Effects of central pathway and postural control technique on stroke patients: a randomized controlled trial

Effects of central pathway and postural control technique on stroke patients: a randomized controlled trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effects of central pathway and postural control technique on stroke patients: a randomized controlled trial Weichun He, Ke Li, Hongyu Li, Ning Xu, Ning Zhu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3025335/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective We investigated the effects of central pathway and postural control (CPPC) technique on motor function, balance function, activities of daily living, degree of neurological deficit, nerve cytokine content and hemorheology indexes of stroke patients. Method 78 stroke patients were randomly divided into an experimental group added the CPPC technique on the basis of routine rehabilitation therapy and a control group receiving routine rehabilitation therapy. All interventions were 1 time / day for 50 days in both groups. Outcome measures were collected at baseline and post-intervention. The primary outcome measures included the National Institutes of Health Stroke Scale (NIHSS) and the Fugel-Meyer assessment scale (FMA). The secondary outcome measures included Berg Balance Scale (BBS), Tinetti Balance and Gait Analysis, Barthel Index (BI), neuronal cytokine content and hemorheological Indices. Result The results of this study show that NIHSS scores of the two groups decreased and FMA scores increased after treatment. Compared with before treatment, BBS score, Tinetti score and the scores of each item of BI scale of the two groups were increased, and there were significant differences between the two groups. The content of NT-3 and NGF in serum of the two groups increased and the hemorheology indexes of HBV, LBV, PV, HCT and fibrinogen decreased after treatment, and there were significant differences between the two groups. Conclusions The CPPC technique can alleviate limb dysfunction and motor limitation and can improve balance function, activities of daily life and blood circulation in stroke patients. The CPPC technique is a promising method for future neuropsychological research and can also be used in clinical treatment of stroke patients. CPPC technique stroke motor function rehabilitation 1. Introduction Postural control and balance dysfunction is a common problem after stroke, which is associated with decreased mobility and limited activities of daily living, and is one of the main risk factors for falls after stroke[ 1 ]. The training and improvement of postural control ability is of great value to stroke patients, which is one of the focuses and hot spots of current research[ 2 , 3 ]. The Rehabilitation Medical Center of West China Hospital of Sichuan University proposed central pathway and postural control (CPPC) technique on the basis of integrating global neurorehabilitation physical therapy technologies[ 4 ]. The CPPC technique applies neuroscience theory to explain and analyze the patient's dysfunction. The core is the internal mechanism and external manifestation of the central nervous conduction pathway of postural control. In addition, the CPPC technique is a postural control-centered rehabilitation therapy based on central activation and inhibition, and carried out through various forms such as rehabilitation training and neuroregulation. It has good curative effect and application prospect. The goal of the current study was to investigate the effects of CPPC technique on motor function, balance function, activities of daily living, degree of neurological deficit, nerve cytokine content and hemorheology indexes of stroke patients. 2. Materials and methods 2.1 General information This study included 78 stroke patients admitted to the General Hospital of Ningxia Medical University from October 2020 to October 2021. The patients were randomly divided into an experimental group and a control group by using a computer-generated random number of sequences. An investigator who was not involved in the assessment, treatment or statistical analysis conducted the randomization. All subjects signed an informed consent form, which was reviewed and approved by the Ethics Committee of the General Hospital of Ningxia Medical University. We applied the following diagnostic criteria: All of them met the diagnostic criteria of stroke in the Diagnostic Points of Major Types of Cerebrovascular Diseases in China, and were confirmed by brain CT. Our inclusion criteria were: 1. All vital signs are stable; 2. All patients gave informed consent to this study, and a written agreement was reached on each item. Our exclusion criteria were: 1. Inability to perform basic communication; 2. Accompanied by serious injury of heart, liver and kidney function, malignant tumor, etc. 3. Patients from the clinical trial who were not able to complete all required procedures for any reason. A total of 39 patients in the experimental group and 39 patients in the control group completed the treatment. In the control group, there were 22 males and 17 females with an average age of 57.52 ± 4.81 years (range, 43–72 years). There were 15 cases with hypertension, 13 cases with diabetes and 11 cases with hyperlipidemia. There were 21 males and 18 females in the experimental group, with an average age of 57.96 ± 4.73 years (range, 45–69 years). There were 16 cases with hypertension, 14 cases with diabetes and 9 cases with hyperlipidemia. There were no significant differences in sex, age, and other general characteristics between the two groups (P > 0.05). 2.2 Interventions The control group received general rehabilitation therapy. Inform the patient of the importance and necessity of early and systematic rehabilitation treatment and mobilize the patient to participate actively in the rehabilitation treatment process. Assisted patients with good limb position placement and performed early joint movement, such as arm lift extension movement, leg extension and flexion movement, etc., 20min / time, 1 time / d. Patients were instructed to practice sitting exercises on their own initiative as their condition stabilized. After the patient can master sitting training, guide the patient to stand appropriately and gradually transition from static training to dynamic training, such as walking training, bed chair transfer training, etc., can adopt crutches, orthoses, AIDS, etc. if necessary. And with the help of rehabilitation therapists, exercise the life must skills one by one, such as washing the face, brushing teeth, hair brushing, etc., to improve self-care ability. It can be used to stimulate the patient's senses by reading, watching television and other ways. It is recommended that the family of the patient communicate with the patient often, exercise the patient's memory, thinking ability, improve cognition, language function and so on. The experimental group added the CPPC technique on the basis of routine rehabilitation therapy. The CPPC technique mainly consists of two parts. The first part is manual rehabilitation training. Rehabilitation training of patients by therapists based on correct sensory input is one of the common treatments used in CPPC technique and is mainly achieved by relying on postural control (PC) maneuvers. PC technique refers to the manipulation method by which the therapist induces a correct postural response and improves the ability of postural control based on sensory input. The main points include an emphasis on correct sensory motor induction, respiratory control training, core stabilization and trunk control training, balance function training, mobility training, and gait correction. The other part is the neuromodulation technique. CPPC technology emphasizes improved patient function through multiple modalities of postural regulation such as rehabilitation training and neuromodulation, including transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). All interventions were 1 time / day for 50 days in both groups. 2.3 Outcome measures Outcome measures were collected at baseline (pre intervention; 2 days before the first session) and post-intervention (1 day after the last session). 2.3.1 Primary outcomes The primary outcome measures included the National Institutes of Health Stroke Scale (NIHSS) and the Fugel-Meyer assessment scale (FMA). NIHSS: total score 42 points, with 0–1 as normal, 1–4 as mild stroke, 5–14 as moderate stroke, 15–20 as moderate severe stroke, and 21–42 as severe stroke. FMA: FMA is one of the commonly used scales for motor function assessment in stroke patients. It included both upper and lower limbs, and the total score was 100 points. The specific grading was as follows: severe < 50 points, severe 50–85 points, moderate 86–95 points, mild 96–99 points, and normal 100 points. 