Objective To assess any differences in brain activation during active,passive and imaginary movement of the hands using blood oxygen level-dependent functional magnetic resonance imaging (fMRI),and to provide references for the cortical reorganization in patients with brain injuries.Methods Twenty healthy,righthanded,adult volunteers were studied,fMRI was performed during active,passive and imaginary fist clutching.Whole brain analysis and group analysis were applied to get the voxels,the volume of activation,the peak t-score and its coordinates.Results Active and passive movement both produced significant activation in the contralateral sensorimotor cortex,the contralateral supplementary motor area and the ipsilateral cerebellum.The sensorimotor cortex was the most frequently and most strongly activated brain area.Imaginary movement produced significant bilateral activation in the supplementary motor area.Conclusions Active and passive movement induce similar brain activation patterns.This indicates that passive might replace active movement when observing activation of the brain's cortex during the rehabilitation of patients with hemiplegia.

OBJECTIVE:To investigate whether electro-acupuncture can serve as a method of inducing brain ischaemic tolerance (BIT) by encouraging the expression of glutamate transporter-1 (GLT-1) and suppressing the release of glutamate (Glu).METHODS:Sprague-Dawley (SD) rats were divided into sham, ischaemia and EA groups. EA was performed on dazhui and baihui acupoints and the rat cerebral ischaemia model was achieved by occluding the middle cerebral artery (MCA) for 2 hours, followed by reperfusion. Dialysate was collected from the striatum in vivo to detect the concentration of Glu and the expression of Glutamate Transporter-1 (GLT-1) was examined. The changes of neurological deficit scores were evaluated at 24 hours after reperfusion, while the infarct volumes of brains were then measured with 2,3,5-triphenyltetrazolium chloride (TTC) staining.RESULTS:Compared with the ischaemia group, the concentration of Glu decreased and the expression of GLT-1 increased at most of the detective time points in the EA group; the neurological deficit scores were lower and the infarct volumes were smaller in the EA group.CONCLUSION:EA can up-regulate the expression of GLT-1 and inhibit the excessive release of Glu in the striatum in the process of subsequent ischaemic-reperfusion brain injury, which may be one of the mechanisms of inducing BIT and, thus, be neuroprotective for early ischaemic brain injury.

目的:利用功能磁共振(fMRI)研究脑卒中患者运动想象训练后上肢功能重组潜在的脑重塑机制,为临床脑卒中患者的康复治疗提供一定的理论基础.方法:选择9例脑卒中偏瘫患者,进行运动想象训练每周5次,每次约30min,共4周,并进行常规康复训练.应用Fugl-Meyer上肢运动功能量表(FMA-UL)分别在治疗前和治疗后4周评估患者的上肢运动功能.在4周康复干预前后对患者进行患手被动握拳任务下的fMRI检查,采用组块设计,利用SPM8软件进行数据处理,采用感兴趣区(ROI)的个体化分析,统计各ROI区的脑皮质激活情况,比较干预前后对侧感觉运动区(cSMC)的激活变化,分析脑卒中患者的脑重塑模式.结果:4周运动想象干预后脑卒中患者的FM-UL评分从(22.44±11.59)分提高到(39.78±14.03)分(P=0.0 11).比较干预前后两次fMRI检查脑皮质SMC区的激活情况,发现9例脑卒中患者的功能恢复呈现出两种不同的皮质重塑模式:一种模式为募集激活,即大部分患者第二次fMRI检查,患手被动任务下cSMC的激活增加(有6例患者);另一种模式是集中激活,即小部分患者第二次fMRI检查,患手被动任务下cSMC的激活虽然是减少的,但其偏侧指数(LI-SMC)却是显著增加的(有3例患者).结论:运动想象训练可改善脑卒中患者的上肢运动功能,经过4周干预后脑卒中患者存在损伤同侧SMC区的募集激活和集中激活两种脑重塑模式,随着患者上肢功能的恢复,脑重塑机制逐渐倾向于损伤侧SMC的激活.

Motor function impairment is a common outcome of stroke. Constraint-induced movement therapy (CIMT) involving intensive use of the impaired limb while restraining the unaffected limb is widely used to overcome the effects of 'learned non-use' and improve limb function after stroke. However, the underlying mechanism of CIMT remains unclear. In the present study, rats were randomly divided into a middle cerebral artery occlusion (model) group, a CIMT + model (CIMT) group, or a sham group. Restriction of the affected limb by plaster cast was performed in the CIMT and sham groups. Compared with the model group, CIMT significantly improved the forelimb functional performance in rats. By western blot assay, the expression of phosphorylated extracellular regulated protein kinase in the bilateral cortex and hippocampi of cerebral ischemic rats in the CIMT group was significantly lower than that in the model group, and was similar to sham group levels. These data suggest that functional recovery after CIMT may be related to decreased expression of phosphorylated extracellular regulated protein kinase in the bilateral cortex and hippocampi.

