Effects of Water Weight-Loss Walking Training on Lower Limb Motor Function and Gait in Stroke Patients

Background: Water weight-loss walking training is an emerging physical therapy technique, which provides new ideas for improving the motor function of stroke patients and improving the quality of life of patients. However, the rehabilitation effect of water weight-loss training in stroke patients is currently unclear. Objective: To analyze the effect of water weight loss walking training in stroke patients. Methods: A total of 180 stroke patients admitted to our hospital from January 2019 to December 2021 were selected and randomly divided into two groups. The control group received routine walking training, and the research group performed weight loss walking training in water on this basis. The lower limb motor function, muscle tone grade, daily living ability, gait and balance ability were compared between the two groups before and after treatment. Results: Compared with the control group, the FMA-LE score (Fugl-Meyer motor assessment of Lower Extremity), MBI score (Modified Barthel Index) and BBS score (berg balance scale) of the study group were higher after treatment, and the muscle tone was lower (P Conclusion: Water weight loss walking training can enhance patients’ muscle tension, correct patients’ abnormal gait, improve patients’ balance and walking ability, and contribute to patients’ motor function recovery and self-care ability improvement.

Major ozonated autohemotherapy promotes the recovery of upper limb motor function in patients with acute cerebral infarction

Major ozonated autohemotherapy is classically used in treating ischemic disorder of the lower limbs In the present study, we performed major ozonated autohemotherapy treatment in patients with acute cerebral infarction, and assessed outcomes according to the U.S. National Institutes of Health Stroke Score, Modified Rankin Scale, and transcranial magnetic stimulation motor-evoked potential. Compared with the control group, the clinical total effective rate and the cortical potential rise rate of the upper limbs were significantly higher, the central motor conduction time of upper limb was significantly shorter, and the upper limb motor-evoked potential amplitude was significantly increased, in the ozone group. In the ozone group, the National Institutes of Health Stroke Score was positively correlated with the central motor conduction time and the motor-evoked potential amplitude of the upper limb. Central motor conduction time and motor-evoked potential amplitude of the upper limb may be effective indicators of motor-evoked potentials to assess upper limb motor function in cerebral infarct patients. Furthermore, major ozonated autohemotherapy may promote motor function recovery of the upper limb in patients with acute cerebral infarction.

Effects of different frequencies of repetitive transcranial magnetic stimulation on the recovery of upper limb motor dysfunction in patients with subacute cerebral infarction

Studies have confirmed that low-frequency repetitive transcranial magnetic stimulation can decrease the activity of cortical neurons, and high-frequency repetitive transcranial magnetic stimulation can increase the excitability of cortical neurons. However, there are few studies concerning the use of different frequencies of repetitive transcranial magnetic stimulation on the recovery of upper-limb motor function after cerebral infarction. We hypothesized that different frequencies of repetitive transcranial magnetic stimulation in patients with cerebral infarction would produce different effects on the recovery of upper-limb motor function. This study enrolled 127 patients with upper-limb dysfunction during the subacute phase of cerebral infarction. These patients were randomly assigned to three groups. The low-frequency group comprised 42 patients who were treated with 1 Hz repetitive transcranial magnetic stimulation on the contralateral hemisphere primary motor cortex （M1）. The high-frequency group comprised 43 patients who were treated with 10 Hz repetitive transcranial magnetic stimulation on ipsilateral M1. Finally, the sham group comprised 42 patients who were treated with 10 Hz of false stimulation on ipsilateral M1. A total of 135 seconds of stimulation was applied in the sham group and high-frequency group. At 2 weeks after treatment, cortical latency of motor-evoked potentials and central motor conduction time were significantly lower compared with before treatment. Moreover, motor function scores were significantly improved. The above indices for the low- and high-frequency groups were significantly different compared with the sham group. However, there was no significant difference between the low- and high-frequency groups. The results show that low- and high-frequency repetitive transcranial magnetic stimulation can similarly improve upper-limb motor function in patients with cerebral infarction.

