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García-Llorente AM, Casimiro-Andújar AJ, Linhares DG, De Souza Vale RG, Marcos-Pardo PJ. Multidomain interventions for sarcopenia and cognitive flexibility in older adults for promoting healthy aging: a systematic review and meta-analysis of randomized controlled trials. Aging Clin Exp Res 2024; 36:47. [PMID: 38386173 PMCID: PMC10884056 DOI: 10.1007/s40520-024-02700-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/08/2024] [Indexed: 02/23/2024]
Abstract
The global population is undergoing rapid aging, making physical activity a crucial element in preventing mortality and lowering the risk of Alzheimer's disease. Age-related declines in muscle mass and cognitive abilities significantly contribute to frailty and dependency. Thus, this study focuses on a meticulous analysis of the protective effects of multidomain interventions, an emerging resource combating age-related declines. It seeks to underscore their profound impact on cognitive flexibility and sarcopenia, highlighting their pivotal role in mitigating the adverse effects of aging. To identify relevant randomized controlled trials up to November 2023, we reviewed eight online academic databases, following PERSiST guidelines, PRISMA reporting system, and PICOs criteria. Meta-analyses on selected functional outcomes utilized a random-effects model, including the Timed Up and Go Test, Sit to Stand Test, Victoria Stroop Test, and Trail Making Test. Out of 2082 scrutinized articles, 17 were included in the systematic review, and 8 in the meta-analysis. Positive effects (p = 0.05, I2 = 57%; 95% CI - 0.63 to - 0.05) were observed in cognitive flexibility for certain interventions. Similarly, interventions addressing muscle strength demonstrated improvements in the Sit to Stand Test for the exercise group compared to the control group (p = 0.02, I2 = 0%; 95% CI - 0.63 to - 0.05). These findings underscore the importance of incorporating physical activity as a primary component of public health interventions for promoting healthy aging and reducing the burden of age-related diseases. Future interventions may explore more homogeneous approaches and evaluate the impact of thrice multidomain weekly sessions.
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Affiliation(s)
- A M García-Llorente
- SPORT Research Group (CTS-1024), Department of Education, CIBIS (Centro de Investigación Para el Bienestar y la Inclusión Social) Research Center, Area of Physical Education and Sport, University of Almería, Office 0.22, Building CITE III, Almería, Spain.
| | - A J Casimiro-Andújar
- SPORT Research Group (CTS-1024), Department of Education, CIBIS (Centro de Investigación Para el Bienestar y la Inclusión Social) Research Center, Area of Physical Education and Sport, University of Almería, Office 0.22, Building CITE III, Almería, Spain
- Department of Education, Faculty of Education Sciences, University of Almeria, 04120, Almeria, Spain
- Active Aging, Exercise and Health/HEALTHY-AGE Network, Consejo Superior de Deportes (CSD), Ministry of Culture and Sport of Spain, 28040, Madrid, Spain
| | - D G Linhares
- Universidade do Estado de Rio de Janeiro, Rio de Janeiro, BR, Brazil
| | - R G De Souza Vale
- Active Aging, Exercise and Health/HEALTHY-AGE Network, Consejo Superior de Deportes (CSD), Ministry of Culture and Sport of Spain, 28040, Madrid, Spain
- Universidade do Estado de Rio de Janeiro, Rio de Janeiro, BR, Brazil
- Laboratorio de Ejercicio y Deporte, Instituto de Educación Física y Deportes, Universidad del Estado de Rio de Janeiro, Rio de Janeiro, 20550-900, Brazil
| | - P J Marcos-Pardo
- SPORT Research Group (CTS-1024), Department of Education, CIBIS (Centro de Investigación Para el Bienestar y la Inclusión Social) Research Center, Area of Physical Education and Sport, University of Almería, Office 0.22, Building CITE III, Almería, Spain.
- Department of Education, Faculty of Education Sciences, University of Almeria, 04120, Almeria, Spain.
- Active Aging, Exercise and Health/HEALTHY-AGE Network, Consejo Superior de Deportes (CSD), Ministry of Culture and Sport of Spain, 28040, Madrid, Spain.
