The majority of motor recovery following stroke occurs within 6 months after onset.The present study examined a patient with a corona radiata infarct,who exhibited an unusual long-term recovery（24 months after onset...The majority of motor recovery following stroke occurs within 6 months after onset.The present study examined a patient with a corona radiata infarct,who exhibited an unusual long-term recovery（24 months after onset）.The patient was a 64-year-old female,who presented with severe paralysis of the left extremities resulting from a corona radiate infarct.Motor recovery from the weakness progressed slowly over a 24-month period following onset,even at 6-12 months after onset.Diffusion tensor tractography at 2 weeks from onset showed disruption of the corticospinal tract of the affected hemisphere resulting from the infarct.However,at 12 and 24 months after onset,the corticospinal tract was elongated to the cortex level,as shown by diffusion tensor tractography.A 2-week transcranial magnetic stimulation showed no motor-evoked potential for the affected hemisphere,but a motor-evoked potential of the corticospinal tract was observed at12 and 24 months.These results suggest that motor function recovery in cerebral infarct patients can occur at least up to 24 months after stroke onset.展开更多
Intracerebral hemorrhage （ICH） is a stroke subtype caused by spontaneous rupture of small vessels and bleeding into the brain paren- chyma, resulting in cell death and sensorimotor deficits. Despite the greater prev...Intracerebral hemorrhage （ICH） is a stroke subtype caused by spontaneous rupture of small vessels and bleeding into the brain paren- chyma, resulting in cell death and sensorimotor deficits. Despite the greater prevalence of the ischemic form of stroke （87%）, ICH has the highest mortality rate of all stroke subtypes. The striatum is the most affected structure in hemorrhagic stroke （35-70%）, followed by cere- bral cortex （15-30%）, brain stem and cerebellum （5-10%）; patients suffering striatal and/or cortical ICH bear persistent sensorimotor disabilities. Although chronic sensorimotor impairment is established, a considerable amount of patients experience some degree of spontaneous recovery during the first six months after stroke （Qureshi et al., 2009）, and the neurobiological basis of this process is not understood.展开更多
The present study reported a 42-year-old male patient who underwent conservative management for a spontaneous intracerebral hemorrhage in the left corona radiata and the basal ganglia. The patient presented with compl...The present study reported a 42-year-old male patient who underwent conservative management for a spontaneous intracerebral hemorrhage in the left corona radiata and the basal ganglia. The patient presented with complete weakness of the right upper and lower extremities at the onset of intracerebral hemorrhage; however, he showed progressive motor recovery to the level that he was able to extent the affected extremities against some resistance at 5 weeks after onset. The corticospinal tract of the affected （left） hemisphere connected to the left Broca＇s area at 3 weeks after onset as shown by diffusion tensor tractography. By contrast, this connection had disappeared at 5 weeks after onset as shown by diffusion tensor tractogaphy. Transcranial magnetic stimulation study showed that no motor evoked potential was elicited from the affected （left） hemisphere at 3 weeks after onset, but motor evoked potentials were elicited at 5 weeks after onset. These findings suggest that the connection between the injured corticospinal tract and Broca＇s area in this patient appears to be a compensation for severe motor weakness; consequently, the connection seems to disappear with motor recovery.展开更多
The presence of the aberrant pyramidal tract has been demonstrated by several studies; however, little is known about its role in motor recovery in stroke patients. In the present study, we reported a 69-year-old righ...The presence of the aberrant pyramidal tract has been demonstrated by several studies; however, little is known about its role in motor recovery in stroke patients. In the present study, we reported a 69-year-old right-handed female patient with an infarct in the mid to lateral portion of the left cerebra peduncle, who showed an aberrant pyramidal tract by diffusion tensor tractography. The patient presented with severe weakness of the right extremities at stroke onset. The patient showed progressive motor recovery as much as being able to extend the affected extremities against some resistance at 6 months after onset. At 20 months after stroke onset, motor function of the left extremities had recovered to a nearly normal state. Diffusion tensor tractography results showed that the PT was disrupted at the lower midbrain of the affected （left） hemisphere at 3 weeks after stroke onset and this disruption was not changed at 20 months. An aberrant pyramidal tract in the left hemisphere was also observed, which originated from the primary motor cortex and descended through the corona radiata, posterior limb of the internal capsule, thalamus, the medial lemniscus pathway from the midbrain to the pons, and then entered into the pyramidal tract area at the pontomedullary junction. Transcranial magnetic stimulation did not elicit motor evoked potential from the affected hand muscle at 3 weeks, but it elicited motor evoked potential with mildly delayed latency and low amplitude in the affected hand muscle at 20 months. The main motor functions of the affected extremities in this patient appeared to be recovered via this aberrant pyramidal tract.展开更多
Artificial intelligence(AI)and machine learning(ML)are powerful technologies with the potential to revolutionize motor recovery in rehabilitation medicine.This perspective explores how AI and ML are harnessed to asses...Artificial intelligence(AI)and machine learning(ML)are powerful technologies with the potential to revolutionize motor recovery in rehabilitation medicine.This perspective explores how AI and ML are harnessed to assess,diagnose,and design personalized treatment plans for patients with motor impairments.The integration of wearable sensors,virtual reality,augmented reality,and robotic devices allows for precise movement analysis and adaptive neurorehabilitation approaches.Moreover,AI-driven telerehabilitation enables remote monitoring and consultation.Although these applications show promise,healthcare professionals must interpret AI-generated insights and ensure patient safety.While AI and ML are in their early stages,ongoing research will determine their effectiveness in rehabilitation medicine.展开更多
BACKGROUND: This systematic review aims to investigate the prediction value of diffusion tensor imaging for motor function recovery of ischemic stroke patients.METHODS: Cochrane Central Register of Controlled Trials(C...BACKGROUND: This systematic review aims to investigate the prediction value of diffusion tensor imaging for motor function recovery of ischemic stroke patients.METHODS: Cochrane Central Register of Controlled Trials(CENTRAL)(the Cochrane Library 2016, Issue 9), Pub Med, Embase, Clarivate Analytics, Scopus, CINAHL, Chinese Biomedical Literature Database, China National Knowledge Infrastructure and Google Scholar were searched for either motor recovery or corticospinal tract integrity by diffusion tensor imaging in different stroke phase from January 1, 1970, to October 31, 2016. The study design and participants were subjected to metrological analysis. Correlation coeffi cient(r) was used for evaluating the relationship between fractional anisotropy(FA) and motor function outcome. Correlation coeffi cient values were extracted from each study, and 95% confidence intervals(CIs) were calculated by Fisher's z transformation. Meta-analysis was conducted by STATA software.RESULTS: Fifteen studies with a total of 414 patients were included. Meta-analysis showed that FA in the subacute phase had the signifi cant correlation with motor function outcome(ES=0.75, 95%CI 0.62–0.87), which showed moderate quality based on GRADE system. The weight correlation coeffi cient revealed that an effect size(ES) of FA in acute phase and chronic phase was 0.51(95%CI 0.33–0.68) and 0.62(95%CI 0.47–0.77) respectively.CONCLUSION: This meta-analysis reveals that FA in the subacute phase after ischemic stroke is a good predictor for functional motor recovery, which shows moderate quality based on the GRADE system.展开更多
