linear model was used to analyse rating scales for motor and non-motor symptoms. The need to increase antiparkinsonian therapies was presented as a Kaplan–Meier plot and as a box plot. The bootstrap method was used to resample for statistical estimation. Results Tai Chi training reduced the annual changes in the deterioration of the Unified Parkinson’s Disease Rating Scale and delayed the need for increasing antiparkinsonian therapies. The annual increase in the levodopa equivalent daily dosage was significantly lower in the Tai Chi group. Moreover, patients benefited from Tai Chi training in motor symptoms, non-motor symptoms and complications. Conclusion Tai Chi training has a long-term beneficial effect on PD, with an improvement in motor and non-motor symptoms and reduced complications. Trial registration number NCT05447975 .
OBJECTIVE:To determine if patients with chronic migraine continue onabotulinumtoxinA (onabotA) long-term. METHODS:We performed a retrospective cohort analysis using aggregated, de-identified patient data from the Stanford Headache Center. We included patients in California who received at least one prescription for onabotA during the years of 2011-2021. The primary outcome was the number of onabotA treatments each patient received. Secondary outcomes included sex, age, race, ethnicity, body mass index (BMI), distance to the treatment facility, and zip code income quartile. RESULTS:A total of 1551 patients received a mean of 7.60 ± 7.26 treatments and a median of 5 treatments, with 16.2% of patients receiving only one treatment and 10.6% receiving at least 19. Time-to-event survival analysis suggested 26.0% of patients would complete at least 29 treatments if able. Younger age and female sex were associated with statistically significant differences between quartile groups of number of onabotA treatments (P = .007, P = .015). BMI, distance to treatment facility, and zip code income quartile were not statistically significantly different between quartile groups (P > .500 for all). Prescriptions of both triptans and non-onabotA preventive medications showed a statistically significant increase with each higher quartile of number of onabotA treatments (P < .001; P < .001). DISCUSSION:We show long-term persistence to onabotA is high and that distance to treatment facility and income are not factors in continuation. Our work also demonstrates that as patients continue onabotA over time, there may be an increased need for adjunctive or alternative treatments.
BACKGROUND:Stroke survivors rate longer-term (> 2 years) psychological recovery as their top priority, but data on how frequently psychological consequences occur is lacking. Prevalence of cognitive impairment, depression/anxiety, fatigue, apathy and related psychological outcomes, and whether rates are stable in long-term stroke, is unknown. METHODS:N = 105 long-term stroke survivors (M [SD] age = 72.92 [13.01]; M [SD] acute NIH Stroke Severity Score = 7.39 [6.25]; 59.0% Male; M [SD] years post-stroke = 4.57 [2.12]) were recruited (potential N = 208). Participants completed 3 remote assessments, including a comprehensive set of standardized cognitive neuropsychological tests comprising domains of memory, attention, language, and executive function, and questionnaires on emotional distress, fatigue, apathy and other psychological outcomes. Ninety participants were re-assessed one year later. Stability of outcomes was assessed by Cohen's d effect size estimates and percent Minimal Clinically Important Difference changes between time points. RESULTS:On the Montreal Cognitive Assessment 65.3% scored < 26. On the Oxford Cognitive Screen 45.9% had at least one cognitive impairment. Attention (27.1%) and executive function (40%) were most frequently impaired. 23.5% and 22.5% had elevated depression/anxiety respectively. Fatigue (51.4%) and apathy (40.5%) rates remained high, comparable to estimates in the first-year post-stroke. Attention (d = -0.12; 85.8% stable) and depression (d = 0.09, 77.1% stable) were the most stable outcomes. Following alpha-adjustments, only perceptuomotor abilities (d = 0.69; 40.4% decline) and fatigue (d = -0.33; 45.3% decline) worsened over one year. Cognitive impairment, depression/anxiety, fatigue and apathy all correlated with worse quality of life. CONCLUSION:Nearly half of participants > 2 years post-event exhibited psychological difficulties including domains of cognition, mood, and fatigue, which impact long-term quality of life. Stroke is a chronic condition with highly prevalent psychological needs, which require monitoring and intervention development.
