BACKGROUND: In the natural evolution of cerebrovascular disease, unconscious use of affected extremity during drug treatment and daily life can improve the function of affected upper extremity partially, but it is ver...BACKGROUND: In the natural evolution of cerebrovascular disease, unconscious use of affected extremity during drug treatment and daily life can improve the function of affected upper extremity partially, but it is very slow and also accompanied by the formation of abnormal mode. Therefore, functional training should be emphasized in recovering the motor function of extremity. OBJECTIVE: To observe the effects of combination of motor relearning program and Bobath method on motor function of upper extremity of patients with stroke. DESIGN: Comparison of therapeutic effects taking stroke patients as observation subjects. SETTING: Department of Neurology, General Hospital of Beijing Jingmei Group. PARTICIPANTS: Totally 120 stroke patients, including 60 males and 60 females, averaged (59±3) years, who hospitalized in the Department of Neurology, General Hospital of Beijing Jingmei Group between January 2005 and June 2006 were recruited. The involved patients met the following criteria: Stroke attack within 2 weeks; diagnosis criteria of cerebral hemorrhage or infarction made in the 4th National Cerebrovascular Disease Conference; confirmed by skull CT or MRI; Informed consents of therapeutic regimen were obtained. The patients were assigned into 2 groups according to their wills: rehabilitation group and control group, with 30 males and 30 females in each group. Patients in rehabilitation group averaged (59±2)years old, and those in the control group averaged (58±2)years old. METHODS: ① Patients in two groups received routine treatment in the Department of Neurology. When the vital signs of patients in the rehabilitation group were stable, individualized treatment was conducted by combined application of motor relearning program and Bobath method. Meanwhile, training of activity of daily living was performed according to the disease condition changes of patients at different phases, including the nursing and instruction of body posture, the maintenance of good extremity position, bed exercise, bedside sit up and sitting position balance, sit up exercise, dynamic and static balance exercise, walking exercise, active training and passive training. The strength, time and speed of training were increased gradually according to their physical abilities. Patients were trained 45 to 60 minutes once, 5 times a week, within 2 weeks. ② Evaluation criteria of therapeutic effect: The motor function of upper extremity was evaluated by Fugl-Meyer method on the day of beginning and end of treatment. Higher points indicated better function of upper extremity. ③ t test and paired t test were used for comparing the difference of intergroup and intragroup measurement data, respectively. MAIN OUTCOME MEASURES: Changes in Fugl-Meyer scoring of two groups before and after treatment. RESULTS: Totally 120 stroke patients participated in the final analysis. Before treatment, Fugl-Meyer scoring was close between rehabilitation group and control group [(14.47±2.38),(14.16±2.39) points, P > 0.05]; Fugl-Meyer scoring of rehabilitation group after treatment was significantly higher than that before treatment and that of control group[(37.93±2.67),(18.36±2.43) points, t =11.053, 5.408, P < 0.01]; There were no significant differences in Fugl-Meyer scoring between before treatment in the control group and control group (P > 0.05). CONCLUSION: Combined application of motor relearning program and Bobath method can significantly improve the motor function of upper extremity of patients with stroke.展开更多