Objective To evaluate the effects of Chinese patent medicine Huatuo Zaizao Pill(HTZZ)on neurological function and limb motor in ischemic stroke(IS)patients during convalescence.Methods This is a prospective,open-label...Objective To evaluate the effects of Chinese patent medicine Huatuo Zaizao Pill(HTZZ)on neurological function and limb motor in ischemic stroke(IS)patients during convalescence.Methods This is a prospective,open-labelled,randomized controlled trial.Patients with IS were recruited from the Neurology Department of Xiyuan Hospital of China Academy of Chinese Medical Sciences from May 2021 to June 2023.Eligible participants were randomly assigned to the HTZZ(40 cases)or control group(40 cases)at a ratio of 1:1.The HTZZ group was treated with oral HTZZ(8 g,thrice daily)combined with conventional treatment,while the control group received only conventional treatment.The treatment duration was 12 weeks.The primary outcome was the change in Modified Ashworth Scale(MAS)score from baseline to week 6 and 12.Secondary outcomes included changes in scores of National Institute of Health Stroke Scale(NIHSS),Fugl-Meyer Assessment(FM),and Barthel Index(BI)from baseline to week 6 and 12,as well as lipid indices after 12 weeks.All adverse events(AEs)were recorded and liver and kidney indices were evaluated.Results A total of 72 patients completed the study(38 in the HTZZ group and 34 in the control group).Compared with the control group,the HTZZ group demonstrated significant improvements in MAS,NIHSS,FM,and BI scores following 6 and 12 weeks of treatment in both intent-to-treat and per-protocol analyses(all P<0.05).No significant differences were noted between groups in lipid indices,AEs,and liver and kidney dysfunction after 12 weeks(P>0.05).Conclusions HTZZ alleviated spasticity and enhanced neurological function and prognosis of IS patients during convalescence.However,further evaluation of HTZZ’s effect on IS outcomes is warranted in clinical trials with larger sample sizes and extended observation periods.(Trial registration No.NCT04910256).展开更多
Fasudil,a Rho-associated protein kinase(ROCK)inhibitor,has a protective effect on the central nervous system.In addition,environmental enrichment is a promising technique for inducing the recovery of motor impairments...Fasudil,a Rho-associated protein kinase(ROCK)inhibitor,has a protective effect on the central nervous system.In addition,environmental enrichment is a promising technique for inducing the recovery of motor impairments in ischemic stroke models.The present study aimed to explore whether environmental enrichment combined with fasudil can facilitate motor function recovery and induce cortical axonal regeneration after stroke.First,a mouse model of ischemic cerebral stroke was established by photochemical embolization of the left sensorimotor cortex.Fasudil solution(10 mg/kg per day)was injected intraperitoneally for 21 days after the photothrombotic stroke.An environmental enrichment intervention was performed on days 7-21 after the photothrombotic stroke.The results revealed that environmental enrichment combined with fasudil improved motor function,increased growth-associated protein 43 expression in the infarcted cerebral cortex,promoted axonal regeneration on the contralateral side,and downregulated ROCK,p-LIM domain kinase(LIMK)1,and p-cofilin expression.The combined intervention was superior to monotherapy.These findings suggest that environmental enrichment combined with fasudil treatment promotes motor recovery after stroke,at least partly by stimulating axonal regeneration.The underlying mechanism might involve ROCK/LIMK1/cofilin pathway regulation.This study was approved by the Institutional Animal Care and Use Committee of Fudan University,China(approval No.20160858A232)on February 24,2016.展开更多
Flavonoids have been reported to have therapeutic potential for spinal cord injury.Hawthorn leaves have abundant content and species of total flavonoids,and studies of the effects of the total flavonoids of hawthorn l...Flavonoids have been reported to have therapeutic potential for spinal cord injury.Hawthorn leaves have abundant content and species of total flavonoids,and studies of the effects of the total flavonoids of hawthorn leaves on spinal cord injury have not been published in or outside China.Therefore,Sprague-Dawley rats were used to establish a spinal cord injury model by Allen's method.Rats were intraperitoneally injected with 0.2 m L of different concentrations of total flavonoids of hawthorn leaves(5,10,and 20 mg/kg)after spinal cord injury.Injections were administered once every 6 hours,three times a day,for 14 days.After treatment with various concentrations of total flavonoids of hawthorn leaves,the Basso,Beattie,and Bresnahan scores and histological staining indicated decreases in the lesion cavity and number of apoptotic cells of the injured spinal cord tissue;the morphological arrangement of the myelin sheath and nerve cells tended to be regular;and the Nissl bodies in neurons increased.The Basso,Beattie,and Bresnahan scores of treated spinal cord injury rats were increased.Western blot assays showed that the expression levels of pro-apoptotic Bax and cleaved caspase-3 were decreased,but the expression level of the anti-apoptotic Bcl-2 protein was increased.The improvement of the above physiological indicators showed a dose-dependent relationship with the concentration of total flavonoids of hawthorn leaves.The above findings confirm that total flavonoids of hawthorn leaves can reduce apoptosis and exert neuroprotective effects to promote the recovery of the motor function of rats with spinal cord injury.This study was approved by the Ethics Committee of the Guangxi Medical University of China(approval No.201810042)in October 2018.展开更多
Peri-lesional reorganization is one of the motor recovery mechanisms following stroke. A 23-year-old female who presented with complete paralysis of the right extremities at the onset of infarct in the left middle cer...Peri-lesional reorganization is one of the motor recovery mechanisms following stroke. A 23-year-old female who presented with complete paralysis of the right extremities at the onset of infarct in the left middle cerebral artery territory was included. She slowly recovered some function, and could extend the affected knee with resistance after 9 months. Diffusion tensor tractography, functional MRI, and transcranial magnetic stimulation testing were performed at 7 years after onset. Results showed that diffusion tensor tractography of the affected （left） hemisphere passed through the medial corona radiata at, or around, the wall of the lateral ventricle. The contralateral primary sensorimotor cortex was activated during affected knee movements. The motor-evoked potential, which was obtained from the affected leg, exhibited corticospinal tract characteristics. Results indicated that motor function of the affected leg recovered via the corticospinal tract, which descended through the corona radiata medial to the infarct. The motor function of the affected leg was reorganized to the medial corona radiata following infarct to the middle cerebral artery territory.展开更多
Perilesional reorganization is an important recovery mechanism for stroke patients because it yields good motor outcomes. However, perilesional reorganization remains poorly understood. The scientific basis for stroke...Perilesional reorganization is an important recovery mechanism for stroke patients because it yields good motor outcomes. However, perilesional reorganization remains poorly understood. The scientific basis for stroke rehabilitation can be established when detailed mechanisms of recovery are clarified. In addition, studies at the subcortical level remain in the early stages. Therefore, the present study suggested that additional investigations should focus on perilesional reorganization at the subcortical level, identifying the critical period for this mechanism and determining treatment strategies and modalities to facilitate development. The present study reviews literature focused on perilesional reorganization in stroke patients with regard to demonstration, clinical characteristics, and rehabilitative aspects, as well as previous studies of perilesional reorganization at cortical and subcortical levels.展开更多