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Lojo-Seoane C, Facal D, Delgado-Losada ML, Rubio-Valdehita S, López-Higes R, Frades-Payo B, Pereiro AX. Normative scores for attentional tests used by the Spanish consortium for ageing normative data (SCAND) study: Trail Making Test, Digit Symbol and Letter Cancellation. Clin Neuropsychol 2023; 37:1766-1786. [PMID: 36772821 DOI: 10.1080/13854046.2023.2173304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 01/20/2023] [Indexed: 02/12/2023]
Abstract
Objective: This paper reports normative data for different attentional tests obtained from a sample of middle-aged and older native Spanish adults and considering effects of age, educational level and sex. Method: 2,597 cognitively intact participants, aged from 50 to 98 years old, participated voluntarily in the SCAND consortium studies. The statistical procedure included conversion of percentile ranges into scaled scores. The effects of age, education and sex were taken into account. Linear regressions were used to calculate adjusted scaled scores. Results: Scaled scores and percentiles corresponding to the TMT, Digit Symbol and Letter Cancellation Task are shown. Additional tables show the values to be added to or subtracted from the scaled scores, for age and education in the case of the TMT and Letter Cancellation Task measures, and for education in the case of the Digit Symbol subtest. Conclusions: The current norms provide clinically useful data for evaluating Spanish people aged 50 to 98 years old and contribute to improving detection of initial symptoms of cognitive impairment.
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Affiliation(s)
- Cristina Lojo-Seoane
- Department of Developmental and Educational Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - David Facal
- Department of Developmental and Educational Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - María Luisa Delgado-Losada
- Department of Experimental Psychology, Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
| | - Susana Rubio-Valdehita
- Department of Social, Work and Differential Psychology, Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
| | - Ramón López-Higes
- Department of Experimental Psychology, Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
| | | | - Arturo X Pereiro
- Department of Developmental and Educational Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
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Therapeutic potential of natural molecules against Alzheimer's disease via SIRT1 modulation. Biomed Pharmacother 2023; 161:114474. [PMID: 36878051 DOI: 10.1016/j.biopha.2023.114474] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/06/2023] Open
Abstract
Alzheimer's disease (AD) is a neurodegenerative disease mainly characterized by progressive cognitive dysfunction and memory impairment. Recent studies have shown that regulating silent information regulator 1 (SIRT1) expression has a significant neuroprotective effect, and SIRT1 may become a new therapeutic target for AD. Natural molecules are an important source of drug development for use in AD therapy and may regulate a wide range of biological events by regulating SIRT1 as well as other SIRT1-mediated signaling pathways. This review aims to summarize the correlation between SIRT1 and AD and to identify in vivo and in vitro studies investigating the anti-AD properties of natural molecules as modulators of SIRT1 and SIRT1-mediated signaling pathways. A literature search was conducted for studies published between January 2000 and October 2022 using various literature databases, including Web of Science, PubMed, Google Scholar, Science Direct, and EMBASE. Natural molecules, such as resveratrol, quercetin, icariin, bisdemethoxycurcumin, dihydromyricetin, salidroside, patchouli, sesamin, rhein, ligustilide, tetramethoxyflavanone, 1-theanine, schisandrin, curcumin, betaine, pterostilbene, ampelopsin, schisanhenol, and eriodictyol, have the potential to modulate SIRT1 and SIRT1 signaling pathways, thereby combating AD. The natural molecules modulating SIRT1 discussed in this review provide a potentially novel multi-mechanistic therapeutic strategy for AD. However, future clinical trials need to be conducted to further investigate their beneficial properties and to determine the safety and efficacy of SIRT1 natural activators against AD.