2.3.2 Secondary outcomes The secondary outcome measures included Berg Balance Scale (BBS), Tinetti Balance and Gait Analysis, Barthel Index (BI), neuronal cytokine content and hemorheological Indices. BBS: BBS is a comprehensive scale for the evaluation of body balance function. It divides the balance function into 14 items from easy to difficult, and each item is divided into 5 levels, namely 0, 1, 2, 3 and 4 points. The maximum total score is 56 points and the minimum score is 0 points. Tinetti Balance and Gait Analysis: The Tinetti scale mainly evaluates the dynamic balance ability of patients during activities, including balance (full score: 16 points) and gait (full score: 12 points). If the total score is less than 24 points, it indicates that there is balance dysfunction; if the total score is less than 15 points, it indicates that there is a risk of falling. BI: BI mainly includes 10 evaluation items, with a full score of 100, reflecting the independence of patients' activities of daily living ability. Neuronal cytokine content: Fasting venous blood was collected before and 50 days after treatment. After centrifugation at a radius of 8cm and 2500r/min for 10min, serum was taken and the contents of neurotrophin-3 (NT-3) and nerve growth factor (NGF) in blood were detected by enzyme-linked immunosorbent assay. Hemorheological Indices: Fasting venous blood was collected before and 50 days after treatment. Blood analyzer was used to detect high shear viscosity (HBV), low shear viscosity (LBV), plasma viscosity (PV), hematocrit (HCT) and fibrinogen. 2.4 Statistical methods Statistical analysis was performed using SPSS 22.0 software, and measurement data were expressed as. The measurement data were tested for normality using the K-S normality test. Differences within groups were analyzed using paired sample t-tests, and differences between groups were analyzed using independent sample t-tests. Count data were analyzed using chi-square tests. P < 0.05 was considered statistically significant. 3. Results 3.1 Results of primary outcomes Compared with before treatment, NIHSS scores of the two groups decreased and FMA scores increased after treatment, and there were significant differences between the two groups (P < 0.05). See Table 1 . Table 1 Comparison of NIHSS and FMA scores between the two groups (Unit: Score), x̄ ± s Group n NIHSS FMA Before After Before After Control 39 14.94 ± 3.12 12.49 ± 2.47 57.51 ± 22.42 61.73 ± 21.69 Experimental 39 14.96 ± 3.23 11.05 ± 2.01 57.72 ± 22.69 75.33 ± 21.48 t 0.028 2.824 0.041 2.782 p 0.978 0.006 0.967 0.007 [ Table 1 near here] 3.2 Results of secondary outcomes Compared with before treatment, BBS score and Tinetti score of the two groups were increased after treatment, and there were significant differences between the two groups (P < 0.05). See Table 2 . Table 2 Comparison of BBS and Tinetti scores between the two groups (Unit: Score), x̄ ± s Group n BBS Tinetti Before After Before After Control 39 38.25 ± 5.62 42.81 ± 5.32 16.52 ± 2.51 19.75 ± 1.68 Experimental 39 38.28 ± 5.64 46.89 ± 6.31 16.58 ± 2.53 20.91 ± 1.51 t 0.024 3.087 0.105 3.207 p 0.981 0.003 0.917 0.002 [ Table 2 near here] Compared with before treatment, the scores of each item of BI scale in the two groups were improved, and there were significant differences between the two groups (P < 0.05). See Table 3 . Table 3 Comparison of BI scores between the two groups (Unit: Score), x̄ ± s Items Group Before t p After t p Dressing Control(n = 39) 4.36 ± 3.54 0.025 0.98 5.02 ± 2.21 2.695 0.009 Experimental(n = 39) 4.34 ± 3.49 6.18 ± 1.53 Bathe Control(n = 39) 3.47 ± 1.24 0.036 0.971 5.43 ± 1.34 2.815 0.006 Experimental(n = 39) 3.46 ± 1.21 6.32 ± 1.45 Eating Control(n = 39) 4.62 ± 3.02 0.13 0.897 5.05 ± 3.11 2.687 0.009 Experimental(n = 39) 4.71 ± 3.08 6.93 ± 3.07 Go to the toilet Control(n = 39) 4.42 ± 3.71 0.012 0.991 5.03 ± 3.08 2.684 0.009 Experimental(n = 39) 4.43 ± 3.69 6.86 ± 2.94 Defecate Control(n = 39) 4.68 ± 2.62 0.1 0.921 5.05 ± 3.23 2.69 0.009 Experimental(n = 39) 4.62 ± 2.69 6.94 ± 2.97 Urinate Control(n = 39) 4.52 ± 2.71 0.033 0.974 5.02 ± 3.01 2.661 0.009 Experimental(n = 39) 4.54 ± 2.72 6.81 ± 2.93 Bed chair transfer Control(n = 39) 3.45 ± 3.37 0.026 0.979 5.05 ± 3.09 2.672 0.009 Experimental(n = 39) 3.47 ± 3.36 6.86 ± 2.89 Make up Control(n = 39) 4.14 ± 2.26 0.02 0.984 5.04 ± 3.07 2.684 0.009 Experimental(n = 39) 4.13 ± 2.25 6.87 ± 2.95 Stair activity Control(n = 39) 4.45 ± 3.43 0.026 0.979 5.14 ± 2.06 3.15 0.002 Experimental(n = 39) 4.47 ± 3.42 6.98 ± 3.01 Walking on flat ground Control(n = 39) 4.22 ± 3.33 0.013 0.989 5.08 ± 2.89 2.725 0.008 Experimental(n = 39) 4.21 ± 3.35 6.92 ± 3.07 [ Table 3 near here] Compared with before treatment, the content of NT-3 and NGF in serum of the two groups were increased after treatment, and there were significant differences between the two groups (P < 0.05). See Table 4 . Table 4 Comparison of neuronal cytokine content between two groups (Unit: ng/L), x̄ ± s Group n NT-3 NGF Before After Before After Control 39 7.16 ± 1.27 9.24 ± 1.71 6.56 ± 1.32 8.27 ± 1.62 Experimental 39 7.17 ± 1.29 10.38 ± 1.83 6.53 ± 1.34 9.29 ± 1.68 t 0.034 2.824 0.1 2.729 p 0.973 0.006 0.921 0.008 [ Table 4 near here] Compared with before treatment, the hemorheology indexes of HBV, LBV, PV, HCT and fibrinogen in the two groups decreased after treatment, and there were significant differences between the two groups (P < 0.05). See Table 5 . Table 5 Comparison of hemorheology indexes between two groups, x̄ ± s Group n HBV(mPa·s) LBV(mPa·s) PV(mPa·s) HCT(%) Fibrinogen(g/L) Before After Before After Before After Before After Before After Control 39 6.21 ± 1.45 4.72 ± 1.16 10.78 ± 2.32 9.36 ± 2.26 3.41 ± 0.79 2.57 ± 0.63 43.39 ± 8.71 39.35 ± 7.75 3.93 ± 0.71 2.45 ± 0.74 Experimental 39 6.23 ± 1.49 3.95 ± 0.98 10.99 ± 2.34 8.03 ± 2.03 3.37 ± 0.84 2.23 ± 0.37 43.32 ± 8.68 34.31 ± 8.02 3.95 ± 0.68 2.03 ± 0.47 t 0.06 3.167 0.398 2.734 0.217 2.906 0.036 2.822 0.127 2.992 p 0.952 0.002 0.692 0.008 0.829 0.005 0.972 0.006 0.899 0.004 [ Table 5 near here] 4. Discussion Due to the different pathogenesis of stroke patients, the timing and severity of the onset affect their prognosis. Clinical treatment focuses on early detection, early diagnosis, early recovery, and prevention of recurrence. In the clinical rehabilitation treatment process, multiple intervention measures are comprehensively applied, but most patients have left varying degrees of dysfunction, so it is particularly important to seek more effective treatment methods[ 5 – 7 ]. The results of this study show that NIHSS scores of the two groups decreased and FMA scores increased after treatment. The results suggest that the CPPC technique can alleviate limb dysfunction and motor limitation in stroke patients. Compared with before treatment, BBS score, Tinetti score and the scores of each item of BI scale of the two groups were increased, and there were significant differences between the two groups. The results suggest that the CPPC technique can improve balance function and activities of daily life in stroke patients. The CPPC technology is mainly based on the principle of posture control, explaining and analyzing patient dysfunction, and focusing on posture control for rehabilitation treatment to improve patient function. Sports behavior is determined by the interaction between the motion target, the reason for executing the motion, and the mechanical stability mediated by posture control[ 8 ]. Posture control plays an important role in maintaining body balance and adjusting movements[ 9 ]. Posture control is a complex process in which the body's proprioceptive, visual, and vestibular systems input and integrate into the central nervous system to form a body schema, in order to maintain body orientation and stability[ 10 ]. Good posture control can adapt various segments of the body to different environmental posture orientations, and maintain the static and dynamic stability of the body during movement. When the human body is faced with predictable or sudden internal and/or external postural disturbances, the central nervous system's response and regulation of the body's postural muscles mainly include three regulatory mechanisms: anticipatory postural adjustment (APA), anticipatory synergy adjustment (ASA) and compensatory postural adjustment (CPA)[ 11 ]. APAs and ASAs both belong to feed-forward mechanisms of postural control acting when a standing person is subjected to a predictable, frequently self-initiated, perturbation. APAs are commonly described as unconscious muscular activities aimed to counterbalance the perturbation caused by the primary movement, so as to ensure the whole-body balance, as well as contributing to initiate the displacement of the body center of mass when starting gait or whole-body reaching movements[ 12 ]. APAs can prevent mechanical disturbances caused by local motion. Without proper balance, these interferences can affect the correct execution of random movements. ASAs are seen prior to self-triggered unloading with known and unknown direction of the perturbation[ 13 ]. During whole-body tasks performed by standing persons, ASAs represent changes in an index of a multi-muscle synergy stabilizing the coordinate of the center of pressure (COP). Such changes may be seen in young, healthy persons about 200–300 ms prior to the action initiation, significantly earlier than APAs[ 14 , 15 ]. ASAs facilitates a change in a salient performance variable, such as COP coordinate, and allows the actor to avoid fighting one’s own synergies stabilizing that variable. CPAs are the recovery process that occur after patients have already lost balance. CPAs mainly include hip strategy, knee strategy, and ankle strategy. Research has shown that core stability exercises are of great significance in improving APAs control, fear of falls, trunk