Dyskinesias

运动障碍
  • 文章类型: Journal Article
    主动运动量表(AMS)是一个简短的屏幕,用于识别影响功能任务表现的运动障碍。
    为了评估评分者之间的可靠性,测试-重测可靠性,地板和天花板效果,以及AMS在患有肌肉骨骼疾病的成年人中的并发有效性。
    从物理治疗过渡的55名受试者(平均年龄:61.3±15.3岁)参加了两次会议。14项AMS由两名治疗师评估,产生总分(AMST)和两个子得分:上半身(AMSU)和下半身(AMSL)。此外,受试者完成了PROMIS物理功能-10a(PPF),生活方式身体功能(LPF),心血管活动水平(CAL)调查,两方敏捷性测试(TSAT),操纵车削(WRMT)和放置(WRMP)的工作率,握力(GS),通常10米步行(GSU)和快速(GSF)步速,和槽板放置(3GPP)和移除(GPR)测试。
    AMST的评估者间可靠性系数,AMSU,和AMSL分别为0.96、0.92和0.96,个别项目的可靠性范围从0.58到1.0。这些评估的重测可靠性产生的系数为0.93、0.84和0.94,单个项目的可靠性范围为0.47至0.88。没有观察到地板效应,但注意到轻微的天花板效应。AMST与LPF呈高度相关(r=0.72),与PPF呈中度相关(r=0.64)。AMSU与3GPP(r=0.61)和WRMP(r=0.57)测试有中等相关性,而AMSL与GSF(r=0.55)和TSAT(r=0.50)测试中度相关。
    这项研究提供了AMS在患有肌肉骨骼疾病的成年人中的可靠性和有效性的证据,以支持康复和健身计划之间的过渡。
    UNASSIGNED: The Active Movement Scale (AMS) is a brief screen for identifying movement impairments affecting functional task performance.
    UNASSIGNED: To assess inter-rater reliability, test-retest reliability, floor and ceiling effects, and concurrent validity of the AMS in adults with musculoskeletal disorders.
    UNASSIGNED: Fifty-five subjects (mean age: 61.3±15.3 years) transitioning from physical therapy attended two sessions. The 14-item AMS was assessed by two therapists, resulting in a total score (AMST) and two sub-scores: upper body (AMSU) and lower body (AMSL). Moreover, subjects completed PROMIS Physical Function-10a (PPF), Lifestyle Physical Function (LPF), Cardio Activity Level (CAL) surveys, Two Square Agility Test (TSAT), WorkAbility Rate of Manipulation Turning (WRMT) and Placing (WRMP), Grip Strength (GS), 10-Meter Walk Usual (GSU) and Fast (GSF) pace, and Grooved Pegboard Placing (GPP) and Remove (GPR) tests.
    UNASSIGNED: Inter-rater reliability coefficients for AMST, AMSU, and AMSL were 0.96, 0.92, and 0.96, respectively, with individual item reliability ranging from 0.58 to 1.0. Test-retest reliability for these assessments yielded coefficients of 0.93, 0.84, and 0.94, with individual item reliability ranging from 0.47 to 0.88. No floor effects were observed, but mild ceiling effects were noted. AMST showed a high correlation with LPF (r = 0.72) and moderate correlation with PPF (r = 0.64) surveys. AMSU had moderate correlations with GPP (r = 0.61) and WRMP (r = 0.57) tests, while AMSL correlated moderately with GSF (r = 0.55) and TSAT (r = 0.50) tests.
    UNASSIGNED: This study provides evidence of the reliability and validity of AMS in adults with musculoskeletal disorders to support transitions between rehabilitation and fitness programs.
