Methodologies to assess muscle co-contraction during gait in people with neurological impairment – A systematic literature review

PurposeTo review the methodologies used to assess muscle co-contraction (MCo) with surface electromyography (sEMG) during gait in people with neurological impairment.MethodsThe Scopus (1995–2013), Web of Science (1970–2013), PubMed (1948-2013) and B-on (1999–2013) databases were searched. Articles were included when sEMG was used to assess MCo during gait in people with impairment due to central nervous system disorders (CNS).ResultsNineteen articles met the inclusion criteria and most studied people with cerebral palsy and stroke. No consensus was identified for gait assessment protocols (surfaces, speed, distance), sEMG acquisition (electrodes position), analysis of sEMG data (filters, normalisation techniques) and quantification of MCo (agonist-antagonist linear envelopes overlapping or agonist-antagonist overlapping periods of muscles activity, onset delimited).ConclusionGiven the wide range of methodologies employed, it is not possible to recommend the most appropriate for assessing MCo. Researchers should adopt recognized standards in future work. This is needed before consensus about the role that MCo plays in gait impairment in neurological diseases and its potential as a target for gait rehabilitation can be determined.     

Differences in foot contact times between obese and non-obese postmenopausal women when crossing obstacles

Abstract

Objective: This study aimed to investigate the foot contact time differences between obese and non-obese subjects during walking when crossing obstacles.

Methods: Ninety-eight postmenopausal women were assigned to four groups, and their plantar pressure temporal data were collected using a two-step protocol during walking when crossing an obstacle set at 30% height of lower limb length of each subject. The initial, final, and duration of contact of 10?foot areas were measured.

Results: Leading limb: (1) the heel groups initiated foot contact using the heel, and the non-heel groups initiated contact using the metatarsals; (2) heel obese subjects showed an earlier initial contact and a longer contact duration of metatarsals 2–3; (3) non-heel obese subjects showed an earlier midfoot initial contact. Regarding the trailing limb: (4) heel obese subjects showed an earlier midfoot initial contact and a longer contact duration of metatarsal 5; (5) non-heel obese subjects showed an earlier initial contact and a longer contact duration of metatarsals 4–5.

Conclusions: (1) The non-heel groups’ foot rollover pattern may result from an attempt of rapidly restoring stability; (2) the heel obese subjects seem to regulate their plantar foot muscles to overcome their overweight; (3) the overweight of the non-heel obese subjects leads to a quicker backward foot roll-over from the metatarsals to the heel; (4) the overweight of the heel obese subjects can distort their footprints and/or their higher inertia may precipitate an anticipation of the midfoot contact, which can also explain the result observed for 5.     

MOTOmed下肢运动训练联合等速肌力训练对脑卒中偏瘫患者下肢运动功能、下肢肌张力和步行步态功能的影响

摘要 目的：观察MOTOmed下肢运动训练联合等速肌力训练在脑卒中偏瘫患者的应用价值。方法：根据随机数字表法将2019年5月-2022年12月期间南京医科大学附属脑科医院收治的158例脑卒中偏瘫患者分为对照组（n=79,接受等速肌力训练）和观察组（n=79,对照组基础上接受MOTOmed下肢运动训练）。对比两组下肢运动功能、下肢肌张力、步行步态功能。结果：干预12周后,两组Fugl-Meyer运动功能评定量表（FMA）、Berg平衡量表（BBS）评分升高,且观察组高于对照组同期（P<0.05）。干预12周后,两组膝关节后伸（FKE）、前屈（FKF）、髋关节后伸（FHE）、前屈（FHF） 肌张力升高,且观察组高于对照组同期（P<0.05）。干预12周后,两组步速、步频、步长、功能性步行分级量表（FAC）评分升高,且观察组高于对照组同期（P<0.05）。结论：MOTOmed下肢运动训练联合等速肌力训练治疗脑卒中偏瘫患者,可有效改善下肢运动功能、下肢肌张力以及步行步态功能。     