function, standing balance, and mobility in patients with hemiplegic stroke[ 16 , 17 ]. A significant and strong positive association exists among trunk control, core muscles strength and balance confidence in community-dwelling patients with chronic stroke[ 18 ]. And using neuromodulatory techniques (e.g. rTMS, tDCS) to supress neural activation of the supplementary motor area (SMA) could affect the timing and amplitude of APAs[ 19 , 20 ]. It seems likely that the APAs are modulated at cortical level, supporting a feedforward model of neural control by which the postural adjustments are prepared prior to voluntary movement[ 21 ]. Interventions targeting the neural control of the APAs to the trunk muscles are important for reducing instability and therefore reducing the risk of falls, to which the elderly are particularly vulnerable[ 22 ]. CPPC technique, which focuses on posture control and neural regulation, may improve the motor and balance functions of stroke patients by regulating APAs and related neural circuits. The content of NT-3 and NGF in serum of the two groups increased and the hemorheology indexes of HBV, LBV, PV, HCT and fibrinogen decreased after treatment, and there were significant differences between the two groups. During the onset of stroke, there will be abnormal hemorheology symptoms, such as increased blood viscosity, platelet activation and strong adhesion and aggregation, which will aggravate the brain damage of patients and affect the prognosis[ 23 , 24 ]. The functional activity of the brain is related to its oxygen consumption, and the blood flow of brain tissue can be used to evaluate brain metabolism. The results of this study suggest that CPPC technique can improve blood circulation, prevent vascular blood flow obstruction, alleviate blood supply disorders, increase brain oxygen supply, and thereby improve stroke patient dysfunction. The limitation of this study was no follow-up of patients. However, according to the research results of this paper and previous research, CPPC technique is a promising method for future neuropsychological research, and can also be used in clinical treatment to improve the motor function and quality of life of patients with stroke and reduce the burden on patients and families. In the future, larger sample sizes and multicenter scientific research are needed to provide higher quality theoretical basis for the clinical application of CPPC technique. Declarations Ethics approval and consent to participate All included patients gave their oral and written informed consent. The study was approved by the Ethics Committee of the General Hospital of Ningxia Medical University (reference number 2019-225). Consent for publication All authors have approved this manuscript for publication. This manuscript has not previously been published and is not pending publication elsewhere. Availability of data and materials The datasets supporting the conclusions of this article are included within the article. Competing interests The author(s) declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding This research project was partially supported by the campus level project of Ningxia Medical University (XM2019050). Authors' contributions Li Hongyu performed the data analysis. Xu Ning performed the formal analysis. Zhu Ning performed the validation. He Weichun and Li Ke wrote the manuscript. All authors have read and approve the final manuscript. References Persson CU, Kjellberg S, Lernfelt B, Westerlind E, Cruce M and Hansson P-O. Risk of falling in a stroke unit after acute stroke: The Fall Study of Gothenburg (FallsGOT). Clinical rehabilitation. 2018; 32(3): 398-409. doi 10.1177/0269215517728325. Sorrentino G, Sale P, Solaro C, Rabini A, Cerri CG and Ferriero G. Clinical measurement tools to assess trunk performance after stroke: a systematic review. European journal of physical and rehabilitation medicine. 2018; 54(5): 772-84. doi 10.23736/S1973-9087.18.05178-X. Criekinge TV, Truijen S, Schröder J, Maebe Z, Blanckaert K, Waal Cvd, et al. The effectiveness of trunk training on trunk control, sitting and standing balance and mobility post-stroke: a systematic review and meta-analysis. Clinical rehabilitation. 2019; 33(6): 992-1002. doi 10.1177/0269215519830159. Jiang HH, Wei QC, Ye SQ, Meng LJ, Zhang J, He L, et al. Basic theory and clinical application of central conduction pathway and posture control technology. West China Medical Journal. 2022; 37(05): 680-687. (in chinese) Henderson SJ, Weitz JI and Kim PY. Fibrinolysis: Strategies to enhance the treatment of acute ischemic stroke. J Thromb Haemost. 2018; 16(10): 1932-40. doi 10.1111/jth.14215. Kuriakose D and Xiao Z. Pathophysiology and Treatment of Stroke: Present Status and Future Perspectives. Int J Mol Sci. 2020; 21(20). doi 10.3390/ijms21207609. Barthels D and Das H. Current advances in ischemic stroke research and therapies. Biochim Biophys Acta Mol Basis Dis. 2020; 4(1866): 165260. doi 10.1016/j.bbadis.2018.09.012. Matthis JS, Yates JL and Hayhoe MM. Gaze and the Control of Foot Placement When Walking in Natural Terrain. Curr Biol. 2018; 28(8): 1224-33. doi 10.1016/j.cub.2018.03.008. Cavallari P, Bolzoni F, Bruttini C and Esposti R. The Organization and Control of Intra-Limb Anticipatory Postural Adjustments and Their Role in Movement Performance. Front Hum Neurosci. 2016; 10(525. doi 10.3389/fnhum.2016.00525. Cruz TL, Pérez SM and Chiappe ME. Fast tuning of posture control by visual feedback underlies gaze stabilization in walking Drosophila. Curr Biol. 2021; 31(20): 4596-607. doi 10.1016/j.cub.2021.08.041. Heß T, Oehlwein C and Milani TL. Anticipatory Postural Adjustments and Compensatory Postural Responses to Multidirectional Perturbations-Effects of Medication and Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease. Brain Sci. 2023; 13(3): 454. doi 10.3390/brainsci13030454. Kung C-F, Lai Y-R, Chiu W-C, Lien C-Y, Huang C-C, Cheng B-C, et al. Effectiveness of Center of Pressure Trajectory as Anticipatory Postural Adjustment Measurement in Parkinson's Disease With Freezing of Gait History. Neurorehabilitation and neural repair. 2023; 37(4): 240-50. doi 10.1177/15459683231166934. Piscitelli D, Falaki A, Solnik S and Latash ML. Anticipatory postural adjustments and anticipatory synergy adjustments: preparing to a postural perturbation with predictable and unpredictable direction. Exp Brain Res. 2017; 235(3): 713-30. doi 10.1007/s00221-016-4835-x. Krishnan V, Aruin AS and Latash ML. Two stages and three components of the postural preparation to action. Exp Brain Res. 2011; 212(1): 47-63. doi 10.1007/s00221-011-2694-z. Krishnan V, Latash ML and Aruin AS. Early and late components of feed-forward postural adjustments to predictable perturbations. Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology. 2012; 123(5): 1016-26. doi 10.1016/j.clinph.2011.09.014. Lee NG, You JSH, Yi CH, Jeon HS, Choi BS, Lee DR, et al. Best Core Stabilization for Anticipatory Postural Adjustment and Falls in Hemiparetic Stroke. Archives of physical medicine and rehabilitation. 2018; 99(11): 2168-74. doi 10.1016/j.apmr.2018.01.027. Haruyama K, Kawakami M and Otsuka T. Effect of Core Stability Training on Trunk Function, Standing Balance, and Mobility in Stroke Patients: A Randomized Controlled Trial. Neurorehabilitation and neural repair. 2017; 31(3): 240-9. doi 10.1177/1545968316675431. Karthikbabu S and Verheyden G. Relationship between trunk control, core muscle strength and balance confidence in community-dwelling patients with chronic stroke. Topics in stroke rehabilitation. 2021; 28(2): 88-95. doi 10.1080/10749357.2020.1783896. Richard A, Hamme AV, Drevelle X, Golmard J-L, Meunier S and Welter M-L. Contribution of the supplementary motor area and the cerebellum to the anticipatory postural adjustments and execution phases of human gait initiation. Neuroscience. 2017; 358(181-9. doi 10.1016/j.neuroscience.2017.06.047. Bolzoni F, Bruttini C, Esposti R, Castellani C and Cavallari P. Transcranial direct current stimulation of SMA modulates anticipatory postural adjustments without affecting the primary movement. Behav Brain Res. 2015; 291(407-13. doi 10.1016/j.bbr.2015.05.044. Chiou S-Y, Hurry M, Reed T, Quek JX and Strutton PH. Cortical contributions to anticipatory postural adjustments in the trunk. The Journal of physiology. 2018; 596(7): 1295-306. doi 10.1113/JP275312. Jacobs JV. Why we need to better understand the cortical neurophysiology of impaired postural responses with age, disease, or injury. Front Integr Neurosci. 2014; 8(69. doi 10.3389/fnint.2014.00069. Hashem SS, Helmy SM, El-Fayomy NM, Oraby MI, Menshawy M, Dawood NA, et al. Predictors of stroke outcome: the role of hemorheology, natural anticoagulants, and serum albumin. Egypt J Neurol Psychiatr Neurosurg. 2018; 54(1): 18. doi 10.1186/s41983-018-0019-x. Lip GYH, Blann AD, Farooqi IS, Zarifis J, Sagar G and Beevers DG. Sequential alterations in haemorheology, endothelial dysfunction, platelet activation and thrombogenesis in relation to prognosis following acute stroke: The West Birmingham Stroke Project. Blood Coagul Fibrinolysis. 2002; 13(4): 339-47. doi 10.1097/00001721-200206000-00010. