Chinese Journal of Stroke

JIA Jie

2021, 16(03): 219-222. DOI: 10.3969/j.issn.1673-5765.2021.03.001

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Effects of a Mirror-imaging Rehabilitation Robot on Hand Motor Function in Subacute Stroke Patients: A Randomized Controlled Study

WANG Chuan-Kai, LIU Lan-Lan, LIU Xiang-Yun, XIANG Yu-Zhi, CHEN Yao, JIA Jie

2021, 16(03): 224-229. DOI: 10.3969/j.issn.1673-5765.2021.03.002

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Objective To explore the rehabilitation effects of a mirror-imaging rehabilitation robot on hand motor function in subacute stroke patients. Methods This retrospective study enrolled subacute stroke patients from June to August 2020. They were randomly divided into observation group and control group by envelope method. Conventional rehabilitation therapy was given in both groups, rehabilitation robot was added on this base in observation group, which lasted for 4 weeks. Hand function was evaluated before and after 4 weeks treatment, and the evaluation tools included Fugl-Meyer assessment upper extremity (FMA-UE), FMA-UE hand score, box and block test (BBT), action research arm test (ARAT), and modified Barthel index (MBI), grip strength and pinch strength of the affected hand. Results A total of 40 patients were included, with 20 ones in each group. There was no statistical difference in each index between the two groups before and after treatment. For intra-group comparison, only MBI (P =0.049) in control group was higher after treatment than before treatment, while FMA-UE score (P =0.024) and FMA-UE hand score (P =0.046) in observation group were higher after treatment than before treatment. For improvement degree, the improvement score of FMA-UE score (P =0.038) and FMA-UE hand score (P =0.048) in observation group were all higher than that in control group. Conclusions The mirror-imaging rehabilitation robot can improve hand motor function in subacute stroke patients, which can be used as an auxiliary therapy technology.

Effect of Dual-task Walking on Cognitive-motor Interference in Stroke Patients

ZHAO Yi-Shuang, ZHOU Ya-Nan,GONG Wei-Jun, ZHANG Yu-Mei

2021, 16(03): 230-235. DOI: 10.3969/j.issn.1673-5765.2021.03.003

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Objective To explore the effects of different cognitive tasks on gait and cognitive-motor interference (CMI) in ischemic stroke patients and healthy adults during dual-task walking (DTW). Methods 24 patients with acute ischemic stroke were selected as stroke group, and 16 healthy controls were matched for age and gender. They all received two cognitive tasks, including serial subtraction (SS) and word list generation (WLG) in sitting. Then, they received single-task walking (STW), serial subtraction in dual task walking (SS-DTW) and word list generation in dual task walking (WLG-DTW). The Codamotion 3D motion capture system was used to collect gait parameters, including gait speed, cadence, stride length and stride time. The number of correct response to cognitive tasks was recorded. The dual task cost of walking task and cognitive task in DTW between the two groups were compared. Results (1) In STW and both DTW, stroke group showed slower stride speed, shorter stride length, slower cadence and longer stride time than control group (P <0.05). Compared with STW, stroke group showed slower gait speed, slower cadence and longer stride time in different DTW, and shorter stride length in SS-DTW (P <0.05). The control group showed slower gait speed, slower cadence, shorter stride length and longer stride time in different DTW (P <0.05). (2) Compared with cognitive ST, the correct number of cognitive tasks in both DTW reduced in stroke group (P <0.05), while the correct number of cognitive tasks reduced in only SS-DTW in control group (P <0.05). Conclusions Gait performance reduced in performing dual task (DT) in stroke patients and healthy adults, and stroke patients were more prone to have gait disorders during DTW. Working memory tasks and semantic memory tasks had similar interference effect on gait. DTW can better reflect the ability of daily living activities. The exploration of CMI mode in DTW provides a theoretical basis for evaluating actual walking function and DT training effect.

A Case of Stroke Rehabilitation under the Mode of Medical Treatment Partnerships in County

WANG Ze-Jun,JIA Jie, LIN Yan-Li, YU Lin-Hua, XU Li-Juan, WANG He-Wei, WANG Jian-Zhi, WANG Xiao-Jing, FENG Zhi-Xiang,ZHAO Wei-Zhong

2021, 16(03): 236-239. DOI: 10.3969/j.issn.1673-5765.2021.03.004

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Advances in Application of Augmented Reality Technology in Upper Limb Functional Rehabilitation Poststroke

LI Chong, TIAN Shi-Liu, LIU Xiang-Yun, JIA Jie

2021, 16(03): 240-245. DOI: 10.3969/j.issn.1673-5765.2021.03.005

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Augmented reality technology, as a new rehabilitation measure, is in its infancy in poststroke upper-limb functional rehabilitation. The key augmented reality technologies for upper limb impairment mainly include tracking registration technology, display technology and interactive technology. The principle of augmented reality technology for upper-limb functional rehabilitation includes: reshaping the normal left-right balance mode through training; promoting brain plasticity and functional rehabilitation through high-intensity, repeatable, task-oriented functional exercise. At present, the common augmented reality technologies for poststroke upper-limb functional rehabilitation include vision-based, tactile-based, mirror-based and mobile phone-based augmented reality systems. There are still many problems in the application of augmented reality technology in upper-limb functional rehabilitation after stroke, which need to be further studied and improved in the future.

