The Study On The Effect Of Exercise Training Intensity And ES On Recovery Mechanism And Function In Cerebral Stroke

Partâ… The effects of different treadmill training intensity on the expression of NR2B receptor in the cerebral ischemic ratsObjectives:To study the effect of different training intensity on the expression of NR2B receptor in rats with cerebral ischemia by the MCAO model and provide a theoretical basis to the selection of the appropriate exercise intensity for clinical rehabilitation.Methods:Adult SD rats were randomly divided into 4 groups, namely no exercise group (NE group), low intensity training group (LIT group, v=15m/min), moderate intensity training group (MIT group, v=20m/min) and sham group. On the 3rd day, the 7th day and the 14th day after the operation, the brains were subjected to detect the expression of the phospho-NR2B (p-NR2B) receptor, one kind of subunits of N-methyl-D-aspartate receptor (NMDA receptor). Addition, neurological deficit score (NDS), body weight, cerebral infarction volume and extent of brain edema were examined to evaluate the safety and the effect of exercise on the acute ischemic rat.Results:Treatment with exercise significantly decreased the expression of the p-NR2B receptor compared with rats in the NE group at the 3rd day, the 7th day and the 14th day after MCAO. At every sampling time point, the expression of the p-NR2B receptor in LIT group was much lower than the MIT group except the 14th day. The TTC staining showed that compared with the NE group, exercise training could significantly decrease the cerebral infarction volume on the 7th day and the 14th day (P<0.01). The cerebral infarction volume of the LIT group was significantly smaller than the MIT group. Exercise training significantly reduced the degree of neurological deficits (p<0.05), but until the 14th day the differences were not stastically. Meantime, the reduced degree of neurological deficit in LIT group was greater than that in MIT group. From the results of the dry and wet brain tissue:the LIT group could significantly reduce the extent of brain edema(P<0.05), but the MIT group did not reduce it. Similarly, from the death record, the LIT might reduce the mortality after cerebral ischemia, while the MIT had no effect like this. Body weight change in rats showed that:compared with the NE group, the LIT could significantly promote the recovery of body weight, while the MIT was ineffective.Conclusion:Exercise training after cerebral ischemia is useful and necessary. LIT is more effective intervention means in reducing the expression of the phosphorylation of NR2B receptor, reducing infarct volume, promoting brain edema absorption and reducing mortality after cerebral ischemia. In the clinical practice, cerebral ischemia treated with low intensity exercise training may be more secure and effective. Part II Effects of Instructional Functional Electrical Stimulation on the Upper Extremity Motor Function and the cognitive deficit in Patients with StrokeObjectives:To explore the effects of instructional functional electrical stimulation (IFES) on the upper extremity motor function and the cognitive deficit in patients with stroke.Methods:Forty-eight patients after stroke were randomly divided into four groups as follow:the IFES group, the traditional electrical stimulation (TES) group, the electromyogram-triggered neuromuscular stimulation (ETNS) group and the no electrical stimulation group. All the subjects received the same rehabilitation training and internal medicine treatment. Besides, patients in IFES, TES and ETNS groups were given a 20 days program of electrical stimulation to the extensor muscles of wrist(20 minutes, once a day) via surface electrodes. All subjects were assessed with the simplified Fugl-Meyer scores (the upper extremity part), the functional comprehensive assessment (FCA), the mini-mental state examination (MMSE) and the Hamilton depression rating scale (HAMD) before treatment and on the 20th day after treatment.Results:No significant differences were found in every rating scale among the groups at the recruitment. After 20-day treatment, every group made progress in some extent, especially in the IFES group, the ETNS group and the TES group (p<0.05) On the 20th day, compared with the no stimulation group and the TES group, there were significant differences in the upper extremity Fugl-Meyer scores and the FCA scores of the IFES group and the ETNS group (p<0.05), but no statistic differences can be found between these two groups (P>0.05). After 20-day's treatment, every group made progress in cognitive function more or less, especially in the IFES group and the ETNS group (p<0.05). On the 20th day, no significant differences in all the cognitive scales were found between the IFES group and the ETNS group. However, compared with the TES group and the no stimulation group there were note differences in MMSE and the cognitive part of the FCA scales (p<0.05). What's more, there were no differences between the TES group and the no stimulation group in all the cognitive scales. After treatment, the patients had an obvious decreasing in depression degree in the IFES group and the ETNS group.Conclusion:The study indicated that IFES could enhance the upper extremity motor function, improve the functional dependence and decrease the cognitive function defict and the degree of depression in patients with stroke. Its therapeutic efficacy was similar to the ETNS group but better than the TES group and the no electrical stimulation group.