Effects Of Rehabilitation Treatment On Functional And Neurological Recovery After Spinal Cord Injury: An Clinical And Experimental Study

Part ?:Effects of rehabilitation treatment on motor function in patients with spinal cord injuryBackgroud:Studies have confirmed that rehabilitation treatment leads to improve locomotor function after spinal cord injury.However,very little is known about whether rehabilitation treatment to aid in the repair of sensory motor tracts,and the relationship between the rehabilitation effect and the sensory motor pathway is still unclear.Objective:To investigate the effects of rehabilitation treatment on somatosensory evoked potential and activities of daily living in patients with various classification of thoracic and lumbar vertebral spinal cord injury,and the value of application on SEPs evaluation of SCI.Methods:Based on America spinal cord injury association(ASIA)impairment scale,19 SCI patients were classfied.All patients received comprehensive rehabilitation treatment,such as PT,OT,NMES and psychotherapy.Somatosensory evoked potentials(SEPs)assessed nerve function of spinal cord,and Modified Barthel Index(MBI)scale assessed activities of dailing living.The improvement of MBI and SEPs of patients were evaluated before and after rahabilitation.Results:There was statistically significant difference between the baseline and after rehabilitation in the grade A,also in the comparison of grade B and grade C and grade D(p<0.05),a significant improvement in MBI scores and SEPs of patients with different illness course were detected after rehabilitation,and there was a linear correlation between them.Conclusion:SEPs associated with MBI scale could accurately evaluate the outcome of rehabilitation,and there was different value of rehabilitation on various classification of SCI.Part ?:A comparison of three high-frequency electrotheraphy on the recovery of neurological function in rats following acute spinal cord injuryBackgroud:Studies have demonstrated that high-frequency electrotheraphy is effective in healing periphery nerve injury.However,very little is known about whether high-frequency to the injured spinal cord improves locomotor function and promotes neurological recovery.Objective:To investigate the effects of three high-frequency electrotheraphy on the recovery of neurological function and the expression of BDNF-TrkB in rats following acute spinal cord injury.Methods:120 adult female SD rats were randomly divided into Sham group,SCI group,SW group,USW group and MW group.The model of SCI was established by compressing the T10 level using the modified Allen weight-drop method in this study.The sham group underwent the laminectomy only and the spinal cord was sustained no impact injury.The SW group received athermal shortwave treatment for 10 minutes at 24 hours after SCI,once a day.The USW group received athermal ultrashort wave treatment for 10 minutes at 24 hours after SCI,once a day.The MW group received athermal microwave treatment for 10 minutes at 24 hours after SCI,once a day.The SCI group received no treatment after surgery.All the rats were sacrificed after 21 days.The Basso,Beattie,and Bresnahan(BBB)scale was used to evaluate the hindlimb motor function at baseline,1,7,14 and 21 days after SCI.Somatosensory evoked potentials(SEPs)and motor evoked potentials(MEPs)were also performed to detect the neural conduction at the same time.Immunohistochemistry method was used to examine the expression of BDNF-TrkB.One-way analysis of variance(ANOVA)with independent samples t test were used to determine the effects of the three treatments.The relationships among the BBB scores,SEPs,MEPs and BDNF-TrkB were determined using the spearman correlation coefficient.Results:The BBB scores were significantly increased in both the SW group and the USW group compared to the SCI group from 7 days to 21 days(P<0.01).There was no significant increase in the BBB scores between the MW group and the SCI group at days(P>0.05),while a significant increase in the BBB scores was observed respectively in the MW group compared to those in the SCI group at 14 days and 21 days(p<0.05).The results of SEPs and MEPs showed that the recovery of neurological function in both the SW group and the USW group was improved obviously compared with the SCI group at 7,14,21 d(P<0.01).The expressions of BDNF-TrkB showed an upword trend at 7 day,and decreased as time went on.The values of BDNF and TrkB were higher in both the SW group and the USW group than those in the SCI group at 7 and 14 days(P<0.01),respectively.While there was no significant increase in the expression of BDNF-TrkB between the MW group and the SCI group at any days(P>0.05).The BBB scores was possible related with the expression of BDNF-TrkB at 7,14,21 d,and the expression of BDNF was positively related with TrkB.The BBB scores was positively related with SEPs and MEPs,and SEPs was also related with MEPs.Conclusion:Athermal shortwave,ultrashort wave and microwave treatment could promote the recovery of neurological functional after spinal cord injury,the mechanism may be related to the increase of BDNF-TrkB expression after treatment in spinal cord damage zone.In terms of efficacy,ultrashort wave was superior to shortwave,shortwave was superior to microwave.whereas,microwave should not be used too early after SCI.