Stroke survivors face a profound burden from functional impairment, but the impact of long-term ambient air pollution on the longitudinal recovery trajectories of activities of daily living (ADL) remains unclear. We aimed to determine the longitudinal associations between long-term exposure to multiple air pollutants and functional recovery in stroke survivors. A longitudinal cohort study was conducted using electronic medical record data from July 1, 2019, to December 31, 2025, in Xiangyang, a highly polluted region in central China. The study included 1,755 patients with incident ischemic or hemorrhagic stroke who had at least 2 complete ADL assessments. Long-term residential exposure to ambient fine particulate matter (PM2.5), inhalable particles (PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO), and ozone (O3) was assessed. The primary outcome was functional change measured by the Modified Barthel Index (MBI). Secondary outcomes included MBI score decline and ADL dependence (defined as MBI score < 60). Inverse probability weighting (IPW)-adjusted models and restricted cubic splines were applied for analysis. The study included 1,755 stroke survivors (1,102 [62.8

Functional electric stimulation (FES) for walking assistance is an essential rehabilitation technology for improving walking function in patients with central nervous system injuries. However, there is a lack of unified standard operational specifications for its clinical application. To standardize the clinical application of FES for walking assistance and enhance therapeutic outcomes and safety, a project team led by experts from Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, has developed the "Clinical Operation Specifications for Walking Assistance with Functional Electric Stimulation", integrating medical evidence and clinical practice experience. Following the clinical operation workflow, this standard establishes guidelines for the clinical indications and contraindications of FES for gait assistance, pre-treatment assessments, motor point detection, equipment setup, environmental considerations, intra-treatment operations, post-treatment procedures, and efficacy evaluations. This standard offers guidance for the systematic and standardized application of FES technology, enhancing the consistency and safety of therapeutic effects, and fostering the standardized application and dissemination of FES technology within the field of neurological rehabilitation.

BACKGROUND:Stroke is a leading cause of long-term disability, often resulting in upper extremity dysfunction. Traditional rehabilitation methods often face challenges such as limited patient access to resources and lack of sustained motivation. Home-based virtual reality (VR) training is gaining traction as an innovative, sustainable, and interactive alternative. However, the effect of home-based VR, specifically for upper extremity recovery in patients with stroke, remains insufficiently explored. OBJECTIVE:This systematic review aims to synthesize existing evidence to evaluate the impact of home-based VR interventions on upper extremity function recovery in patients with stroke. METHODS:This systematic review followed the guidelines of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). A comprehensive literature search was conducted across PubMed, Web of Science, Scopus, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) Ultimate databases, targeting English-language randomized controlled trials (RCTs) published up to June 30, 2024. Eligible studies involved patients with stroke with upper extremity dysfunction who received home-based VR interventions. Data extraction was performed by 2 independent reviewers, and study quality was assessed using the Physiotherapy Evidence Database scale. Due to heterogeneity in study designs and outcome measures, a narrative synthesis was performed instead of a meta-analysis. RESULTS:A total of 8 RCTs with 392 participants were included. This review shows that home-based VR training positively affects upper extremity function recovery in patients with stroke, especially in motor control improvement. Customized VR systems were more effective than commercial VR systems in patients with moderate to severe disorders. Although studies generally showed positive results, differences in intervention protocols and small sample sizes limited the validity of results. The effect of VR therapy also varied based on the VR system type, intervention intensity, and the functional level of patients. CONCLUSIONS:This systematic review shows that home-based VR training has a positive impact on upper extremity rehabilitation for patients with stroke, particularly in those with varying degrees of dysfunction. However, heterogeneity in study design and differences in outcome measures affect the reliability of the current conclusions. Future studies should include larger, standardized RCTs with long-term follow-up to assess their continued effects. Future research should explore how VR technology can be integrated into comprehensive rehabilitation programs, focusing on patient-centered approaches that incorporate sustainable, personalized technology, and support services to optimize recovery outcomes. TRIAL REGISTRATION:PROSPERO CRD42024526650; https://tinyurl.com/5dny5bhp.