We report on a stroke patient who showed delayed gait recovery between 8 and 11 months after the onset of intracerebral hemorrhage. This 32-year-old female patient underwent craniotomy and drainage for right intracere...We report on a stroke patient who showed delayed gait recovery between 8 and 11 months after the onset of intracerebral hemorrhage. This 32-year-old female patient underwent craniotomy and drainage for right intracerebral hemorrhage due to rupture of an arteriovenous malformation. Brain MR images revealed a large leukomalactic lesion in the right fronto-parietal cortex. Diffusion tensor tractography at 8 months after onset revealed that the right corticospinal tract was severely injured. At this time, the patient could not stand or walk despite undergoing rehabilitation from 2 months after onset. It was believed that severe spasticity of the left leg and right ankle was largely responsible, and thus, antispastic drugs, antispastic procedures （alcohol neurolysis of the motor branch of the tibial nerve and an intramuscular alcohol wash of both tibialis posterior muscles） and physical therapy were tried to control the spasticity. These measures relieved the severe spasticity, with the result that the patient was able to stand at 3 months. In addition, the improvements in sensorimotor function, visuospatial function, and cognition also seemed to contribute to gait recovery. As a result, she gained the ability to walk independently on even floor with a left ankle foot orthosis at 11 months after onset. This case illustrates that clinicians should attempt to find the cause of gait inability and to initiate intensive rehabilitation in stroke patients who cannot walk at 3-6 months after onset.展开更多
The mechanisms of motor recovery through the transcallosal pathway remain poorly understood. The present study reports on a hemiplegic patient with corona radiata infarct; it attempts to confirm motor recovery through...The mechanisms of motor recovery through the transcallosal pathway remain poorly understood. The present study reports on a hemiplegic patient with corona radiata infarct; it attempts to confirm motor recovery through the transcallosal motor pathway, from the affected motor cortex to the affected hand, using diffusion tensor tractography and transcranial magnetic stimulation. A 54-year-old, male patient and eight age-matched, normal subjects were enrolled in the study. The patient＇s right hand was initially completely paralyzed, but slowly recovered over 6 months. In the control subjects and the unaffected hemisphere （right） of the patient, the corticospinal tracts originated from the motor cortex and descended along the known corticospinal tract pathway. However, the corticospinal tract of the affected hemisphere was disrupted at the upper pons. Following transcranial stimulation of the affected （left） motor cortex, motor evoked potential from the affected （right） abductor pollicis brevis muscle exhibited longer latency than opposite motor evoked potential. Results from the present study suggest that motor function of the affected （right） hand recovered via the transcallosal motor pathway from the affected （left） motor cortex in this patient.展开更多
Many studies have attempted to elucidate the motor recovery mechanism of stroke, but the majority of these studies focus on cerebral infarct and relatively little is known about the motor recovery mechanism of intrace...Many studies have attempted to elucidate the motor recovery mechanism of stroke, but the majority of these studies focus on cerebral infarct and relatively little is known about the motor recovery mechanism of intracerebral hemorrhage. In this study, we report on a patient with intracerebral hemorrhage who displayed a change in injured corticospinal tract originating from the premotor cortex to the primary motor cortex on diffusion tensor imaging. An 86-year-old woman presented with complete paralysis of the right extremities following spontaneous intracerebral hemorrhage in the left frontoparietal cortex. The patient showed motor recovery, to the extent of being able to extend affected fingers against gravity and to walk independently on even ground at 5 months after onset. Diffusion tensor imaging showed that the left corticospinal tract originated from the premotor cortex at 1 month after intracerebral hemorrhage and from the left primary motor cortex and premotor cortex at 5 months after intracerebral hemorrhage. The change of injured corticospinal tract originating from the premotor cortex to the primary motor cortex suggests motor recovery of intracerebral hemorrhage.展开更多
BACKGROUND:Hemiplegia,a prevalent stroke-related condition,is often studied for motor dysfunction;however,spasticity remains under-researched.Abnormal muscle tone significantly hinders hemiplegic patients’walking rec...BACKGROUND:Hemiplegia,a prevalent stroke-related condition,is often studied for motor dysfunction;however,spasticity remains under-researched.Abnormal muscle tone significantly hinders hemiplegic patients’walking recovery.OBJECTIVE:To determine whether early suspension-protected training with a personal assistant machine for stroke patients enhances walking ability and prevents muscle spasms.METHODS:Thirty-two early-stage stroke patients from Shenzhen University General Hospital and the China Rehabilitation Research Center were randomly assigned to the experimental group(n=16)and the control group(n=16).Both groups underwent 4 weeks of gait training under the suspension protection system for 30 minutes daily,5 days a week.The experimental group used the personal assistant machine during training.Three-dimensional gait analysis(using the Cortex motion capture system),Brunnstrom staging,Fugl-Meyer Assessment for lower limb motor function,Fugl-Meyer balance function,and the modified Ashworth Scale were evaluated within 1 week before the intervention and after 4 weeks of intervention.RESULTS AND CONCLUSION:After the 4-week intervention,all outcome measures showed significant changes in each group.The experimental group had a small but significant increase in the modified Ashworth Scale score(P<0.05,d=|0.15|),while the control group had a large significant increase(P<0.05,d=|1.48|).The experimental group demonstrated greater improvements in walking speed(16.5 to 38.44 cm/s,P<0.05,d=|4.01|),step frequency(46.44 to 64.94 steps/min,P<0.05,d=|2.32|),stride length(15.50 to 29.81 cm,P<0.05,d=|3.44|),and peak hip and knee flexion(d=|1.82|to|2.17|).After treatment,the experimental group showed significantly greater improvements than the control group in walking speed(38.44 vs.26.63 cm/s,P<0.05,d=|2.75|),stride length,peak hip and knee flexion(d=|1.31|to|1.45|),step frequency(64.94 vs.59.38 steps/min,P<0.05,d=|0.85|),and a reduced support phase(bilateral:24.31%vs.28.38%,P<0.05,d=|0.88|;non-paretic:66.19%vs.70.13%,P<0.05,d=|0.94|).For early hemiplegia,personal assistant machine-assisted gait training under the suspension protection system helps establish a correct gait pattern,prevents muscle spasms,and improves motor function.展开更多
Spinal cord injury(SCI)causes motor,sensory,and autonomic dysfunctions.The gut microbiome has an important role in SCI,while short-chain fatty acids(SCFAs)are one of the main bioactive mediators of microbiota.In the p...Spinal cord injury(SCI)causes motor,sensory,and autonomic dysfunctions.The gut microbiome has an important role in SCI,while short-chain fatty acids(SCFAs)are one of the main bioactive mediators of microbiota.In the present study,we explored the effects of oral administration of exogenous SCFAs on the recovery of locomotor function and tissue repair in SCI.Allen’s method was utilized to establish an SCI model in Sprague-Dawley(SD)rats.The animals received water containing a mixture of 150 mmol/L SCFAs after SCI.After 21 d of treatment,the Basso,Beattie,and Bresnahan(BBB)score increased,the regularity index improved,and the base of support(BOS)value declined.Spinal cord tissue inflammatory infiltration was alleviated,the spinal cord necrosis cavity was reduced,and the numbers of motor neurons and Nissl bodies were elevated.Enzyme-linked immunosorbent assay(ELISA),real-time quantitative polymerase chain reaction(qPCR),and immunohistochemistry assay revealed that the expression of interleukin(IL)-10 increased and that of IL-17 decreased in the spinal cord.SCFAs promoted gut homeostasis,induced intestinal T cells to shift toward an anti-inflammatory phenotype,and promoted regulatory T(Treg)cells to secrete IL-10,affecting Treg cells and IL-17^(+)γδT cells in the spinal cord.Furthermore,we observed that Treg cells migrated from the gut to the spinal cord region after SCI.The above findings confirm that SCFAs can regulate Treg cells in the gut and affect the balance of Treg and IL-17^(+)γδT cells in the spinal cord,which inhibits the inflammatory response and promotes the motor function in SCI rats.Our findings suggest that there is a relationship among gut,spinal cord,and immune cells,and the“gut-spinal cord-immune”axis may be one of the mechanisms regulating neural repair after SCI.展开更多