MOTOmed下肢智能运动训练联合运动想象疗法对脑卒中偏瘫患者下肢功能、步行能力和躯干屈伸肌群肌力的影响

摘要 目的：探讨MOTOmed下肢智能运动训练联合运动想象疗法对脑卒中偏瘫患者下肢功能、步行能力和躯干屈伸肌群肌力的影响。方法：148例脑卒中偏瘫患者来源于我院2019年5月~2021年5月期间我院接收的患者,根据随机数字表法分为对照组（n=74,常规康复训练的基础上结合MOTOmed下肢智能运动训练）和研究组（n=74,对照组的基础上结合运动想象疗法）。两组均干预12周。对比两组下肢功能、步行能力和躯干屈伸肌群肌力变化。结果：两组干预12周后Fugl-Meyer运动功能量表（FMA）、Barthel指数（BI）、功能性步行能力分级量表（FAC）评分升高,且研究组高于对照组（P<0.05）。两组干预12周后步频、步速、跨步长比率升高,且研究组高于对照组（P<0.05）。两组干预12周后健侧腹直肌、竖脊肌表面肌电信号的均方根值未见明显变化,且组间同时点对比无差异（P>0.05）。两组干预12周后患侧腹直肌、竖脊肌表面肌电信号的均方根值升高,且研究组高于对照组（P<0.05）。结论：脑卒中偏瘫患者在MOTOmed下肢智能运动训练的基础上进行运动想象疗法,可促进下肢功能改善,提高步行能力,同时还可改善患侧躯干屈伸肌群肌力。     

Maximum walking speed and lower limb length in hominids

In 1984, Helene (Am. J. Physics 52:656) and Alexander (Am. Scientist 72:348–354) presented equations which purported to explain how lower limb length limited maximum walking speed in humans. The equations were based on a simplified model of human walking in which the center of mass (CoM) “vaults” over the supporting leg. Increasing walking speed by increasing stride frequency or stride length would increase the upward acceleration of the CoM in the first half of stance phase, to the point that it would be greater than the downward pull of gravity, and the individual would become airborne. This constitutes running by most definitions. While these models ignored various mechanical factors, such as knee flexion during midstance, that reduce the vertical movement of the CoM, the general idea is plausible inasmuch as the CoM of the body does oscillate vertically with each step. One hypothesis tested here is whether it is indeed the interaction between the pull of gravity and the individual's own upward acceleration that determines at what speed (or cadence) he changes from walking to running. Another hypothesis considered is that increased lower limb length (L) was selected for in early hominids, because of the locomotor advantages of longer lower limbs. Results indicate, however, that while L was clearly related to maximum possible walking speed, it was not an important factor in determining maximum “comfortable” walking speed. These and other results from the recent literature suggest that increased lower limb length provided no selective advantage in locomotion, and other explanations should be sought. © 1996 Wiley-Liss, Inc.     

三维旋进式振动疗法联合常规康复训练对脑卒中偏瘫患者上下肢痉挛状态、步行能力及生活质量的影响

摘要 目的：探讨三维旋进式振动疗法联合常规康复训练对脑卒中偏瘫患者上下肢痉挛状态、步行能力及生活质量的影响。方法：按照随机数字表法,将南京医科大学附属苏州医院2020年4月~2022年4月期间收治的80例脑卒中偏瘫患者分为对照组（常规康复训练）和实验组（三维旋进式振动疗法联合常规康复训练）,每组各40例。对比两组偏瘫侧上下肢痉挛状态、步行能力及生活质量情况。结果：两组干预4周后、干预8周后Fugl-Meyer运动功能评分（FMA）上肢、下肢评分均较干预前升高,且实验组高于对照组（P<0.05）。两组干预4周后、干预8周后步长、步速、6 min步行试验（6MWT）均较干预前升高,且实验组高于对照组（P<0.05）。两组干预8周后,生理职能（RP）、活力（VT）、生理功能（PF）、总体健康（GH）、社会功能（SF）、躯体疼痛（BP）、情感职能（RE）、精神健康（MH）均较干预前升高,且实验组高于对照组（P<0.05）。结论：三维旋进式振动疗法联合常规康复训练应用于脑卒中偏瘫患者,可有效改善上下肢痉挛状态,提高步行能力,促进生活质量提高。     

