| Objective: To evaluate the effects on motor function and self-care ability of patients with post-stroke limb spasticity through the treatment of early post-stroke limb spasticity with "Tongjing Tiaoxing" massage therapy.We also observed the effect of Glu,an excitatory transmitter,on post-stroke limb spasticity in rats after massage therapy based on the glutamate-glutamine cycle and analyzed the mechanism of the effect of "Tongjing Tiaoxing" massage therapy on post-stroke spasticity to provide a theoretical reference for the clinical treatment of post-stroke limb spasticity,promote the rehabilitation process and reduce the disability rate.Methods:1 Clinical trial: The randomized controlled study method was chosen for the subject.72 patients with early post-stroke limb spasms were randomly divided into a test group and a control group,and the test group was treated with "Tongjing Tiaoxing" massage therapy,while the control group was treated with exercise therapy.The treatment time was once a day,5 times a week,for 4 weeks.The modified Ashworth scale(MAS),the simplified Fugl-Meyer motor assessment(FMA),and the modified Barthel index(MBI)were used before and after the treatment.The evaluation was used to assess the patient’s degree of spasticity,motor function,and life skills.All data results were analyzed using SPSS 28.0software.2 Animal experiment: 50 Sprague Dawley rats were randomly divided into 10sham-operated,20 each in the MCAO group and Tuina group.The cerebral ischemia-reperfusion model was established by the wire bolus method,and the rats were randomly divided into the MCAO group and the Tuina group after successful modeling.The Tuina group was treated with Tuina therapy for 24 h after modeling,by pressing the Governor Meridian and both sides of the pinched spine points and pointing the affected side of the Quchi point,Yanglingquan point,Weizhong point,Hegu point,and Taichong point for7 days.The other two groups were fed routinely and not treated.(1)The effect of "Tongjing Tiaoxing" massage therapy on the behavior of rats with post-stroke limb spasm.The rats in the three groups were subjected to the Zealonga score,modified Ashworth spasticity score,net screen test,and muscle tone test at 24 h after modeling and after the treatment was completed.(2)The effect of "Tongjing Tiaoxing" massage therapy on cortical neuronal damage and astrocyte activation in rats with post-stroke limb spasm.After the treatment,the brain tissues of three groups of rats were stained with TTC to observe the volume of cerebral infarction,and the cortical neuronal damage was detected by Nixon’s staining,and type A1astrocytes(neurotoxic marker C3)/ the cortical astrocyte activation(GFAP)was observed by immunodouble staining.(3)Study on the mechanism of AKT-m TOR signaling pathway based on "Tongjing Tiaoxing" massage therapy on post-stroke limb spasticity in rats.The expression of AKT,m TOR,and GLT-1 in rat cortex was determined by western blot and fluorescence quantitative PCR.Results:Clinical trial: Before treatment,there were no statistical differences in gender,age,spasticity side,modified Ashworth score,Fugl-Meyer motor function scale,and modified Barthel index score between the two groups(P>0.05).The modified Ashworth score effectively reduced the degree of upper and lower extremity spasticity in both groups after treatment compared with that before treatment(P<0.001),and the test group was better than the control group in the improvement of the degree of upper extremity spasticity(P<0.05).The Fugl-Meyer scale showed that the restoration of motor function of the limbs with "Tongjing Tiaoxing" massage therapy was better than the exercise treatment therapy(P<0.05);the modified Barthel index score showed that the test group improved the subjects’ ability to live better than that of the control group(P<0.05).Animal experiment:(1)After 7 days of Tuina treatment,the Zea-longa score of the Tuina group was lower than the MCAO group(P<0.05);the spasticity of the Tuina group was significantly improved compared with the modified Ashworth score of the MCAO group(P<0.01);the net screen experimental score of the Tuina group was significantly lower than that of the MCAO group(P<0.05);The results of tension measurement showed that there was no significant change in muscle tone before and after treatment in the sham-operated group.After 24 h of modeling,the muscle tone of the two groups increased,and there was a significant difference between the two groups and the sham-operated group(P<0.001).After7 days of treatment,there was a statistically significant difference between the Tuina group and the MCAO group.(2)The results of TTC staining showed that no infarct foci were seen in the sham-operated group,there were significant focal infarcts in the MCAO group compared with the sham-operated group(P<0.001),and the infarct volume was significantly reduced in the Tuina group compared with the MCAO group(P<0.01).The results of Nissler staining showed that the number of neurons in the sham-operated group was large,with large cytosol and regular arrangement;the number of neurons in the MCAO group was reduced,with an irregular arrangement and widened the gap with surrounding cells;the number,morphology,arrangement,and gap of neurons in the cortex of the Tuina group were restored to different degrees.The results of immunofluorescence quantitative double-staining showed that the ratio of C3/GFAP cells was significantly lower in the Tuina group compared with the MCAO group(P<0.001).(3)The concentration of glutamate was determined by a biochemical assay kit,and the concentration of Glu protein in the rat cortex was reduced in the pushing group compared with the model group(P<0.05).The expression of AKT,p-AKT,m TOR,p-m TOR and GLT-1 protein in the cortical neurons of rats in each group was determined by Western Blot.The AKT,p-AKT,m TOR,p-m TOR,and GLT-1 proteins were lowly expressed in the cortex of the model group compared with the sham-operated group(P<0.01).p-AKT,AKT,m TOR,m TOR,p-m TOR,and GLT-1 were highly expressed in the cortex compared with the model group(P<0.05).In the changes of AKT m RNA,m TOR m RNA,and GLT-1 m RNA expression in the cortex of rats in each group,as measured by PCR experimental method,the expression of AKT m RNA,m TOR m RNA,and GLT-1 m RNA was significantly higher in the pushing group compared with the model group(P<0.05).Conclusion:Clinical trial: "Tongjing Tiaoxing" massage therapy can reduce the degree of spasticity in patients with early post-stroke limb spasticity,especially in improving the degree of spasticity in the upper limbs,which is better than conventional exercise therapy in terms of clinical efficacy,helping patients to recover the motor function of the limbs and improving their ability to perform daily life.Animal experiments: "Tongjing Tiaoxing" can repair neuronal damage in the cortex of rats with post-stroke limb spasm,slow down the activation of astrocytes by the cascade reaction of brain injury,and reduce the concentration of Glu in the cerebral cortex of rats by activating the AKT-m TOR pathway to up-regulate the expression of GLT-1 protein,thus reducing the damage to neurons caused by excitotoxicity.It also helps to correct neurotransmitter disorders,effectively improving spasticity and reducing muscle tone. |
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