Application and Prospect of Computer-based Cognitive Training Technology in Improving Cognitive Function in the Elderly

LIU Zhi-Lan, JIA Jie

2021, 16(03): 246-250. DOI: 10.3969/j.issn.1673-5765.2021.03.006

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As a non-invasive cognitive rehabilitation measure, the computer-based cognitive training technology has different forms and abundant training contents, including computer-assisted cognitive rehabilitation, exergames and virtual reality. It is welcomed by the therapists and elderly patients. Currently, it has been applied in some developed countries and regions, and it is expected to be popularized in the communities. Studies suggested that the computer-based cognitive training has some effects in improving cognitive function in the elderly, and play a role in different cognitive domains, such as executive function, attention, memory, processing speed. However, there is lack of high-quality research, and it has some limitations in clinical application. There is also a lack of unified training standards and exercise prescriptions for the elderly patients, which is expected to be improved in the future.

The Language and Non-linguistic Cognitive Impairment in Poststroke Aphasia: A Resting-state Functional Magnetic Resonance Imaging Study

YAO Jing-Fan, XU Cheng, CHEN Hong-Yan, WANG Shuo, ZHANG Yu-Mei

2021, 16(03): 251-258. DOI: 10.3969/j.issn.1673-5765.2021.03.007

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Objective To explore the language and non-linguistic cognitive impairment characteristics and related brain functional changes in patients with poststroke aphasia (PSA) using resting-state functional magnetic resonance imaging (rs-fMRI). Methods Patients with PSA who were consecutively admitted to Beijing Tiantan Hospital, Capital Medical University from March 2019 to January 2020 were enrolled in this retrospective analysis. The healthy controls (HCs) matched for age, gender, and education were selected. Western aphasia battery (WAB) and Loewenstein occupational therapy cognitive assessment (LOTCA) were used to evaluate the language and non-linguistic cognitive function. The amplitude of low frequency fluctuation (ALFF) and functional connectivity density (FCD) were collected by rs-fMRI. The imaging parameters of the two groups were compared, and pearson correlation analysis was used to analyze the correlation of WAB/LOTCA scores with the imaging parameters. Results 16 PSA patients with and 17 controls were included. Compared to the HCs, the ALFF values of the bilateral hippocampus, parahippocampal gyrus, and inferior temporal gyrus significantly increased, the ALFF values of the left inferior frontal gyrus pars perculairs and insular lobe significantly decreased, the FCD values of the right hippocampus and parahippocampal gyrus significantly increased, and the FCD values of the left inferior parietal lobule, superior occipital gyrus, middle occipital gyrus, and precuneus significantly decreased in PSA patients. Correlation analysis found that the ALFF value of the left inferior frontal gyrus partes opercularis was positively correlated with WAB-aphasia quotient (AQ), fluency score (r =0.693, P =0.026; r =0.662, P =0.037). The ALFF value of the left inferior frontal gyrus pars perculairs was positively correlated with LOTCA orientation score (r =0.642, P =0.045), and the ALFF value of the left hippocampus was positively correlated with LOTCA attention score (r =0.706, P =0.022). Conclusions The intensity of local cerebral spontaneous activity in some brain regions and brain functional connectivity changed in PSA patients, which are closely related to the language and nonlinguistic cognitive impairment. These imaging changes may be used as the important imaging markers for PSA.

Upper Limb Somatosensory Impairments in Subacute Stroke: Association with Upper Limb Motor Function and Age

HE Jie-Ying, LI Chong, LIN Jia-Li, SHU Bei-Bei, CHEN Yao, GAO Jia-Jia, WANG Jian-Hui, JIA Jie