Background: Trigeminal nerve stimulation (TNS) has been proposed as a promising intervention for coma awakening. However, the effect of TNS on patients with prolonged disorders of consciousness (pDoC) is still unclear.Objective: This study aimed to investigate the therapeutic effects of TNS in pDoC caused by stroke, trauma, and anoxia.Methods: A total of 60 patients (male =25, female =35) aged over 18 who were in a vegetative state or minimally conscious state were randomly assigned to the TNS (N = 30) or sham TNS (N = 30) groups. 4 weeks of inter-vention and a followed up for 8 weeks were performed. The Glasgow Coma Scale (GCS) and Coma Recovery Scale-Revised (CRS-R) scores as primary outcomes were assessed at baseline and at 2, 4, 8, and 12 weeks.Results: The score changes in the TNS group over time for CRS-R (2-week: mean difference = 0.9, 95% CI = [0.3, 1.5], P = 0.006; 4-week: 1.6, 95% CI = [0.8, 2.5], P < 0.001; 8-week: mean difference = 2.4, 95% CI = [1.3, 3.5], P < 0.001; 12-week: mean difference = 2.3, 95% CI = [1.1, 3.4], P < 0.001) and GCS (4-week: mean difference = 0.7, 95% CI = [0.3, 1.2], P = 0.002; 8-week: mean difference = 1.1, 95% CI = [0.6, 1.7], P < 0.001; 12-week: 1.1, 95% CI = [0.5, 1.7], P = 0.003) were higher than those in the sham group. 18-Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) revealed that the metabolism of the right parahippocampal cortex, right precuneus, and bilateral middle cingulate cortex was significantly increased in TNS group. Conclusion: The results of this study indicate that TNS could increase local brain metabolism and may promote functional recovery in patients with prolonged disorders of consciousness.
Introduction/AimsThe aim in this study is to describe the clinical and electrophysiological patterns of pregnancy-related carpal tunnel syndrome (PRCTS) occurring during pregnancy or after delivery. MethodsClinical, epidemiological, and electrodiagnostic (EDx) data were studied in 130 women with PRCTS onset during pregnancy (n = 80) or after delivery (n = 50). Twenty-six women with PRCTS underwent EDx analysis during pregnancy and 104 after delivery (83 within 6 months of delivery and 21 up to 24 months after pregnancy onset). PRCTS was compared with idiopathic CTS in a control group consisting of 57 age-matched women with 98 cases of CTS. Twenty-four women with PRCTS had clinical and electrophysiological follow-up after corticosteroid injection (CSI) at the wrist. ResultsClinical analysis showed a higher rate of bilateral and diurnal/permanent paraesthesia and more severe symptoms in PRCTS compared with idiopathic CTS. EDx analysis showed more severe abnormalities in classical tests and a higher rate of conduction block (CB) in PRCTS. Statistical analysis showed a strong negative correlation between the incidence and importance of CB and the time interval at which PRCTS women underwent EDx examination, between pregnancy onset and 24 months later. CSI resulted in significant clinical and EDx improvement in 22 of 24 PRCTS women, with disappearance of all motor and most sensory CBs. DiscussionThe EDx pattern of PRCTS is an acute/subacute median nerve lesion at the wrist identified by many CBs. This occurs concurrently with hormonal changes, is responsible for more severe clinical symptoms and EDx data, and it explains why CSI is so effective.
Introduction/AimsAn important mechanism of peripheral nerve motor and sensory dysfunction is conduction block (CB). However, recovery from mechanically induced CB has been rarely studied in humans. The aim of this study was to describe clinical, electrodiagnostic (EDx), and ultrasonographic (US) characteristics of CB recovery in ulnar neuropathy at the elbow (UNE). MethodsWe recruited a group of consecutive patients presenting to our EDx laboratory with UNE and >50% motor CB. Patients' histories were obtained and neurologic, EDx, and US examinations were repeated every 1-3 mo for at least 12 mo. ResultsWe studied 10 patients (5 men), with a mean age of 63 y (range, 51-81 y). In all affected arms CB was localized to the retrocondylar groove. Following conservative management, myometrically measured index finger abduction improved from a median of 49% to 100% relative to the contralateral index finger, and ulnar nerve CB decreased from a median of 74% to 6%. Most of the improvement took place within 8 mo of symptom onset, and 6 mo after receiving treatment instructions. Mean motor nerve conduction velocity improved from 15 to 27 m/s in the most affected 2-cm ulnar nerve segment. DiscussionThe resolution of CB after typical chronic compression may take longer than after acute compression. This should be considered by clinicians when estimating prognosis for discussions with patients.
