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功能性电刺激辅助步行设备的应用进展
功能性电刺激(functional electrical stimulation,FES)是应用低强度的电脉冲刺激恢复或改善肢体的功能,这些肢体功能在正常情况下接受中枢神经系统的控制,但因为疾病、创伤、发育缺陷等原因失去控制或控制不良,属于神经肌肉电刺激(neuromuscular electrical stimulation,NMES)的一种.应用于下肢、辅助患者站立和步行的FES设备称为FES辅助步行设备(FES-assisted walking device).本文拟对FES在辅助步行方面的应用作一回顾.
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神经肌电刺激治疗失神经肌肉萎缩研究进展
功能性电刺激(functional electrical stimulation,FES)作为一种安全、有效的治疗方式,目前正逐步应用于临床治疗多种神经肌肉疾患.功能性电刺激主要利用电流的作用来防治骨骼肌失神经萎缩,为修复后的神经重新支配肌肉争取时间.大限度地保留残存肌肉形态与功能.本文就其在治疗失神经肌肉萎缩方面的新进展做一综述.
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新型多通道双相体外肌肉刺激器的设计
功能性电刺激(functional electrical stimulation,FES)是神经肌肉功能恢复与重建的新途径,其工作原理是通过人工产生电脉冲微量电流,经由皮肤,刺激由于高位中枢障碍引起信号传输通路受阻而失去中枢神经控制的骨骼肌,使相应的肌肉产生收缩,带动关节按一定的规律运动,从而完成相应的运动功能,实现康复的目的.
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新方法">"强制性使用"运动疗法--脑损伤后康复治疗的一种新方法
过去几十年,脑损伤后运动障碍的康复治疗广泛应用神经发育疗法(neurodevelopment treatment,NDT),其典型代表为Bobath技术、Brunnstrom技术、Rood技术、Kabat-Knott-Voss技术等[1~3].这些技术的流行,促进了20世纪中后期脑损伤患者运动功能的恢复.80年代以来,从事脑损伤治疗的临床(包括康复治疗专业)人员发现,神经发育疗法在治疗环境中具有良好的效果,但在患者的生活环境中常不能较好地发挥作用[3,4];文献中报告的关于神经发育疗法的临床研究,设计不够严谨,缺乏有说服力的对照组.在严格设计的临床研究中,经过与对照组比较,未能发现神经发育疗法各技术之间及其与传统的治疗方法之间有显著性的差异[3,4].为此,专业人员一直在致力于寻找新的不同于神经发育疗法或传统疗法的更为有效的治疗方法.例如,运动再学习技术(motor relearning program,MRP)[1]、抗阻力训练(resisted exercise)[5]、功能性电刺激(functional electrical stimulation, FES)[6]、经皮神经电刺激(transcutaneous electrical nerve stimulation, TENS)[7]、强制性使用运动疗法(constraint-induced movement therapy,CIMT)[8~10]等.其中以强制性使用运动疗法发展较快.
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心脏收缩性调节在慢性心力衰竭治疗中的应用
慢性心力衰竭(chronic heart failure,CHF)是多种心血管疾病的后期转归,尽管目前以纠正神经-内分泌亢进为主的药物治疗得到广泛应用,仍有相当比例患者存在生活质量不佳和预后不良.近年来,心脏再同步化治疗(cardiac resynchronization therapy,CRT)已成为心室间或左心室壁各节段非同步的标准治疗,但符合上述标准的CHF患者比例不足50%[1].接受CRT的患者中,30%存在CRT无应答[2].究其原因,上述治疗未能解决心肌细胞收缩乏力这一根本问题.绝对不应期的电刺激(absolute refractory period electrical stimulation,ARPES)可增强正常和衰竭心肌的收缩力[3-5],该治疗又被称为心脏收缩性调节(cardiac contractility modulation,CCM).近来研究发现,CCM治疗能显著改善CHF患者生活质量、提高运动耐力[6 ]且不受心肌同步性与否的影响[7].与正性肌力药物不同,CCM在显著改善心脏收缩功能时并不增加心肌的氧消耗[8].现就CCM在CHF 治疗中的新进展做一汇总.
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Previous studies have indicated that electrical stimulation of the cerebellar fastigial nucleus in rats may reduce brain infarct size, increase the expression of Ku70 in cerebral ischemia/reperfusion area, and decrease the number of apoptotic neurons. However, the anti-apoptotic mechanism of Ku70 remains unclear. In this study, fastigial nucleus stimulation was given to rats 24, 48, and 72 hours before cerebral ischemia/reperfusion injury. Results from the electrical stim-ulation group revealed that rats exhibited a reduction in brain infarct size, a signiifcant increase in the expression of Ku70 in cerebral ischemia/reperfusion regions, and a decreased number of terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL)-positive cells. Double immunofluorescence staining revealed no co-localization of Ku70 with TUNEL-positive cells. However, Ku70 partly co-localized with Bax protein in the cytoplasm of rats with cerebral ischemia/reperfusion injury. These ifndings suggest an involvement of Ku70 with Bax in the cy-toplasm of rats exposed to electrical stimulation of the cerebellar fastigial nucleus, and may thus provide an understanding into the anti-apoptotic activity of Ku70 in cerebral ischemia/reperfu-sion injury.
