Nutritional support and rehabilitative training are crucial for functional recovery in stroke patients with dysphagia. Malnutrition often aggravates motor, cognitive, and emotional deficits, underscoring the need for tailored nutritional strategies to improve swallowing and motor outcomes. We present a case of severe dysphagia complicated by secondary gastroparesis following a medullary infarction. After assessment by a multidisciplinary team (MDT), a multimodal rehabilitation protocol was implemented, consisting of repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), and neuromuscular electrical stimulation (NMES), combined with conventional swallowing training. Concurrently, a structured stepwise nutritional management plan was executed, progressing from nasojejunal (NJ) feeding to intermittent oro-esophageal (IOE) tube feeding, and finally to independent oral intake. After 3 months of integrated treatment, the patient’s Modified Mann Assessment of Swallowing Ability (MMASA) score improved from 81 to 94(out of 100). Videofluoroscopic Swallowing Study (VFSS) demonstrated a reduction in laryngeal elevation latency and safe pharyngeal transit, allowing for the successful removal of the feeding tube. This case suggests that MDT-guided stepwise nutritional management, when combined with multimodal swallowing rehabilitation, may offer a beneficial and feasible therapeutic approach for severe dysphagia post-medullary infarction. This integrated model successfully balances therapeutic safety with functional recovery, providing a practical framework for breaking the vicious cycle of post-stroke dysphagia and malnutrition.

Background: Post-stroke cognitive impairment (PSCI) involves complex pathophysiology and lacks specific therapeutic approaches. Synaptic plasticity and mitochondrial dysfunction are key pathological mechanisms in PSCI, with mitochondrial autophagy playing a crucial role in maintaining cellular homeostasis. HDP15 is an active, highly conserved peptide secreted by hippocampal neurons. While it is associated with synaptic plasticity, its effects on PSCI remain unknown. Objective: To investigate the effects of HDP15 on cognitive impairment following ischemia-reperfusion injury and explore its potential mechanisms. Methods: The cerebral middle artery occlusion (MCAO) model was used to evaluate HDP15's impact on neurological function and spatial cognition in rats. Oxygen-glucose deprivation re-perfusion (OGD/R) experiments were conducted to study HDP15's regulatory effects on cell viability and mitochondrial function. Results: HDP15 significantly reduced neurological deficits in MCAO rats, shortened escape latency in the Morris water maze, and increased platform crossing attempts, demonstrating marked improvement in spatial cognition. HDP15 enhanced survival rates of OGD/R-treated SH-SY5Y cells, decreased lactate dehydrogenase (LDH) leakage, and upregulated expression of PSD-95, SYP, and alpha-synuclein. Additionally, HDP15 enhanced mitochondrial function by increasing basal respiration, maximal respiration, and ATP production, while promoting clearance of damaged mitochondria via PRKN-mediated autophagy. Conclusion: HDP15 significantly protects against ischemic stroke by regulating PRKN-mediated mitochondrial autophagy, thereby identifying a new potential target for PSCI treatment.

Objective To investigate the clinical effect of external diaphragmatic pacing(EDP) combined with Hu Xi Jian Fei Gong in the treatment of pulmonary dysfunction in stroke patients. Methods From July 2020 to July 2022, 162 stroke patients in Shanghai Tongren Hospital and Yueyang Hospital of Integrated Traditional Chinese and Western Medicine were randomly divided into a control group and an observation group, with 81 patients in each group.Both group received conventional rehabilitation and EDP, and the observation group additionally received Hu Xi Jian Fei Gong.Forced vital capacity(FVC), forced expiratory volume in 1 second(FEV1), peak expiratory flow(PEF), diaphragmatic mobility, end-expiratory diaphragmatic thickness, and end-inspiratory diaphragmatic thickness were compared between the two groups before treatment and after 4 weeks of treatment.The activity of daily living(ADL) of 72 patients admitted to Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine were compared before treatment, after 4 weeks of treatment and 12 weeks after the end of treatment. Results After treatment, FVC, FEV1, PEF, end-expiratory diaphragmatic thickness and end-inspiratory diaphragmatic thickness in the two groups were higher than those before treatment(P<0.05), and the observation group was higher than the control group(P<0.05).After 4 weeks of treatment and 12 weeks after the end of treatment, the ADL scores of 72 patients were higher than those before treatment(P<0.05), and the observation group was higher than the control group(P<0.05). Conclusion EDP combined with Hu Xi Jian Fei Gong training can better improve the pulmonary function of patients after stroke.