[Objectives]To evaluate the effects of repetitive transcranial magnetic stimulation(rTMS)on neurophysiological outcomes in patients with acute stroke.[Methods]A systematic literature search was conducted across PubMed...[Objectives]To evaluate the effects of repetitive transcranial magnetic stimulation(rTMS)on neurophysiological outcomes in patients with acute stroke.[Methods]A systematic literature search was conducted across PubMed,EMBASE,Web of Science,the Cochrane Central Register of Controlled Trials(CENTRAL),and CINAHL databases up to March 1,2025.Randomized controlled trials(RCTs)and clinical controlled trials(CCTs)involving adult patients(≥18 years)with acute ischemic stroke(within 2 weeks of onset)who received rTMS intervention were included.Data on motor evoked potential(MEP)amplitude,resting motor threshold(RMT),and central motor conduction time(CMCT)were extracted.The quality of the studies was assessed using the Cochrane risk of bias tool.Statistical analyses were performed using Stata 18.0,with standardized mean differences(SMDs)and 95%confidence intervals(CIs)calculated.Heterogeneity was evaluated using the I^(2)statistic.[Results]Eight studies involving 932 identified records met the inclusion criteria.Meta-analysis revealed that rTMS significantly increased MEP amplitude(Hedges'g=0.77,95%CI:0.52-1.02,P<0.01)and reduced RMT(Hedges g=-1.13,95%CI:-1.63 to-0.62,P<0.01)in the lesioned hemisphere,indicating enhanced corticospinal excitability.No significant effects were observed on MEP amplitude or RMT in the unaffected hemisphere.Additionally,rTMS did not significantly alter CMCT in either hemisphere.Heterogeneity was low to moderate for most outcomes,and no significant publication bias was detected.[Conclusions]rTMS is a safe and effective intervention for improving corticospinal excitability and motor recovery in patients with acute stroke.Both high-frequency stimulation of the ipsilesional hemisphere and low-frequency stimulation of the contralesional hemisphere have demonstrated beneficial effects,supporting the interhemispheric inhibition model.Future large-scale,multi-center RCTs are needed to optimize rTMS parameters and establish standardized treatment protocols for acute stroke rehabilitation.展开更多
Recent studies in patients with spinal cord injuries(SCIs)have confirmed the diagnostic potential of biofluid-based biomarkers,as a topic of increasing interest in relation to SCI diagnosis and treatment.This paper re...Recent studies in patients with spinal cord injuries(SCIs)have confirmed the diagnostic potential of biofluid-based biomarkers,as a topic of increasing interest in relation to SCI diagnosis and treatment.This paper reviews the research progress and application prospects of recently identified SCI-related biomarkers.Many structural proteins,such as glial fibrillary acidic protein,S100-β,ubiquitin carboxy-terminal hydrolase-L1,neurofilament light,and tau protein were correlated with the diagnosis,American Spinal Injury Association Impairment Scale,and prognosis of SCI to different degrees.Inflammatory factors,including interleukin-6,interleukin-8,and tumor necrosis factorα,are also good biomarkers for the diagnosis of acute and chronic SCI,while non-coding RNAs(micro RNAs and long non-coding RNAs)also show diagnostic potential for SCI.Trace elements(Mg,Se,Cu,Zn)have been shown to be related to motor recovery and can predict motor function after SCI,while humoral markers can reflect the pathophysiological changes after SCI.These factors have the advantages of low cost,convenient sampling,and ease of dynamic tracking,but are also associated with disadvantages,including diverse influencing factors and complex level changes.Although various proteins have been verified as potential biomarkers for SCI,more convincing evidence from large clinical and prospective studies is thus required to identify the most valuable diagnostic and prognostic biomarkers for SCI.展开更多
Oscillating field stimulation(OFS)with regular alterations in the polarity of electric current is a unique,experimental approach to stimulate,support,and potentially guide the outgrowth of both sensory and motor nerve...Oscillating field stimulation(OFS)with regular alterations in the polarity of electric current is a unique,experimental approach to stimulate,support,and potentially guide the outgrowth of both sensory and motor nerve fibers after spinal cord injury(SCI).In previous experiments,we demonstrated the beneficial effects of OFS in a 4-week survival period after SCI.In this study,we observed the major behavioral,morphological,and protein changes in rats after 15 minutes of T9 spinal compression with a 40 g force,followed by long-lasting OFS(50μA),over a 8-week survival period.Three groups of rats were analyzed:rats after T9 spinal compression(SCI group);SCI rats subjected to implantation of active oscillating field stimulator(OFS+SCI group);and SCI rats subjected to nonfunctional OFS(nOFS+SCI group).Histopathological analysis of spinal tissue indicated a strong impact of epidural OFS on the reduction of tissue and myelin loss after SCI in the segments adjacent to the lesion site.Quantitative fluorescent analysis of the most affected areas of spinal cord tissue revealed a higher number of spared axons and oligodendrocytes of rats in the OFS+SCI group,compared with rats in the SCI and nOFS+SCI groups.The protein levels of neurofilaments(NF-l),growth-associated protein-43(marker for newly sprouted axons),and myelin basic protein in rats were signifiantly increased in the OFS+SCI group than in the nOFS+SCI and SCI groups.This suggests a supporting role of the OFS in axonal and myelin regeneration after SCI.Moreover,rats in the OFS+SCI group showed great improvements in sensory and motor functions than did rats in the nOFS+SCI and SCI groups.All these findings suggest that long-lasting OFS applied immediately after SCI can provide a good microenviroment for recovery of damaged spinal tissue by triggering regenreative processes in the acute phase of injury.展开更多
Integrity of the corticospinal tract is mandatory for good recovery of impaired motor function in patients who have suffered a stroke.A 67-year-old left hemiparetic female showed an infarct in the right pons.Three mon...Integrity of the corticospinal tract is mandatory for good recovery of impaired motor function in patients who have suffered a stroke.A 67-year-old left hemiparetic female showed an infarct in the right pons.Three months after onset,motor function of the affected extremities recovered rapidly to a nearly complete state.Diffusion tensor tractography of both hemispheres showed that the corticospinal tract originated from the primary sensori-motor cortex and descended through the known corticospinal tract pathway.The tract of the affected（right）hemisphere descended through an area within the pontine infarct.The diffusion tensor tractography results suggest that from the onset,the integrity of the corticospinal tract appears to have been spared within the pontine infarct.展开更多
基金the National Research Foundation of Korea Grant Funded by the Korean Government, No. KRF-2008-314-E00173
文摘The majority of motor recovery following stroke occurs within 6 months after onset.The present study examined a patient with a corona radiata infarct,who exhibited an unusual long-term recovery（24 months after onset）.The patient was a 64-year-old female,who presented with severe paralysis of the left extremities resulting from a corona radiate infarct.Motor recovery from the weakness progressed slowly over a 24-month period following onset,even at 6-12 months after onset.Diffusion tensor tractography at 2 weeks from onset showed disruption of the corticospinal tract of the affected hemisphere resulting from the infarct.However,at 12 and 24 months after onset,the corticospinal tract was elongated to the cortex level,as shown by diffusion tensor tractography.A 2-week transcranial magnetic stimulation showed no motor-evoked potential for the affected hemisphere,but a motor-evoked potential of the corticospinal tract was observed at12 and 24 months.These results suggest that motor function recovery in cerebral infarct patients can occur at least up to 24 months after stroke onset.