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3025335","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":207053705,"identity":"cd6d10ff-9089-4f60-875a-36f4829793a4","order_by":0,"name":"Weichun He","email":"","orcid":"","institution":"General Hospital of Ningxia Medical University","correspondingAuthor":false,"prefix":"","firstName":"Weichun","middleName":"","lastName":"He","suffix":""},{"id":207053706,"identity":"8eae994a-b874-430a-a2ef-0c455a63f7e5","order_by":1,"name":"Ke Li","email":"","orcid":"","institution":"General Hospital of Ningxia Medical University","correspondingAuthor":false,"prefix":"","firstName":"Ke","middleName":"","lastName":"Li","suffix":""},{"id":207053707,"identity":"5d046d6b-572c-41ab-9a29-57ff719c5c15","order_by":2,"name":"Hongyu Li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAz0lEQVRIiWNgGAWjYBAC++PNBx98qJCQY2xvIFbPmWPJhjPO2Bgz9xwgVsuNHDNp3ra0xPYZCUTqYJyRYCDNw3aYsXfm4403GGpsoglqYeZ5kGA4h+cws+TstGILhmNpuQ2EtLCxJxxIeCNxmM1wdo6ZBGPDYcJaeBgSGw7wGBzmsb95hkgtEhzJjI08CWkSjDN4iNRiwHOMmXHGARsDxh6gXxKI8YsBe//3Hx//SdQ3th/eeONDjQ1hLSjaJRJIUQ7RQqqOUTAKRsEoGBkAAGogQ0apLt4KAAAAAElFTkSuQmCC","orcid":"","institution":"General Hospital of Ningxia Medical University","correspondingAuthor":true,"prefix":"","firstName":"Hongyu","middleName":"","lastName":"Li","suffix":""},{"id":207053708,"identity":"927cdaed-3cf3-439f-b221-36b077fcb05a","order_by":3,"name":"Ning Xu","email":"","orcid":"","institution":"General Hospital of Ningxia Medical University","correspondingAuthor":false,"prefix":"","firstName":"Ning","middleName":"","lastName":"Xu","suffix":""},{"id":207053709,"identity":"b26b63c5-54d6-4bc3-8501-235561ba8bd7","order_by":4,"name":"Ning Zhu","email":"","orcid":"","institution":"General Hospital of Ningxia Medical University","correspondingAuthor":false,"prefix":"","firstName":"Ning","middleName":"","lastName":"Zhu","suffix":""}],"badges":[],"createdAt":"2023-06-05 15:29:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3025335/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3025335/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":38779169,"identity":"2794be9c-0993-469b-a71d-403db5d70bba","added_by":"auto","created_at":"2023-06-19 18:00:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":260336,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3025335/v1/7b9e8364-6477-46f1-ada9-6894eb6a1882.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effects of central pathway and postural control technique on stroke patients: a randomized controlled trial","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003ePostural control and balance dysfunction is a common problem after stroke, which is associated with decreased mobility and limited activities of daily living, and is one of the main risk factors for falls after stroke[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The training and improvement of postural control ability is of great value to stroke patients, which is one of the focuses and hot spots of current research[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe Rehabilitation Medical Center of West China Hospital of Sichuan University proposed central pathway and postural control (CPPC) technique on the basis of integrating global neurorehabilitation physical therapy technologies[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The CPPC technique applies neuroscience theory to explain and analyze the patient's dysfunction. The core is the internal mechanism and external manifestation of the central nervous conduction pathway of postural control. In addition, the CPPC technique is a postural control-centered rehabilitation therapy based on central activation and inhibition, and carried out through various forms such as rehabilitation training and neuroregulation. It has good curative effect and application prospect.\u003c/p\u003e \u003cp\u003eThe goal of the current study was to investigate the effects of CPPC technique on motor function, balance function, activities of daily living, degree of neurological deficit, nerve cytokine content and hemorheology indexes of stroke patients.\u003c/p\u003e"},{"header":"2. Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 General information\u003c/h2\u003e \u003cp\u003eThis study included 78 stroke patients admitted to the General Hospital of Ningxia Medical University from October 2020 to October 2021. The patients were randomly divided into an experimental group and a control group by using a computer-generated random number of sequences. An investigator who was not involved in the assessment, treatment or statistical analysis conducted the randomization. All subjects signed an informed consent form, which was reviewed and approved by the Ethics Committee of the General Hospital of Ningxia Medical University.\u003c/p\u003e \u003cp\u003eWe applied the following diagnostic criteria: All of them met the diagnostic criteria of stroke in the Diagnostic Points of Major Types of Cerebrovascular Diseases in China, and were confirmed by brain CT.\u003c/p\u003e \u003cp\u003eOur inclusion criteria were: 1. All vital signs are stable; 2. All patients gave informed consent to this study, and a written agreement was reached on each item.\u003c/p\u003e \u003cp\u003eOur exclusion criteria were: 1. Inability to perform basic communication; 2. Accompanied by serious injury of heart, liver and kidney function, malignant tumor, etc. 3. Patients from the clinical trial who were not able to complete all required procedures for any reason.\u003c/p\u003e \u003cp\u003eA total of 39 patients in the experimental group and 39 patients in the control group completed the treatment. In the control group, there were 22 males and 17 females with an average age of 57.52\u0026thinsp;\u0026plusmn;\u0026thinsp;4.81 years (range, 43\u0026ndash;72 years). There were 15 cases with hypertension, 13 cases with diabetes and 11 cases with hyperlipidemia. There were 21 males and 18 females in the experimental group, with an average age of 57.96\u0026thinsp;\u0026plusmn;\u0026thinsp;4.73 years (range, 45\u0026ndash;69 years). There were 16 cases with hypertension, 14 cases with diabetes and 9 cases with hyperlipidemia. There were no significant differences in sex, age, and other general characteristics between the two groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Interventions\u003c/h2\u003e \u003cp\u003eThe control group received general rehabilitation therapy. Inform the patient of the importance and necessity of early and systematic rehabilitation treatment and mobilize the patient to participate actively in the rehabilitation treatment process. Assisted patients with good limb position placement and performed early joint movement, such as arm lift extension movement, leg extension and flexion movement, etc., 20min / time, 1 time / d. Patients were instructed to practice sitting exercises on their own initiative as their condition stabilized. After the patient can master sitting training, guide the patient to stand appropriately and gradually transition from static training to dynamic training, such as walking training, bed chair transfer training, etc., can adopt crutches, orthoses, AIDS, etc. if necessary. And with the help of rehabilitation therapists, exercise the life must skills one by one, such as washing the face, brushing teeth, hair brushing, etc., to improve self-care ability. It can be used to stimulate the patient's senses by reading, watching television and other ways. It is recommended that the family of the patient communicate with the patient often, exercise the patient's memory, thinking ability, improve cognition, language function and so on.\u003c/p\u003e \u003cp\u003eThe experimental group added the CPPC technique on the basis of routine rehabilitation therapy. The CPPC technique mainly consists of two parts. The first part is manual rehabilitation training. Rehabilitation training of patients by therapists based on correct sensory input is one of the common treatments used in CPPC technique and is mainly achieved by relying on postural control (PC) maneuvers. PC technique refers to the manipulation method by which the therapist induces a correct postural response and improves the ability of postural control based on sensory input. The main points include an emphasis on correct sensory motor induction, respiratory control training, core stabilization and trunk control training, balance function training, mobility training, and gait correction. The other part is the neuromodulation technique. CPPC technology emphasizes improved patient function through multiple modalities of postural regulation such as rehabilitation training and neuromodulation, including transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS).\u003c/p\u003e \u003cp\u003eAll interventions were 1 time / day for 50 days in both groups.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Outcome measures\u003c/h2\u003e \u003cp\u003eOutcome measures were collected at baseline (pre intervention; 2 days before the first session) and post-intervention (1 day after the last session).\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.3.1 Primary outcomes\u003c/h2\u003e \u003cp\u003eThe primary outcome measures included the National Institutes of Health Stroke Scale (NIHSS) and the Fugel-Meyer assessment scale (FMA).\u003c/p\u003e \u003cp\u003eNIHSS: total score 42 points, with 0\u0026ndash;1 as normal, 1\u0026ndash;4 as mild stroke, 5\u0026ndash;14 as moderate stroke, 15\u0026ndash;20 as moderate severe stroke, and 21\u0026ndash;42 as severe stroke.