A novel glasses-free virtual reality rehabilitation system on improving upper limb motor function among patients with stroke:A feasibility pilot study

Background:Virtual reality(VR)technology is increasingly used in stroke rehabilitation.This study aimed to investigate the effectiveness of using the glasses-free VR training to improve motor function of upper limb in patients with stroke.Methods:Twelve patients with stroke were recruited to participate in the intervention of 3 weeks.At the baseline and post intervention,two times of evaluation including Fugl-Meyer upper-extremity scale(FMS-UE),transcranial magnetic stimulation(TMS)measurement and motion evaluation were performed.Results:No significant difference was observed between two groups at baseline evaluation.After the intervention,the FMS-UE scores presented a greater improvement in the VR group compared with the control group.TMS measurement showed that there was significant difference in cortex latency and central motor conduction time between two groups after the intervention,but no significant difference in the amplitude of motor event potential was observed.In addition,there was a significant correlation between game scores and FMS-UE scores.Conclusions:The novel glasses-free VR training was at least as effective as conventional occupational therapy in upper limb motor function,improving nerve conduction time and corticospinal excitability in patient with stroke.

Botulinum toxin type A plus rehabilitative training for improving the motor function of the upper limbs and activities of daily life in patients with stroke and brain injury

BACKGROUND: Botulinum toxin type A (BTX-A) is mostly to be used to treat various diseases of motor disorders, whereas its effect on muscle spasm after stroke and brain injury needs further observation. OBJECTIVE: To observe the effect of BTX-A plus rehabilitative training on treating muscle spasm after stroke and brain injury. DESIGN: A randomized controlled observation. SETTINGS: Department of Rehabilitation, Department of Neurology and Department of Neurosurgery, the Second Hospital of Hebei Medical University. PARTICIPANTS: Sixty inpatients with brain injury and stroke were selected from the Department of Rehabilitation, Department of Neurology and Department of Neurosurgery, the Second Hospital of Hebei Medical University from January 2001 to August 2006. They were all confirmed by CT and MRI, and had obvious increase of spastic muscle strength in upper limbs, their Ashworth grades were grade 2 or above. The patients were randomly divided into treatment group (n =30) and control group (n =30). METHODS: ① Patients in the treatment group undertook comprehensive rehabilitative trainings, and they were administrated with domestic BTX-A, which was provided by Lanzhou Institute of Biological Products, Ministry of Health (S10970037), and the muscles of flexion spasm were selected for upper limbs, 20-25 IU for each site. ② Patients in the treatment group were assessed before injection and at 1 and 2 weeks, 1 and 3 months after injection respectively, and those in the control group were assessed at corresponding time points. The recovery of muscle spasm was assessed by modified Ashworth scale (MAS, grade 0-Ⅳ; Grade 0 for without increase of muscle strength; Grade Ⅳ for rigidity at passive flexion and extension); The recovery of motor function of the upper limbs was evaluated with Fugl-Meyer Assessment (FMA, total score was 226 points, including 100 for exercise, 14 for balance, 24 for sense, 44 for joint motion, 44 for pain and 66 for upper limb); The ADL were evaluated with Barthel index, the total score was 100 points, 60 for mild dysfunction, 60-41 for moderate dysfunction, < 40 for severe dysfunction). MAIN OUTCOME MEASURES: Changes of MAS grade, FMA scores and Barthel index before and after BTX-A injection. RESULTS: All the 60 patients with brain injury and stroke were involved in the analysis of results. ① FMA scores of upper limbs: The FMA score in the treatment group at 2 weeks after treatment was higher than that before treatment [(14.98±10.14), (13.10±9.28) points, P < 0.05], whereas there was no significant difference at corresponding time point in the control group. The FMA scores at 1 and 3 months in the treatment group [(23.36±10.69), (35.36±11.36) points] were higher than those in the control group [(20.55±10.22), (30.33±10.96) points, P < 0.01]. ② MAS grades of upper limbs: There were obviously fewer cases of grade Ⅲ in MAS at 2 weeks after treatment than before treatment in the treatment group (0, 9 cases, P < 0.05), whereas there was no obvious difference in the control group. There were obviously fewer cases of grade Ⅲ in MAS at 2 weeks and 1 month after treatment in the treatment group (0, 0 case) than the control group (5, 2 cases, P < 0.01). ③ Barthel index of upper limbs: The Barthel index at 2 weeks after treatment was higher than that before treatment in the treatment group [(30.36±22.25), (28.22±26.21) points, P < 0.05], whereas there was no significant difference in the control group. The Barthel indexes at 1 and 3 months after treatment in the treatment group were obviously higher than those in the control group [(20.55±10.22), (30.33±10.96) points, P < 0.01]. CONCLUSION: BTX-A has obvious efficacy on decreasing muscle tension after stroke and brain injury, and relieving muscle spasm; Meanwhile, the combination with rehabilitative training can effectively ameliorate the motor function of upper limbs and ADL of the patients.