文摘Intracerebral hemorrhage （ICH） is a stroke subtype caused by spontaneous rupture of small vessels and bleeding into the brain paren- chyma, resulting in cell death and sensorimotor deficits. Despite the greater prevalence of the ischemic form of stroke （87%）, ICH has the highest mortality rate of all stroke subtypes. The striatum is the most affected structure in hemorrhagic stroke （35-70%）, followed by cere- bral cortex （15-30%）, brain stem and cerebellum （5-10%）; patients suffering striatal and/or cortical ICH bear persistent sensorimotor disabilities. Although chronic sensorimotor impairment is established, a considerable amount of patients experience some degree of spontaneous recovery during the first six months after stroke （Qureshi et al., 2009）, and the neurobiological basis of this process is not understood.
基金a grant from Daegu Metropolitan City R&D Project
文摘The present study reported a 42-year-old male patient who underwent conservative management for a spontaneous intracerebral hemorrhage in the left corona radiata and the basal ganglia. The patient presented with complete weakness of the right upper and lower extremities at the onset of intracerebral hemorrhage; however, he showed progressive motor recovery to the level that he was able to extent the affected extremities against some resistance at 5 weeks after onset. The corticospinal tract of the affected （left） hemisphere connected to the left Broca＇s area at 3 weeks after onset as shown by diffusion tensor tractography. By contrast, this connection had disappeared at 5 weeks after onset as shown by diffusion tensor tractogaphy. Transcranial magnetic stimulation study showed that no motor evoked potential was elicited from the affected （left） hemisphere at 3 weeks after onset, but motor evoked potentials were elicited at 5 weeks after onset. These findings suggest that the connection between the injured corticospinal tract and Broca＇s area in this patient appears to be a compensation for severe motor weakness; consequently, the connection seems to disappear with motor recovery.
基金a grant from Daegu Metropolitan City R&D Project
文摘The presence of the aberrant pyramidal tract has been demonstrated by several studies; however, little is known about its role in motor recovery in stroke patients. In the present study, we reported a 69-year-old right-handed female patient with an infarct in the mid to lateral portion of the left cerebra peduncle, who showed an aberrant pyramidal tract by diffusion tensor tractography. The patient presented with severe weakness of the right extremities at stroke onset. The patient showed progressive motor recovery as much as being able to extend the affected extremities against some resistance at 6 months after onset. At 20 months after stroke onset, motor function of the left extremities had recovered to a nearly normal state. Diffusion tensor tractography results showed that the PT was disrupted at the lower midbrain of the affected （left） hemisphere at 3 weeks after stroke onset and this disruption was not changed at 20 months. An aberrant pyramidal tract in the left hemisphere was also observed, which originated from the primary motor cortex and descended through the corona radiata, posterior limb of the internal capsule, thalamus, the medial lemniscus pathway from the midbrain to the pons, and then entered into the pyramidal tract area at the pontomedullary junction. Transcranial magnetic stimulation did not elicit motor evoked potential from the affected hand muscle at 3 weeks, but it elicited motor evoked potential with mildly delayed latency and low amplitude in the affected hand muscle at 20 months. The main motor functions of the affected extremities in this patient appeared to be recovered via this aberrant pyramidal tract.
文摘Artificial intelligence(AI)and machine learning(ML)are powerful technologies with the potential to revolutionize motor recovery in rehabilitation medicine.This perspective explores how AI and ML are harnessed to assess,diagnose,and design personalized treatment plans for patients with motor impairments.The integration of wearable sensors,virtual reality,augmented reality,and robotic devices allows for precise movement analysis and adaptive neurorehabilitation approaches.Moreover,AI-driven telerehabilitation enables remote monitoring and consultation.Although these applications show promise,healthcare professionals must interpret AI-generated insights and ensure patient safety.While AI and ML are in their early stages,ongoing research will determine their effectiveness in rehabilitation medicine.
文摘BACKGROUND: This systematic review aims to investigate the prediction value of diffusion tensor imaging for motor function recovery of ischemic stroke patients.METHODS: Cochrane Central Register of Controlled Trials(CENTRAL)(the Cochrane Library 2016, Issue 9), Pub Med, Embase, Clarivate Analytics, Scopus, CINAHL, Chinese Biomedical Literature Database, China National Knowledge Infrastructure and Google Scholar were searched for either motor recovery or corticospinal tract integrity by diffusion tensor imaging in different stroke phase from January 1, 1970, to October 31, 2016. The study design and participants were subjected to metrological analysis. Correlation coeffi cient(r) was used for evaluating the relationship between fractional anisotropy(FA) and motor function outcome. Correlation coeffi cient values were extracted from each study, and 95% confidence intervals(CIs) were calculated by Fisher's z transformation. Meta-analysis was conducted by STATA software.RESULTS: Fifteen studies with a total of 414 patients were included. Meta-analysis showed that FA in the subacute phase had the signifi cant correlation with motor function outcome(ES=0.75, 95%CI 0.62–0.87), which showed moderate quality based on GRADE system. The weight correlation coeffi cient revealed that an effect size(ES) of FA in acute phase and chronic phase was 0.51(95%CI 0.33–0.68) and 0.62(95%CI 0.47–0.77) respectively.CONCLUSION: This meta-analysis reveals that FA in the subacute phase after ischemic stroke is a good predictor for functional motor recovery, which shows moderate quality based on the GRADE system.