肌内效贴镇痛联合康复训练对脑卒中偏瘫患者下肢运动功能、步行参数和生活质量的影响

目的:探讨肌内效贴镇痛联合康复训练对脑卒中偏瘫患者下肢运动功能、步行参数和生活质量的影响。方法:选取2017年1月-2018年1月期间我院收治的脑卒中偏瘫患者200例为研究对象。根据随机数表法将患者分为对照组(n=100)与观察组(n=100)。两组患者均接受常规康复训练,观察组在此基础上联合肌内效贴镇痛治疗。两组均治疗4周,观察并比较两组患者治疗前后下肢运动功能、步行参数和生活质量。结果:两组患者治疗后简化Fugl-Meyer运动功能量表(FMA-L)、徒手肌力测试(MMT)、Berg平衡量表(BBS)均较治疗前升高,且观察组高于对照组(P0.05);两组患者治疗后改良Ash-worth量表(MAS)、计时起立行走测试(TGUT)均较治疗前降低,且观察组低于对照组(P0.05)。两组患者治疗后步速、步幅、患侧步长、健侧步长、步态周期、双腿支撑期均较治疗前升高,且观察组高于对照组(P0.05);两组患者治疗后步态不对称指数较治疗前降低,且观察组低于对照组(P0.05)。两组患者治疗后Barthel指数(BI)较治疗前升高,且观察组高于对照组(P0.05)。结论:肌内效贴镇痛与康复训练联合治疗脑卒中偏瘫患者,疗效满意,可显著改善患者下肢运动功能、步行参数以及生活质量。     

Pendular activity of human upper limbs during slow and normal walking

When walking at normal and fast speeds, humans swing their upper limbs in alternation, each upper limb swinging in phase with the contralateral lower limb. However, at slow and very slow speeds, the upper limbs swing forward and back in unison, at twice the stride frequency of the lower limbs. The change from “single swinging” (in alternation) to “double swinging” (in unison) occurs consistently at a certain stride frequency for agiven individual, though different individuals may change at different stride frequencies. To explain this change in the way we use our upper limbs and individual variations in the occurrence of the change, the upper limb is modelled as a compound pendulum. Based on the kinematic properties of pendulums, we hypothesize that the stride frequency at which the change from “single swinging” to “double swinging” occurs will be at or slightly below the natural pendular frequency (NPF) of the upper limbs. Twenty-seven subjects were measured and then filmed while walking at various speeds. The mathematically derived NPF of each subject's upper limbs was compared to the stride frequency at which the subject changed from “single swinging” to “double swinging.” The results of the study conform very closely to the hypothesis, even when the NPF is artificially altered by adding weights to the subjects' hands. These results indicate that the pendulum model of the upper limb will be useful in further investigations of the function of the upper limbs in human walking. © 1994 Wiley-Liss, Inc.     

Activation timing of soleus and tibialis anterior muscles during sit-to-stand and stand-to-sit in post-stroke vs. healthy subjects

Introduction. Sit-to-stand (SitTS) and stand-to-sit (StandTS) are very important functional tasks that become compromised in stroke patients. As in other voluntary movements, they require an adequate postural control (PC) involving the generation of anticipatory postural adjustments (APAs). In order to give clues for more efficient and directed rehabilitation programs, a deeper knowledge about APAs during challenging and daily life movements is essential.

Purpose. To analyze the activation timing of tibialis anterior (TA) and soleus (SOL) muscles during SitTS and StandTS in healthy subjects and in post-stroke patients.

Methods. Two groups participated in this study: one composed of ten healthy subjects and the other by ten subjects with a history of stroke and increased H-reflex. Electromyographic activity (EMGa) of SOL and TA was analyzed during SitTS and StandTS in the ipsilateral (IPSI) and the contralateral (CONTRA) limb to the side lesion in stroke subjects, and in one limb in healthy subjects. A force plate was used to identify the movement onset.