Background In neurorehabilitation, limited research exists on response performance and attention deficits in individuals with neglect across allocentric (aSC) and egocentric (eSC) spatial coding frameworks. These deficits are commonly assessed using pen-and-paper tests, which often fail to detect subclinical lateralized attention deficits. A computer-based task involving detecting shapes using a cue-to-target paradigm offers precise and sensitive data for identifying allocentric and egocentric spatial attention deficits. Methods This pilot study involved 18 right-handed healthy volunteers (HC) aged 23.89 ± 3.44 years, 13 individuals with right-hemispheric stroke and neglect (USN+) aged 32.83 ± 4.45 years, and 10 with stroke but no neglect (USN-) aged 32.6 ± 5.18 years, who performed a computer-based attention task. Response time (RT), accuracy rate (AR), lateralized visual perception deficits, reorienting spatial attention deficits, and disengagement deficits were recorded and analyzed. Results The USN + group had lower AR and slower RT in both aSC and eSC conditions than the USN- and HC groups across visual fields and cue types. Notably, the USN + group showed a greater RT delay for left and right visual fields (LVF) targets in the contralesional visual field than in the ipsilesional field, a pattern absent in the USN- or HC. No significant differences in AR and total RT were found between the aSC and eSC groups, but both stroke groups took longer to identify LVF targets in aSC than in eSC. Only the HC group displayed a significantly positive validity effect, with slower RT after invalid cues. This reflected their ability to disengage attention and maintain alertness. The USN + group had significantly slower RT for invalidly cued contralesional targets compared to the USN- and HC groups both in conditions. Conclusion Our study shows that individuals with neglect exhibit a rightward attentional bias during visuospatial tasks in both aSC and eSC conditions. Individuals without neglect, though classified as subclinical by pen-and-paper tests, showed a rightward bias in aSC and a leftward bias in eSC tasks using computer-based assessments. Those with or without neglect had greater difficulty with allocentric target identification in the contralesional visual field compared to egocentric processing. Additionally, individuals with neglect demonstrated a disengagement deficit, while both groups showed reorienting deficits in visuospatial attention.

目的:探讨新型冠状病毒肺炎疫情期间,参与核酸采样的医护人员的脑力负荷情况.方法:采用脑力负荷评估量表,即中文版修订后的美国国家航空航天任务负荷指数(NASA-TLX)量表评估防疫期间连续参与核酸采样2天以上的医护人员的脑力负荷情况,通过描述性统计分析、相关分析调查核酸采样岗位的医护人员脑力负荷状态,包括心智需求、体力需求、时间需求、自我绩效、努力程度、受挫程度,通过独立样本t检验分析年龄、性别、工龄对脑力负荷状态的影响效应.结果:总共回收合格问卷112份,整体年龄为30.68±9.16岁,工龄为8.12±6.06年,其中女性占60.71%,且护理人员占40.18%.本研究发现医护人员的总体脑力负荷处于偏高程度(67.21±14.7),无论是负荷程度排序还是相关性分析,结果均提示脑力负荷维度中,最突出表现在体力需求(20.10±9.04)、努力程度需求(13.74±6.09)、时间需求(12.56±7.02),提示医护人员完成工作所承受的脑力负荷,最大的因素来自于所需的体力耗费、完成工作需要付出很大的努力程度及完成工作的时间紧迫感;而自我绩效的负荷值最低(3.75±5.21),提示医护人员认可当下的工作价值和获得满意感.女性医护人员在受挫折方面较重,中年组在体力需求、努力程度、总脑力负荷方面显著高于青年组(P<0.05),高工龄组在心智需求、总脑力负荷方面高于低工龄组(P<0.05),在自我绩效负荷方面优于低工龄组(P<0.01).结论:研究提示长期从事核酸采样的一线医护人员整体处于偏高的脑力负荷状态;医护人员的脑力负荷不同程度上受年龄、工龄、性别影响,需要加以重视,尤其是高危医护人群,应积极采取相应的干预措施.