目的:观察早期运动对中重度颅脑外伤(TBI)大鼠认知功能的影响.方法:成年雄性SD大鼠30只,随机分为运动组、对照组和假手术组.制作中重度控制性皮质损伤(CCI)颅脑外伤模型,运动组大鼠在术后1天进行电动跑台运动训练,30min/d,1次/d,为期2周,训练结束后休息1周;术后第21-25天行Morris水迷宫(MWM)检查,评估大鼠认知功能的变化;术后第26天行Western blot检查海马区脑源性神经营养因子(BDNF)表达.结果:运动组术后第21-24天平台搜索的潜伏期较对照组缩短,术后第25天颅脑外伤后运动组的象限游泳路程占总路程的百分值(29.1±0.02)大于对照组(23.10±0.02)(P＜0.05);运动组和对照组大鼠损伤对侧皮质内BDNF蛋白表达分别为(0.94±0.10)和(0.65±0.03),表明运动上调损伤对侧的海马区BDNF的表达.结论:早期进行适宜强度的运动训练治疗能改善颅脑外伤大鼠认知功能和上调海马BDNF的表达.

目的:通过康复中心-社区卫生服务中心-家庭康复三者有机结合的方式进行脑卒中康复,探索闵行区康复的新模式.方法:将97例脑卒中患者以区组随机化的方式将患者分为治疗组(48例)和对照组(49例),分别于入选时、入组后第1个月末、第3个月末和第6个月末采用功能综合评定量表、改良Barthel指数进行评测.治疗组采用康复中心-社区卫生服务中心-家庭康复三结合的模式,由治疗师、全科医生运用康复适宜技术,在社区卫生服务中心或家庭开展康复治疗活动.对照组除基础治疗外不接受专业康复训练.结果:入选时治疗组和对照组不存在明显差异.两组患者在入组后各阶段比较,治疗组的综合功能测评积分和日常生活活动能力,与对照组相比较,均有显著性增加,差异有显著性意义(P＜0.05).6个月随访治疗后治疗组改善了(41.38±15.23)分,而对照组的综合功能测评积分为(25.64±16.33)分.治疗组的MBI提高(33.52±14.86)分,对照组提高(20.16±13.52)分,两组比较差异有显著性(P＜0.05).结论:康复中心-社区卫生服务中心-家庭康复三者有机结合的模式,为脑卒中患者提供全程康复治疗,改善患者的综合功能,可以作为一种社区康复模式开展.

Autophagy is a degradative mechanism for cellular proteins and organelles, but its role in the nervous system is still not clear. In the present study, we found that exercise pretreatment and p38 inhibition had influence on autophagic process after cerebral ischemia, contributing to their neuroprotective effects. We examined the levels of p62 and phosphorylated ERK1/2 as an autophagic marker and cell-survival marker respectively after cerebral ischemic injury. The brain infarction volume after ischemia was measured as well. Both treadmill training pretreatment and p38 inhibition decreased the degradation of p62, promoted the phosphorylation of ERK1/2, and alleviated the brain infarction, indicating that these treatments could provide neuroprotection in cerebral ischemic injury via autophagy suppression.

Exercise training is a neuroprotective strategy in cerebral ischemic injury, but the underlying mechanisms are not yet clear. In the present study, we investigated the effects of treadmill exercise pretreatment on the expression of mitochondrial dynamic proteins. We examined the expression of OPA1/DLP1/MFF/Mfn1/Mfn2, which regulatesmitochondrial fusion and fission, and cytochrome C oxidase subunits (COX subunits), which regulatemitochondrial functions, after middle cerebral artery occlusion (MCAO) in rats. T2-weighted magnetic resonance imaging (MRI) was evaluated as indices of brain edema after ischemia as well. Treadmill training pretreatment increased the expression levels of OPA1 and COXII/III/IV and alleviated brain edema, indicating that exercise pretreatment provided neuroprotection in cerebral ischemic injury via the regulation of mitochondrial dynamics and functions.

