BACKGROUND： Previous studies believed that the effect of rehabilitation training within 6 months after stroke （early rehabilitation training） is usually unsatisfactory. The rehabilitation training when acute stroke...BACKGROUND： Previous studies believed that the effect of rehabilitation training within 6 months after stroke （early rehabilitation training） is usually unsatisfactory. The rehabilitation training when acute stroke is stabilized may be better for the recovery of limb function. OBJECTIVE： To observe the effects of the rehabilitation training of motor relearning program plus Bobath technique on the motor function of limbs, nerve function and activities of daily life （ADL） in patients with acute stroke hemiplegia. DESIGN： A randomized controlled observation SETTING： Department of Neurology, Yaan People＇s Hospital PARTICIPANTS： A total of 150 patients with acute post-stroke hemiplegia were selected from the Department of Neurology, Yaan People＇s Hospital from March 2000 to October 2002. The patients were all accorded with the diagnostic standards about stroke set by the Fifth National Academic Meeting for Cerebrovascular Disease （1996）, confirmed by CT and MRI, and they were all informed with the interventions and the items of evaluation. The enrolled patients were randomly divided into training group （n=78） and control group （n=72） at admission. METHODS ： ① Interventions： All the patients were given routine treatments for stroke, including managin blood pressure, maintaining the balance of hydrolyte and electrolure, reducing intracranial pressure by dehydration, and venous injection of citicoline, besides those in the training group received rehabilitation training by motor relearning program and Bobath technique. The rehabilitation training began after the vital signs became stable within 24 hours to 3 days after attack for the patients with cerebral infarction and 48 hours to 5 days after at- tack for those with cerebral hemorrhage respectively, three times a day in the morning, at noon and in the evening respectively, 30 minutes for each time, they were trained for 1 month. Lying position： The patients should keep the anti-spasm posture in the supine position, contralateral and ipsilateral lying positions, and the postures should be changed regularly; The patients should exercise each joint passively; turn the body over and move actively; They should also performed the bringing training, and the weight loading training for the affected upper limb. Sitting position： The patients should finish the conversion from a lying position to a sitting one independently. Standing position： The patients should finish the conversion from a sitting position to a standing one independently; They also took weight loading training for the affected lower limb. The walking training should be performed when the affected lower limb could support 2/3 of body mass. Walking training： In a standing position supported by the affected lower limb, the unaffected one stepped in small range forward and backward; Each process of balancing and controlling standing position was trained by supporting the body mass by the affected lower limb; In swinging position, the independent movement of the ipsilateral knee joint was trained in alternation of flexion and extension. ② Evaluation of limb function, ADL and nerve function： The motor function of the affected limb was evaluated with the Fugl-Meyer assessment （FMA）, the total score of the motor function of upper and lower limbs was 100 points, the higher the score, the better the limb function. ADL were assessed with the modified Barthel index （MBI）, the total score was 100 points, the higher the score, the better the independence and the smaller the dependence. The severities of neurological deficit were assessed with neurological deficit score （NDS）, the total score ranged 0-45 points, the higher the score, the severer the neurological deficit. ③ Statistical analysis： The ttest was applied to compare the differences of the measurement data. MAIN OUTCOME MEASURES： The changes of nerve function, motor function and ADL in patients with post-stroke hemiplegia after motor relearning program training were observed. RESULTS： All the 150 patients with post-stroke hemiplegia were involved in the analysis of results. ① The scores of NDS, FMA and MBI before intervention in the training group were （25±9）, （23±23）, （20±16） points, which were close to those in the control group [（24±8）, （24±21）, （24±20） points, P 〉 0.05]. ② The NDS score after intervention in the training group was obviously lower than that in the control group [（10±7）, （18±9） points, t=4.07, P 〈 0.01], but the FMA and MBI scores were markedly higher than those in the control group [（72±28）, （80±24） points; （43±28）, （40±24） points, t=3.99, 6.50, P 〈 0.01]. CONCLUSION ： The comprehensive rehabilitation of motor relearning program plus Bobath technique at early period can remarkably improve the motor function of the affected limbs, nerve function and ADL in patients with post-stroke hemiplegia.展开更多
Background：Benign cicatricial airway stenosis （BCAS） is a life-threatening disease.While there are numerous therapies,all have their defects,and stenosis can easily become recurrent.This study aimed to investigate ...Background：Benign cicatricial airway stenosis （BCAS） is a life-threatening disease.While there are numerous therapies,all have their defects,and stenosis can easily become recurrent.This study aimed to investigate the efficacy and complications of nonstent combination interventional therapy （NSCIT） when used for the treatment of BCAS of different causes and types.Methods：This study enrolled a cohort of patients with BCAS resulting from tuberculosis,intubation,tracheotomy,and other origins.The patients were assigned to three groups determined by their type of stenosis：Web-like stenosis,granulation stenosis,and complex stenosis,and all patients received NSCIT.The efficacy and complications of treatment in each group of patients were observed.The Chi-square test,one-factor analysis of variance （ANOVA）,and the paired t-test were used to analyze different parameters.Results：The 10 patients with web-like stenosis and six patients with granulation stenosis exhibited durable remission rates of 100%.Among 41 patients with complex stenosis,36 cases （88%） experienced remission and 29 cases （71%） experienced durable remission.When five patients with airway collapse were eliminated from the analysis,the overall remission rate was 97%.The average treatment durations for patients with web-like stenosis,granulation stenosis,and complex stenosis were 101,21,and 110 days,respectively,and the average number of treatments was five,two,and five,respectively.Conclusions：NSCIT demonstrated good therapeutic efficacy and was associated with few complications.However,this approach was ineffective for treating patients with airway collapse or malacia.展开更多