基金Supported by the Guangzhou Science and Technology Program(No.2024B03J1331)。
文摘Objective To evaluate the effects of Chinese patent medicine Huatuo Zaizao Pill(HTZZ)on neurological function and limb motor in ischemic stroke(IS)patients during convalescence.Methods This is a prospective,open-labelled,randomized controlled trial.Patients with IS were recruited from the Neurology Department of Xiyuan Hospital of China Academy of Chinese Medical Sciences from May 2021 to June 2023.Eligible participants were randomly assigned to the HTZZ(40 cases)or control group(40 cases)at a ratio of 1:1.The HTZZ group was treated with oral HTZZ(8 g,thrice daily)combined with conventional treatment,while the control group received only conventional treatment.The treatment duration was 12 weeks.The primary outcome was the change in Modified Ashworth Scale(MAS)score from baseline to week 6 and 12.Secondary outcomes included changes in scores of National Institute of Health Stroke Scale(NIHSS),Fugl-Meyer Assessment(FM),and Barthel Index(BI)from baseline to week 6 and 12,as well as lipid indices after 12 weeks.All adverse events(AEs)were recorded and liver and kidney indices were evaluated.Results A total of 72 patients completed the study(38 in the HTZZ group and 34 in the control group).Compared with the control group,the HTZZ group demonstrated significant improvements in MAS,NIHSS,FM,and BI scores following 6 and 12 weeks of treatment in both intent-to-treat and per-protocol analyses(all P<0.05).No significant differences were noted between groups in lipid indices,AEs,and liver and kidney dysfunction after 12 weeks(P>0.05).Conclusions HTZZ alleviated spasticity and enhanced neurological function and prognosis of IS patients during convalescence.However,further evaluation of HTZZ’s effect on IS outcomes is warranted in clinical trials with larger sample sizes and extended observation periods.(Trial registration No.NCT04910256).
基金This study was supported by the National Natural Science Foundation of China,Nos.81672242(to YW),81972141(to YW)Shanghai Sailing Program,No.20YF1403500(to QZ)and Shanghai Municipal Key Clinical Specialty of China,No.shslczdzk02702(to YW).
文摘Fasudil,a Rho-associated protein kinase(ROCK)inhibitor,has a protective effect on the central nervous system.In addition,environmental enrichment is a promising technique for inducing the recovery of motor impairments in ischemic stroke models.The present study aimed to explore whether environmental enrichment combined with fasudil can facilitate motor function recovery and induce cortical axonal regeneration after stroke.First,a mouse model of ischemic cerebral stroke was established by photochemical embolization of the left sensorimotor cortex.Fasudil solution(10 mg/kg per day)was injected intraperitoneally for 21 days after the photothrombotic stroke.An environmental enrichment intervention was performed on days 7-21 after the photothrombotic stroke.The results revealed that environmental enrichment combined with fasudil improved motor function,increased growth-associated protein 43 expression in the infarcted cerebral cortex,promoted axonal regeneration on the contralateral side,and downregulated ROCK,p-LIM domain kinase(LIMK)1,and p-cofilin expression.The combined intervention was superior to monotherapy.These findings suggest that environmental enrichment combined with fasudil treatment promotes motor recovery after stroke,at least partly by stimulating axonal regeneration.The underlying mechanism might involve ROCK/LIMK1/cofilin pathway regulation.This study was approved by the Institutional Animal Care and Use Committee of Fudan University,China(approval No.20160858A232)on February 24,2016.
基金the National Natural Science Foundation of China,No.81860391(to GFZ)the Natural Science Foundation of Guangxi Zhuang Autonomous Region of China,No.2018GXNSFAA281144(to GFZ)the Key Research and Development Project of Guangxi Zhuang Autonomous Region of China,No.guike AB18221021(to SHZ)。
文摘Flavonoids have been reported to have therapeutic potential for spinal cord injury.Hawthorn leaves have abundant content and species of total flavonoids,and studies of the effects of the total flavonoids of hawthorn leaves on spinal cord injury have not been published in or outside China.Therefore,Sprague-Dawley rats were used to establish a spinal cord injury model by Allen's method.Rats were intraperitoneally injected with 0.2 m L of different concentrations of total flavonoids of hawthorn leaves(5,10,and 20 mg/kg)after spinal cord injury.Injections were administered once every 6 hours,three times a day,for 14 days.After treatment with various concentrations of total flavonoids of hawthorn leaves,the Basso,Beattie,and Bresnahan scores and histological staining indicated decreases in the lesion cavity and number of apoptotic cells of the injured spinal cord tissue;the morphological arrangement of the myelin sheath and nerve cells tended to be regular;and the Nissl bodies in neurons increased.The Basso,Beattie,and Bresnahan scores of treated spinal cord injury rats were increased.Western blot assays showed that the expression levels of pro-apoptotic Bax and cleaved caspase-3 were decreased,but the expression level of the anti-apoptotic Bcl-2 protein was increased.The improvement of the above physiological indicators showed a dose-dependent relationship with the concentration of total flavonoids of hawthorn leaves.The above findings confirm that total flavonoids of hawthorn leaves can reduce apoptosis and exert neuroprotective effects to promote the recovery of the motor function of rats with spinal cord injury.This study was approved by the Ethics Committee of the Guangxi Medical University of China(approval No.201810042)in October 2018.
基金the Korea Research Foundation funded by the Korean Government, No.KRF-2008-314-E00173
文摘Peri-lesional reorganization is one of the motor recovery mechanisms following stroke. A 23-year-old female who presented with complete paralysis of the right extremities at the onset of infarct in the left middle cerebral artery territory was included. She slowly recovered some function, and could extend the affected knee with resistance after 9 months. Diffusion tensor tractography, functional MRI, and transcranial magnetic stimulation testing were performed at 7 years after onset. Results showed that diffusion tensor tractography of the affected （left） hemisphere passed through the medial corona radiata at, or around, the wall of the lateral ventricle. The contralateral primary sensorimotor cortex was activated during affected knee movements. The motor-evoked potential, which was obtained from the affected leg, exhibited corticospinal tract characteristics. Results indicated that motor function of the affected leg recovered via the corticospinal tract, which descended through the corona radiata medial to the infarct. The motor function of the affected leg was reorganized to the medial corona radiata following infarct to the middle cerebral artery territory.
基金the National Research Foundation of Korea Grant funded by the Korean Government, No. KRF-2008-314-E00173
文摘Perilesional reorganization is an important recovery mechanism for stroke patients because it yields good motor outcomes. However, perilesional reorganization remains poorly understood. The scientific basis for stroke rehabilitation can be established when detailed mechanisms of recovery are clarified. In addition, studies at the subcortical level remain in the early stages. Therefore, the present study suggested that additional investigations should focus on perilesional reorganization at the subcortical level, identifying the critical period for this mechanism and determining treatment strategies and modalities to facilitate development. The present study reviews literature focused on perilesional reorganization in stroke patients with regard to demonstration, clinical characteristics, and rehabilitative aspects, as well as previous studies of perilesional reorganization at cortical and subcortical levels.