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  • 文章类型: Journal Article
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  • 文章类型: Journal Article
    目的:我们的目的是获得关于两种儿茶酚-O-甲基转移酶抑制剂(COMT-i)与无COMT-i治疗晚期帕金森病患者的成本效益的科学证据。
    方法:决策树的混合模型和按OFF时间水平具有三种健康状态的马尔可夫模型(<25%,≥25%,和死亡)是为了比较opicapone(OPC),entacapone(ENT),一辈子都没有COMT-i。根据BIPARK试验受试者的特征,创建并模拟了一个由10,000名患者组成的假设队列。
    结果:与没有COMT-i相比,两个COMT-i(OPC和ENT)被确定为具有成本效益的选择。概率敏感性分析表明,超过90%的模拟证明了COMT-i的强大成本效益。当作为最有影响因素的时间范围减少到5年和10年时,COMT-i可以是节省成本的选择。尽管ENT在经济上可能是OPC的首选,因为它的价格较低,如果药品价格降低17%,OPC是可以接受的。
    结论:与不使用COMT-i相比,接受左旋多巴/卡比多巴的PD患者使用COMT-i的附加治疗似乎可以节省成本。在未来,有必要基于长期的现实证据来评估COMT-i的经济评价。
    OBJECTIVE: We aimed to elicit scientific evidence on the cost-effectiveness of two catechol-O-methyltransferase inhibitors (COMT-i) versus no COMT-i in patients with advanced Parkinson\'s disease.
    METHODS: A mixed model of the decision tree and a Markov model with three health states by OFF-time level (<25%, ≥25%, and death) was constructed to compare opicapone (OPC), entacapone (ENT), and no COMT-i over a lifetime. A hypothetical cohort of 10,000 patients was created and simulated based on the characteristics of the BIPARK trial subjects.
    RESULTS: Two COMT-i (OPC and ENT) were identified as a cost-effective option compared to no COMT-i. Probabilistic sensitivity analysis showed that over 90% of the simulations proved the robust cost-effectiveness of COMT-i. When the time horizon as the most influential factor decreases to a 5- and 10-year period, COMT-i can be a cost-saving option. Although ENT may be the preferred option over OPC economically because of its lower price, OPC can be acceptable if the drug price is reduced by 17%.
    CONCLUSIONS: Add-on treatment with COMT-i in patients with PD receiving levodopa/carbidopa appears to be cost-saving compared with not using COMT-i. In the future, it is necessary to evaluate the economic evaluation of COMT-i based on long-term real-world evidence.
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  • 文章类型: Journal Article
    UNASSIGNED: To compare the dopamine transporter (DAT) density with other risk factors for L-DOPA-induced dyskinesia (LID) in patients with Parkinson\'s disease (PD), with and without LID.
    UNASSIGNED: We evaluated 67 subjects: 44 patients with idiopathic PD of varying degrees of severity (PD group), and 23 healthy age-matched volunteers (control group). Among the 44 patients in the PD group, 29 were male and the following means were recorded at baseline: age, 59 ± 7 years; disease duration, 10 ± 6 years; Hoehn and Yahr (H&Y) stage, 2.16 ± 0.65; and Unified Parkinson\'s Disease Rating Scale part III (UPDRS III) score, 29.74 ± 17.79. All subjects underwent 99mTc-TRODAT-1 SPECT. We also calculated specific uptake ratios or binding potentials in the striatum.
    UNASSIGNED: The DAT density in the ipsilateral and contralateral striata was lower in the PD group. The variables disease duration, L-DOPA dosage, doses per day, L-DOPA effect duration time, H&Y stage, and UPDRS III score explained the occurrence of LID. The DAT density in the ipsilateral striatum, contralateral striatum, and caudate nucleus was lower in the patients with LID than in those without.
    UNASSIGNED: Our findings suggest that presynaptic dopaminergic denervation is associated with LID in individuals with PD.
    UNASSIGNED: Comparar a densidade do transportador de dopamina (DAT) com outros fatores de risco para discinesia induzida pela L-DOPA em pacientes com doença de Parkinson, com e sem discinesias.
    UNASSIGNED: Sessenta e sete sujeitos, 23 voluntários saudáveis e 44 pacientes pareados por idade com diferentes graus de gravidade da doença de Parkinson idiopática (29 homens; idade média ± desvio-padrão (DP), 59 ± 7 anos; duração média ± DP dos sintomas, 10 ± 6 anos; H&Y: média ± DP, 2,16 ± 0,65; UPDRS III: média ± DP, 29,74 ± 17,79). Todos os sujeitos realizaram SPECT cerebral com 99mTc-TRODAT-1. Além disso, foram calculadas as taxas de captação específica ou potenciais de ligação no estriado.