Objective Treadmill pre-training can ameliorate blood brain barrier (BBB) dysfunction in ischemia-reperfusion injury, however, its role in ischemic brain edema remains unclear. This study assessed the neuroprotective effects induced by treadmill pre-training, particularly on brain edema in transient middle cerebral artery occluded model. Methods Transient middle cerebral artery occlusion to induce stroke was performed on rats after 2 weeks of treadmill pre-training. Magnetic resonance imaging (MRI) was used to evaluate the dynamic impairment of cerebral edema after ischemia-reperfusion injury. In addition, measurements of wet and dry brain weight, Evans Blue assay and Garcia scores were performed to investigate the cerebral water content, BBB permeability and neurologic deficit, respectively. Moreover, during ischemia-reperfusion injury, the expression of Aquaporin 4 (AQP4) was detected using immunofluorescence and Western bloting analyses. Results Treadmill pre-training improved the relative apparent diffusion coefficient (rADC) loss in the ipsilateral cortex and striatum at 1 hour and 2.5 hours after cerebral ischemia. In the treadmill pre-training group, T2W1 values of the ipsilateral cortex and striatum increased less at 7.5 hours, 1 day, and 2 days after stroke while the brain water content decreased at 2 days after ischemia. Regarding the BBB permeability, the semi-quantitative amount of contrast agent leakage of treadmill pre-training group significantly decreased. Less Evans Blue exudation was also observed in treadmill pre-training group at 2 days after stroke. In addition, treadmill pre-training mitigated the Garcia score deficits at 2 days after stroke. Immunofluorescence staining and Western blotting results showed a significant decrease in the expression of AQP4 after treadmill ischemia following pre-training. Conclusions Treadmill pre-training may reduce cerebral edema and BBB dysfunction during cerebral ischemia/reperfusion injury via the down-regulation of AQP4.

Objective :To establish an animal experimental focal traumatic brain injury (TBI) model for investiga-ting the underlying mechanisms of rehabilitation .Methods :After adult SD rats had received a severe controlled corti-cal impact (CCI) injury ,they were randomly assigned to TBI group (n=8) or sham operation group (n=8) .After TBI ,the neurological deficits scoring ,foot-fault test and cylinder test were performed .On 21-25 days post-injury ,rats were tested for spatial learning and memory in a Morris Water Maze .On 28 days post-injury ,animals were sacrificed and evaluated for quantitative cortical lesion volume and pathological changes .Results :The rats in TBI group demon-strated declined neurological deficits scores ,coordination and asymmetry compared to sham operation group (P<0 .05) .The rats in TBI group showed obvious deficits in spatial learning and memory (P<0 .05) .We also observed significant change in lesion volume ,neuron loss and overexpression of microglia around the lesion in TBI group (P<0 .05) .Conclusion :Rats undergoing a severe CCI injury showed significant sensorimotor ,cognitive performance im-pairment and pathological changes .It is suggest that the model should be useful for assessing the effects of rehabili-tation in TBI .

Objective To evaluate the effectiveness of standardized three-stage rehabilitation program on spasticity and motor function in the upper extremities after cerebral hemorrhage.Methods A total of 364 patients were included and randomly assigned to a control group (n =181) and a rehabilitation group (n =183).The standardized three-stage rehabilitation program,which included early-stage bedside rehabilitation,specialized treatment in rehabilitation ward during recovery and rehabilitation follow-up at regular intervals was applied in the rehabilitation group,but only rehabilitation guidance and follow-up after discharge were provided for the control group.The modified Ashworth scale (MAS) and Fugl-Meyer assessment (FMA) were performed at the time of recruitment,1 month (M1),3 months(M3) and 6 months(M6) later.Results There was no statistical difference between the groups at recruitment.The occurrence rate of spasticity was 22.7％ in the control and 23.5％ in the rehabilitation group.At M6 the occurrence rate of spasticity was about 59.7％ and 43.2％ in control group and rehabilitation group respectively,and the number of patients grade 1 + and grade 2 on the MAS was 50/181 in the control group,significantly more than in the rehabilitation group (25/183).At all time points,MAS grade 0 accounted for a large proportion of both groups.At M6,both MAS distributions and scores of the two groups were different statistically (P ＜ 0.01).FMA scores in both groups increased significantly (P ＜ 0.01) with time,with the score being (17.13 ± 16.46),(24.87±18.36),(30.68±19.41) at M1,M3 and M6 in the control group and (24.71 ±19.80),(39.83 ± 19.50),(48.87 ± 18.25) in the rehabilitation group,but the average scores of the latter were consistently significantly higher than the former (P ＜ 0.01).Conclusions Standardized three-stage rehabilitation can alleviate spasticity and improve motor function of the upper extremities in cerebral hemorrhage patients.