基金supported by the 2012 Yeungnam University Research Grant
文摘We report on a stroke patient who showed delayed gait recovery between 8 and 11 months after the onset of intracerebral hemorrhage. This 32-year-old female patient underwent craniotomy and drainage for right intracerebral hemorrhage due to rupture of an arteriovenous malformation. Brain MR images revealed a large leukomalactic lesion in the right fronto-parietal cortex. Diffusion tensor tractography at 8 months after onset revealed that the right corticospinal tract was severely injured. At this time, the patient could not stand or walk despite undergoing rehabilitation from 2 months after onset. It was believed that severe spasticity of the left leg and right ankle was largely responsible, and thus, antispastic drugs, antispastic procedures （alcohol neurolysis of the motor branch of the tibial nerve and an intramuscular alcohol wash of both tibialis posterior muscles） and physical therapy were tried to control the spasticity. These measures relieved the severe spasticity, with the result that the patient was able to stand at 3 months. In addition, the improvements in sensorimotor function, visuospatial function, and cognition also seemed to contribute to gait recovery. As a result, she gained the ability to walk independently on even floor with a left ankle foot orthosis at 11 months after onset. This case illustrates that clinicians should attempt to find the cause of gait inability and to initiate intensive rehabilitation in stroke patients who cannot walk at 3-6 months after onset.
基金the National Research Foundation of Korea Grant Funded by the Korean Government,No.KRF-2008-314-E00173
文摘The mechanisms of motor recovery through the transcallosal pathway remain poorly understood. The present study reports on a hemiplegic patient with corona radiata infarct; it attempts to confirm motor recovery through the transcallosal motor pathway, from the affected motor cortex to the affected hand, using diffusion tensor tractography and transcranial magnetic stimulation. A 54-year-old, male patient and eight age-matched, normal subjects were enrolled in the study. The patient＇s right hand was initially completely paralyzed, but slowly recovered over 6 months. In the control subjects and the unaffected hemisphere （right） of the patient, the corticospinal tracts originated from the motor cortex and descended along the known corticospinal tract pathway. However, the corticospinal tract of the affected hemisphere was disrupted at the upper pons. Following transcranial stimulation of the affected （left） motor cortex, motor evoked potential from the affected （right） abductor pollicis brevis muscle exhibited longer latency than opposite motor evoked potential. Results from the present study suggest that motor function of the affected （right） hand recovered via the transcallosal motor pathway from the affected （left） motor cortex in this patient.
基金supported by Daegu Innopolis R&BD Project by the Korea Institute for Advancement of Technology
文摘Many studies have attempted to elucidate the motor recovery mechanism of stroke, but the majority of these studies focus on cerebral infarct and relatively little is known about the motor recovery mechanism of intracerebral hemorrhage. In this study, we report on a patient with intracerebral hemorrhage who displayed a change in injured corticospinal tract originating from the premotor cortex to the primary motor cortex on diffusion tensor imaging. An 86-year-old woman presented with complete paralysis of the right extremities following spontaneous intracerebral hemorrhage in the left frontoparietal cortex. The patient showed motor recovery, to the extent of being able to extend affected fingers against gravity and to walk independently on even ground at 5 months after onset. Diffusion tensor imaging showed that the left corticospinal tract originated from the premotor cortex at 1 month after intracerebral hemorrhage and from the left primary motor cortex and premotor cortex at 5 months after intracerebral hemorrhage. The change of injured corticospinal tract originating from the premotor cortex to the primary motor cortex suggests motor recovery of intracerebral hemorrhage.
文摘BACKGROUND:Hemiplegia,a prevalent stroke-related condition,is often studied for motor dysfunction;however,spasticity remains under-researched.Abnormal muscle tone significantly hinders hemiplegic patients’walking recovery.OBJECTIVE:To determine whether early suspension-protected training with a personal assistant machine for stroke patients enhances walking ability and prevents muscle spasms.METHODS:Thirty-two early-stage stroke patients from Shenzhen University General Hospital and the China Rehabilitation Research Center were randomly assigned to the experimental group(n=16)and the control group(n=16).Both groups underwent 4 weeks of gait training under the suspension protection system for 30 minutes daily,5 days a week.The experimental group used the personal assistant machine during training.Three-dimensional gait analysis(using the Cortex motion capture system),Brunnstrom staging,Fugl-Meyer Assessment for lower limb motor function,Fugl-Meyer balance function,and the modified Ashworth Scale were evaluated within 1 week before the intervention and after 4 weeks of intervention.RESULTS AND CONCLUSION:After the 4-week intervention,all outcome measures showed significant changes in each group.The experimental group had a small but significant increase in the modified Ashworth Scale score(P<0.05,d=|0.15|),while the control group had a large significant increase(P<0.05,d=|1.48|).The experimental group demonstrated greater improvements in walking speed(16.5 to 38.44 cm/s,P<0.05,d=|4.01|),step frequency(46.44 to 64.94 steps/min,P<0.05,d=|2.32|),stride length(15.50 to 29.81 cm,P<0.05,d=|3.44|),and peak hip and knee flexion(d=|1.82|to|2.17|).After treatment,the experimental group showed significantly greater improvements than the control group in walking speed(38.44 vs.26.63 cm/s,P<0.05,d=|2.75|),stride length,peak hip and knee flexion(d=|1.31|to|1.45|),step frequency(64.94 vs.59.38 steps/min,P<0.05,d=|0.85|),and a reduced support phase(bilateral:24.31%vs.28.38%,P<0.05,d=|0.88|;non-paretic:66.19%vs.70.13%,P<0.05,d=|0.94|).For early hemiplegia,personal assistant machine-assisted gait training under the suspension protection system helps establish a correct gait pattern,prevents muscle spasms,and improves motor function.
基金National Natural Science Foundation of China(No.82060399)Guangxi Medical High-level Key Talents Training“139”Program Training Project(No.[2020]15),China.
文摘Spinal cord injury(SCI)causes motor,sensory,and autonomic dysfunctions.The gut microbiome has an important role in SCI,while short-chain fatty acids(SCFAs)are one of the main bioactive mediators of microbiota.In the present study,we explored the effects of oral administration of exogenous SCFAs on the recovery of locomotor function and tissue repair in SCI.Allen’s method was utilized to establish an SCI model in Sprague-Dawley(SD)rats.The animals received water containing a mixture of 150 mmol/L SCFAs after SCI.After 21 d of treatment,the Basso,Beattie,and Bresnahan(BBB)score increased,the regularity index improved,and the base of support(BOS)value declined.Spinal cord tissue inflammatory infiltration was alleviated,the spinal cord necrosis cavity was reduced,and the numbers of motor neurons and Nissl bodies were elevated.Enzyme-linked immunosorbent assay(ELISA),real-time quantitative polymerase chain reaction(qPCR),and immunohistochemistry assay revealed that the expression of interleukin(IL)-10 increased and that of IL-17 decreased in the spinal cord.SCFAs promoted gut homeostasis,induced intestinal T cells to shift toward an anti-inflammatory phenotype,and promoted regulatory T(Treg)cells to secrete IL-10,affecting Treg cells and IL-17^(+)γδT cells in the spinal cord.Furthermore,we observed that Treg cells migrated from the gut to the spinal cord region after SCI.The above findings confirm that SCFAs can regulate Treg cells in the gut and affect the balance of Treg and IL-17^(+)γδT cells in the spinal cord,which inhibits the inflammatory response and promotes the motor function in SCI rats.Our findings suggest that there is a relationship among gut,spinal cord,and immune cells,and the“gut-spinal cord-immune”axis may be one of the mechanisms regulating neural repair after SCI.