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Mild Cognitive Impairment Is Associated with Poorer Nutritional Status on Hospital Admission and after Discharge in Acutely Hospitalized Older Patients. Geriatrics (Basel) 2022; 7:geriatrics7050095. [PMID: 36136804 PMCID: PMC9498394 DOI: 10.3390/geriatrics7050095] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022] Open
Abstract
In acutely hospitalized older patients (≥65 years), the association between mild cognitive impairment (MCI) and malnutrition is poorly described. We hypothesized that (1) MCI is associated with nutritional status on admission and after discharge; (2) MCI is associated with a change in nutritional status; and (3) a potential association is partly explained by frailty, comorbidity, medication use, and age. We combined data from a randomized controlled trial (control group data) and a prospective cohort study (ClinicalTrials.gov: NCT01964482 and NCT03052192). Nutritional status was assessed on admission and follow-up using the Mini Nutritional Assessment—Short Form. MCI or intact cognition (noMCI) was classified by three cognitive performance tests at follow-up. Data on frailty, comorbidity, medication use, and age were drawn from patient journals. MCI (n = 42) compared to noMCI (n = 47) was associated with poorer nutritional status with an average difference of −1.29 points (CI: −2.30; −0.28) on admission and −1.64 points (CI: −2.57; −0.70) at 4-week follow-up. Only age influenced the estimates of −0.85 (CI: −1.86; 0.17) and −1.29 (CI: −2.25; −0.34), respectively. In acutely hospitalized older patients, there is an association between MCI and poorer nutritional status upon admission and four weeks after discharge. The association is partly explained by higher age.
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Nishimura A, Sutoko S, Kiguchi M, Atsumori H, Obata A, Funane T, Kandori A, Mizuguchi T, Shimonaga K, Hama S, Tsuji T. Projection of Damaged Visual and Language Regions on Low Trail Making Test Part-B Performance in Stroke Patients. Front Neurol 2022; 13:853942. [PMID: 35720060 PMCID: PMC9201080 DOI: 10.3389/fneur.2022.853942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe Trail Making Test Part-B (TMT-B) is an attention functional test to investigate cognitive dysfunction. It requires the ability to recognize not only numbers but also letters. We analyzed the relationship between brain lesions in stroke patients and their TMT-B performance.MethodsFrom the TMT-B, two parameters (score and completion time) were obtained. The subjects were classified into several relevant groups by their scores and completion times through a data-driven analysis (k-means clustering). The score-classified groups were characterized by low (≤10), moderate (10 < score < 25), and high (25) scores. In terms of the completion time, the subjects were classified into four groups. The lesion degree in the brain was calculated for each of the 116 regions classified by automated anatomical labeling (AAL). For each group, brain sites with a significant difference (corrected p < 0.1) between each of the 116 regions were determined by a Wilcoxon Rank–Sum significant difference test.ResultsLesions at the cuneus and the superior occipital gyrus, which are mostly involved in visual processing, were significant (corrected p < 0.1) in the low-score group. Furthermore, the moderate-score group showed more-severe lesion degrees (corrected p < 0.05) in the regions responsible for the linguistic functions, such as the superior temporal gyrus and the supramarginal gyrus. As for the completion times, lesions in the calcarine, the cuneus, and related regions were significant (corrected p < 0.1) in the fastest group as compared to the slowest group. These regions are also involved in visual processing.ConclusionThe TMT-B results revealed that the subjects in the low-score group or the slowest- group mainly had damage in the visual area, whereas the subjects in the moderate-score group mainly had damage in the language area. These results suggest the potential utility of TMT-B performance in the lesion site.