\u003c/p\u003e \u003cp\u003eFMA: FMA is one of the commonly used scales for motor function assessment in stroke patients. It included both upper and lower limbs, and the total score was 100 points. The specific grading was as follows: severe\u0026thinsp;\u0026lt;\u0026thinsp;50 points, severe 50\u0026ndash;85 points, moderate 86\u0026ndash;95 points, mild 96\u0026ndash;99 points, and normal 100 points.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.3.2 Secondary outcomes\u003c/h2\u003e \u003cp\u003eThe secondary outcome measures included Berg Balance Scale (BBS), Tinetti Balance and Gait Analysis, Barthel Index (BI), neuronal cytokine content and hemorheological Indices.\u003c/p\u003e \u003cp\u003eBBS: BBS is a comprehensive scale for the evaluation of body balance function. It divides the balance function into 14 items from easy to difficult, and each item is divided into 5 levels, namely 0, 1, 2, 3 and 4 points. The maximum total score is 56 points and the minimum score is 0 points.\u003c/p\u003e \u003cp\u003eTinetti Balance and Gait Analysis: The Tinetti scale mainly evaluates the dynamic balance ability of patients during activities, including balance (full score: 16 points) and gait (full score: 12 points). If the total score is less than 24 points, it indicates that there is balance dysfunction; if the total score is less than 15 points, it indicates that there is a risk of falling.\u003c/p\u003e \u003cp\u003eBI: BI mainly includes 10 evaluation items, with a full score of 100, reflecting the independence of patients' activities of daily living ability.\u003c/p\u003e \u003cp\u003eNeuronal cytokine content: Fasting venous blood was collected before and 50 days after treatment. After centrifugation at a radius of 8cm and 2500r/min for 10min, serum was taken and the contents of neurotrophin-3 (NT-3) and nerve growth factor (NGF) in blood were detected by enzyme-linked immunosorbent assay.\u003c/p\u003e \u003cp\u003eHemorheological Indices: Fasting venous blood was collected before and 50 days after treatment. Blood analyzer was used to detect high shear viscosity (HBV), low shear viscosity (LBV), plasma viscosity (PV), hematocrit (HCT) and fibrinogen.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Statistical methods\u003c/h2\u003e \u003cp\u003e Statistical analysis was performed using SPSS 22.0 software, and measurement data were expressed as. The measurement data were tested for normality using the K-S normality test. Differences within groups were analyzed using paired sample t-tests, and differences between groups were analyzed using independent sample t-tests. Count data were analyzed using chi-square tests. P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003e3.1 Results of primary outcomes\u003c/h2\u003e\n \u003cp\u003eCompared with before treatment, NIHSS scores of the two groups decreased and FMA scores increased after treatment, and there were significant differences between the two groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). See Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u0026nbsp;\u003c/p\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of NIHSS and FMA scores between the two groups (Unit: Score),\u0026nbsp;\u003cem\u003ex̄\u003c/em\u003e \u0026plusmn; s\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eNIHSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eFMA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBefore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAfter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBefore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAfter\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.94\u0026thinsp;\u0026plusmn;\u0026thinsp;3.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.49\u0026thinsp;\u0026plusmn;\u0026thinsp;2.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57.51\u0026thinsp;\u0026plusmn;\u0026thinsp;22.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61.73\u0026thinsp;\u0026plusmn;\u0026thinsp;21.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExperimental\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.96\u0026thinsp;\u0026plusmn;\u0026thinsp;3.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.05\u0026thinsp;\u0026plusmn;\u0026thinsp;2.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57.72\u0026thinsp;\u0026plusmn;\u0026thinsp;22.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75.33\u0026thinsp;\u0026plusmn;\u0026thinsp;21.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.824\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.782\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.978\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.967\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cem\u003e[\u003c/em\u003eTable \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e \u003cem\u003enear here]\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003e3.2 Results of secondary outcomes\u003c/h2\u003e\n \u003cp\u003eCompared with before treatment, BBS score and Tinetti score of the two groups were increased after treatment, and there were significant differences between the two groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). See Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u0026nbsp;\u003c/p\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of BBS and Tinetti scores between the two groups (Unit: Score),\u0026nbsp;\u003cem\u003ex̄\u003c/em\u003e \u0026plusmn; s\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eBBS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eTinetti\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBefore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAfter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBefore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAfter\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.25\u0026thinsp;\u0026plusmn;\u0026thinsp;5.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.81\u0026thinsp;\u0026plusmn;\u0026thinsp;5.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.52\u0026thinsp;\u0026plusmn;\u0026thinsp;2.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.75\u0026thinsp;\u0026plusmn;\u0026thinsp;1.68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExperimental\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.28\u0026thinsp;\u0026plusmn;\u0026thinsp;5.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46.89\u0026thinsp;\u0026plusmn;\u0026thinsp;6.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.58\u0026thinsp;\u0026plusmn;\u0026thinsp;2.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.91\u0026thinsp;\u0026plusmn;\u0026thinsp;1.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.087\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.207\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.981\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.917\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cem\u003e[\u003c/em\u003eTable \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e \u003cem\u003enear here]\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eCompared with before treatment, the scores of each item of BI scale in the two groups were improved, and there were significant differences between the two groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). See Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of BI scores between the two groups (Unit: Score),\u0026nbsp;\u003cem\u003ex̄\u003c/em\u003e \u0026plusmn; s\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eItems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBefore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAfter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDressing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eControl(n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.36\u0026thinsp;\u0026plusmn;\u0026thinsp;3.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.02\u0026thinsp;\u0026plusmn;\u0026thinsp;2.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.695\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExperimental(n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.34\u0026thinsp;\u0026plusmn;\u0026thinsp;3.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.18\u0026thinsp;\u0026plusmn;\u0026thinsp;1.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBathe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eControl(n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.47\u0026thinsp;\u0026plusmn;\u0026thinsp;1.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.971\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.815\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExperimental(n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.46\u0026thinsp;\u0026plusmn;\u0026thinsp;1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.32\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEating\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eControl(n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.62\u0026thinsp;\u0026plusmn;\u0026thinsp;3.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.897\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.05\u0026thinsp;\u0026plusmn;\u0026thinsp;3.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.687\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExperimental(n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.71\u0026thinsp;\u0026plusmn;\u0026thinsp;3.