    UNASSIGNED: A densidade de DAT do estriado ipsilateral ou contralateral foi menor no grupo doença de Parkinson. As variáveis duração da doença, dosagem de L-DOPA, doses por dia, tempo de duração do efeito da L-DOPA, H&Y e UPDRS III explicaram a ocorrência de discinesia. Adicionalmente, pacientes com discinesia exibiram menor densidade de DAT no estriado ipsilateral ou contralateral e no núcleo caudado do que os pacientes sem discinesia.
    UNASSIGNED: O presente estudo sugere que a denervação dopaminérgica pré-sináptica na doença de Parkinson está associada ao desenvolvimento de discinesia induzida pela L-DOPA.
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  • 文章类型: Case Reports
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  • 文章类型: Journal Article
    背景:运动障碍是中风最常见的并发症之一。针刺疗法(AT)和镜像疗法(MT)是治疗中风后运动障碍的有希望的康复措施。尽管一些研究表明AT和MT对运动障碍是有效和安全的,的影响,由于缺乏强有力的证据,安全性仍然不确定。目的探讨AT联合MT治疗脑卒中后运动障碍的疗效和安全性。
    方法:我们搜索了以下数据库:PubMed,WebofScience,科克伦图书馆,EMBASE,Medline,中国知网,万方,和中国生物医学文献数据库,从开始到2023年1月1日,以确定符合条件的研究。总有效率,Fugl-Meyer评估量表(FMA)上肢和下肢评分,修改后的Barthel指数得分,伯格平衡量表,改良的Ashworth秤,并以不良反应作为结局指标。2名独立评审员使用建议评估开发和评估系统来评估研究中包含的结果指标的证据质量。采用RevManV.5.4软件进行统计分析。
    结果:共纳入24项随机对照研究,包括2133例脑卒中后运动障碍患者。AT联合MT治疗脑卒中后运动障碍的总有效率更有优势(相对危险度=1.31,95%置信区间[CI][1.22-1.42],Z=6.96,P<.0001)。AT联合MT对FMA上肢评分更有利(平均差[MD]=6.67,95%CI[5.21-8.13],Z=8.97,P<.00001)和FMA下肢评分(MD=3.72,95%CI[2.81-4.63],Z=7.98,P<.00001)。Meta分析显示,AT联合MT治疗脑卒中后运动障碍的改良Barthel指数评分更有优势(MD=9.51,95%CI[7.44-11.58],Z=9.01,P<.00001)。
    结论:AT联合MT可有效改善患者的运动功能和日常生活能力。尤其是改善肌肉痉挛.然而,鉴于评估结果的证据质量较低,因此应谨慎对待这些结果。
    BACKGROUND: Dyskinesia is one of the most common complications of stroke. Acupuncture therapy (AT) and mirror therapy (MT) are promising rehabilitation measures for the treatment of post-stroke dyskinesia. Although some studies suggested that AT and MT are effective and safe for dyskinesia, the effects, and safety remain uncertain due to lacking strong evidence. The purpose of this study is to investigate the efficacy and safety of AT combined with MT in the treatment of post-stroke dyskinesia.
    METHODS: We searched the following databases: PubMed, Web of Science, Cochrane Library, EMBASE, Medline, China Knowledge Network, WANFANG, and China Biomedical Literature Database, from inception to 1 January 2023 to identify eligible studies. Total effective rate, the Fugl-Meyer assessment scale (FMA) upper and lower limb scores, modified Barthel index scores, Berg balance scale, modified Ashworth scale, and adverse reactions were adopted as outcome indicators. The Grading of Recommendations Assessment Development and Evaluation system was used by 2 independent reviewers to assess the quality of evidence for the outcome indicators included in the study. The statistical analysis was conducted by RevMan V.5.4 software.
