The Clinical Study Of Rehabilitation In Spasticity And Type ? Complex Regional Pain Syndrome After Stroke

Part ? Effects of Traditional Chinese Medicine therapy for reducing the post-stroke spasticityObjective: To investigate the effects of Traditional Chinese Medicine therapy for reducing the post-stroke spasticity and promoting the motor function and activities of daily living(ADL).Methods: 150 patients with first-time stroke occurring at least 1 month before the study.Patients were randomly divided into four groups: conventional rehabilitation group(control gorup,Group A),Traditional Chinese Medicine massage + Chinese herb bath(Group B),Traditional Chinese Medicine massage + Baimai ointment(Group C),Tibetan herb bath +Baimai ointment(Group D).All groups received interventions for five days/week for four weeks.The outcome measures included: Modidified Ashworth scale(MAS)for elbow flexors,wrist flexors,finger flexors,knee extensors and plantar flexors,Fugl-Meyer assessment for upper limb(FMA),and Modidified Barthel Index(MBI).Results:(1)Comparing with the results before the treatment,when finished the 4 weeks' treatment,patients in the Group A showed a significant improvement on reducing the spasticity of finger flexors(P < 0.05).But for the Group B,the spasticity of finger flexors was decreased at the end of 2 weeks' treatment,and all the muscles spasticity decreased at the end of 4 weeks' treatment(P < 05),and except the plantar flexors other muscles spasticity also decreased at 3 months' follow-up(P < 0.05).For the Group C,the spasticity of wrist flexors and finger flexors were decreased at the end of 2 weeks' treatment(P < 0.05),and all the muscles spasticity decreased at the end of 4 weeks' treatment(P < 0.05),and except the plantar flexors other muscles spasticity also decreased at 3 months' follow-up(P < 0.05).For the Group D,the spasticity of elbow flexors decreased at the end of 2 weeks' treatment(P < 0.05),and all the muscles spasticity decreased at the end of 4 weeks' treatment(P < 0.05),and except the finger flexors other muscles spasticity also decreased at 3 months' follow-up(P < 0.05).FMA of four groups were improved at 3 months and 6 months' follow-up when comparing to the results before the treatment(P < 0.05).MBI of four groups improved at all the time point of evaluation(P < 0.05).(2)For the intergroup comparing,the spasticity of elbow flexors of three experimental groups decreased at the end of 4 weeks' treatment and 3 months' follow-up(P < 0.05).For the intergroup comparing,the spasticity of wrist flexors showed significant differences among the Group B and Group C at the end of 4 weeks' treatment and 3 months' follow-up(P < 0.05).The spasticity of finger flexors decreased more than other three groups at the end of 4 weeks' treatment and 3 months' follow-up(P < 0.05)and other three groups showed no significant differences at the same time evaluation point(P > 0.05).The spasticity of knee extensors of three experimental groups decreased at the end of 4 weeks' treatment,but at 3 months' follow-up(P < 0.05),the Group B and Group C showed significant spasticity reduction more the Group A and Group D(P < 0.05).The spasticity of plantar flexors of Group D showed significant differences than other three groups(P < 0.05).For FMA,there was no significant differences among four groups at all the evaluation time point(P > 0.05).MBI of three experimental groups were improved more than the control group.Conclusion: Addition of Traditional Chinese Medicine therapy to the conventional rehabilitation may reduce post-stroke spasticity,improve motor function and ADL.But for the same spasmodic muscles,there was differences among different Traditional Chinese Medicine therapies.Part ? Effects of Baimai ointment for type 1 complex regional pain syndrome in stroke patientsObjective: To investigate the effects of Baimai ointment for type 1 complex regional pain syndrome in stroke patients.Methods: 22 patients with first-time stroke occurring at least 1 month before the study.All patients with informed consent were randomly divided into two groups: the control group and Baimai ointment group.Patients in each group received interventions once a day,five days a week for four weeks.All patients were evaluated before and after the treatments.The evaluation included Visual analogue scale(VAS),Fugl-Meyer assessment for upper limb(FMA),Modidified Ashworth scale for elbow flexors and wrist flexors(MAS)and Modidified Barthel Index(MBI).Results:(1)There were no significant differences in VAS(P = 0.082)and MAS(P = 0.705)of control group compared with that before treatment.A statistical difference was found in FMA(P < 0.001)and MBI(P <.001).The four indexes of the patients in the treatment group were statistically significant compared with those before the treatment.(2)The difference between the four evaluation indexes of two groups before and after treatment was compared.VAS(P < 0.001)and MAS(P = 0.035)had significant differences compared with that before treatment,while FMA and MBI showed no difference(P > 0.05).It indicated that the treatment group improved more significantly than the control group in pain and upper limb spasticity,but motor function and daily living ability were not improved significantly.Conclusion: Combined Baimai ointment treatment with conventional rehabilitation therapy can reduce the type I complex regional pain syndrome and upper limb spasticity in patients with stroke.Part ? Effects of mirror therapy combined with neuromuscular electrical stimulation for promoting walking ability and plantar flexor spasticity in stroke patients.Objective: To investigate the effects of mirror therapy combined with neuromuscular electrical stimulation for promoting walking ability and plantar flexor spasticity in footdrop patients after stroke.Methods: Sixty-nine patients with foot-drop due to a first-time stroke occurring at least 1 month before the study.Patients were randomly divided into three groups: control,mirror therapy,and mirror therapy + neuromuscular electrical stimulation group.All patients in each group received interventions for 0.5 hours/day and five days/week for four weeks.10-Meter walk test,Brunnstrom stage of motor recovery of the lower limbs,Modified Ashworth Scale score of plantar flexor spasticity,and passive ankle joint dorsiflexion range of motion were assessed before and after the four-week period.Results: After four weeks of intervention,Brunnstrom stage(P = 0.04),10-meter walk test(P < 0.05),and passive range of motion(P < 0.05)showed obvious improvements between patients in the mirror therapy and control groups.Patients in the mirror therapy + neuromuscular electrical stimulation group showed better results than those in the mirror therapy group in the 10-meter walk test(P < 0.05).There was no significant difference in spasticity between patients in the two intervention groups.However,compared with patients in the control group,patients in the mirror therapy + neuromuscular electrical stimulation group showed a significant decrease in spasticity(P < 0.001).Conclusion: Therapy combining mirror therapy and neuromuscular electrical stimulation may help improve walking ability and reduce spasticity in stroke patients with foot drop.