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.93\u0026thinsp;\u0026plusmn;\u0026thinsp;3.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGo to the toilet\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eControl(n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.42\u0026thinsp;\u0026plusmn;\u0026thinsp;3.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.991\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.03\u0026thinsp;\u0026plusmn;\u0026thinsp;3.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.684\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExperimental(n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.43\u0026thinsp;\u0026plusmn;\u0026thinsp;3.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.86\u0026thinsp;\u0026plusmn;\u0026thinsp;2.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDefecate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eControl(n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.68\u0026thinsp;\u0026plusmn;\u0026thinsp;2.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.921\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.05\u0026thinsp;\u0026plusmn;\u0026thinsp;3.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExperimental(n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.62\u0026thinsp;\u0026plusmn;\u0026thinsp;2.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.94\u0026thinsp;\u0026plusmn;\u0026thinsp;2.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUrinate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eControl(n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.52\u0026thinsp;\u0026plusmn;\u0026thinsp;2.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.974\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.02\u0026thinsp;\u0026plusmn;\u0026thinsp;3.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.661\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExperimental(n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.54\u0026thinsp;\u0026plusmn;\u0026thinsp;2.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.81\u0026thinsp;\u0026plusmn;\u0026thinsp;2.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBed chair transfer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eControl(n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.45\u0026thinsp;\u0026plusmn;\u0026thinsp;3.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.979\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.05\u0026thinsp;\u0026plusmn;\u0026thinsp;3.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.672\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExperimental(n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.47\u0026thinsp;\u0026plusmn;\u0026thinsp;3.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.86\u0026thinsp;\u0026plusmn;\u0026thinsp;2.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMake up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eControl(n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.14\u0026thinsp;\u0026plusmn;\u0026thinsp;2.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.984\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.04\u0026thinsp;\u0026plusmn;\u0026thinsp;3.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.684\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExperimental(n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.13\u0026thinsp;\u0026plusmn;\u0026thinsp;2.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.87\u0026thinsp;\u0026plusmn;\u0026thinsp;2.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStair activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eControl(n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.45\u0026thinsp;\u0026plusmn;\u0026thinsp;3.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.979\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.14\u0026thinsp;\u0026plusmn;\u0026thinsp;2.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExperimental(n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.47\u0026thinsp;\u0026plusmn;\u0026thinsp;3.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.98\u0026thinsp;\u0026plusmn;\u0026thinsp;3.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWalking on flat ground\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eControl(n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.22\u0026thinsp;\u0026plusmn;\u0026thinsp;3.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.989\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.08\u0026thinsp;\u0026plusmn;\u0026thinsp;2.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.725\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExperimental(n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.21\u0026thinsp;\u0026plusmn;\u0026thinsp;3.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.92\u0026thinsp;\u0026plusmn;\u0026thinsp;3.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cem\u003e[\u003c/em\u003eTable \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e \u003cem\u003enear here]\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eCompared with before treatment, the content of NT-3 and NGF in serum of the two groups were increased after treatment, and there were significant differences between the two groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). See Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e.\u0026nbsp;\u003c/p\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of neuronal cytokine content between two groups (Unit: ng/L),\u0026nbsp;\u003cem\u003ex̄\u003c/em\u003e \u0026plusmn; s\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eNT-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eNGF\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBefore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAfter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBefore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAfter\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.16\u0026thinsp;\u0026plusmn;\u0026thinsp;1.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.24\u0026thinsp;\u0026plusmn;\u0026thinsp;1.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.56\u0026thinsp;\u0026plusmn;\u0026thinsp;1.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.27\u0026thinsp;\u0026plusmn;\u0026thinsp;1.62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExperimental\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.17\u0026thinsp;\u0026plusmn;\u0026thinsp;1.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.38\u0026thinsp;\u0026plusmn;\u0026thinsp;1.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.29\u0026thinsp;\u0026plusmn;\u0026thinsp;1.68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.824\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.729\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.973\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.921\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cem\u003e[\u003c/em\u003eTable \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e \u003cem\u003enear here]\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eCompared with before treatment, the hemorheology indexes of HBV, LBV, PV, HCT and fibrinogen in the two groups decreased after treatment, and there were significant differences between the two groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). See Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e.\u0026nbsp;\u003c/p\u003e\n \u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of hemorheology indexes between two groups, \u003cem\u003ex̄\u003c/em\u003e \u0026plusmn; s\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eHBV(mPa\u0026middot;s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eLBV(mPa\u0026middot;s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003ePV(mPa\u0026middot;s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eHCT(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eFibrinogen(g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBefore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAfter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBefore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAfter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBefore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAfter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBefore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAfter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBefore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAfter\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.21\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.72\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.78\u0026thinsp;\u0026plusmn;\u0026thinsp;2.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.36\u0026thinsp;\u0026plusmn;\u0026thinsp;2.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.39\u0026thinsp;\u0026plusmn;\u0026thinsp;8.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.35\u0026thinsp;\u0026plusmn;\u0026thinsp;7.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExperimental\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.23\u0026thinsp;\u0026plusmn;\u0026thinsp;1.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.95\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.99\u0026thinsp;\u0026plusmn;\u0026thinsp;2.