Objective:To analyze the current situation and influencing factors of community rehabilitation services for disabled persons in Xiamen,and provide reference for community rehabilitation services for disabled persons.Methods:A questionnaire was designed to conduct a questionnaire survey on the disabled persons in a certain area of Xiamen by means of centralized or household survey.The demand for rehabilitation services of 2349 disabled persons was analyzed by cross contingency table,and the influencing factors of the demand for rehabilitation services of disabled persons were analyzed by logistic regression model.Results:The rehabilitation demand rate of the physical disabled participating in this survey was 42.49%;45.3 4% received community rehabilitation services.Age was the most significant factor affecting the rehabilitation needs（P＜0.001）.The rehabilitation needs of the physical disabled aged 0～17 years were significantly higher than those of those aged 69 years or above（or=4.372,P＜0.001）.Conclusion:age is the influencing factor of the demand for rehabilitation services.In community rehabilitation,children’s rehabilitation facilities should be arranged and community rehabilitation knowledge should be popularized.

BackgroundThis study investigated the cortical activation mechanism underlying locomotor control during healthy and hemiplegic walking.MethodsA total of eight healthy individuals with right leg dominance (male patients, 75%; mean age, 40.06 ± 4.53 years) and six post-stroke patients with right hemiplegia (male patients, 86%; mean age, 44.41 ± 7.23 years; disease course, 5.21 ± 2.63 months) completed a walking task at a treadmill speed of 2 km/h and a functional electrical stimulation (FES)-assisted walking task, respectively. Functional near-infrared spectroscopy (fNIRS) was used to detect hemodynamic changes in neuronal activity in the bilateral sensorimotor cortex (SMC), supplementary motor area (SMA), and premotor cortex (PMC).ResultsfNIRS cortical mapping showed more SMC-PMC-SMA locomotor network activation during hemiplegic walking than during healthy gait. Furthermore, more SMA and PMC activation in the affected hemisphere was observed during the FES-assisted hemiplegic walking task than during the non-FES-assisted task. The laterality index indicated asymmetric cortical activation during hemiplegic gait, with relatively greater activation in the unaffected (right) hemisphere during hemiplegic gait than during healthy walking. During hemiplegic walking, the SMC and SMA were predominantly activated in the unaffected hemisphere, whereas the PMC was predominantly activated in the affected hemisphere. No significant differences in the laterality index were noted between the other groups and regions (p > 0.05).ConclusionAn important feature of asymmetric cortical activation was found in patients with post-stroke during the walking process, which was the recruitment of more SMC-SMA-PMC activation than in healthy individuals. Interestingly, there was no significant lateralized activation during hemiplegic walking with FES assistance, which would seem to indicate that FES may help hemiplegic walking recover the balance in cortical activation. These results, which are worth verifying through additional research, suggest that FES used as a potential therapeutic strategy may play an important role in motor recovery after stroke.

Objective:To investigate the after-effects of 25-Hz repetitive transcranial magnetic stimulation (rTMS) at 60, 100, and 120% resting motor threshold (rMT) on long-term potentiation (LTP) in the rat hippocampus, to clarify the intensity dependence of rTMS, and to determine whether it simultaneously affects learning and memory ability. Methods:Five rats were randomly selected from 70 male Wistar rats, and evoked rMT potentials were recorded in response to magnetic stimulation. The remaining 65 rats were randomly assigned to five groups (n = 13), including sham rTMS, 1 Hz 100% rMT, and 25 Hz rTMS groups with 3 subgroups of 60% rMT, 100% rMT, and 120% rMT. Five rats in each group were anesthetized and induced by a priming TMS-test design for population spike (PS) response of the perforant path-dentate gyrus in the hippocampus; the remaining eight rats in each group were evaluated for object recognition memory in the novel object recognition (NOR) task after the different rTMS protocols. Results:Forty-five percent (approximately 1.03 T) of the magnetic stimulator output was confirmed as rMT in the biceps femoris muscle. The PS ratio was ranked as follows: 25 Hz 100% rMT (267.78 ± 25.71%) > sham rTMS (182 ± 9.4%) >1 Hz 100% rMT (102.69 ± 6.64%) > 25 Hz 120% rMT (98 ± 11.3%) > 25 Hz 60% rMT (36 ± 8.5%). Significant differences were observed between the groups, except for the difference between the 25 Hz 120% rMT and the 1 Hz 100% rMT groups (p = 0.446). LTP was successfully induced over the 60-min recording period only in the sham rTMS and 25 Hz 100% rMT groups. Moreover, these two groups spent more time exploring a novel object than a familiar object during the NOR task (p < 0.001), suggesting long-term recognition memory retention. In the between-group analysis of the discrimination index, the following ranking was observed: 25 Hz 100% rMT (0.812 ± 0.158) > sham rTMS (0.653 ± 0.111) > 25 Hz 120% rMT (0.583 ± 0.216) >1 Hz 100% rMT (0.581 ± 0.145) > 25 Hz 60% rMT (0.532 ± 0.220). Conclusion:The after-effect of 25-Hz rTMS was dependent on stimulus intensity and provided an inverted (V-shaped) bidirectional modulation on hippocampal plasticity that involved two forms of metaplasticity. Furthermore, the effects on the recognition memory ability were positively correlated with those on LTP induction in the hippocampus in vivo.