Objective This study aimed to compare the efficacy and safety of ultrasound-guided local injection (UGLI) of betamethasone around the shoulder and extracorporeal shock wave therapy (ESWT) in patients with hemiplegic shoulder pain. Method Forty-two patients with hemiplegic shoulder pain were randomly divided into the UGLI group ( N = 21) and the ESWT group ( N = 21). In the UGLI group, betamethasone was injected at the pain point around the shoulder under ultrasonic localization. In the ESWT group, an extracorporeal shock wave was performed at the pain points around the shoulder for 20 min of time, once a week, for 4 consecutive weeks. Both groups received rehabilitation training. The visual analog scale (VAS) evaluation was performed at baseline, 1 h, 1 week, and 1 month after treatment. Furthermore, Neer shoulder joint function scores, upper limb Fugl–Meyer assessment (FMA), modified Barthel index (MBI), Hamilton Depression Scale (HAMD), the MOS-item short-form health survey (SF-36) scores, and serum expression level of cytokine were evaluated at baseline and 1 month after treatment. Results After 1-h treatment, the UGLI group showed a greater effect on the degree of pain than the ESWT group ( P = 0.017). After 4 consecutive weeks of intervention, the UGLI group showed a significant improvement in the serum level of cytokine expression compared with the ESWT group ( P < 0.05). The range of motion (ROM) of the hemiplegic shoulder ( P < 0.05) has no difference between the two groups ( P > 0.05). Conclusion The ultrasonic-guided betamethasone local injection and extracorporeal shock wave both can improve hemiplegic shoulder pain. However, the UGLI can induce a more cytokine expression level.

Hypoxic-ischemic encephalopathy (HIE) is an important factor leading to permanent damage of central nervous system (CNS) and even neonatal death. Long non-coding RNAs (lncRNAs) has been shown to get involved in the pathogenesis of nervous system diseases. LINC00938 is an intergenic lncRNA which is reported to be involved in neurodegenerative disease. However, the potential role of LINC00938 in nerve injury of neonatal HIE is undetermined. Here, we found that the expression of LINC00938 in the whole blood of neonates with HIE was downregulated compared with the non-HIE group. Functional study revealed that the expression of LINC00938 was significantly decreased in oxygen-glucose deprivation (OGD)-induced SH-SY5Y. Knockdown of LINC00938 induced the neural cell apoptosis by increased the protein level of Bax, Cleaved-Caspase3 and decreased the expression of Bcl-2. In addition, overexpression of LINC00938 prevented the apoptosis of SH-SY5Y from OGD injury. RNA-seq analysis showed that MAPK signaling was involved in the anti-apoptosis function of LINC00938. LINC00938 knockdown induced the activation of c-Jun-N-terminal kinase (JNK), p38 mitogen-activated protein kinase, and inhibited the activation of ERK signaling. However, LINC00938 play neuroprotective role in OGDinduced SH-SY5Y by suppression the phosphorylation of JNK and p38 MAPK rather than regulation of ERK signaling pathway. Further analyses illustrated that the cell apoptosis of neuronal cell was dependent on the elevation of reactive oxygen species (ROS) and result in mitochondria dysfunction in LINC00938 knockdown SHSY5Y. Pretreated with ROS inhibitor N-acetylcysteine amide (NACA) dramatically suppressed LINC00938 knockdown induced oxidative stress and mitochondria dysfunction which induced cell apoptosis. In addition, NACA treatment significantly reduced the expression of p-JNK and p-p38 in OGD-induced SH-SY5Y. Furthermore, overexpression of LINC00938 displayed a notably neuroprotective effect by suppress central nervous system cell apoptosis via alleviating oxidative stress in CoCl2-induced hypoxic HIE model of zebrafish. Taken together, these results suggested that LINC00938 can act as a neuroprotective factor to inhibit oxidative stress and apoptosis of CNS under HIE conditions.