文摘[Objectives]To evaluate the effects of repetitive transcranial magnetic stimulation(rTMS)on neurophysiological outcomes in patients with acute stroke.[Methods]A systematic literature search was conducted across PubMed,EMBASE,Web of Science,the Cochrane Central Register of Controlled Trials(CENTRAL),and CINAHL databases up to March 1,2025.Randomized controlled trials(RCTs)and clinical controlled trials(CCTs)involving adult patients(≥18 years)with acute ischemic stroke(within 2 weeks of onset)who received rTMS intervention were included.Data on motor evoked potential(MEP)amplitude,resting motor threshold(RMT),and central motor conduction time(CMCT)were extracted.The quality of the studies was assessed using the Cochrane risk of bias tool.Statistical analyses were performed using Stata 18.0,with standardized mean differences(SMDs)and 95%confidence intervals(CIs)calculated.Heterogeneity was evaluated using the I^(2)statistic.[Results]Eight studies involving 932 identified records met the inclusion criteria.Meta-analysis revealed that rTMS significantly increased MEP amplitude(Hedges'g=0.77,95%CI:0.52-1.02,P<0.01)and reduced RMT(Hedges g=-1.13,95%CI:-1.63 to-0.62,P<0.01)in the lesioned hemisphere,indicating enhanced corticospinal excitability.No significant effects were observed on MEP amplitude or RMT in the unaffected hemisphere.Additionally,rTMS did not significantly alter CMCT in either hemisphere.Heterogeneity was low to moderate for most outcomes,and no significant publication bias was detected.[Conclusions]rTMS is a safe and effective intervention for improving corticospinal excitability and motor recovery in patients with acute stroke.Both high-frequency stimulation of the ipsilesional hemisphere and low-frequency stimulation of the contralesional hemisphere have demonstrated beneficial effects,supporting the interhemispheric inhibition model.Future large-scale,multi-center RCTs are needed to optimize rTMS parameters and establish standardized treatment protocols for acute stroke rehabilitation.
基金financially supported by the National Key Research and Development Project of Stem Cell and Transformational Research,No.2019YFA0112100(to SQF)。
文摘Recent studies in patients with spinal cord injuries(SCIs)have confirmed the diagnostic potential of biofluid-based biomarkers,as a topic of increasing interest in relation to SCI diagnosis and treatment.This paper reviews the research progress and application prospects of recently identified SCI-related biomarkers.Many structural proteins,such as glial fibrillary acidic protein,S100-β,ubiquitin carboxy-terminal hydrolase-L1,neurofilament light,and tau protein were correlated with the diagnosis,American Spinal Injury Association Impairment Scale,and prognosis of SCI to different degrees.Inflammatory factors,including interleukin-6,interleukin-8,and tumor necrosis factorα,are also good biomarkers for the diagnosis of acute and chronic SCI,while non-coding RNAs(micro RNAs and long non-coding RNAs)also show diagnostic potential for SCI.Trace elements(Mg,Se,Cu,Zn)have been shown to be related to motor recovery and can predict motor function after SCI,while humoral markers can reflect the pathophysiological changes after SCI.These factors have the advantages of low cost,convenient sampling,and ease of dynamic tracking,but are also associated with disadvantages,including diverse influencing factors and complex level changes.Although various proteins have been verified as potential biomarkers for SCI,more convincing evidence from large clinical and prospective studies is thus required to identify the most valuable diagnostic and prognostic biomarkers for SCI.
基金supported by grants of the Scientific Grant Agency of the Slovak Academy of Sciences:2/0098/20(JG)2/0145/21(NL)+3 种基金the Slovak Research and Development Agency:APVV19-0324(to NL)APVV-18-0163(MB)the Operational Programme Integrated Infrastructure for the project:Long-term strategic research of prevention, intervention and mechanisms of obesity and its comorbidities, IMTS:313011V344co-financed by the European Regional Development Fund”(JG)
文摘Oscillating field stimulation(OFS)with regular alterations in the polarity of electric current is a unique,experimental approach to stimulate,support,and potentially guide the outgrowth of both sensory and motor nerve fibers after spinal cord injury(SCI).In previous experiments,we demonstrated the beneficial effects of OFS in a 4-week survival period after SCI.In this study,we observed the major behavioral,morphological,and protein changes in rats after 15 minutes of T9 spinal compression with a 40 g force,followed by long-lasting OFS(50μA),over a 8-week survival period.Three groups of rats were analyzed:rats after T9 spinal compression(SCI group);SCI rats subjected to implantation of active oscillating field stimulator(OFS+SCI group);and SCI rats subjected to nonfunctional OFS(nOFS+SCI group).Histopathological analysis of spinal tissue indicated a strong impact of epidural OFS on the reduction of tissue and myelin loss after SCI in the segments adjacent to the lesion site.Quantitative fluorescent analysis of the most affected areas of spinal cord tissue revealed a higher number of spared axons and oligodendrocytes of rats in the OFS+SCI group,compared with rats in the SCI and nOFS+SCI groups.The protein levels of neurofilaments(NF-l),growth-associated protein-43(marker for newly sprouted axons),and myelin basic protein in rats were signifiantly increased in the OFS+SCI group than in the nOFS+SCI and SCI groups.This suggests a supporting role of the OFS in axonal and myelin regeneration after SCI.Moreover,rats in the OFS+SCI group showed great improvements in sensory and motor functions than did rats in the nOFS+SCI and SCI groups.All these findings suggest that long-lasting OFS applied immediately after SCI can provide a good microenviroment for recovery of damaged spinal tissue by triggering regenreative processes in the acute phase of injury.
基金the National Research Foundation of Korea Grant Funded by the Korean Government, No. KRF-2008-314-E00173
文摘Integrity of the corticospinal tract is mandatory for good recovery of impaired motor function in patients who have suffered a stroke.A 67-year-old left hemiparetic female showed an infarct in the right pons.Three months after onset,motor function of the affected extremities recovered rapidly to a nearly complete state.Diffusion tensor tractography of both hemispheres showed that the corticospinal tract originated from the primary sensori-motor cortex and descended through the known corticospinal tract pathway.The tract of the affected（right）hemisphere descended through an area within the pontine infarct.The diffusion tensor tractography results suggest that from the onset,the integrity of the corticospinal tract appears to have been spared within the pontine infarct.