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.03\u0026thinsp;\u0026plusmn;\u0026thinsp;2.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.32\u0026thinsp;\u0026plusmn;\u0026thinsp;8.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34.31\u0026thinsp;\u0026plusmn;\u0026thinsp;8.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.95\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.398\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.734\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.217\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.906\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.822\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.992\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.952\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.692\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.829\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.972\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.899\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cem\u003e[\u003c/em\u003eTable \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e \u003cem\u003enear here]\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eDue to the different pathogenesis of stroke patients, the timing and severity of the onset affect their prognosis. Clinical treatment focuses on early detection, early diagnosis, early recovery, and prevention of recurrence. In the clinical rehabilitation treatment process, multiple intervention measures are comprehensively applied, but most patients have left varying degrees of dysfunction, so it is particularly important to seek more effective treatment methods[\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe results of this study show that NIHSS scores of the two groups decreased and FMA scores increased after treatment. The results suggest that the CPPC technique can alleviate limb dysfunction and motor limitation in stroke patients. Compared with before treatment, BBS score, Tinetti score and the scores of each item of BI scale of the two groups were increased, and there were significant differences between the two groups. The results suggest that the CPPC technique can improve balance function and activities of daily life in stroke patients. The CPPC technology is mainly based on the principle of posture control, explaining and analyzing patient dysfunction, and focusing on posture control for rehabilitation treatment to improve patient function.\u003c/p\u003e \u003cp\u003eSports behavior is determined by the interaction between the motion target, the reason for executing the motion, and the mechanical stability mediated by posture control[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Posture control plays an important role in maintaining body balance and adjusting movements[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Posture control is a complex process in which the body's proprioceptive, visual, and vestibular systems input and integrate into the central nervous system to form a body schema, in order to maintain body orientation and stability[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Good posture control can adapt various segments of the body to different environmental posture orientations, and maintain the static and dynamic stability of the body during movement.\u003c/p\u003e \u003cp\u003eWhen the human body is faced with predictable or sudden internal and/or external postural disturbances, the central nervous system's response and regulation of the body's postural muscles mainly include three regulatory mechanisms: anticipatory postural adjustment (APA), anticipatory synergy adjustment (ASA) and compensatory postural adjustment (CPA)[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAPAs and ASAs both belong to feed-forward mechanisms of postural control acting when a standing person is subjected to a predictable, frequently self-initiated, perturbation. APAs are commonly described as unconscious muscular activities aimed to counterbalance the perturbation caused by the primary movement, so as to ensure the whole-body balance, as well as contributing to initiate the displacement of the body center of mass when starting gait or whole-body reaching movements[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. APAs can prevent mechanical disturbances caused by local motion. Without proper balance, these interferences can affect the correct execution of random movements. ASAs are seen prior to self-triggered unloading with known and unknown direction of the perturbation[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. During whole-body tasks performed by standing persons, ASAs represent changes in an index of a multi-muscle synergy stabilizing the coordinate of the center of pressure (COP). Such changes may be seen in young, healthy persons about 200\u0026ndash;300 ms prior to the action initiation, significantly earlier than APAs[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. ASAs facilitates a change in a salient performance variable, such as COP coordinate, and allows the actor to avoid fighting one\u0026rsquo;s own synergies stabilizing that variable. CPAs are the recovery process that occur after patients have already lost balance. CPAs mainly include hip strategy, knee strategy, and ankle strategy.\u003c/p\u003e \u003cp\u003eResearch has shown that core stability exercises are of great significance in improving APAs control, fear of falls, trunk function, standing balance, and mobility in patients with hemiplegic stroke[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. A significant and strong positive association exists among trunk control, core muscles strength and balance confidence in community-dwelling patients with chronic stroke[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. And using neuromodulatory techniques (e.g. rTMS, tDCS) to supress neural activation of the supplementary motor area (SMA) could affect the timing and amplitude of APAs[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. It seems likely that the APAs are modulated at cortical level, supporting a feedforward model of neural control by which the postural adjustments are prepared prior to voluntary movement[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Interventions targeting the neural control of the APAs to the trunk muscles are important for reducing instability and therefore reducing the risk of falls, to which the elderly are particularly vulnerable[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. CPPC technique, which focuses on posture control and neural regulation, may improve the motor and balance functions of stroke patients by regulating APAs and related neural circuits.\u003c/p\u003e \u003cp\u003eThe content of NT-3 and NGF in serum of the two groups increased and the hemorheology indexes of HBV, LBV, PV, HCT and fibrinogen decreased after treatment, and there were significant differences between the two groups. During the onset of stroke, there will be abnormal hemorheology symptoms, such as increased blood viscosity, platelet activation and strong adhesion and aggregation, which will aggravate the brain damage of patients and affect the prognosis[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The functional activity of the brain is related to its oxygen consumption, and the blood flow of brain tissue can be used to evaluate brain metabolism. The results of this study suggest that CPPC technique can improve blood circulation, prevent vascular blood flow obstruction, alleviate blood supply disorders, increase brain oxygen supply, and thereby improve stroke patient dysfunction.\u003c/p\u003e \u003cp\u003eThe limitation of this study was no follow-up of patients. However, according to the research results of this paper and previous research, CPPC technique is a promising method for future neuropsychological research, and can also be used in clinical treatment to improve the motor function and quality of life of patients with stroke and reduce the burden on patients and families. In the future, larger sample sizes and multicenter scientific research are needed to provide higher quality theoretical basis for the clinical application of CPPC technique.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll included patients gave their oral and written informed consent. The study was approved by the Ethics Committee of the General Hospital of Ningxia Medical University (reference number 2019-225).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have approved this manuscript for publication. This manuscript has not previously been published and is not pending publication elsewhere.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets supporting the conclusions of this article are included within the article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author(s) declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research project was partially supported by the campus level project of Ningxia Medical University (XM2019050).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLi Hongyu performed the data analysis. Xu Ning performed the formal analysis. Zhu Ning performed the validation. He Weichun and Li Ke wrote the manuscript. All authors have read and approve the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePersson CU, Kjellberg S, Lernfelt B, Westerlind E, Cruce M and Hansson P-O. Risk of falling in a stroke unit after acute stroke: The Fall Study of Gothenburg (FallsGOT). Clinical rehabilitation. 