重复外周磁刺激(repetitive peripheral magnetic stimu-lation,rPMS)作为一种远隔神经肌肉刺激模式正在运用于临床,发挥双向的神经激活作用,其疗效也在临床研究中得到证实[1].rPMS常与重复经颅磁刺激(repetitive transcrani-al magnetic Stimulation,rTMS)联合使用,形成了外周联合中枢双靶点磁刺激[2].但目前rPMS及其与rTMS联合临床应用尚无统一认识,缺乏规范化.在此背景下,本专家共识团队根据现有临床研究和临床实践经验对rPMS及其与rT-MS 联合使用进行了总结并给出推荐意见.

Purpose To translate the Moorong Self-Efficacy Scale (MSES) into Chinese and to examine its reliability and validity in patients with spinal cord injury (SCI). Methods A cross-sectional study design was employed. The MSES was translated into Chinese by forward- and back-translation and its psychometric properties were examined among 176 patients with SCI recruited from four rehabilitation centers in China using convenience sampling. Results In this study, all 176 patients were aged from 18 to 90 years old with an average of 39.51 +/- 14.07. The content validity index of the scale was 0.99. Principal components analysis with varimax orthogonal rotation was used. Three factors were extracted accounting for 39.083%, 11.149%, and 8.391% of the total variance and labeled as general self-efficacy (eight items), social self-efficacy (five items), and self-management self-efficacy (three items). Confirmatory factor analysis showed acceptable fit compared with previous studies. Pearson's correlation coefficient between the total scores of the MSES and the General Self-Efficacy Scale was 0.660 (p < 0.001). Cronbach's alpha coefficient was 0.892 for total items and 0.862, 0.817, and 0.739 for the three factors. The interclass correlation coefficients between the pretest and retest were 0.859 (0.733-0.925) for the total score. Conclusions The Chinese version of the MSES is reliable and valid, suggesting that it is suitable for evaluating self-efficacy of Chinese patients with SCI.

Objective Cortical electrical stimulation (CES) can modulate cortical excitability through a plasticity-like mechanism and is considered to have therapeutic potentials in Parkinson’s disease (PD). However, the precise therapeutic value of such approach for PD remains unclear. Accordingly, we adopted a PD rat model to determine the therapeutic effects of CES. The current study was thus designed to identify the therapeutic potential of CES in PD rats. Methods A hemiparkinsonian rat model, in which lesions were induced using unilateral injection of 6-hydroxydopamine (6-OHDA) into the medial forebrain bundle, was applied to identify the therapeutic effects of long-term (4-week) CES with intermittent theta-burst stimulation (iTBS) protocol (starting 24 h after PD lesion observation, 1 session/day, 5 days/week) on motor function and neuroprotection. After the CES intervention, detailed functional behavioral tests including gait analysis, akinesia, open-field locomotor activity, apomorphine-induced rotation as well as degeneration level of dopaminergic neurons were performed weekly up to postlesion week 4. Results After the CES treatment, we found that the 4-week CES intervention ameliorated the motor deficits in gait pattern, akinesia, locomotor activity, and apomorphine-induced rotation. Immunohistochemistry and tyrosine hydroxylase staining analysis demonstrated that the number of dopamine neurons was significantly greater in the CES intervention group than in the sham treatment group. Conclusion This study suggests that early and long-term CES intervention could reduce the aggravation of motor dysfunction and exert neuroprotective effects in a rat model of PD. Further, this preclinical model of CES may increase the scope for the potential use of CES and serve as a link between animal and PD human studies to further identify the therapeutic mechanism of CES for PD or other neurological disorders.