2021, 16(03): 259-264. DOI: 10.3969/j.issn.1673-5765.2021.03.008

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Objective To investigate the association between upperlimb somatosensory impairment and motor function in subacute stroke patients of different ages. Methods This prospective study enrolled the poststroke patients in subacute phase who were consecutively admitted to Shanghai Jing'an District Central Hospital, Shanghai Third Rehabilitation Hospital, and Henan University Nanshi Hospital from June to December 2020. Semmes-Weinstein monofilaments (SWMs) and two-point discrimination instrument were used to evaluate the patient’s upper extremity tactile and two-point discrimination separately. Fugl-Meyer sensory scale was used to evaluate the patient’s upper limb tactile and proprioception. Fugl-Meyer Assessment-Upper Extremity Scale (FMA-UE) and Action Research Arm Test (ARAT) were used to evaluate upper limb motor. The patients were divided into the young and middle-aged group (18-59 years) and the elderly group (≥60 years). Bilateral sensory function between the two groups were compared, and the association between upper limb somatosensory function and motor function was analyzed. Results A total of 117 patients were included, with an average age of 61.1±11.7 years, and the average disease course of 40.0 (22.0-61.5) days and 49 cases (41.9%) in young and middle-aged group and 68 cases (58.1%) in the elderly group. There was statistical difference in SWMs and twopoint discrimination of healthy upper limb between the two groups (both P <0.05). For all the stroke patients, the upper limb SWMs score was positively correlated with FMA-UE score and ARAT score (r values were 0.296 and 0.297, both P <0.01); Fugl-Meyer sensory function scale score was positively correlated with FMA-UE score and ARAT score (r values were 0.402 and 0.397, both P <0.01). For both groups, Fugl-Meyer sensory function scale score were positively correlated with FMA-UE score and ARAT score (r value in young and middle-aged group were 0.416 and 0.401, separately; the r value in the elderly group were 0.389 and 0.371, separately all P <0.01). Additionally, the upper limb SWMs score in the elderly group was positively correlated with FMA-UE score and ARAT score (r values were 0.330 and 0.365, separately, both P <0.01). Conclusions The upper limb tactile and proprioceptive sensations were positively correlated with motor function in subacute stroke patients. Age may have an impact on the association between tactile and motor function in the patients poststroke.

Review on Health Economic Evaluation Models of Ischemic Stroke

WANG Fang-Xu, TAO Li-Bo

2021, 16(03): 265-271. DOI: 10.3969/j.issn.1673-5765.2021.03.009

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Objective To review and analyze the health economic evaluation models of ischemic stroke, to provide reference and support for standardizing the health economic evaluation model of ischemic stroke in China. Methods We systematically reviewed the literatures on health economic evaluation of ischemic stroke, and summarized the structure characteristics of the existing models. Results A total of 20 literatures were included. Of the analyzed evaluation models, the model of decision tree combined with Markov was the most common. Due to different understanding for the onset and progression of stroke, different Markov models with 3, 4, 7 or more states were developed. Conclusions It was necessary to standardize the health economic evaluation model of ischemic stroke, which should be constructed based on disease progression features and clinical pathway.

Analysis of Risk Factors of Poststroke Cognitive Impairment

QIU Xiao-Xue, CHEN Hong-Xia, LI Shi-Wen,LIN Jie

2021, 16(03): 272-277. DOI: 10.3969/j.issn.1673-5765.2021.03.010

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Objective To explore the risk factors for poststroke cognitive impairment. Methods The patients with acute ischemic stroke (AIS) who were consecutively admitted to Department of Neurology of the First Hospital of Handan from June 2018 to June 2019 were enrolled in this retrospective study. MMSE and MoCA were used to assess cognitive function, and all the patients were divided into poststroke cognitive impairment (PSCI) group and no cognitive impairment (NCI) group. Multivariate logistic regression model was used to analyze the risk factors for poststroke cognitive impairment. Results A total of 162 AIS patients were included, with an average age of 59.79±6.71 years old and 97 males (59.9%); 78 cases (48.1%) in PSCI group, and 84 cases (51.9%) in NCI group. Multivariate analysis showed that high level education (OR 0.153, 95%CI 0.052-0.454), stroke history (OR 2.915, 95%CI 1.262-6.730), large infarcts (OR 7.710, 95%CI 1.591-37.364) and brain atrophy (OR 4.494, 95%CI 1.210-16.698) were independent influencing factors for PSCI. Conclusions The incidence of PSCI was relatively high; high level education was an independent protective factor for PSCI, while stroke history, large infarcts, and brain atrophy were independent risk factors for PSCI.