目的:探讨坐式八段锦训练对截瘫患者坐位平衡的疗效及其临床应用.方法:将截瘫患者 40 例随机分为对照组和观察组各 20 例.分别采用常规坐位平衡训练、坐式八段锦训练 4 周,治疗前后采用功能性前伸及 T恤测试观察 2 组坐位平衡疗效变化.结果:治疗后,2 组患者的功能性前伸得分均显著高于治疗前(P＜0.05);T恤测试耗时均显著低于治疗前(P＜0.05).治疗后,观察组功能性前伸测试提高值显著高于对照组(P＜0.05),观察组治疗后的T恤测试耗时显著低于对照组(P＜0.05).结论:坐式八段锦训练能明显提高截瘫患者的坐位平衡能力,其不受时间与场地的限制,具有社区推广价值.
目的:观察重复经颅磁刺激(rTMS)对脑卒中后认知并摄食障碍患者的认知及摄食功能的疗效.方法:将60 例脑卒中后具有认知障碍和摄食障碍的患者随机分为对照组和观察组各 30 例.2 组患者均给予常规药物治疗、常规认知训练及常规摄食训练,观察组另外行 rTMS治疗,疗程共 4 周.于治疗 4 周前后评估患者认知及摄食功能变化情况.结果:治疗 4 周后,2 组患者简易精神状态量表(MMSE)评分、24h摄入量均较治疗前显著提高(P＜0.01),荧光透视吞咽困难量表(VDS)评分、口腔转运时间(OTT)及软腭上抬时间(SET)数值均较前治疗前显著缩短(P＜0.01);治疗 4 周后,观察组 MMSE评分、24h摄入量均较对照组升高(P＜0.01),VDS评分、OTT及SET数值较对照组缩短(P＜0.01).观察组治疗后 MMSE 评分与 24h 摄入量呈显著正相关(rs=0.757,P＜0.01),MMSE评分与 VDS 评分呈负相关(rs=-0.432,P＜0.05),MMSE 评分与 OTT 数值呈负相关(rs=-0.422,P＜0.05),MMSE评分与 SET数值呈负相关(rs=-0.430,P＜0.05).结论:rTMS治疗能有效改善脑卒中后认知并摄食障碍患者的认知及摄食功能.
目的:探讨镜像疗法同步气动式手康复装置对脑卒中后肩手综合征(SHS)患者的手肿胀程度、疼痛程度、手功能及日常生活活动能力的影响.方法:将 48 例脑卒中后肩手综合征患者随机分为对照组、观察组各 24 例.2组均进行常规康复治疗,对照组在常规治疗基础上加入气动手治疗,观察组在常规治疗基础上进行镜像疗法及气动手同步治疗,2 组均进行 4 周的干预治疗,在干预前后,采用手肿胀程度评估(掌指关节、8 字缠绕法围度)、视觉模拟评估法(VAS)、上田敏手功能分级(MFT)、改良Barthel指数(MBI)评估患者手肿胀程度、疼痛程度、运动功能及日常生活活动能力.结果:治疗 4 周后,与组内治疗前比较,2 组患者上田敏手功能分级评分、MBI、VAS评分均明显提高,手肿胀程度减轻(P＜0.05),且观察组上田敏手功能分级、MBI、手肿胀程度改善效果优于对照组(P＜0.05),在 VAS评分方面,治疗后 2 组差异无统计学意义.结论:采用镜像疗法及气动式手康复装置同步治疗有利于提升患者日常生活活动能力及手功能,降低手肿胀程度.