Effective treatments for patients in a persistent vegetative state due to traumatic brain injury (TBI) are currently unavailable. The purpose of this study was to investigate the therapeutic use of sensitive sensory stimulation for patients in persistent vegetative state following TBI. This case report discussed a 36-year-old male patient who experienced TBI 75 days prior to admission. Upon hospital admission, the patient was unconscious, could automatically open his eyes, but could not avoid light, trace motions, or execute commands. He was placed on a nasal feeding diet, exhibited urinary and fecal incontinence and developed postoperative urinary retention and a pulmonary infection. He showed no mobility of the upper and lower extremities with hypomyotonia. Medications for nerve repair, regaining consciousness, preventing seizure, resolving phlegm, and protecting the stomach were administered. The activity of the extremities was improved by exercise therapies and low or medium-frequency electric stimulation, bladder and bowel function was improved by acupuncture and abdominal massage, and consciousness recovery was promoted by acupuncture and hyperbaric oxygen therapy. Five months following admission, the patient regained consciousness with improved bladder and bowel function. Electroencephalogram indicated that brain function had significantly improved. Auditory evoked potentials and somatosensory evoked potentials suggested that sensation conduction pathways had improved significantly. Sensitive sensory stimulation in combination with routine rehabilitation treatment can effectively cause the regain of consciousness in patients with persistent vegetative state following TBI and improve activities of daily living and the function of the sensation conduction pathways..

目的 探究头皮针联合镜像视觉反馈(MVF)训练系统治疗脑卒中患者认知功能障碍的临床疗效.方法 选取2017年10月～2019年7月上海市同仁医院治疗的脑卒中患者60例,分为镜像组和联合治疗组,每组各30例.两组均接受常规认知功能训练,镜像组同时接受镜像神经元康复训练系统(MNST-med)进行训练,联合治疗组接受头皮针联合镜像视觉反馈训练.治疗前及治疗8周后,比较两组蒙特利尔认知评估量表(MoCA)评分、简单反应时、改良Barthel指数评分(MBI)、威斯康星卡片分类测验(WCST).结果 治疗后,两组患者各项功能评分均较治疗前有所改善(P＜0.05),联合治疗组在改善脑卒中患者的认知功能及日常生活能力方面优于镜像组(P＜0.05).结论 头皮针联合镜像视觉反馈训练,能更好地改善卒中后患者的认知功能.

OBJECTIVE:To investigate the effect of transcranial direct current stimulation (tDCS) combined with conventional comprehensive rehabilitation on dysphagia after brainstem stroke.MATERIALS AND METHODS:Forty brainstem stroke patients were randomly divided into tDCS group and conventional comprehensive treatment group, including 20 patients in each group. Both groups were given routine swallowing function training, and tDCS group added transcranial direct current stimulation (tDCS). The Dysphagia Outcome and Severity Scale (DOSS) and Functional Dysphagia Scale (FDS) were evaluated respectively before and after 8 weeks of continuous treatment with VFSS. The white blood cell (WBC), c-reactive protein, prealbumin (PAB), albumin (Alb), and hemoglobin (Hb) were also compared between the two groups before and after 8 weeks of continuous treatment.RESULTS:After 8 consecutive weeks of treatment, the score of DOSS scale and FDS scale in both groups was improved (P < 0.05), WBC and CRP were decreased (P < 0.05), and Alb and Hb were improved (P < 0.05), and PAB had no differences (P=0.474). The tDCS group was superior to conventional comprehensive group in improving the swallowing function and nutritional indexes (P < 0.05).CONCLUSIONS:tDCS therapy combined with routine training can improve the swallowing function and nutritional status of patients, and reduce infection.

