A型肉毒毒素联合肌电生物反馈治疗脑卒中后上肢肌痉挛的临床疗效分析

目的:分析A型肉毒毒素与肌电生物反馈联合用于治疗脑卒中后上肢肌痉挛的临床疗效。方法:选择2014年10月至2016年12月辽宁本溪市中心医院和北京博爱医院收治的84例脑卒中后上肢肌痉挛患者,并将其随机分为观察组和对照组,每组42例。两组患者均首先接受常规康复训练,随后对照组加用肌电生物反馈治疗,观察组患者在对照组的基础之上注射A型肉毒毒素。采用改良Ashworth痉挛量表(MAS)比较两组治疗前后的上肢肌痉挛改善情况,采用Fugl-Meyer评定量表评价患者上肢运动功能,采用量角器测量治疗前后患者的腕关节主动活动范围,采用改良的Barthel指数评价患者治疗前后的日常生活能力。结果:治疗后,观察组的上肢痉挛改善总有效率显著高于对照组(P0.05);治疗2周和4周时,两组的Fugl-Meyer评分、腕关节主动活动范围、改良的Barthel指数(MBI)均较治疗前显著升高(P0.05),且观察组治疗后2周和4周的Fugl-Meyer评分、腕关节主动活动范围、改良的Barthel指数(MBI)均显著高于对照组(P0.05)。结论:A型肉毒毒素与肌电生物反馈联合用于治疗脑卒中后上肢肌痉挛的临床疗效显著,可有效降低患者上肢痉挛状态,改善上肢和腕部运动能力,提高患者的日常生活能力。     

Faster intrinsic rate of torque development in elbow flexors than knee extensors: Effect of muscle architecture?

We studied the effect of pennate vs. fusiform muscle architecture on the rate of torque development (RTD) by examining the predominately fusiform elbow flexors (EF) and highly-pennate knee extensors (KE). Seventeen male volunteers (28.4 ± 6.2 years) performed explosive isometric EF and KE contractions (MVCs). Biceps brachii and vastus lateralis fascicle angles were measured to confirm their architecture, and both the rate of voluntary muscle activation (root-mean-square EMG in the 50 ms before contraction onset; EMG_-50) and electromechanical delay (EMD; depicting muscle-tendon series elasticity) were assessed as control variables to account for their influence on RTD. MVC torque, early (RTD₅₀) and late (RTD₂₀₀) RTDs were calculated and expressed as absolute and normalized values. Absolute MVC torque (+412%), RTD₅₀ (+215%), and RTD₂₀₀ (+427%) were significantly (p < 0.001) higher in KE than EF. However, EF RTD₅₀ was faster (+178%) than KE after normalization (p = 0.02). EMG_-50 and EMD did not differ between muscle groups. The results suggest that the faster absolute RTD in KE is largely associated with its higher maximal torque capacity, however in the absence of differences in rates of muscle activation, fiber type, and EMD the fusiform architecture of EF may be considered a factor allowing its faster early RTD relative to strength capacity.     

Clinical feasibility of mandibular implant overdenture retainers submitted to immediate load

Gerodontology 2010; doi: 10.1111/j.1741‐2358.2010.00374.x
Clinical feasibility of mandibular implant overdenture retainers submitted to immediate load Introduction: Millions of people around the world do not have access to the benefits of osseointegration. Treatments involving oral rehabilitation with overdentures have been widely used by specialists in the oral medicine field. This is an alternative therapy for retention and stability achievement in total prosthesis with conventional treatment, and two implants are enough to establish a satisfactory overdenture. Objective: The objectives of the study were to evaluate 16 patients of both sexes, with an average age of 47.4 ± 4 years, using electromyographic analysis of masseter and temporal muscles and analyse the increase of incisive and molar maximal bite force with their existing complete dentures and following mandibular implant overdenture therapy to assess the benefits of this treatment. Materials and methods: For these tests, the Myosystem‐BR1 electromyograph and the IDDK Kratos dynamometer were used. Statistical analysis was performed using the repeated measures test (SPSS 17.0). Results: A decrease in electromyographic activity during the rest, lateral and protrusion movements and increase of the maximal incisive and molar bite force after 15 months with a mandibular implant overdenture was observed. Conclusion: All the patients in this study reported a considerable improvement in the masticatory function and prostheses stability following treatment. It is possible to propose that the use of mandibular implants overdenture should become the selected treatment for totally edentulous patients to facilitate oral function and quality of life.