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Affiliation(s)
- Ayako Nishimura
- Center for Exploratory Research, Research & Development Group, Hitachi. Ltd., Kokubunji, Japan
- Department of Rehabilitation, Hibino Hospital, Hiroshima, Japan
- *Correspondence: Ayako Nishimura
| | - Stephanie Sutoko
- Center for Exploratory Research, Research & Development Group, Hitachi. Ltd., Kokubunji, Japan
- Department of Rehabilitation, Hibino Hospital, Hiroshima, Japan
| | - Masashi Kiguchi
- Center for Exploratory Research, Research & Development Group, Hitachi. Ltd., Kokubunji, Japan
- Department of Rehabilitation, Hibino Hospital, Hiroshima, Japan
| | - Hirokazu Atsumori
- Center for Exploratory Research, Research & Development Group, Hitachi. Ltd., Kokubunji, Japan
- Department of Rehabilitation, Hibino Hospital, Hiroshima, Japan
| | - Akiko Obata
- Center for Exploratory Research, Research & Development Group, Hitachi. Ltd., Kokubunji, Japan
- Department of Rehabilitation, Hibino Hospital, Hiroshima, Japan
| | - Tsukasa Funane
- Center for Exploratory Research, Research & Development Group, Hitachi. Ltd., Kokubunji, Japan
- Department of Rehabilitation, Hibino Hospital, Hiroshima, Japan
| | - Akihiko Kandori
- Center for Exploratory Research, Research & Development Group, Hitachi. Ltd., Kokubunji, Japan
- Department of Rehabilitation, Hibino Hospital, Hiroshima, Japan
| | - Tomohiko Mizuguchi
- IoT Innovation Department, New Business Produce Division, Maxell Ltd., Yokohama, Japan
| | - Koji Shimonaga
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Seiji Hama
- Department of Rehabilitation, Hibino Hospital, Hiroshima, Japan
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Toshio Tsuji
- Graduate School of Advanced Science and Engineering, Hiroshima University, Higashihiroshima, Japan
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Suzuki H, Sakuma N, Kobayashi M, Ogawa S, Inagaki H, Edahiro A, Ura C, Sugiyama M, Miyamae F, Watanabe Y, Shinkai S, Awata S. Normative Data of the Trail Making Test Among Urban Community-Dwelling Older Adults in Japan. Front Aging Neurosci 2022; 14:832158. [PMID: 35693348 PMCID: PMC9175082 DOI: 10.3389/fnagi.2022.832158] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/21/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Population aging is likely to increase the number of people with dementia living in urban areas. The Trail Making Test (TMT) is widely used as a cognitive task to measure attention and executive function among older adults. Normative data from a sample of community-dwelling older adults are required to evaluate the executive function of this population. The purpose of this study was to examine the Trail Making Test completion rate and completion time among urban community-dwelling older adults in Japan. Methods A survey was conducted at a local venue or during a home visit (n = 1,966). Cognitive tests were conducted as a part of the survey, and TMT Parts A (TMT-A) and B (TMT-B) were completed after the completion of the Japanese version of the Mini-Mental State Examination (MMSE-J). Testers recorded TMT completion status, completion time, and the number of errors observed. Results In the TMT-A, 1,913 (99.5%) participants understood the instructions, and 1,904 (99.1%) participants completed the task within the time limit of 240 s. In the TMT-B, 1,839 (95.9%) participants understood the instructions, and 1,584 (82.6%) participants completed the task within the time limit of 300 s. The completion rate of TMT-B was 90.2 and 41.8% for participants with an MMSE-J score of >23 points and ≦23 points, respectively. Results of multiple regression analyses showed that age, education, and the MMSE-J score were associated with completion time in both TMTs. Conclusion In both TMTs, completion time was associated with age, education, and general cognitive function. However, not all participants completed the TMT-B, and the completion rate was relatively low among participants with low MMSE-J scores. These findings may help interpret future TMT assessments.
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Affiliation(s)
- Hiroyuki Suzuki
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
- *Correspondence: Hiroyuki Suzuki,
| | - Naoko Sakuma
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Momoko Kobayashi
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Susumu Ogawa
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Hiroki Inagaki
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Ayako Edahiro
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Chiaki Ura
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Mika Sugiyama
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Fumiko Miyamae
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Yutaka Watanabe
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Shoji Shinkai
- Faculty of Nutrition Sicences, Kagawa Nutrition University, Sakado, Japan
| | - Shuichi Awata
- Social and Human Sciences, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
- Integrated Research Initiative for Living Well with Dementia, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
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Dassanayake TL, Hewawasam C, Baminiwatta A, Ariyasinghe DI. Regression-based, demographically adjusted norms for Victoria Stroop Test, Digit Span, and Verbal Fluency for Sri Lankan adults. Clin Neuropsychol 2021; 35:S32-S49. [PMID: 34499569 DOI: 10.1080/13854046.2021.1973109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Lack of test norms is a major limitation in neuropsychological assessment in many non-English-speaking countries. Our objective was to generate sex-, age-, and education-adjusted, regression-based norms for three pen-and-paper-based executive function/working memory tests, viz. Victoria Stroop Test (VST), Digit Span, and Verbal Fluency, for Sinhala-Speaking Sri Lankan adults. METHOD Six-hundred and six healthy, community-living, Sinhala-speaking adults (273 men) aged 19-83 years completed VST, Digit Span (forward and backward), and Phonemic (Sinhala phonemes "N," "P," and "S") and Category (animals and vegetables) Fluency tests. We conducted multiple linear regression analyses with sex, age, and years of education fitted as predictors to model the test outcome variables. RESULTS Younger age was associated with better performance in all tests except in Phonemic Fluency. Longer education was associated with better performance in all outcomes except VST errors and interference. Women had a significant but small advantage over men in VST Neutral and Color Word tests, and Phonemic Fluency. We report regression equations to predict norms for the test performance measures based on sex, age, and years of education; and the test variances accounted by these factors. CONCLUSIONS We propose demographically adjusted norms for VST, Digit Span, and Verbal Fluency for Sinhala-speaking Sri Lankans aged 19-83 years, and supplement the regression formulae with a calculator that produces predicted and standard scores. These norms would help in interpreting the results of clinical samples in the future, taking into account the variability introduced by sex, age, and education.