Objective:To explore the characteristics of cortical activation during the stimulation-assisted walking of hemiplegic stroke survivors using functional near-infrared spectroscopy (fNIRS).Methods:Eight stroke survivors with right hemiplegia (average age 44.4±7.2 years) in a self-controlled study each walked at 2km/h on a treadmill, alone and assisted by functional electronic stimulation (FES). Real-time near-infrared spectroscopic images were recorded. The Matlab NIRS-SPM toolkit was employed to calculate the changes in oxyhemoglobin concentration in different cortical regions. A general linear model was evaluated which integrated the task effects, and version 20.0 of the SPSS statistical software was used to perform single sample or paired sample t-tests of the beta values so as to produce activation hot maps of the significant differences.Results:During unassisted walking channels 8, 10, 11, 13-20, 23-28, 30 and 32-37 were significantly activated. During FES-assisted walking it was the same channels plus channels 9 and 22, 31. The results suggest that in walking the cortical regions activated are mainly located in M1 of the unaffected hemisphere, supplemented by M1 and SMA, PMC and S1 in the affected hemisphere. There were significant differences in the activation of channels 9, 24, 27, 32, 33 between the two walking tasks. FES-assistance enhances S1 activation on the unaffected side, as well as the SMA and PMC of the affected side more significantly.Conclusions:Bilateral asymmetrical activation is found mostly in M1 during walking with or without FES assistance. FES assistance significantly strengthens the compensatory activation of the PMC and SMA of the affected hemisphere while walking for those with hemiplegia.

Objective: To assess the effect of a self-management intervention delivered by mobile application (APP) for depression among community-dwell-ing individuals with spinal cord injury (SCI). Design: Randomized controlled trial.Settings: General communities in China.Participants: Community-dwelling individuals with SCI who were diagnosed within 2 years were recruited in this study (N=98). It was a conve-nience sample with an average age of 41.71, 82.7% participants were men.Interventions: Participants in the intervention group (n=49) received 5 sessions on self-management training provided by nurse-led multidisci-plinary team via APP at the second, fourth, sixth, eighth, and 12th weeks, respectively, after they discharge from hospitals. Participants in the con-trol group (n=49) received routine telephone counselling provided by follow-up nurses at the 12th week after they discharge.Outcome Measure: The outcome of this study is depression, which is not the primary outcomes in the registration of this program. Depression was measured by version 2 of Beck Depression Inventory at discharge (T0), the 12th week after discharge from hospitals (T1), and the 24th week after discharge from hospitals (T2).Results: There were 98 participants (49 in the intervention group and 49 in the control group) completing the intervention and data collection. Compared with the control group, the intervention group had lower level of depression at T2 (B=-5.76; 95% CI=-9.97,-1.54; P=.007). Small to moderate effect sizes on depression favoring the intervention were demonstrated at T1 (Cohen's d=-.178) and T2 (Cohen's d=-.535).Conclusions: APP-based self-management support can be a potential intervention to reduce depression among community-dwelling individuals with SCI.Archives of Physical Medicine and Rehabilitation 2023;104:195-202 (c) 2022 by the American Congress of Rehabilitation Medicine.

目的 调查分析厦门市翔安区残疾人的康复现状及需求,并探讨总结出相应对策,以期提升残疾人的生存质量.方法 本文选取厦门市翔安区2021年1-12月2 349名持证残疾人作为此次研究对象,在该区政府的协助下,采用问卷调查的方式统计该区残疾人的基本情况、康复状况及康复需求等内容,找出存在的问题,并分析总结出相对应的策略.结果2 349名残疾人中,年龄分布主要集中在46岁及以上,占比为80.63%;以大嶝街道残疾人数最多,占24.69%,其次是马巷街道,占20.69%,第三是新圩镇,占17.11%,内厝镇占比最低,为4.17%;肢体残疾人数占比最高,为45.00%,言语残疾人数占比最低,为1.15%;二级残疾人数最多,占比为41.93%,其次为四级残疾,占比为26.35%.2 349名残疾人中有998名有康复需求,康复需求率为42.49%;医院、社区、居家康复需求占比分别为32.48%、21.88%、14.73%;曾接受康复医疗服务的残疾人占比最高,为23.97%,其次依次为康复知识宣传23.37%、辅助器具配备20.39%、康复训练指导18.39%、心理辅导17.11%,24.56%的残疾人没有接受过任何康复项目;需要康复医疗服务的残疾人占比最高,为29.03%,然后依次为康复知识宣传26.35%、辅助器具配备23.41%、康复训练指导19.84%、心理辅导18.48%,30.91%的残疾人无康复需求.结论 不同类型残疾人的基本康复服务需求有一定差异,应该在残疾人康复服务体系广泛覆盖的基础上提供有针对性的服务,提高康复资源利用效率,而基于国际功能、残疾和健康分类标准的残疾人康复服务数据平台的构建能够促进为残疾人提供精准服务,有利于残疾人康复服务业发展.