Results. In both sequences, in the stroke group SOL activation timing occurred prior to movement onset, contrary to the pattern observed in the healthy subjects. Statistically significant differences were found in SOL activation timings between each lower limb of the stroke and healthy groups, but no significant differences were found between the IPSI and the CONTRA limb. The TA activation timing seems to be delayed in the CONTRA limb when compared to the healthy subjects and showed a better organization of TA timing activation in StandTS when compared to SitTS.

Conclusion. Compared to healthy subjects, APAs seem to be altered in both limbs of the post-stroke subjects, with the SOL activation timing being anticipated in both SitTS and StandTS.     

Dynamic stability of individuals with transtibial amputation walking in destabilizing environments

Lower limb amputation substantially disrupts motor and proprioceptive function. People with lower limb amputation experience considerable impairments in walking ability, including increased fall risk. Understanding the biomechanical aspects of the gait of these patients is crucial in improving their gait function and their quality of life. In the present study, 9 persons with unilateral transtibial amputation and 13 able-bodied controls walked on a large treadmill in a Computer Assisted Rehabilitation Environment (CAREN). While walking, subjects were either not perturbed, or were perturbed either by continuous mediolateral platform movements or by continuous mediolateral movements of the visual scene. Means and standard deviations of both step lengths and step widths increased significantly during both perturbation conditions (all p<0.001) for both groups. Measures of variability, local and orbital dynamic stability of trunk movements likewise exhibited large and highly significant increases during both perturbation conditions (all p<0.001) for both groups. Patients with amputation exhibited greater step width variability (p=0.01) and greater trunk movement variability (p=0.04) during platform perturbations, but did not exhibit greater local or orbital instability than healthy controls for either perturbation conditions. Our findings suggest that, in the absence of other co-morbidities, patients with unilateral transtibial amputation appear to retain sufficient sensory and motor function to maintain overall upper body stability during walking, even when substantially challenged. Additionally, these patients did not appear to rely more heavily on visual feedback to maintain trunk stability during these walking tasks.     

运动想象疗法联合PNF躯干模式训练对脑卒中偏瘫患者上肢功能、步行功能和躯干控制能力的影响

摘要 目的：探讨运动想象疗法（MI）联合神经肌肉本体感觉促进术(PNF)躯干模式训练对脑卒中偏瘫患者上肢功能、步行功能和躯干控制能力的影响。方法：选取2015年1月-2019年6月期间中国人民解放军第九八三医院及中国中医科学院望京医院康复治疗中心收治的112例脑卒中偏瘫患者。根据按入院顺序编号的奇、偶数分为对照组（n=56）和研究组（n=56）,对照组给予常规康复训练联合MI训练,研究组在对照组基础上联合PNF躯干模式训练,两组均干预8周。对比两组干预前、干预4周后、干预8周后的Carroll手功能评定(UEFT)、Fugl-Meyer运动功能评定(FMA)、改良的Barthel指数（mBI）、功能性步行分级(FAC)、Tinetti步态评估量表(TGA)、躯干控制能力测试(TCT)、Berg平衡功能量表(BBS)、坐-站-坐时间以及躯干前倾距离。结果：两组干预4周后、干预8周后UEFT、FMA、mBI评分逐渐升高,且研究组高于对照组（P<0.05）。两组干预4周后、干预8周后FAC、TGA评分逐渐升高,且研究组高于对照组（P<0.05）。两组干预4周后、干预8周后TCT、BBS评分逐渐升高,且研究组高于对照组（P<0.05）。两组干预4周后、干预8周后坐-站-坐时间逐渐降低,且研究组低于对照组（P<0.05）,躯干前倾距离逐渐升高,且研究组高于对照组（P<0.05）。结论：MI联合PNF躯干模式训练治疗脑卒中偏瘫患者,可有效改善患者步行功能、上肢功能和躯干控制能力。     

The loss of dexterity in the bilateral lower extremities in patients with stroke

The aim of this study was to examine the dexterity of both lower extremities in patients with stroke. Twenty patients with stroke and 20 age-matched control subjects participated in this study. To determine the dexterity of the lower extremities, we examined the ability to control muscle force during submaximal contractions in the knee extensor muscles using a force tracking task. The root mean square errors were calculated from the difference between the target and response force. The root mean square error was significantly greater in the affected limb of patients with stroke compared with those of the unaffected limb and the control subjects, and in the unaffected limb compared with that of the control subjects. Furthermore, the root mean square error of the affected limb was related significantly to motor function as determined by Fugl-Myer assessment. These results demonstrate impairment of the dexterity of both the affected and the unaffected lower extremities in patients with stroke.     