    RESULTS: A total of 24 randomized controlled studies included 2133 patients with post-stroke dyskinesia were included. The total effective rate of AT combined with MT was more advantageous in the treatment of post-stroke dyskinesia (relative risk = 1.31, 95% confidence interval [CI] [1.22-1.42], Z = 6.96, P < .0001). AT combined with MT was more advantageous for FMA upper limb score (mean difference [MD] = 6.67, 95% CI [5.21-8.13], Z = 8.97, P < .00001) and FMA lower limb score (MD = 3.72, 95% CI [2.81-4.63], Z = 7.98, P < .00001). Meta-analysis showed that AT combined with MT for post-stroke dyskinesia had a more advantageous modified Barthel index score (MD = 9.51, 95% CI [7.44-11.58], Z = 9.01, P < .00001).
    CONCLUSIONS: AT combined with MT is effective in improving motor function and daily living ability of patients, especially in improving muscle spasms. However, these results should be regarded with caution given the low quality of evidence for the evaluation results.
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  • 文章类型: Systematic Review
    目的:了解肩胛骨肌肉在肩胛骨发育不良(SD)的头顶运动员中的主要表现。
    方法:系统评价。
    方法:在Pubmed(MedLine)中进行电子搜索,Embase,CINAHL,和SPORTDiscus数据库。
    方法:具有SD的高架运动员。
    方法:上部(UT)的肌电图活动,中间(MT),和下(LT)斜方肌,和前锯肌(SA)。
    结果:本综述纳入了8项研究。与45°相比,UT活性显示出主要在90°以上的任务期间倾向于增加其活性。SA活性也有类似的行为,主要是在等距任务期间。与较低的角度相比,MT还主要在具有高架角度的任务中增加了其活动。在患有SD的高架运动员中,LT激活倾向于在60°以下的角度降低其EMG活性。
    结论:非运动员的UT和SA的EMG行为似乎与文献中已经描述的不同。在患有SD的头顶运动员中,MT似乎是肩胛骨稳定最被忽视的肌肉。LT活动的减少表明这可能对这些运动员的表现产生影响。
    OBJECTIVE: Understanding how the main scapular muscles behave in overhead athletes with scapular dyskinesis (SD).
    METHODS: Systematic Review.
    METHODS: Electronic searches were performed in Pubmed (MedLine), Embase, CINAHL, and SPORTDiscus databases.
    METHODS: Overhead athletes with SD.
    METHODS: Electromyographic activity of the upper (UT), middle (MT), and lower (LT) trapezius, and serratus anterior (SA).
    RESULTS: Eight studies were included in this review. The UT activity showed a tended to increase its activity mainly during tasks over 90° compared to 45°. SA activity had similar behavior, mainly during isometric tasks. The MT also increased its activity mainly in tasks with overhead angulations when compared to lower angulations. The LT activation tended to decrease its EMG activity at angulations below 60° in overhead athletes with SD.
    CONCLUSIONS: The EMG behaviour of UT and SA for non-athletes appears to differ from what has already been described in the literature. The MT seems to be the most neglected muscle for scapular stabilization in overhead athletes with SD. The decrease in LT activity suggests that this may have implications for the performance of these athletes.
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  • 文章类型: Journal Article
    背景:无症状的运动员普遍存在肩胛骨发育不良,特别是那些参与开销活动的人,并且会显著影响他们的神经肌肉控制。这些变化可能会损害上肢功能和力量,增加受伤的风险。因此,必须研究肩胛骨皮肤发育不良如何影响肩部本体感觉,上肢动态稳定性,和头顶运动员的握力。这项研究比较了有和没有肩胛骨发育不良的高架运动员的这些参数。
    方法:该研究包括20名无症状的专业头顶运动员肩胛骨发育不良和20名无肩胛骨发育不良,使用肩胛骨外侧滑动试验确定。在这项横断面研究中,肩部活动关节位置感,作为肩膀本体感受,使用等速测功机测量。使用上部四分之一改进的星形偏移平衡测试(UQ-mSEBT)和手持式测力计评估上肢动态稳定性和手握力。
    结果:研究发现,与无肩胛骨发育不全组相比,肩胛骨发育不全组的肩关节活动位置感明显较低(外旋转=0.003,内旋转<0.001,前屈=0.002)。然而,两组在UQ-mSEBT和握力评分方面无显著差异.