近年来,国内围绕国际功能、残疾和健康分类(Interna-tional Classification of Functioning,Disability and Health,ICF)临床应用方面的研究逐年增多[1-3],而《国际功能、残疾和健康分类(ICF)专家共识》的发表[4],又推动了 ICF及其核心组合如康复组合(ICF rehabilitation set,ICF-RS)的临床应用及标准的编制[5-6].本文仅就ICF及ICF-RS在国内的应用作一介绍,旨在进一步推动ICF及ICF-RS在国内临床的应用及研究.

Background Spinal cord injury (SCI) severely impairs the physical and mental health of patients, decreasing their self-efficacy in coping with daily life and quality of life (QOL). In China, a large gap remains between the complex long-term health needs of SCI patients and the current community care system. With the prevalence of mobile terminals, the usage of mobile health apps has the potential to fill this gap by extending qualified medical resources to the families of SCI patients. Our team developed the app Together for the transitional care of home-dwelling SCI patients in China. Objective This study aimed to evaluate the effects of app-based transitional care on the self-efficacy and QOL of SCI patients. Methods Through a three-round Delphi process, an Android app was designed. Both medical staff and patients could access the app. Medical staff used it for providing remote transitional care to SCI patients. Patients used it to view transitional care time and send messages to medical staff. Thereafter, a multicenter and assessor-blinded randomized controlled trial was conducted. Participants (n=98) who had SCI and lived at home following discharge were recruited and randomly assigned to a study group (n=49) and control group (n=49) using a randomized number list in four research centers. Patients in both groups received systematic discharge education before discharge. The study group received five follow-ups conducted by trained nurses through the app, which had four core functions, namely remote assessment, health education, interdisciplinary referral, and patient interaction, at weeks 2, 4, 6, 8, and 12 following discharge. The control group received a routine telephone follow-up conducted by nurses at week 12 following discharge. The outcome measures were the Moorong Self-Efficacy Scale (MSES) and 36-item Short-Form Health Survey (SF-36) scores. Data were collected before discharge (T0) and at weeks 12 (T1) and 24 following discharge (T2). Differences between the groups were tested by repeated measures analysis of variance and simple effect analysis. Results After the follow-up, the total MSES scores in the study group improved over time (T0=67.80, T1=71.90, and T2=76.29) and were higher than those in the control group (T2=64.49) at 24 weeks following discharge (simple effect analysis: F1=8.506, P=.004). Regarding the total SF-36 score, although it was higher in patients from the study group (T2=65.36) than those from the control group (T2=58.77) at 24 weeks following discharge, only time effects were significant (F2,95=6.671, P=.002) and neither the group effects nor the interaction effects influenced the change in QOL (group effects: F1,96=0.082, P=.78; interaction effects: F2,95=3.059, P=.052). Conclusions This study confirmed that app-based transitional care improves the self-efficacy of SCI patients. Nevertheless, QOL improvement is not yet evident. Future investigations with larger sample sizes and longer observation periods are warranted to further verify the effects. Trial Registration Chinese Clinical Trial Registry ChiCTR-IPR-17012317; http://www.chictr.org.cn/showproj.aspx?proj=19828