目的:通过对康复治疗学专业本科生就"八步一体"混合式教学模式在《传统康复方法学》课程中的应用效果进行调查,旨在探索出一条将中医传统康复技术与现代康复技术协同发展的路径,为培养中西方康复相融通的高水平应用型康复人才提供新思路.方法:采用目的抽样的方法选择四年制康复治疗学学生作为研究对象.2016级学生 27 例作为对照组,采用传统以教师主导型的教学模式;2017 级学生 55 例作为研究组,采用"八步一体"线上线下混合式教学模式.教学效果以学生该门课程的考评成绩进行评定.采用线上问卷调查的方法对《传统康复方法学》课程混合式教学模式的学生满意度进行调查.结果:与对照组比较,研究组学生该门课程的考评成绩明显提升(P＜0.05).满意度问卷调查结果显示研究组学生对该混合式教学模式的满意度基本在 90%以上.结论:运用"八步一体"线上线下混合式教学模式能有效地提高学生《传统康复方法学》课程的学习效果和满意度.
肌肉减少症(sarcopenia,SP)简称肌少症,是一种进行性全身骨骼肌疾病,好发于 65 岁以上的老年人,可导致一系列不良后果,如日常生活活动能力下降、跌倒、残疾、肺炎及呼吸功能障碍等,严重者甚至死亡.
慢性踝关节不稳(chronic ankle instability,CAI)是指因踝关节结构或功能障碍导致的反复发生的单侧或双侧踝关节扭伤,疼痛、肿胀、及打软腿等症状是其主要表现,一般是由于首次踝扭伤后未能及时正确的治疗或者过早参与运动等造成的踝关节反复扭伤,严重者可引起其他关节损伤,出现连锁的不良反应和恶性循环[1].
脊髓型颈椎病(CSM)是最常出现脊髓功能障碍的疾病.手术干预可以提供相对较好的疗效,早期康复主要依赖于逆转脊髓受压所致的脊髓缺血.由于外周神经电刺激已被证明可以暂时增加脊髓血供(30 分钟至 1 小时),研究者假设可以利用外周神经电刺激来检测中枢神经系统的活性.
目的:探究筋膜松解手法配合悬吊康复运动在产后腹直肌分离患者中的应用效果.方法:将 300 例产后腹直肌分离患者随机分为 2 组,每组 150 例.对照组接受悬吊康复运动,观察组接受筋膜松解手法配合悬吊康复运动,干预时间 8 周.观察 2 组干预后临床疗效、干预前后激惹、抑郁和焦虑自评量表(IDA)、腰背部疼痛视觉模拟量表(VAS)评分、脐围及腹直肌分离距离、生存质量测定量表简表(WHOQOL-BREF)评分变化.结果:干预后,观察组总有效率高于对照组(97.33%、85.33%,P＜0.05);干预 4 周、8 周后,2 组IDA量表中抑郁、焦虑、内外向性激惹各维度评分、腰背部疼痛 VAS评分、脐上围、脐下围、脐围及腹直肌分离距离均较干预前降低(P＜0.05),且观察组更低于对照组(P＜0.05);干预 8 周后及干预后 3 个月,2 组 WHOQOL-BREF量表中生理领域、心理领域、社会关系领域评分均高于干预前(P＜0.05),且观察组高于对照组(P＜0.05).结论:在产后腹直肌分离修复中,筋膜松解手法配合悬吊康复运动可调节患者不良情绪、提高其生活质量水平,可能与该方案能修复产后受损腹直肌、减轻腰背部疼痛有关.
睡眠不足和睡眠—觉醒障碍(SWDs)被认为是导致脑卒中等脑部疾病的危险因素.然而,既往没有研究探索过多发 SWDs对后续心脑血管事件 (CCEs)的影响.从两个卒中中心招募 18 至 85 岁患有缺血性脑卒中或短暂性脑缺血发作的受试者.采用呼吸描记图评估睡眠呼吸紊乱(SDB),采用失眠严重指数量表(ISI)评估失眠,采用国际不安腿综合征(RLS)研究小组严重程度评分和自我估测的 1 个月和 3 个月睡眠时间评估 RLS.睡眠负荷指数(SBI)是通过将这四者结合起来计算得出的.
经颅直流电刺激(tDCS)是一种非侵入性的神经调控技术,已被证明能够改善脑卒中患者的运动功能.这项研究评估了应用于小脑的 tDCS对脑卒中患者上肢功能障碍的疗效.受试者为首次发生单侧缺血性脑卒中患者,且发病时间在两周至六个月之间.所有患者均表现出单侧上肢运动功能障碍.受试者被随机分为 tDCS组和对照组,两组均接受标准康复治疗.