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Affiliation(s)
| | - Chandana Hewawasam
- Department of Physiology, Faculty of Medicine and Allied Health Sciences, Rajarata University of Sri Lanka, Saliyapura 50008, Sri Lanka
| | - Anuradha Baminiwatta
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya 20400, Sri Lanka
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Xue X, Jin XM, Luo KL, Liu XH, Zhang L, Hu J. Effectiveness of Yijinjing on cognitive functions in post-stroke patients with mild cognitive impairment: study protocol for a randomized controlled trial. Trials 2021; 22:265. [PMID: 33836807 PMCID: PMC8034135 DOI: 10.1186/s13063-021-05220-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 03/24/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Statistics show that every year, 5.4 million people in the world suffer a stroke. Post-stroke cognitive impairment (PSCI) is one of the most common complications after stroke with a rate of 75%, which leads to decreased functions for independent living and reduced quality of life (QOL). Exercise training has been reported to be useful to improve the cognitive functions of post-stroke patients. Yijinjing, a traditional Chinese Qigong exercise characterized by an integration of mind and body in moderate exercise intensity, can improve cognitive functions of PSCI patients. This study aims to explore the feasibility and effectiveness of the Yijinjing exercise in this regard. METHODS A single-blind, superiority, randomized controlled trial will be employed with evaluations at 3 and 6 months. Seventy-two PSCI patients will be recruited and randomly assigned to the Yijinjing exercise intervention group or the control group (1:1). Participants in the control group will receive routine rehabilitation therapies, including occupational therapy, physical therapy, acupuncture therapy, and health education 5 times a week for 3 months. The intervention group will receive a 12-week routine rehabilitation therapy combined with the Yijinjing exercise intervention for 40 min each session and 3 sessions a week. The primary outcome of cognition will be measured by the Montreal Cognitive Assessment scale (MoCA). Secondary outcomes include executive function, memory function, visuospatial function, sleep quality, gait and motor function, activity of daily living (ADL), and quality of life (QOL). DISCUSSION Current evidence has reported the effectiveness of traditional Chinese exercise in improving the post-stroke population's motor functions. This research is a randomized controlled trial that evaluates traditional Chinese exercise's effectiveness for PSCI patients. It is expected to expand the traditional Chinese exercise scope and provide a new treatment approach for stroke populations with cognitive impairments. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR1900026532 . Registered on 13 October 2019.
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Affiliation(s)
- Xin Xue
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, No. 1200, Cai-Lun Road, Shanghai, China
| | - Xue-Ming Jin
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, No. 1200, Cai-Lun Road, Shanghai, China
| | - Kai-Liang Luo
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, No. 1200, Cai-Lun Road, Shanghai, China
| | - Xin-Hao Liu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, No. 1200, Cai-Lun Road, Shanghai, China
| | - Li Zhang
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, No. 1200, Cai-Lun Road, Shanghai, China
| | - Jun Hu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, No. 1200, Cai-Lun Road, Shanghai, China.
- Shanghai Second Rehabilitation Hospital, Shanghai, China.
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