目的:探讨镜像视觉反馈训练在合并认知障碍的脑卒中吞咽障碍患者吞咽功能康复中的临床效果.方法 :选取经蒙特利尔认知评估量表(MoCA)筛选合并认知障碍的脑卒中吞咽障碍患者40例,随机分成镜像组和对照组各20例.对照组接受常规吞咽康复训练,镜像组在此基础上给予镜像视觉反馈训练.比较治疗前后临床吞咽功能与认知水平.结果 :治疗2周后,2组的标准吞咽功能评价量表(SSA)评分较治疗前明显降低(P＜0.05),MoCA评分较治疗前明显提高(P＜0.05),且镜像组明显高于对照组(P＜0.05);2组简单反应时均较治疗前明显缩短(均P＜0.05),且镜像组明显快于对照组(P＜0.05).结论 :镜像视觉反馈训练能改善脑卒中后认知障碍合并吞咽困难患者的吞咽功能和注意力、执行力.

目的:观察经颅直流电刺激(tDCS)配合常规综合康复对脑干卒中后吞咽障碍患者的疗效。方法:将脑干卒中后吞咽障碍患者40例按随机数字法分为tDCS治疗组和常规综合治疗组，每组患者20例。2组均给予常规吞咽功能综合训练，tDCS治疗组在此基础上配合应用tDCS进行治疗。于治疗前和治疗8周后(治疗后)采用吞咽造影检查(VFSS)对2组患者进行吞咽障碍的结局和严重程度评估(DOSS)，以及吞咽功能(FDS)评分，同时检验2组患者的营养相关指标[包括血红蛋白(Hb)、白蛋白(Alb)、前白蛋白(PAB)]和感染指标[(包括血白细胞(WBC)、C反应蛋白(CRP)]，并记录治疗过程中2组患者不良反应发生情况。结果:经治疗后，2组患者的DOSS评分和FDS评分较组内治疗前均改善，差异均有统计学意义( P<0.05)，且tDCS治疗组的DOSS评分和FDS评分分别为(6.20±1.62)分和(46.15±18.82)分，显著优于常规综合治疗组治疗后，差异均有统计学意义( P<0.05)。治疗后，2组患者的营养相关指标和感染指标与组内治疗前比较，差异均有统计学意义( P<0.05)，且tDCS治疗组的营养相关指标Alb和Hb以及感染指标WBC和CRP与常规综合治疗组治疗后比较，差异均有统计学意义( P<0.05)。 结论:tDCS疗法与常规综合治疗相结合可更好地改善脑干卒中后吞咽障碍患者的吞咽功能和营养状况，并减少感染。

脑卒中是成人致残的主要原因之一,患者通常会出现持续性的运动障碍和功能障碍[1].我国永久性功能障碍分级标准中指出,人的上肢功能占全身功能的60％,手指功能占上肢功能的90％.在现代社会的发展过程中手所承担的功能日益突出.手在人类大脑皮质的精细分布、手功能的复杂神经支配与脑区投射,使得脑卒中后手功能的康复成为世界性难题[2].本研究应用动作观察法(action observation therapy,AOT)联合手与上肢优化运动技巧训练模式,观察该项技术对脑卒中患者手功能的临床疗效.旨在探求临床上更有效、更便捷地治疗脑卒中后患者上肢及手功能的康复训练方案.