Evaluation of lower limb cross planar kinetic connectivity signatures post-stroke

Following stroke, aberrant three dimensional multijoint gait impairments emerge that present in kinematic asymmetries such as circumduction. A precise pattern of cross-planar coordination may underlie abnormal hemiparetic gait as several studies have underscored distinctive neural couplings between medio-lateral control and sagittal plane progression during walking. Here we investigate potential neuromechanical constraints governing abnormal multijoint coordination post-stroke. 15 chronic monohemispheric stroke patients and 10 healthy subjects were recruited. Coupled torque production patterns were assessed using a volitional isometric torque generation task where subjects matched torque targets for a primary joint in 4 directions while receiving visual feedback of the magnitude and direction of the torque. Secondary torques at other lower limb joints were recorded without subject feedback. We find that common features of cross-planar connectivity in stroke subjects include statistically significant frontal to sagittal plane kinetic coupling that overlay a common sagittal plane coupling in healthy subjects. Such coupling is independent of proximal or distal joint control and limb biomechanics. Principal component analysis of the stroke aggregate kinetic signature reveals unique abnormal frontal plane coupling features that explain a larger percentage of the total torque coupling variance. This study supports the idea that coupled cross-planar kinetic outflow between the lower limb joints uniquely emerges during pathological control of frontal plane degrees of freedom resulting in a generalized extension of the limb. It remains to be seen if a pattern of lower limb motor outflow that is centrally mediated contributes to abnormal hemiparetic gait.     

Safety and efficacy of granulocyte–colony-stimulating factor administration following autologous intramuscular implantation of bone marrow mononuclear cells: a randomized controlled trial in patients with advanced lower limb ischemia

Background aimsThe aim was to investigate the therapeutic effect of granulocyte–colony-stimulating factor (G-CSF) administration following implantation of autologous bone marrow mononuclear cells (BM MNC) for patients with lower limb ischemia.MethodsThe design was a randomized controlled trial. Fifteen patients with severe chronic limb ischemia were treated with autologous BM MNC [without G-CSF (MNC–G-CSF) or combined with G-CSF administration for 5 days following transplantation (MNC+G-CSF)].ResultsAll clinical parameters, including ankle brachial index, visual analog scale and pain-free walking distance, showed a mean improvement from baseline, which was measured at 4 and 24 weeks after transplantation in both groups. However, in three (20%) patients, the clinical course did not improve and limb salvage was not achieved. No significant difference was observed among the patients treated in the MNC–G-CSF and MNC+G-CSF groups. No severe adverse reactions were reported during the study period. No relationship was observed between both the numbers of viable MNC or CD34⁺ cells and the clinical outcome.ConclusionsAutologous transplantation of BM MNC into ischemic lower limbs is safe, feasible and efficient for patients with severe peripheral artery disease. However, the administration of G-CSF following cell transplantation does not improve the effect of BM MNC implantation and therefore would not have any beneficial value in clinical applications of such cases.     