目的:探讨运动想象训练对慢性期脑卒中患者运动功能和生活自理能力恢复的影响.方法:选择符合入组标准的32例脑卒中偏瘫患者,按随机数字表将其随机分为运动想象训练组(EXP组)和常规康复对照组(CON组)两组,每组各16例.两组患者均进行常规康复训练,每周5次,每次40分钟,共4周,同时接受相同的传统治疗如肌电生物反馈电刺激、针灸、推拿等,共4周.在此基础上,EXP组每周增加运动想象治疗5次,每次约30分钟,共4周;CON组予每周5次、每次约30分钟关于脑卒中病情的宣教,共4周.分别在治疗前和治疗后4周应用Fugl-Meyer上肢运动功能量表(FM-UL)和改良Barthel指数(MBI)评估患者上肢运动功能和生活自理能力.结果:干预前,EXP组和CON组FM-UL评分和MBI评分均无明显差异(P＞0.05).4周干预后EXP组FM-UL评分和MBI评分较干预前均显著提高(P＜0.05).与干预前比较,CON组干预4周后FM-UL评分和MBI评分也均有提高,差异有统计学意义(P＜0.05).4周干预后EXP组FM-UL评分和MBI评分均较CON组明显增加,差异有统计学意义(P＜0.05).结论:运动想象训练提高慢性期脑卒中偏瘫患者上肢运动功能和生活自理能力,是一种有效的治疗方法.

To investigate the effects of rehabilitation interventions on spasticity and activities of daily living (ADL) in ischemic stroke patients. A total of 165 ischemic stroke patients were recruited and assigned randomly to a control group (CG, n=82) or a therapeutic group (TG, n=83). Rehabilitation interventions were performed in the TG. The Modified Ashworth Scale was used to evaluate the severity of spasticity in the fingers, elbows, and plantar flexors, and the Modified Barthel Index (MBI) was used to measure ADL performance. Evaluations were performed at baseline (M0) and at the end of the first, third, and sixth months (M1, M3, M6) after enrollment. At M0, 20.8% (16/77) in the CG and 29.9% (23/77) in the TG developed spasticity, whereas at M6, the incidence of spasticity increased to 36.4% (28/77) in the TG and 42.9% (33/77) of patients in the CG. Fewer patients developed spasticity in the fingers, elbows, and ankles in the TG than CG, respectively. Both groups showed significant improvements in MBI scores (M6 vs. M0, P<0.01). MBI scores correlated negatively with the severity of spasticity in both groups at M6. Long-term standardized rehabilitation interventions alleviate spasticity and promote ADL with the presence of minor spasticity (Supplementary video, Supplemental digital content 1, http://links.lww.com/WNR/A291).

This study examined whether very early initiated physical rehabilitation (VEIPR), as a recommended therapy for postischemia, could improve motor performance and cerebral blood flow (CBF). Adult male rats with ischemic injury caused by middle cerebral artery occlusion (MCAO) were trained to run on a treadmill for 30min per day at 12m/min. Through such exercise training for 3 days, the ischemic rats exhibited increased motor function and decreased infarct volume, as measured by a behavioral score and 2,3,5-triphenyltetrazolium chloride (TTC) staining method, as well as accelerated CBF, as detected with laser speckle imaging (LSI). Furthermore, to determine whether the observed improved CBF provided the protective factor for motor function recovery, we investigated the apoptosis of ischemic rat brain microvascular endothelial cells (rBMECs), which accepted the mechanical force of CBF directly, under flow intervention. The findings indicated that a modest flow decreased cell apoptosis in the ischemic condition and that this effect is magnitude dependent, as excessive flow increased apoptosis.

Objective To analyze the effects of rehabilitation training,acupuncture and the combination of these two therapies on the motor function of stroke survivors,and to evaluate their health economics.Methods Two hundred and five stroke survivors were randomly divided into a rehabilitation group (64 cases),an acupuncture group (69 cases) and a combined group (72 cases).The rehabilitation group received conventional rehabilitation training for 28 days,while the acupuncture group received scalp needling combined with body acupuncture.The combined group received both the training and the acupuncture.The clinical neural functional deficiency scale (NDS) and functional comprehensive assessments (FCA) were evaluated at baseline and on the 28th day after treatment and 28th day after the treatment had ended.The total cost including the direct medical costs,direct non-medical costs and indirect costs were calculated and analyzed.Results The NDS and FCA scores showed no significant difference between the three groups at baseline.At the 28th day after treatment and and 28th day after the treatment had ended,both the NDS and FCA scores had improved significantly in all groups compared with the baseline.However,there was no significant difference between the groups.At the 28th day there was a significant difference in the NDS results of the combined group compared to the other two groups.Significant differences in NDS results among all three groups had appeared by the 56th day,but there was still no significant difference in average FCA scores.At the 28th day no significant difference in cost was observed among the three groups,but the combined group spent significantly less in total cost,direct medical costs,direct non-medical costs and indirect costs for a one point NDS decrement.However,there was no significant difference in the cost of producing a one point increment in FCA among the three groups.Conclusion Combining rehabilitation training with acupuncture is more economical and effective than either treatment alone.