目的系统评价上肢强化训练对脑瘫儿童上肢运动功能的效果。方法构建PICO架构,检索PubMed、Embase、Cochrane Library、Scopus、Web of Science、中国知网、中国生物医学文献数据库、维普和万方数据库,搜集关于上肢强化训练改善脑瘫儿童...目的系统评价上肢强化训练对脑瘫儿童上肢运动功能的效果。方法构建PICO架构,检索PubMed、Embase、Cochrane Library、Scopus、Web of Science、中国知网、中国生物医学文献数据库、维普和万方数据库,搜集关于上肢强化训练改善脑瘫儿童上肢运动功能的随机对照试验,检索时限均为2010年1月至2024年3月。按照Cochrane系统评价手册和物理治疗证据数据库量表对纳入文献进行质量评价,由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.4和Stata 17.0进行网状Meta分析。结果共纳入27篇文献,包括1173例患者,涉及3种上肢强化训练。强制性运动疗法、改良强制性运动疗法和手-臂双侧强化训练均可提高辅助手功能评分与Peabody精细运动功能评分;强制性运动疗法和改良强制性运动疗法可提高上肢技能质量量表评分;手-臂双侧强化训练可提高儿童生活功能量表评分。在提高辅助手功能、上肢技能质量量表评分和Peabody精细运动功能评分方面,强制性运动疗法为最佳干预方式;在提高儿童生活功能量表评分方面,手-臂双侧强化训练为最佳干预方式。结论上肢强化训练可显著改善脑瘫儿童的上肢运动功能、精细运动功能和日常生活活动能力,强制性运动疗法在改善上肢运动功能和精细运动功能方面效果最好,手-臂双侧强化训练在提高日常生活活动能力方面疗效最佳。展开更多
文摘BACKGROUND: In the natural evolution of cerebrovascular disease, unconscious use of affected extremity during drug treatment and daily life can improve the function of affected upper extremity partially, but it is very slow and also accompanied by the formation of abnormal mode. Therefore, functional training should be emphasized in recovering the motor function of extremity. OBJECTIVE: To observe the effects of combination of motor relearning program and Bobath method on motor function of upper extremity of patients with stroke. DESIGN: Comparison of therapeutic effects taking stroke patients as observation subjects. SETTING: Department of Neurology, General Hospital of Beijing Jingmei Group. PARTICIPANTS: Totally 120 stroke patients, including 60 males and 60 females, averaged (59±3) years, who hospitalized in the Department of Neurology, General Hospital of Beijing Jingmei Group between January 2005 and June 2006 were recruited. The involved patients met the following criteria: Stroke attack within 2 weeks; diagnosis criteria of cerebral hemorrhage or infarction made in the 4th National Cerebrovascular Disease Conference; confirmed by skull CT or MRI; Informed consents of therapeutic regimen were obtained. The patients were assigned into 2 groups according to their wills: rehabilitation group and control group, with 30 males and 30 females in each group. Patients in rehabilitation group averaged (59±2)years old, and those in the control group averaged (58±2)years old. METHODS: ① Patients in two groups received routine treatment in the Department of Neurology. When the vital signs of patients in the rehabilitation group were stable, individualized treatment was conducted by combined application of motor relearning program and Bobath method. Meanwhile, training of activity of daily living was performed according to the disease condition changes of patients at different phases, including the nursing and instruction of body posture, the maintenance of good extremity position, bed exercise, bedside sit up and sitting position balance, sit up exercise, dynamic and static balance exercise, walking exercise, active training and passive training. The strength, time and speed of training were increased gradually according to their physical abilities. Patients were trained 45 to 60 minutes once, 5 times a week, within 2 weeks. ② Evaluation criteria of therapeutic effect: The motor function of upper extremity was evaluated by Fugl-Meyer method on the day of beginning and end of treatment. Higher points indicated better function of upper extremity. ③ t test and paired t test were used for comparing the difference of intergroup and intragroup measurement data, respectively. MAIN OUTCOME MEASURES: Changes in Fugl-Meyer scoring of two groups before and after treatment. RESULTS: Totally 120 stroke patients participated in the final analysis. Before treatment, Fugl-Meyer scoring was close between rehabilitation group and control group [(14.47±2.38),(14.16±2.39) points, P > 0.05]; Fugl-Meyer scoring of rehabilitation group after treatment was significantly higher than that before treatment and that of control group[(37.93±2.67),(18.36±2.43) points, t =11.053, 5.408, P < 0.01]; There were no significant differences in Fugl-Meyer scoring between before treatment in the control group and control group (P > 0.05). CONCLUSION: Combined application of motor relearning program and Bobath method can significantly improve the motor function of upper extremity of patients with stroke.