    结论:结果表明,肩胛骨脱位会影响无症状头顶运动员的肩关节活动位置感。然而,不影响其上肢动态稳定性和手握力。
    BACKGROUND: Scapular dyskinesis is prevalent among asymptomatic athletes, particularly those involved in overhead activities, and can significantly impact their neuromuscular control. These changes may impair upper extremity function and strength, elevating the risk of injury. Therefore, it is imperative to investigate how scapular dyskinesis affects shoulder proprioception, upper extremity dynamic stability, and hand grip strength in overhead athletes. This study compared these parameters between overhead athletes with and without scapular dyskinesis.
    METHODS: The study included twenty asymptomatic professional overhead athletes with scapular dyskinesis and twenty without scapular dyskinesis, identified using the lateral scapular slide test. In this cross-sectional study, shoulder active joint position sense, serving as shoulder proprioception, was measured using an isokinetic dynamometer. Upper extremity dynamic stability and hand grip strength were evaluated using an upper quarter modified star excursion balance test (UQ-mSEBT) and a handheld dynamometer.
    RESULTS: The study found that the shoulder active joint position sense was significantly lower in the scapular dyskinesis group compared to the group without scapular dyskinesis (PExternal Rotation = 0.003, PInternal Rotation < 0.001, and PForward Flexion = 0.002). However, the two groups had no significant differences in UQ-mSEBT and hand grip strength scores.
    CONCLUSIONS: The results showed that scapular dyskinesis could affect the sense of shoulder active joint position among asymptomatic overhead athletes. However, it did not affect their upper extremity dynamic stability and hand grip strength.
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  • DOI:
    文章类型: Journal Article
    目的:肩胛骨皮肤发育不良是导致肩关节紊乱的原因之一,与前锯肌肌无力有关。这项研究调查了汽车单位(MU)是否招募和射击财产,这对肌肉锻炼很重要,在肩胛骨皮肤发育不良的个体的前锯齿中发生了改变。
    方法:分析了有(SD)和没有(对照)肩胛骨发育不良的无症状成年人。在前锯肌的次最大自愿收缩时收集表面肌电图(sEMG)波形。将sEMG波形分解为MU动作电位振幅(MUAPAMP),平均激发率(MFR),招聘门槛。MU分为低位,中度,和高门槛,比较了各组的MU招募和解雇属性。
    结果:高阈值MUAPAMP在SD组明显小于对照组。对照组还展示了反映规模原则的招聘属性,然而,SD组没有。此外,SD组的MFR低于对照组。
    结论:肩胛骨皮肤发育不良患者表现出改变的MU募集特性和较低的前锯肌放电率;这可能对肌肉性能有害。因此,在矫正肩胛骨发育不全时,可能需要改善前锯齿肌的神经驱动。
    OBJECTIVE: Scapular dyskinesis is one of the causes of shoulder disorders and involves muscle weakness in the serratus anterior. This study investigated whether motor unit (MU) recruitment and firing property, which are important for muscle exertion, have altered in serratus anterior of the individuals with scapular dyskinesis.
    METHODS: Asymptomatic adults with (SD) and without (control) scapular dyskinesis were analyzed. Surface electromyography (sEMG) waveforms were collected at submaximal voluntary contraction of the serratus anterior. The sEMG waveform was decomposed into MU action potential amplitude (MUAPAMP), mean firing rate (MFR), and recruitment threshold. MUs were divided into low, moderate, and high thresholds, and MU recruitment and firing properties of the groups were compared.
    RESULTS: High-threshold MUAPAMP was significantly smaller in the SD group than in the control group. The control group also exhibited recruitment properties that reflected the size principle, however, the SD group did not. Furthermore, the SD group had a lower MFR than the control group.
    CONCLUSIONS: Individuals with scapular dyskinesis exhibit altered MU recruitment properties and lower firing rates of the serratus anterior; this may be detrimental to muscle performance. Thus, it may be necessary to improve the neural drive of the serratus anterior when correcting scapular dyskinesis.
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  • 文章类型: Case Reports
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