AbstractObjectiveTo investigate the clinical effects of the mirror neuron system (MNS)‐based training on upper extremity motor function and cognitive function in stroke patients.MethodsSixty stroke patients (time from stroke onset 3–9 months) with upper extremity paresis (Brunnstrom stage II–IV) and cognitive impairment (MoCA score ≥ 15) were enrolled in this study. Patients were randomly allocated into MNS treatment group (N = 30) and control group (N = 30). Both groups underwent regular training for upper extremity motor function and cognitive function, and the MNS group was trained with a therapeutic apparatus named mirror neuron system training (MNST) including different levels of action observation training (AOT). Training lasted 20 min/day, 5 days/week for 8 weeks. MoCA, reaction time, and Wisconsin Card Sorting Test (WCST) were assessed at baseline and 8 weeks after training. Furthermore, Fugl‐Meyer assessment (FMA) and Modified Barthel index (MBI) were adopted to evaluated upper extremity motor function and daily life ability.ResultsAfter 8 consecutive weeks’ training, both groups showed significant improvements on the upper extremity motor function, cognitive function, and daily life ability score after training (p < .05). The MNS group showed significantly improved upper extremity motor function and cognitive function (p < .05) compared with control group.ConclusionsCombining MNS‐based and conventional training can improve upper extremity motor function and cognitive function in stroke patients.

目的 自行制作上肢功能锻炼测量器,并将其应用于康复科脑卒中后患侧上肢功能障碍患者中,观察其应用效果.方法 采用方便抽样法,选取2018年1月—12月在上海市某二级甲等医院康复科住院的60例脑卒中患者为研究对象,按照随机数字表法将其分为观察组和对照组,每组各30例.对照组采用常规康复治疗及康复护理,观察组在对照组的基础上使用上肢功能锻炼测量器.在项目实施前、项目实施2周后,采用简式Fugl-Myer上肢运动功能评价量表(FMA)评定两组患者的上肢功能;采用Lovett分级的国际肌力评定法评定患者的患侧上肢肌力;采用改良Barthel指数(MBI)量表评定患者的日常生活自理能力;所得数据用统计软件SPSS 19.0进行统计分析.结果 治疗后,观察组的患侧上肢FMA评分、MBI评分均高于治疗前和对照组,差异有统计学意义(P<0.05);项目实施后,观察组的患侧上肢肌力优于对照组,差异有统计学意义(P<0.05).结论 使用自制上肢功能训练器能有效改善脑卒中后患者的患侧上肢功能,提高患侧上肢肌力和患者的日常生活自理能力.

目的 观察镜像神经元训练系统对脑卒中后患者上肢运动功能的影响.方法 将50名脑卒中偏瘫患者随机分为镜像组(n=25)和对照组(n=25).两组患者均接受常规康复治疗,同时对照组患者使用舒尔特方格训练,镜像组患者使用镜像神经元训练系统训练,每次训练时间为20 min,3次/w,共6 w.治疗前后,通过Fugl-Myer上肢量表和Barthel指数分别对上肢运动功能和日常生活能力进行评估.结果 经过6 w治疗后,两组Fugl-Myer量表上肢评分及Barthel指数较治疗前有显著提高(P<0.05);镜像组治疗前后上述评定结果的评分差值均显著优于对照组(P<0.05).结论 基于镜像神经元理论的动作观察对脑卒中患者具有较好的临床疗效,可改善上肢运动功能,提高生活质量.

目的 研究以镜像视觉反馈(MVF)训练系统对脑卒中患者上肢运动功能及认知功能的临床疗效.方法 2016年10月至2017年7月,60例脑卒中患者随机分为对照组和治疗组,各30例.两组均予常规上肢及认知功能训练,治疗组应用基于镜像神经元理论的MNST治疗仪进行训练.治疗前及治疗8周后,采用蒙特利尔认知评估量表、简单反应时、Fugl-Meyer评定量表上肢部分、改良Barthel指数和威斯康星卡片分类测验进行评定.结果 治疗后,两组患者各项功能评分均较治疗前显著改善(t>3.915,P<0.001),治疗组优于对照组(t>2.452,P<0.05).结论 MVF与常规训练相结合,能更好地改善患者上肢功能和认知功能.