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Previous studies have demonstrated that deacetyl chitin conduit nerve bridging or electrical stimulation can effectively promote the regeneration of the injured peripheral nerve. We hypoth-esized that the combination of these two approaches could result in enhanced regeneration. Rats with right sciatic nerve injury were subjected to deacetyl chitin conduit bridging combined with electrical stimulation (0.1 ms, 3 V, 20 Hz, for 1 hour). At 6 and 12 weeks after treatment, nerve conduction velocity, myelinated axon number, ifber diameter, axon diameter and the thickness of the myelin sheath in the stimulation group were better than in the non-stimulation group. The results indicate that deacetyl chitin conduit bridging combined with temporary electrical stimu-lation can promote peripheral nerve repair.
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Peripheral and central sensitizations are phenomena that occur during migraine. The role of pentin, a migraine preventive drug, on central sensitization remains unclear. In this study, a rat model of migraine was established by electrical stimulation of the trigeminal ganglion, and the an-imals were given intragastric gabapentin. Changes in amino acid content in the cerebrospinal fluid and protein kinase C membrane translocation in the spinal trigeminal nucleus were examined to clarify the mechanisms underlying the efficacy of gabapentin in the treatment of central sensitization during migraine. Electrophysiology, liquid chromatography-mass spectrometry and western blot analysis results revealed that gabapentin reduces neuronal excitability in the spinal nucleus in the trigeminal nerve, decreases excitatory amino acid content and inhibits the activation of protein ki-nase C. This provides evidence that excitatory amino acids and protein kinase C are involved in the formation and maintenance of central sensitization during migraine. Gabapentin inhibits migraine by reducing excitatory amino acid content in the cerebrospinal fluid and inhibiting protein kinase C ac-tivation.
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Previous studies have shown that, anode block electrical stimulation of the sacral nerve root can produce physiological urination and reconstruct urinary bladder function in rabbits. However, whether long-term anode block electrical stimulation causes damage to the sacral nerve root re-mains unclear, and needs further investigation. In this study, a complete spinal cord injury model was established in New Zealand white rabbits through T9-10 segment transection. Rabbits were given continuous electrical stimulation for a short period and then chronic stimulation for a longer period. Results showed that compared with normal rabbits, the structure of nerve cells in the anterior sacral nerve roots was unchanged in spinal cord injury rabbits after electrical stimu-lation. There was no signiifcant difference in the expression of apoptosis-related proteins such as Bax, Caspase-3, and Bcl-2. Experimental ifndings indicate that neurons in the rabbit sacral nerve roots tolerate electrical stimulation, even after long-term anode block electrical stimulation.
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An injury potential is the direct current potential difference between the site of spinal cord injury and the healthy nerves. Its initial amplitude is a significant indicator of the severity of spinal cord injury, and many cations, such as sodium and calcium, account for the major portion of injury potentials. This injury potential, as wel as injury current, can be modulated by direct current field stimulation;however, the appropriate parameters of the electrical field are hard to define. In this paper, injury potential is used as a parameter to adjust the intensity of electrical stimulation. Injury potential could be modulated to slightly above 0 mV (as the anode-centered group) by placing the anodes at the site of the injured spinal cord and the cathodes at the rostral and caudal sections, or around-70 mV, which is resting membrane potential (as the cathode-centered group) by reversing the polarity of electrodes in the anode-centered group. In addition, rats receiving no electrical stimulation were used as the control group. Results showed that the absolute value of the injury potentials acquired after 30 minutes of electrical stimulation was higher than the control group rats and much lower than the initial absolute value, whether the anodes or the cathodes were placed at the site of injury. This phenomenon il ustrates that by changing the polarity of the electrical field, electrical stimulation can effectively modulate the injury potentials in rats after spinal cord injury. This is also beneficial for the spontaneous repair of the cel membrane and the reduction of cation influx.