文摘目的:探讨经皮耳迷走神经刺激(transcutaneous auricular vagus nerve stimulation,taVNS)联合任务导向性训练对卒中后偏瘫患者上肢功能及脑可塑性的影响。方法:将40例卒中后偏瘫患者随机分配至试验组(n=20)或对照组(n=20)。试验组接受taVNS联合任务导向性训练,而对照组仅接受任务导向性训练。在基线、治疗结束后分别用运动诱发电位(motor evoked potentials,MEP)、上肢Fugl-Meyer运动功能评估量表(Fugl-Meyer assessment upper extremity,FMA-UE)、偏瘫上肢功能测试香港版(functional test for the hemiplegic upper extremity,FTHUE)、手臂动作调查测试(action research arm test,ARAT)、改良Barthel指数(modified Barthel index,MBI)、疲劳严重度量表(fatigue severity scale,FSS)对患者进行评定,同时对治疗过程中患者出现的不良反应进行监测。结果:两组FMA-UE、FTHUE、ARAT、MBI、FSS评分在基线无显著性差异(P>0.05),经21天治疗后,两组除FSS外其余指标均较基线提高(P<0.05),且试验组FMA-UE、FTHUE、ARAT、MBI(作业能力)得分优于对照组(P<0.05)。两组健侧MEP潜伏期、波幅以及患侧MEP引出率在基线无显著差异(P>0.05),治疗后试验组健侧MEP潜伏期较对照组缩短(P<0.05),患侧MEP引出率高于对照组(P<0.05),而两组间波幅无显著差异;试验组健侧MEP潜伏期缩短与FMA-UE、FTHUE、MBI(作业能力)改善程度的相关系数分别为-0.705、-0.458、-0.654,具有显著性差异(P<0.05)。结论:taVNS联合任务导向性训练可以通过调节运动皮层的可塑性改善卒中后偏瘫患者的上肢运动功能。
文摘目的:评价运动想象训练(motor imagery training,MIT)对卒中后患者上肢运动功能的干预效果,采用功能性近红外光谱技术(functional near-infrared spectroscopy,fNIRS)初探MIT脑网络功能连接(functional connectivity,FC)特征。方法:纳入78例脑卒中偏瘫患者随机分为对照组和试验组,每组39例。对照组接受常规康复训练100min/天,6次/周,试验组在对照组基础上接受MIT 30min/天,6次/周,两组均干预3周。干预前以及3周后进行Fugl-Meyer上肢运动功能评定量表(FMA-UE)评定。在两组中各抽取10例左侧偏瘫且病变部位均在基底节区患者,采集10min fNIRS静息态血氧数据。设定感兴趣区(regions of interest,ROI)包括双侧前额叶(prefrontal cortex,PFC)、背外侧前额叶(dorsolateral prefrontal cortex,DLPFC)、前运动区和辅助运动皮层区(pre-motor and supplementary motor cortex,PMC&SMA)、体感联合皮层(somatosensory association cortex,SSAC)及感觉运动区(sensorimotor cortex,SMC),基于氧合血红蛋白(HbO)在时间序列上浓度计算两组患者在所有通道间及ROI间静息态FC强度差异。通过Person相关性检验,计算PMC&SMA、SMC血氧相对增量与FMA-UE评分相对增量之间的相关性。结果:干预3周后,两组患者FMA-UE评分均较干预前提高(P<0.05),且试验组提高FMA-UE评分更为显著(P<0.05)。基于HbO静息态FC分析发现,两组所有通道间FC均增加,与对照组相比,试验组具有显著性差异(P<0.01);干预3周后连通性存在显著性差异(0.01<P<0.05)的ROI-ROI包括:L_PFC-R_SSAC、L_DLPFC-R_SSAC、L_PFC-R_SMC、R_SSAC-L_DLPFC、R_SSAC-L_SSA、R_SSAC-R_PMC&R_SMA、R_SMC-L_SSAC、R_SMC-L_DLPFC、R_SMC-R_PMC&R_SMA。相关性分析发现,试验组PMC&SMA血氧相对增量与FMA-UE评分相对增量存在正相关性(r=0.658,P=0.039)。结论:MIT可改善卒中后患者的上肢运动功能,其作用机制可能与改变脑功能网络的失连接异常模式有关,如增加两侧半球运动皮质间固有FC,增加损伤侧半球运动皮质与健侧半球运动皮质、损伤侧额叶皮层间FC强度。