低频重复经颅磁刺激联合Bobath疗法对脑卒中偏瘫患者神经功能、运动功能及平衡能力的影响

摘要 目的：观察Bobath疗法联合低频重复经颅磁刺激对脑卒中偏瘫患者运动功能、神经功能、平衡能力的影响。方法：研究对象为我院2020年05月-2022年05月期间收治的脑卒中偏瘫患者148例。按照随机数字表法分为对照组（Bobath疗法,74例）和研究组（低频重复经颅磁刺激联合Bobath疗法,74例）。观察两组平衡能力[Berg平衡量表（BBS）]、神经功能[美国国立卫生研究院卒中量表（NIHSS）]、日常生活自理能力[改良Barthel指数（mBI）]、运动功能[Fugl-Meyer上肢运动功能评定量表（FMA-UE）、Fugl-Meyer下肢运动功能评定量表（FMA-LE）]、凝血功能[凝血酶原时间（PT）、纤维蛋白原（FIB）、D- 二聚体（D-D）、活化部分凝血活酶时间（APTT）]的变化情况。结果：两组治疗20 d后NIHSS评分下降, mBI评分升高,且研究组变化程度大于对照组（P<0.05）。两组治疗20 d后FMA-UE、FMA-LE评分升高,且研究组高于对照组（P<0.05）。两组治疗20 d后BBS评分升高,且研究组高于对照组（P<0.05）。两组治疗20 d后FIB、APTT、D-D、PT均下降,且研究组低于对照组（P<0.05）。结论：低频重复经颅磁刺激联合Bobath疗法用于脑卒中偏瘫患者,可改善其凝血功能,恢复神经功能,进而改善运动功能,提高其日常生活活动能力。     

Effect of functional electrical stimulation on the effort and walking speed,surface electromyography activity,and metabolic responses in stroke subjects

ObjectiveTo investigate the effects of functional electrical stimulation (FES) combined with conventional rehabilitation program on the effort and speed of walking, the surface electromyographic (sEMG) activity and metabolic responses in the management of drop foot in stroke subjects.MethodsFifteen patients with a drop foot resulting from stroke at least 3 months prior to the start of the trial took part in this study. All subjects were treated 1 h a day, 5 days a week, for 12 weeks, including conventional stroke rehabilitation program and received 30 min of FES to the tibialis anterior (TA) muscle of the paretic leg in clinical settings. Baseline and post-treatment measurements were made for temporal and spectral EMG parameters of TA muscle, walking speed, the effort of walking as measured by physiological cost index (PCI) and metabolic responses.ResultsThe experimental results showed a significant improvement in mean-absolute-value (21.7%), root-mean-square (66.3%) and median frequency (10.6%) of TA muscle EMG signal, which reflects increased muscle strength. Mean increase in walking speed was 38.7%, and a reduction in PCI of 34.6% between the beginning and at end of the trial. Improvements were also found in cardiorespiratory responses with reduction in oxygen consumption (24.3%), carbon dioxide production (19.9%), heart rate (7.8%) and energy cost (22.5%) while walking with FES device.ConclusionsThe results indicate that the FES may be a useful therapeutic tool combined with conventional rehabilitation program to improve the muscle strength, walking ability and metabolic responses in the management of drop foot with stroke patients.     

The Prevalence of Dysglycemia-Based Chronic Disease in a European Population – a New Paradigm to Address Diabetes Burden: A Kardiovize Study

ObjectiveTo determine the prevalence rate and associated risk factors for each stage of the Dysglycemia-Based Chronic Disease (DBCD) model, which 4 distinct stages and prompts early prevention to avert Diabetes and cardiometabolic complications.MethodsSubjects between 25 and 64 years old from a random population-based sample were evaluated in Czechia from 2013 to 2014 using a cross-sectional design. DBCD stages were: stage 1 “insulin resistance” (inferred risk from abdominal obesity or a family history of diabetes); stage 2 “prediabetes”(fasting glucose between 5.6 and 6.9 mmol/L); stage 3 “type 2 diabetes (T2D)” (self-report of T2D or fasting glucose ≥7 mmol/L); and stage 4 “vascular complications” (T2D with cardiovascular disease).ResultsA total of 2147 subjects were included (57.8% women) with a median age of 48 years. The prevalence of each DBCD stage were as follows: 54.2% (stage 1); 10.3% (stage 2), 3.7% (stage 3); and 1.2% (stage 4). Stages 2 to 4 were more frequent in men and stage 1 in women (P < .001). Using binary logistic regression analysis adjusting by age/sex, all DBCD stages were strongly associated with abnormal adiposity, hypertension, dyslipidemia, and smoking status. Subjects with lower educational levels and lower income were more likely to present DBCD.ConclusionUsing the new DBCD framework and available metrics, 69.4% of the population had DBCD, identifying far more people at risk than a simple prevalence rate for T2D (9.2% in Czechia, 2013-2014). All stages were associated with traditional cardiometabolic risk factors, implicating common pathophysiologic mechanisms and a potential for early preventive care. The social determinants of health were related with all DBCD stages in alarming proportions and will need to be further studied.     