Objective This study explored whether acupuncture affects the maintenance of long-term potentiation (LTP)-like plasticity induced by transcranial magnetic stimulation (TMS) and the acquisition of motor skills following repetitive sequential visual isometric pinch task (SVIPT) training. Methods Thirty-six participants were recruited. The changes in the aftereffects induced by intermittent theta-burst stimulation (iTBS) and followed acupuncture were tested by the amplitude motor evoked potential (MEP) at pre-and-post-iTBS for 30 min and at acupuncture-in and -off for 30 min. Secondly, the effects of acupuncture on SVIPT movement in inducing error rate and learning skill index were tested. Results Following one session of iTBS, the MEP amplitude was increased and maintained at a high level for 30 min. The facilitation of MEP was gradually decreased to the baseline level during acupuncture-in and did not return to a high level after needle extraction. The SVIPT-acupuncture group had a lower learning skill index than those in the SVIPT group, indicating that acupuncture intervention after SVIPT training may restrain the acquisition ability of one’s learning skills. Conclusion Acupuncture could reverse the LTP-like plasticity of the contralateral motor cortex induced by iTBS. Subsequent acupuncture may negatively affect the efficacy of the acquisition of learned skills in repetitive exercise training.

目的:检验ICF康复量表在创伤性脊髓损伤(TSCI)人群的信效度情况.方法:采用ICF康复量表、改良Barthel指数、Berg平衡能力、SDS抑郁量表等常用量表对45个TSCI恢复期患者进行综合评估.Cronbachα系数和Spearman相关系数分别检验ICF康复量表的内部一致性信度和与其他量表的校标关联效度.结果:采用ICF康复量表评估TSCI患者最主要障碍表现在:b640性功能、b280G痛觉、b455运动和耐受能力、b710关节活动能力、b620排尿功能,S610泌尿系统的结构、S430呼吸系统的结构,d660帮助别人、d450G步行、d470利用交通工具、d230进行日常事务、d540穿着、d850有报酬的就业,e115个人日常生活用的用品和技术、e580卫生的服务、体制和政策.ICF康复量表及4个子领域Cronbachα系数分别为0.870、0.560、0.368、0.896、0.717,如删除一些条目可提升整体的内部一致性.患者在身体功能(BF)与抑郁量表分数呈高度正相关(P＜0.05),活动与参与(AP)和改良Barthel指数呈高度负相关(P＜0.05).环境因素(EF)与其他量表的相关性低(P＞0.05).结论:ICF康复量表可用于评估TSCI恢复期患者的功能状况,具有可靠的内部一致性信度和较好的校标关联效度.

目的:探究功能性近红外光谱技术(functional near-infrared spectroscopy,fNIRS)动态观察经颅直流电刺激(tran-scranial direct current stimulation,tDCS)与功能性电刺激(functional electrical stimulation,FES)的不同时序组合治疗对脑卒中偏瘫患者初级运动皮质(primary motor cortex,M1)脑功能连接的即时影响.方法:采用自身对照,将15例符合入选标准的脑卒中偏瘫患者,依次给予单纯tDCS治疗、单纯FES治疗、tDCS和FES同步治疗、先tDCS后FES时序治疗,每种干预各1次,洗脱期为2天.干预前后进行fNIRS检测,静息态脑功能连接(resting state functional connectivity,RSFC)采用相关分析和基于图论的复杂网络分析.利用NIRS-SPM工具包计算不同干预下氧合血红蛋白的脑激活图.结果:发现单纯FES治疗、tDCS+FES同步治疗、tDCS_FES时序治疗下激活脑区显著于单纯tDCS治疗(P=0.023),而tDCS_FES时序治疗下脑区激活显著于单纯FES治疗和tDCS+FES同步治疗组(P＜0.05).相关分析发现不同治疗方法下运动区相关皮质FC均较干预前增多,依次为tDCS FES时序治疗、单纯FES治疗、FES+tDCS同步治疗、单纯tDCS治疗.图论分析显示单纯tDCS或FES治疗在局部/全局网络效率、小世界方面程度相似,tDCS+FES同步治疗可一定程度改善脑区连接效率优于单纯电刺激治疗,tDCS FES时序治疗在改善脑区域连接效率方面最明显.结论:tDCS或FES的单纯或联合治疗均能不同程度增强患者的脑功能连接和效率,提高患者的运动皮质兴奋性,但建议临床多采用tDCS FES时序治疗,有助于促进运动区脑神经功能连接.