2018; 32(3): 398-409. doi 10.1177/0269215517728325.\u003c/li\u003e\n\u003cli\u003eSorrentino G, Sale P, Solaro C, Rabini A, Cerri CG and Ferriero G. Clinical measurement tools to assess trunk performance after stroke: a systematic review. European journal of physical and rehabilitation medicine. 2018; 54(5): 772-84. doi 10.23736/S1973-9087.18.05178-X.\u003c/li\u003e\n\u003cli\u003eCriekinge TV, Truijen S, Schr\u0026ouml;der J, Maebe Z, Blanckaert K, Waal Cvd, et al. The effectiveness of trunk training on trunk control, sitting and standing balance and mobility post-stroke: a systematic review and meta-analysis. Clinical rehabilitation. 2019; 33(6): 992-1002. doi 10.1177/0269215519830159.\u003c/li\u003e\n\u003cli\u003eJiang HH, Wei QC, Ye SQ, Meng LJ, Zhang J, He L, et al. Basic theory and clinical application of central conduction pathway and posture control technology. West China Medical Journal. 2022; 37(05): 680-687. (in chinese)\u003c/li\u003e\n\u003cli\u003eHenderson SJ, Weitz JI and Kim PY. Fibrinolysis: Strategies to enhance the treatment of acute ischemic stroke. J Thromb Haemost. 2018; 16(10): 1932-40. doi 10.1111/jth.14215.\u003c/li\u003e\n\u003cli\u003eKuriakose D and Xiao Z. Pathophysiology and Treatment of Stroke: Present Status and Future Perspectives. Int J Mol Sci. 2020; 21(20). doi 10.3390/ijms21207609.\u003c/li\u003e\n\u003cli\u003eBarthels D and Das H. Current advances in ischemic stroke research and therapies. Biochim Biophys Acta Mol Basis Dis. 2020; 4(1866): 165260. doi 10.1016/j.bbadis.2018.09.012.\u003c/li\u003e\n\u003cli\u003eMatthis JS, Yates JL and Hayhoe MM. Gaze and the Control of Foot Placement When Walking in Natural Terrain. Curr Biol. 2018; 28(8): 1224-33. doi 10.1016/j.cub.2018.03.008.\u003c/li\u003e\n\u003cli\u003eCavallari P, Bolzoni F, Bruttini C and Esposti R. The Organization and Control of Intra-Limb Anticipatory Postural Adjustments and Their Role in Movement Performance. Front Hum Neurosci. 2016; 10(525. doi 10.3389/fnhum.2016.00525.\u003c/li\u003e\n\u003cli\u003eCruz TL, P\u0026eacute;rez SM and Chiappe ME. Fast tuning of posture control by visual feedback underlies gaze stabilization in walking Drosophila. Curr Biol. 2021; 31(20): 4596-607. doi 10.1016/j.cub.2021.08.041.\u003c/li\u003e\n\u003cli\u003eHe\u0026szlig; T, Oehlwein C and Milani TL. Anticipatory Postural Adjustments and Compensatory Postural Responses to Multidirectional Perturbations-Effects of Medication and Subthalamic Nucleus Deep Brain Stimulation in Parkinson\u0026apos;s Disease. Brain Sci. 2023; 13(3): 454. doi 10.3390/brainsci13030454.\u003c/li\u003e\n\u003cli\u003eKung C-F, Lai Y-R, Chiu W-C, Lien C-Y, Huang C-C, Cheng B-C, et al. Effectiveness of Center of Pressure Trajectory as Anticipatory Postural Adjustment Measurement in Parkinson\u0026apos;s Disease With Freezing of Gait History. Neurorehabilitation and neural repair. 2023; 37(4): 240-50. doi 10.1177/15459683231166934.\u003c/li\u003e\n\u003cli\u003ePiscitelli D, Falaki A, Solnik S and Latash ML. Anticipatory postural adjustments and anticipatory synergy adjustments: preparing to a postural perturbation with predictable and unpredictable direction. Exp Brain Res. 2017; 235(3): 713-30. doi 10.1007/s00221-016-4835-x.\u003c/li\u003e\n\u003cli\u003eKrishnan V, Aruin AS and Latash ML. Two stages and three components of the postural preparation to action. Exp Brain Res. 2011; 212(1): 47-63. doi 10.1007/s00221-011-2694-z.\u003c/li\u003e\n\u003cli\u003eKrishnan V, Latash ML and Aruin AS. Early and late components of feed-forward postural adjustments to predictable perturbations. Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology. 2012; 123(5): 1016-26. doi 10.1016/j.clinph.2011.09.014.\u003c/li\u003e\n\u003cli\u003eLee NG, You JSH, Yi CH, Jeon HS, Choi BS, Lee DR, et al. Best Core Stabilization for Anticipatory Postural Adjustment and Falls in Hemiparetic Stroke. Archives of physical medicine and rehabilitation. 2018; 99(11): 2168-74. doi 10.1016/j.apmr.2018.01.027.\u003c/li\u003e\n\u003cli\u003eHaruyama K, Kawakami M and Otsuka T. Effect of Core Stability Training on Trunk Function, Standing Balance, and Mobility in Stroke Patients: A Randomized Controlled Trial. Neurorehabilitation and neural repair. 2017; 31(3): 240-9. doi 10.1177/1545968316675431.\u003c/li\u003e\n\u003cli\u003eKarthikbabu S and Verheyden G. Relationship between trunk control, core muscle strength and balance confidence in community-dwelling patients with chronic stroke. Topics in stroke rehabilitation. 2021; 28(2): 88-95. doi 10.1080/10749357.2020.1783896.\u003c/li\u003e\n\u003cli\u003eRichard A, Hamme AV, Drevelle X, Golmard J-L, Meunier S and Welter M-L. Contribution of the supplementary motor area and the cerebellum to the anticipatory postural adjustments and execution phases of human gait initiation. Neuroscience. 2017; 358(181-9. doi 10.1016/j.neuroscience.2017.06.047.\u003c/li\u003e\n\u003cli\u003eBolzoni F, Bruttini C, Esposti R, Castellani C and Cavallari P. Transcranial direct current stimulation of SMA modulates anticipatory postural adjustments without affecting the primary movement. Behav Brain Res. 2015; 291(407-13. doi 10.1016/j.bbr.2015.05.044.\u003c/li\u003e\n\u003cli\u003eChiou S-Y, Hurry M, Reed T, Quek JX and Strutton PH. Cortical contributions to anticipatory postural adjustments in the trunk. The Journal of physiology. 2018; 596(7): 1295-306. doi 10.1113/JP275312.\u003c/li\u003e\n\u003cli\u003eJacobs JV. Why we need to better understand the cortical neurophysiology of impaired postural responses with age, disease, or injury. Front Integr Neurosci. 2014; 8(69. doi 10.3389/fnint.2014.00069.\u003c/li\u003e\n\u003cli\u003eHashem SS, Helmy SM, El-Fayomy NM, Oraby MI, Menshawy M, Dawood NA, et al. Predictors of stroke outcome: the role of hemorheology, natural anticoagulants, and serum albumin. Egypt J Neurol Psychiatr Neurosurg. 2018; 54(1): 18. doi 10.1186/s41983-018-0019-x.\u003c/li\u003e\n\u003cli\u003eLip GYH, Blann AD, Farooqi IS, Zarifis J, Sagar G and Beevers DG. Sequential alterations in haemorheology, endothelial dysfunction, platelet activation and thrombogenesis in relation to prognosis following acute stroke: The West Birmingham Stroke Project. Blood Coagul Fibrinolysis. 2002; 13(4): 339-47. doi 10.1097/00001721-200206000-00010.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"CPPC technique, stroke, motor function, rehabilitation","lastPublishedDoi":"10.21203/rs.3.rs-3025335/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3025335/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eWe investigated the effects of central pathway and postural control (CPPC) technique on motor function, balance function, activities of daily living, degree of neurological deficit, nerve cytokine content and hemorheology indexes of stroke patients.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003e78 stroke patients were randomly divided into an experimental group added the CPPC technique on the basis of routine rehabilitation therapy and a control group receiving routine rehabilitation therapy. All interventions were 1 time / day for 50 days in both groups. Outcome measures were collected at baseline and post-intervention. The primary outcome measures included the National Institutes of Health Stroke Scale (NIHSS) and the Fugel-Meyer assessment scale (FMA). The secondary outcome measures included Berg Balance Scale (BBS), Tinetti Balance and Gait Analysis, Barthel Index (BI), neuronal cytokine content and hemorheological Indices.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e \u003cp\u003eThe results of this study show that NIHSS scores of the two groups decreased and FMA scores increased after treatment. Compared with before treatment, BBS score, Tinetti score and the scores of each item of BI scale of the two groups were increased, and there were significant differences between the two groups. The content of NT-3 and NGF in serum of the two groups increased and the hemorheology indexes of HBV, LBV, PV, HCT and fibrinogen decreased after treatment, and there were significant differences between the two groups.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe CPPC technique can alleviate limb dysfunction and motor limitation and can improve balance function, activities of daily life and blood circulation in stroke patients. The CPPC technique is a promising method for future neuropsychological research and can also be used in clinical treatment of stroke patients.\u003c/p\u003e","manuscriptTitle":"Effects of central pathway and postural control technique on stroke patients: a randomized controlled trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-06-06 03:30:50","doi":"10.21203/rs.3.rs-3025335/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"80a02ed1-7791-435e-ae1b-23b02120bae6","owner":[],"postedDate":"June 6th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-06-19T18:00:06+00:00","versionOfRecord":[],"versionCreatedAt":"2023-06-06 03:30:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3025335","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3025335","identity":"rs-3025335","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}