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Objective. To study the features and mechanism of the cerebral evoked potentials by repetitive stimulation of calf muscle in Duchenne muscular dystrophy (DMD) patients with obvious muscular dystrophy and psuedohypertrophy. Methods. Cerebral evoked potentials by stimulation of calf muscles and somatosensory evoked potentials (SEPs) by the stimulation of posterior tibial nerves at ankle were measured in 10 patients with DMD and 10 normal controls matched with gender and age. The intensity of the magnetic stimulation was at 30% of maximal output (2.1 Tesla, MagPro magnetic stimulator, Dantec) and the frequency was 1 Hz. The low intensity of magnetic stimulation was just sufficient to produce a contraction of the muscle belly underneath the coil. Recording electrode was placed at 2 cm posterior to the Cz, reference to Fpz. The latencies of N33, P38, N48 and P55 and amplitude (P38- N48) were recorded. SEPs were recorded by routine methods. Results. In normal subjects, the amplitudes of cerebral evoked potentials by magnetic stimulation of calf muscle was 40% lower than that by electrical stimulation of the posterior tibial nerves at ankle. The latency of P38 was 2.9± 2.1 ms longer compared with electrical stimulation of the posterior tibial nerves at ankle. In 6 patients, P38 latency from magnetic stimulation was remarkably prolonged (P<0.01), and in 4 patients, there was no remarkable response. SEPs evoked by electrical stimulation were normal in all of the patients.? Conclusion. DMD is an available model for the study of mechanism of cerebral evoked potentials by magnetic stimulating muscle. We can conclude that the responses from magnetic stimulation were produced by muscle input. The abnormal responses in patients may relate to decreased input of muscle by stimulating dystrophic and psedohypertrophic muscle.
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纵行神经束内微电极刺激和记录家兔坐骨神经束电生理信号的研究
功能性电刺激(functional electrical stimulation, FES)是用于恢复上运动神经元损伤(如大脑、脊髓损伤等)引起的肢体运动和感觉丧失的一种方法,目前已能应用FES使截瘫患者站立或恢复排尿功能.但应用于FES系统的传统神经外电极由于选择性差及缺乏感觉反馈信息,虽经过长期的应用和实践,只取得了有限的效果[1].另外,人们应用电子假肢来替代缺损肢体的形状与功能,虽然目前已开发出多功能的多自由度电子假手,但要实现对其控制,完成不同的功能,需要多个信息源.如何记录并应用反映大脑功能的周围神经的信息完成对假肢的控制是一个人们一直想解决的问题.因此,制作并应用神经束内微电极对周围神经进行选择性刺激并应用记录的单根神经束动作电位作为反馈信息或进行假肢的控制是近年来研究的热点.我们应用自制的纵行神经束内微电极插入家兔坐骨神经的神经束内,分别作为记录和刺激电极,应用Dantec经颅电刺激系统,记录运动诱发电位(motor evoked potential, MEP)和皮质体感诱发电位(cortical somatosensory evoked potential,CSEP),测定电极的刺激和记录特性,探讨自制电极的应用价值.
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盆底肌功能训练辅助电刺激加生物反馈治疗女性压力性尿失禁
女性压力性尿失禁(stress urinary incontinence,SUI)是临床常见病,给妇女生活带来严重困扰,有报道其患病率为29%~64%[1.2].近年来,随着对尿失禁认识和研究的进展,出现了多种治疗方法,非侵入性疗法成为首选.我科对15例轻度、中度女性压力性尿失禁病人行盆底肌功能训练辅助电刺激加生物反馈治疗,疗效明显.现总结如下.
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刺激迷走神经后不同组织肿瘤坏死因子变化的实验研究
AIM:To investigate the effect of proinflammatory cytokine and anti inflammatation cytokine on liver and lung tissues in rats with endotoxemia.METHODS:Male Wistar rats were randomly divided into 4 groups: group treated with stimulating vagus nerve, group receiving lipopolysaccharide(LPS) intravenous injection after transecting vagus nerve, group treated with sham operation and group treated with injecting LPS intravenously alone, and then measured the levels of TNF α in liver and lung and those of cortisol and Alanine aminotransferase (ALT) in plasma.RESULTS:Compared with group treated with sham operation,LPS treated groups showed a significant increase in TNF level, which was at most 15 fold higher than that of the former group.There was a significant decrease in TNF level in group treated with stimulating vagus nerve,compared with both group receiving LPS intravenous injection after transecting vagous nerve and group treated only with LPS.In addition,we observed plasma cortisol level in LPS treated group was much higher than other 3 groups and the plasma ALT level was greatly lower than that of group treated only with LPS.CONCLUSION:Stimulating vagous nerve can significantly decrease the production of proinflammatory cytokine and alleviate inflammation in rats with endotoxemia.
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电刺激小脑顶核对脑梗死患者神经功能恢复的疗效观察
Objective To observe curative effect of electrical stimulation cerebellar fastigial nucleus on nerve function recovery of cerebral infarction patients.Method The patients were treated with electrical stimulation cerebellar fastigial nucleus except for routine drugs,the electrode were placed on the bilateral mastoid processes,giving pulse electric current for forty minutes two times per day,for a 10 day couse treatment.The parameter was set at model 1,frequency was 131% ~ 136% and intensity was 70% ~ 90% .Result Total effective rate of therapeutic group and control group were 91.7% and 71.4% separately.χ 2=4.860(P< 0.05).The nerver function defect score was manifestly decreased.There was a significant difference between the therapeutic group and control group,and between before and after treatment in therapeutic group(P< 0.01).Conclusion The experiment suggested that the treatment of cerebral infarction by drugs except adding electrical stimulation of cerebellar fastigial nucleus is better than by drugs along.The electrical stimulation of cerebellar fastigial nucleus has obvious protective effect.It can promote recovery of cerebral infarction.