Exercise has been proposed for the treatment of traumatic brain injury (TBI). However, the proper intensity of exercise in the early phase following a severe TBI is largely unknown. To compare two different treadmill exercise intensities on the cognitive function following a severe TBI in its early phase, rats experienced a controlled cortical impact (CCI) and were forced to treadmill exercise for 14 days. The results revealed that the rats in the low intensity exercise group had a shorter latency to locate a platform and a significantly better improvement in spatial memory in the Morris water maze (MWM) compared to the control group (p < 0.05). The high intensity exercise group showed a longer latency and a mild improvement in spatial memory compared to the control group rats in the MWM; however, this difference was not statistically significant (p > 0.05). The brain-derived neurotrophic factor (BDNF) and p-CREB protein levels in the contralateral hippocampus were increased significantly in the low intensity exercise group. Our results suggest that 2 weeks of low intensity of treadmill exercise is beneficial for improving cognitive function and increasing hippocampal BDNF expression after a severe TBI in its early phase.

BACKGROUND:Early exercise after stroke promoted angiogenesis and increased microvessles density. However, whether these newly formatted vessels indeed give rise to functional vascular and improve the cerebral blood flow (CBF) in impaired brain region is still unclear. The present study aimed to determine the effect of early exercise on angiogenesis and CBF in ischemic region.METHODS:Adult male Sprague Dawley rats were subjected to 90 min middle cerebral artery occlusion(MCAO)and randomly divided into early exercise and non-exercised control group 24 h later. Two weeks later, CBF in ischemic region was determined by laser speckle flowmetry(LSF). Meantime, micro vessels density, the expression of tie-2, total Akt and phosphorylated Akt (p-Akt), and infarct volume were detected with immunohistochemistry, 2,3,5 triphenyltetrazolium chloride (TTC) staining and western blotting respectively. The function was evaluated by seven point's method.RESULTS:Our results showed that CBF, vessel density and expression of Tie-2, p-Akt in ischemic region were higher in early exercise group compared with those in non-exercise group. Consistent with these results, rats in early exercise group had a significantly reduced infarct volume and better functional outcomes than those in non-exercise group.CONCLUSIONS:Our results indicated that early exercise after MCAO improved the CBF in ischemic region, reduced infarct volume and promoted the functional outcomes, the underlying mechanism was correlated with angiogenesis in the ischemic cortex.

BACKGROUND: The present study investigated the efficacy of Tuina rehabilitation on the patients with rheumatoid arthritis after total knee arthroplasty and the mechanism underlying Tuina rehabilitation. OBJECTIVE: To observe the clinical effect of early Tuina comprehensive rehabilitation therapy on rheumatoid arthritis patients after total knee arthroplasty, in order to provide some objective evidences for clinical rehabilitation treatment. METHODS: Sixty-six rheumatoid arthritis patients after total knee arthroplasty were equal y divided into two groups control group and Tuina group. The patients in the control group underwent continuous passive motion training after replacement, and the patients in the Tuina group underwent continuous passive motion training combined with Tuina rehabilitation. The effect of Tuina comprehensive rehabilitation was observed through Hospital for Special Surgery system and 36-Item Short-Form Health Survey. RESULTS AND CONCLUSION: Comparison of the Hospital for Special Surgery score among groups at 3 months after replacement found that the function (P=0.020), muscle strength (P=0.020), stability (P=0.011) and total scores (P=0.019) were improved, and there were significant differences when compared with those before treatment (P < 0.05). Comparison of the 36-Item Short-Form Health Survey scores among groups at 3 months after replacement found that the emotional health score (P=0.003) and total health score (P=0.008) were significantly improved, and there were significant differences when compared with those before treatment (P <0.05). Early Tuina rehabilitation could facilitate function restoration and improve strength, stability, emotional health and total health for the rheumatoid arthritis patients after total knee arthroplasty.