文摘BACKGROUND： Previous studies believed that the effect of rehabilitation training within 6 months after stroke （early rehabilitation training） is usually unsatisfactory. The rehabilitation training when acute stroke is stabilized may be better for the recovery of limb function. OBJECTIVE： To observe the effects of the rehabilitation training of motor relearning program plus Bobath technique on the motor function of limbs, nerve function and activities of daily life （ADL） in patients with acute stroke hemiplegia. DESIGN： A randomized controlled observation SETTING： Department of Neurology, Yaan People＇s Hospital PARTICIPANTS： A total of 150 patients with acute post-stroke hemiplegia were selected from the Department of Neurology, Yaan People＇s Hospital from March 2000 to October 2002. The patients were all accorded with the diagnostic standards about stroke set by the Fifth National Academic Meeting for Cerebrovascular Disease （1996）, confirmed by CT and MRI, and they were all informed with the interventions and the items of evaluation. The enrolled patients were randomly divided into training group （n=78） and control group （n=72） at admission. METHODS ： ① Interventions： All the patients were given routine treatments for stroke, including managin blood pressure, maintaining the balance of hydrolyte and electrolure, reducing intracranial pressure by dehydration, and venous injection of citicoline, besides those in the training group received rehabilitation training by motor relearning program and Bobath technique. The rehabilitation training began after the vital signs became stable within 24 hours to 3 days after attack for the patients with cerebral infarction and 48 hours to 5 days after at- tack for those with cerebral hemorrhage respectively, three times a day in the morning, at noon and in the evening respectively, 30 minutes for each time, they were trained for 1 month. Lying position： The patients should keep the anti-spasm posture in the supine position, contralateral and ipsilateral lying positions, and the postures should be changed regularly; The patients should exercise each joint passively; turn the body over and move actively; They should also performed the bringing training, and the weight loading training for the affected upper limb. Sitting position： The patients should finish the conversion from a lying position to a sitting one independently. Standing position： The patients should finish the conversion from a sitting position to a standing one independently; They also took weight loading training for the affected lower limb. The walking training should be performed when the affected lower limb could support 2/3 of body mass. Walking training： In a standing position supported by the affected lower limb, the unaffected one stepped in small range forward and backward; Each process of balancing and controlling standing position was trained by supporting the body mass by the affected lower limb; In swinging position, the independent movement of the ipsilateral knee joint was trained in alternation of flexion and extension. ② Evaluation of limb function, ADL and nerve function： The motor function of the affected limb was evaluated with the Fugl-Meyer assessment （FMA）, the total score of the motor function of upper and lower limbs was 100 points, the higher the score, the better the limb function. ADL were assessed with the modified Barthel index （MBI）, the total score was 100 points, the higher the score, the better the independence and the smaller the dependence. The severities of neurological deficit were assessed with neurological deficit score （NDS）, the total score ranged 0-45 points, the higher the score, the severer the neurological deficit. ③ Statistical analysis： The ttest was applied to compare the differences of the measurement data. MAIN OUTCOME MEASURES： The changes of nerve function, motor function and ADL in patients with post-stroke hemiplegia after motor relearning program training were observed. RESULTS： All the 150 patients with post-stroke hemiplegia were involved in the analysis of results. ① The scores of NDS, FMA and MBI before intervention in the training group were （25±9）, （23±23）, （20±16） points, which were close to those in the control group [（24±8）, （24±21）, （24±20） points, P 〉 0.05]. ② The NDS score after intervention in the training group was obviously lower than that in the control group [（10±7）, （18±9） points, t=4.07, P 〈 0.01], but the FMA and MBI scores were markedly higher than those in the control group [（72±28）, （80±24） points; （43±28）, （40±24） points, t=3.99, 6.50, P 〈 0.01]. CONCLUSION ： The comprehensive rehabilitation of motor relearning program plus Bobath technique at early period can remarkably improve the motor function of the affected limbs, nerve function and ADL in patients with post-stroke hemiplegia.
文摘Background：Benign cicatricial airway stenosis （BCAS） is a life-threatening disease.While there are numerous therapies,all have their defects,and stenosis can easily become recurrent.This study aimed to investigate the efficacy and complications of nonstent combination interventional therapy （NSCIT） when used for the treatment of BCAS of different causes and types.Methods：This study enrolled a cohort of patients with BCAS resulting from tuberculosis,intubation,tracheotomy,and other origins.The patients were assigned to three groups determined by their type of stenosis：Web-like stenosis,granulation stenosis,and complex stenosis,and all patients received NSCIT.The efficacy and complications of treatment in each group of patients were observed.The Chi-square test,one-factor analysis of variance （ANOVA）,and the paired t-test were used to analyze different parameters.Results：The 10 patients with web-like stenosis and six patients with granulation stenosis exhibited durable remission rates of 100%.Among 41 patients with complex stenosis,36 cases （88%） experienced remission and 29 cases （71%） experienced durable remission.When five patients with airway collapse were eliminated from the analysis,the overall remission rate was 97%.The average treatment durations for patients with web-like stenosis,granulation stenosis,and complex stenosis were 101,21,and 110 days,respectively,and the average number of treatments was five,two,and five,respectively.Conclusions：NSCIT demonstrated good therapeutic efficacy and was associated with few complications.However,this approach was ineffective for treating patients with airway collapse or malacia.