Correlation between Glomerular Filtration Rate and Acute Ischemic Stroke

CHI Xiao-Dong, LENG Chang-Mu,GU Ying, LI Xiao-Hong

2021, 16(03): 278-282. DOI: 10.3969/j.issn.1673-5765.2021.03.011

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Objective To explore the effects of glomerular filtration rate (GFR) on the stroke incidence, stroke severity and cognitive function in acute ischemic stroke (AIS) patients. Methods AIS patients who were admitted to Department of Neurology of Dalian Friendship Hospital from August 2018 to October 2019 were included in this retrospective analysis. Inpatients with no stroke history during the same period were used as the control group. Univariate and multivariate analyses were performed to determine the independent influencing factors for ischemic stroke. According to the estimated GFR (eGFR), the ischemic stroke group was divided into normal eGFR subgroup (eGFR≥90 mL/min), mild decrease subgroup (60 mL/min≤eGFR<90 mL/min), moderate decrease subgroup (30 mL/min≤eGFR<60 mL/min) and severe decrease subgroup (15 mL/min≤eGFR<30 mL/min), and the differences in NIHSS score, cerebral infarction volume and cognitive function among the four subgroups were compared. Results 181 AIS patients and 133 controls were included. Lower eGFR, lower HDL-C, elevated systolic blood pressure, elevated HbA1c, history of diabetes, and advanced age were independent risk factors for AIS. In ischemic stroke group, 58 cases in normal eGFR subgroup, 75 cases in mild decrease subgroup, 32 cases in moderate decrease subgroup and 16 cases in severe decrease subgroup. Both NIHSS and cerebral infarct volume tended to increase with the decrease of eGFR. There was no statistical difference between moderate decrease subgroup and normal eGFR subgroup, while the NIHSS and cerebral infarction volume in moderate and severe decrease eGFR subgroups were significantly higher than those in normal eGFR subgroup. The cognitive function tended to decrease with the decrease of eGFR. There was no statistical difference in MMSE and MoCA scores between moderate decrease subgroup and normal eGFR subgroup, while the MMSE and MoCA scores in moderate and severe decrease subgroups were significantly lower than those in normal eGFR subgroup. Conclusions Low eGFR was an independent risk factor for ischemic stroke. eGFR mild decrease was not associated with stroke severity and cognitive impairment, while eGFR moderate or severe decrease were associated with neurological deficit and cognitive impairment.

Dynamic Changes of T Lymphocyte Subsets after Hypertensive Intracerebral Hemorrhage

FAN Hua-Sheng,WEI Feng, ZHONG Shi-Mao, HU Bei-Quan, YANG Song, LIU Hai-Feng, WU Jing

2021, 16(03): 283-287. DOI: 10.3969/j.issn.1673-5765.2021.03.012

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Objective To observe the dynamic changes of T lymphocyte subsets in peripheral blood of patients with hypertensive intracerebral hemorrhage, and to explore the immunosuppression state after hypertensive intracerebral hemorrhage. Methods This prospective study included 30 patients with mild (GCS 12-15 points), moderate (GCS 9-11) and severe (GCS 3-8 points) hypertensive cerebral hemorrhage according to the GCS score at admission. 30 patients with essential hypertension without cerebral hemorrhage were selected as the controls. Venous blood was collected on day1, 3, 7, 14 and 28 after intracerebral hemorrhage in hypertensive intracerebral hemorrhage group and on the second day of hospitalization in the control group, to detect the proportion of peripheral blood CD4+ and CD8+ lymphocytes and calculate the CD4+/CD8+ ratio, and analyze the trend of changes in the levels of CD4+ and CD8+ T lymphocytes in patients with hypertensive cerebral hemorrhage. Results In the differences of the groups, the proportion of CD4+ and CD8+ lymphocytes in the mild, medium, and severe hypertensive intracerebral hemorrhage subgroups were all lower than that in control group on day 1, 3, and 7; the proportion of CD4+ and CD8+ only in severe subgroup on day 14 were lower than that in control group; there was no statistical difference in the proportion of CD4+and CD8+ cells among the 4 subgroups on day 28. In the changes trend, the proportion of CD4+ and CD8+ lymphocytes in all the hypertensive cerebral hemorrhage patients showed a trend of first decreasing and then increasing after onset. The proportion of CD4+ lymphocytes was lowest on day 3, and then gradually increased; the proportion of CD8+ lymphocytes was the lowest on day 1, then gradually increased, and basically rose to the level of control group on day 28. Conclusions The percentage of T-lymphocytes (CD4+, CD8+) all decreased firstly and then returned to normal level after cerebral hemorrhage. In the early stage (within 7 days after onset), the level of immune cells was significantly lower than the normal level, indicating that the immune function is in suppression state. The immune cells level basically returned to normal level on day14 after cerebral hemorrhage in mild and moderate hypertensive intracerebral hemorrhage patients, while that returned to normal level on day 28 in severe patients.

Design Specifications for Clinical Trials of Testing Drugs for Cerebral Small Vessel Disease: A Consensus Statement

CHEN Wei-Qi, PAN Yue-Song, CHEN Xia, BAI Feng, CAO Yong-Jun, FAN Yu-Hua, HU Bo, LIU Jun, MAO Ling, NI Jun, QU Hui, SUN Li, SUN Zhong-Wu, WANG Li-Hua, WU Bo, WU Dan-Hong, XIE Chun-Ming, XU Yu-Ming

2021, 16(03): 288-297. DOI: 10.3969/j.issn.1673-5765.2021.03.013

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