目的 通过吞咽X线荧光透视检查(VFSS)判断脑干梗死后吞咽障碍患者吞咽过程中不同阶段的问题,有针对性地采用康复措施,评价针对性的系统强化吞咽康复训练的疗效.方法 收集40例脑干梗死后吞咽障碍的患者,通过VFSS判断吞咽过程中的问题,并进行有针对性的强化吞咽训练,共治疗6 w.治疗前后通过洼田饮水试验、吞咽障碍程度评分标准(VGF)总分、口腔期及咽期的VGF积分、误咽程度的积分变化等评定其吞咽障碍改善情况.结果 经过6 w的系统强化的康复治疗,40例患者的洼田饮水试验筛查结果、VGF总分、口腔期及咽期的VGF积分、误咽程度的积分均较各自治疗前有显著改善(P<0.05).结论 在脑干梗死后吞咽障碍的评估和治疗中,VFSS可以精准评估,明确问题关键,指导临床有针对性地采用康复措施,从而获得很好的临床疗效.

目的:观察老年性膝骨关节炎(KOA)采用低强度聚焦超声波治疗与超短波治疗的临床疗效.方法:选取2016年1月-2016年12月我院门诊治疗的老年性膝骨关节炎患者60例,将60例患者随机分为观察组与对照组.观察组采用低强度聚焦超声波治疗配合康复指导;对照组采用超短波治疗配合康复指导.旨在探究对缓解该病疼痛、肿胀的物理因子治疗更行之有效的方法.每次15分钟,每天1次;10次为1个治疗疗程,3个疗程后观察临床疗效.观察2组治疗后的各项相关指标,主要表现为VAS评分、Lysholm膝关节功能评分和汉密尔顿抑郁量表(HAMD-17)评分.结果:研究显示通过治疗,2组内治疗前、后VAS评分、Lysholm评分、HAMD评分的比较中均有改善,差异具有显著性(P<0.05).2组间比较观察组在治疗后VAS评分、HAMD评分均优于对照组,差异具有显著性(P<0.05);观察组在改善Lysholm评分方面与对照组无差别(P>0.05).但是将Ly-sholm评分中的肿胀单项分值改变,进行组间前后比较具有显著差异性(P<0.05).结论:观察到两种方法在用于老年性KOA的临床治疗中均有效,且低强度聚焦超声波治疗较超短波治疗就肿胀、疼痛及情绪改善方面疗效更优.

目的 对比评估深层肌肉刺激仪(DMS)与传统推拿手法对颈肩综合征的临床疗效.方法 将60例颈肩综合征患者随机分为DMS组和传统推拿(TN)组30例.DMS组运用DMS疗法,TN组运用推拿手法.连续治疗20次后观察患者治疗前后疼痛视觉模拟评分(VAS)、汉密尔顿抑郁量表(HAMD)、Northwick Park颈痛量表(NPQ)颈痛积分及美国加州大学肩关节评分(UCLA)的变化,并比较两组差异.结果 经过连续20 d的治疗后,两组NPQ评分及VAS均较治疗前有显著改善(P<0.05).DMS组在改善颈椎疼痛症状及VAS方面优于TN组(P<0.05),两组总有效率无统计学差异(P>0.05).结论 传统手法推拿治疗有其特有的优势和特点,但是在颈肩综合征的治疗方面,DMS不失为一个有效的替代方法.

目的 观察下肢强化负重运动训练对脑卒中后偏瘫患者骨质疏松(OP)的影响.方法 追踪观察脑卒中偏瘫合并OP患者50例,均按照OP指南进行标准化药物治疗,并随机分成观察组和对照组,对照组进行常规康复训练和治疗,观察组增加强化下肢负重运动训练.两组在治疗前、治疗3个月及1年后分别检测骨钙素、碱性磷酸酶、25羟基维生素D3及甲状旁腺素等骨代谢相关生化指标.结果 两组在干预前各观察指标无明显差异(P>0.05),治疗3个月和1年后各项指标较干预前均有明显改善,且观察组改善更明显(P<0.05).结论 强化下肢负重训练可以改善全身OP,增加药物疗效.