■中风后上肢(UL)运动改善与适应性神经可塑性和运动学习有关。两者都与干预相关(包括提供密集、变量,和特定于任务的实践)和特定于个体的因素(包括遗传多态性的存在)影响改善。在中风患者中,最常见的是,在脑源性神经营养因子(BDNF)中发现多态性,载脂蛋白(APOE)和儿茶酚-O-甲基转移酶(COMT)。这些涉及用精氨酸(APOEε4)或1或2个甲硫氨酸(BDNF:val66met,met66met;COMT:val158met;met158met)。然而,这些多态性对卒中后UL运动改善的具体意义尚未阐明.
■研究遗传多态性对卒中后UL运动改善的影响。
■系统评价和荟萃分析。
■我们对英文文献进行了系统的检索。修改后的Downs和Black检查表有助于评估研究质量。我们比较了有和没有多态性的个体之间UL运动障碍和活动评分的变化。荟萃分析有助于根据至少2项研究/时间点评估运动障碍(FuglMeyer评估)评分的变化。效应大小(ES)根据康复治疗规范系统量化如下:小(0.08-0.18),中等(0.19-0.40)和大(≥0.41)。
■我们检索了10项(4项良好,6项质量相当)研究。与BDNFval66met和met66met多态性相比,荟萃分析显示,在干预完成时(0.5,95%CI:0.11-0.88)和保留时(0.58,95%CI:0.06-1.11),没有多态性的患者的运动障碍(大ES)较低。CoMTval158met或met158met多态性的存在具有相似的结果,在没有多态性的人中,损伤较低(大ES≥1.5)和活动评分较高(大ES范围为0.5-0.76)。APOEε4形式的存在并不影响UL运动的改善。
■BDNF和COMT中存在1或2个met等位基因的多态性对UL运动改善产生负面影响。
■https://osf.io/wk9cf/。
本研究论文的重点是某些基因的DNA序列变异对中风患者手臂改善的影响。在这项研究中,我们研究了以前鉴定为DNA序列变异的3个基因的作用。作者搜索了从2000年开始发表的研究文章,并选择了满足某些标准的文章。然后我们检查了所选论文的质量。接下来,我们结合了来自相同测试的共同数据,用于检查手臂的运动改善,以检查是否有整体效果。共找到10篇论文。选定的文章质量良好或中等。所研究的3个基因中有2个DNA结构的变化影响了中风后改善手臂在日常生活中使用的能力。这些信息对中风后可能的恢复程度具有重要意义。这也有助于决定可以提供的最佳康复选择,以帮助最大限度地提高他们在中风后使用手臂的能力。
UNASSIGNED: Post-stroke upper limb (UL) motor improvement is associated with adaptive neuroplasticity and motor learning. Both intervention-related (including provision of intensive, variable, and task-specific practice) and individual-specific factors (including the presence of genetic polymorphisms) influence improvement. In individuals with stroke, most commonly, polymorphisms are found in Brain Derived Neurotrophic Factor (BDNF),
Apolipoprotein (APOE) and Catechol-O-Methyltransferase (COMT). These involve a replacement of cystine by arginine (APOEε4) or valines by 1 or 2 methionines (BDNF:val66met, met66met; COMT:val158met; met158met). However, the implications of these polymorphisms on post-stroke UL motor improvement specifically have not yet been elucidated.
UNASSIGNED: Examine the influence of genetic polymorphism on post-stroke UL motor improvement.
UNASSIGNED: Systematic
Review and Meta-Analysis.
UNASSIGNED: We conducted a systematic search of the literature published in English language. The modified Downs and Black checklist helped assess study quality. We compared change in UL motor impairment and activity scores between individuals with and without the polymorphisms. Meta-analyses helped assess change in motor impairment (Fugl Meyer Assessment) scores based upon a minimum of 2 studies/time point. Effect sizes (ES) were quantified based upon the Rehabilitation Treatment Specification System as follows: small (0.08-0.18), medium (0.19 -0.40) and large (≥0.41).
UNASSIGNED: We retrieved 10 (4 good and 6 fair quality) studies. Compared to those with BDNF val66met and met66met polymorphism, meta-analyses revealed lower motor impairment (large ES) in those without the polymorphism at intervention completion (0.5, 95% CI: 0.11-0.88) and at retention (0.58, 95% CI:0.06-1.11). The presence of CoMT val158met or met158met polymorphism had similar results, with lower impairment (large ES ≥1.5) and higher activity scores (large ES ranging from 0.5-0.76) in those without the polymorphism. Presence of APOEε4 form did not influence UL motor improvement.
UNASSIGNED: Polymorphisms with the presence of 1 or 2 met alleles in BDNF and COMT negatively influence UL motor improvement.
UNASSIGNED: https://osf.io/wk9cf/.
This research paper focuses on the impact of variations in DNA sequence in certain genes on improvement seen in the arms in people who have had a stroke. In this study, we studied the role of 3 genes previously identified as having variations in DNA sequence. The authors searched published research articles from 2000 onwards and selected articles that satisfied certain criteria. We then checked the quality of the selected papers. Next, we combined common data from same tests used to examine motor improvement in the arms to check if there was an overall effect. A total of 10 papers were found. The selected articles were either good or moderate in quality. Variations in DNA structure in 2 out of the 3 genes studied affected the ability to improve the use of the arms in daily life after a stroke. Such information can have important implications in the extent of recovery that is possible after a stroke. It can also be helpful to decide the best rehabilitation options that can be offered to help maximize their ability to use the arms after a stroke.