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Effect of Electroacupuncture on Chronic Visceral Pain and Involvement of Spinal NMDA Receptor in IBS Rats
Objective:To clarify effect of electroacupuncture (EA) on relieving chronic visceral pain and the underlying neurobiological mechanism for such an effect,we observed the effect of EA on the Irritable bowel syndrome (IBS) rat and then examined spinal expression of N-methyl-D-aspartate (NMDA)receptor-1 in rats.Methods:Daily mechanical colon distention was performed on male Sprague-Dawley neonatal rats to produce IBS model.EA was applied at acupoints of Zusanli (ST 36) and Shangjuxu (ST 37)in each hind leg.Abdominal withdrawal reflex (AWR) assessment or rectus abdominis electromyograms (AEMG) recordings were then performed after EA treatment.The mRNA expression of the NMDA subtype of glutamate receptors in the spinal dorsal horn (L4-5) before and after EA was investigated by RT-PCR analysis in IBS rats.Results:The results demonstrated that EA could significantly decreased both AWR scores from behavioral test and AEMG discharges from electrophysiological recording in IBS model rats elicited by colorectal distension (CRD) stimuli with strengths of 20,40,60 and 80 mmHg,respectively (P<0.05).Meanwhile there was a significant decrease in mRNA expression of NMDA receptor-1 in the spinal dorsal horn of IBS rats treated by EA (P<0.05),but no such effect was observed in IBS rats treated by sham EA (inserting needles without electrical stimulation).Conclusion:These results indicate that EA can relieve chronic visceral hyperalgesia in IBS rats and this effect might be correlated with the down-regulation of NMDA receptor-1 in the dorsal hom of the spinal cord.
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海马电刺激在癫(癎)治疗中的进展
癫(癎)是神经系统一种慢性疾病.临床上一旦确诊,就需要进行长期的治疗,大多数患者经过正规的抗癫(癎)药物(antiepileptic drugs,AEDs)治疗能够得到有效地控制,但仍有20%~25%的患者因不能耐受长期服药或对AEDs不敏感而未得到有效控制,发展为难治性癫(癎)[1],其中有近半数患者可以通过外科手术途径来控制发作.虽有新的AEDs不断问世,但难治性癫(癎)的发病率并没有因此而下降.癫(癎)患者,特别是难治性癫(癎)患者普遍都有不同程度的心理障碍[2,3],而且生活质量和社会功能都受到严重损害[4].
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多通道功能性电刺激及其在脑卒中偏瘫侧肢体康复中的应用
脑卒中具有高发病率和高致残率的特点[1],存活者大多遗留不同程度的功能障碍,尤以运动功能障碍为常见[2],严重影响患者的日常生活活动能力和生活质量,给家庭和社会带来了沉重负担.因此,采用有效的康复治疗方法,大限度改善脑卒中患者的运动功能障碍,已经成为社会普遍关注的热点[3].临床研究证明,功能性电刺激(functional electrical stimulation,FES)是一种有效改善脑卒中后偏瘫肢体运动障碍的治疗方法[4-6],临床应用时多以单通道或双通道FES为主.近年来,多通道FES临床报道日益增多[7-9].本文就多通道 FES及其在脑卒中偏瘫侧肢体康复中的应用做一介绍,为其今后的临床应用和研究提供参考.
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针对下肢运动康复的功能性电刺激控制模式研究进展
功能性电刺激(functional electrical stimulation,FES)是目前临床公认的对截瘫下肢运动功能恢复有效的治疗方法之一,其中,FES控制模式的选择是取得良好疗效的关键技术.近年来,FES技术已广泛用于康复医学、神经电生理学及生物信息学等领域,成为神经重建研究的必备工具,并取得了瞩日的研究成果.本文针对下肢运动功能康复与神经重建研究中各类FES控制原理、应用方法及其前景作一综述.
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神经肌肉电刺激在脑性瘫痪儿童治疗中的应用进展
自从Dubowitz等[1]于1988年首先报道,对脑性瘫痪(脑瘫)儿童应用神经肌肉电刺激(neuromuscular electrical stimulation,NMES)可提高肌力和运动能力以来,电刺激在脑瘫康复治疗中的应用越来越广泛,有关这方面的报道也日益增多.本文拟对这方面的临床应用进展作一简要综述.