三维旋进式振动疗法联合运动想象训练对脑卒中偏瘫患者上肢功能、平衡能力及日常生活活动能力的影响

摘要 目的：研究运动想象训练联合三维旋进式振动疗法对脑卒中偏瘫患者平衡能力、上肢功能及日常生活活动能力的影响。方法：研究对象来源于苏州市立医院康复医学科2019年4月~2022年4月期间收治的80例脑卒中偏瘫患者。入院后按照计算机产生随机数进行随机分配为对照组和研究组,每组各40例。对照组患者接受运动想象训练,研究组患者接受三维旋进式振动疗法联合运动想象训练。对比两组疗效、上肢功能、平衡能力及日常生活活动能力。结果：两组患者干预2周后、干预4周后Fugl-Meyer上肢运动功能量表（FM-uL）、上肢动作研究量表（ARAT）评分均升高,且研究组均高于对照组同期;改良Ashworth痉挛量表（MAS）评分均下降,且研究组低于对照组同期（P<0.05）。两组患者干预2周后、干预4周后Berg平衡量表（BBS）评分均升高,且研究组高于对照组同期（P<0.05）。两组患者干预2周后、干预4周后Barthel指数（BI）评分均升高,且研究组高于对照组同期（P<0.05）。结论：运动想象训练联合三维旋进式振动疗法干预脑卒中偏瘫患者,可有效改善患者的平衡能力、上肢功能及日常生活活动能力。     

Sensory retraining improves light touch threshold of the paretic hand in chronic stroke survivors: a single-subject A-B design

Abstract

Background: Light touch, one of the primary and basic sensations, is often neglected in sensory retraining programmes for stroke survivors.

Objective: This study aimed to investigate the effects of sensory retraining on the light touch threshold of the hand, dexterity and upper limb motor function of chronic stroke survivors.

Methods: Five chronic stroke survivors with sensory impairment participated in this single-subject A-B design study. In baseline (A) phase, they only received standard rehabilitation. In the treatment (B) phase, they received a 6-week sensory retraining intervention in addition to standard rehabilitation. In both phases, they were evaluated every 3 days. Light touch threshold, manual dexterity and upper limb motor function were assessed using Semmes-Weinstein Monofilaments, Box-Block Test and Fugl-Meyer Assessment, respectively. Visual analysis, nonparametric Mann-Whitney U test and, c-statistic were used for assessing the changes between phases.

Results: All participants indicated changes in trend or slope of the total score of light touch or both between the two phases. The results of the c-statistic also showed the statistical difference in the total score of light touch between baseline and treatment in all participants (p?<?0.001). Also, the results of the c-statistic and Mann-Whitney U test supported the difference of manual dexterity and motor function of the upper limb between baseline and treatment in all participants (p?<?0.001).

Conclusion: Current findings showed that sensory retraining may be an effective adjunctive intervention for improving the light touch threshold of the hand, dexterity and upper limb motor function in chronic stroke survivors.     

Relationship between sleep stages and short‐term changes in rectal temperature in humans

Abstract

Sixteen volunteers have been studied during 3–4 control nights and eight of these subjects again during four successive sleeps on 30‐h “days”;. The experiments took place in a comfortable environment provided by an isolation chamber. Rectal temperature and the sleep EEG were measured throughout. The relationship between sleep stages, particularly SWS and REM sleep, and short‐term changes in rectal temperature has been investigated during both protocols. Care was taken to correct for or remove those temperature changes that could be attributed to circadian rhythmicity or the effects of loss of masking due to being awake. Results showed that there was a small but significant effect of sleep stages, with SWS producing a fall and REM sleep a rise in rectal temperature after a delay of about 30–48 minutes. It is concluded that such spontaneous changes in sleeping subjects accord with the results of other studies which indicate that thermoregulatory reflexes to hot or cold stimuli alter in different sleep stages.