Evaluation of the Curative Effect of "Xingnao Kaiqiao" Acupuncture Based on Brunnstrom Staging on Upper Limb and Hand Motor Function in the Recovery Period after Stroke

Objective: To observe the effects of Xingnao Kaiqiao acupuncture(醒脑开窍针) on the motor function of upper limb and hand in the recovery period after stroke. Methods: Seventy-six cases of hemiplegia patients with ischemic stroke were divided into the treatment group and the control group(n=38 in each). Based on the Brunnstrom's stage of Xingnao Kaiqiao acupuncture combined with rehabilitation training was used in the treatment group, and the control group was given rehabilitation training. FuglMeyer Assessment of the upper extremity(FMA-UE), Action Research Arm Test(ARAT) and Simple Test for Evaluating hand Function(STEF) were adopted separately to compare scores before treatment and 8 weeks after treatment. Results: The difference was not statistically significant in the two groups of patients for comparison of FMA-UE, ARAT and STEF scores before treatment(P>0.05). The difference was statistically significant in the two groups of score comparison of FMA-UE, ARAT and STEF after treatment(P<0.05). Conclusion: The Xingnao Kaiqiao acupuncture has its unique advantages in improving recovery of motor function of upper limb and hand in recovery period after stroke.

Early application of percutaneous neuromuscular electric stimulation in interfering motor function of limbs and difference in temperature of axilla of patients with ischemic stroke

BACKGROUND： Temperature of axilla could be affected due to motor dysfunction of limbs and neural changes of vessel after ischemic stroke. OBJECTIVE： To observe the effect of percutaneous neuromuscular electric stimulation （PNES） on difference in temperature of axilla and analyze the relationship between function of limbs and difference in temperature of axilla. DESIGN： Randomized grouping and controlled observation SETTING： Department of Neurology, General Hospital of Shenyang Military Area Command of Chinese PLA PARTICIPANTS： Sixty patients with ischemic stroke were selected from Neurological Department of General Hospital of Shenyang Military Area Command of Chinese PLA from January to June 2003. All cases were diagnosed with clinical diagnosis criteria of ischemic stroke established by the Fourth Chinese Classification of Cerebrovasular Disease and CT examination and received neuromuscular electric stimulation （NES）. Patients were randomly divided into control group and treatment group with 30 in each group. METHODS： Control group： Patients received routinely neurological therapy. Treatment group： Except routine therapy, patients suffered from NES at 48 hours after hospitalization. NMT-91 NES equipment was used to stimulated injured limbs with low frequency once 30 minutes a day in total of 10 times a course, especially extensor muscle of upper limb and flexor muscle of lower limb. Prescription of hemiplegia was internally decided by equipment with the output frequency of 200 Hz. Intensity of electric output could cause muscle contraction. The therapy needed two or three courses. Temperature of bilateral axilla was measured every day to calculate the difference with the formula of （temperature of axilla on the injured side - temperature of axilla on the healthy side）. Motor function of limbs was measured with FugI-Meyer Motor Assessment （FMA） during hospitalization and at 2 and 4 hours after hospitalization. Among 90 points, upper and lower limb function was 54, equilibrium function 10, sensory function 10, and motion of joint 16. The higher the scores were, the better the function was. Correlation of data was dealt with linear correlation analysis. MAIN OUTCOME MEASURES ： Assessment and correlation between difference in temperature of axilla and motor function of injured limbs during hospitalization and at 2 and 4 weeks after hospitalization. RESULTS： All 60 patients with ischemic stroke were involved in the final analysis. ① Difference in temperature： Difference of 2 and 4 weeks after hospitalization was lower than that in control group and at just hospitalization [treatment group： （0.056±0.000）, （0.024±0.003） ℃; control group： （0.250±0.001）, （0.131 ±0.001）℃; hospitalization; （0.513±0.001） ℃, P 〈 0.05-0,01]. ② FMA scores： Scores of 2 and 4 weeks after hospitalization were higher than those in control group and at just hospitalization [treatment group; （43.50±15.09）, （67.97 ±18.21） points; control group： （33.33 ±13.54）, （40.87±19.34） points; hospitalization： （26.43 ±11.87） points, P 〈 0.05-0.01]. ③ Correlation： Difference in temperature of axilla was negative correlation with FMA scores （c=- -0.255 1, P 〈 0.05）. CONCLUSION： ① PNES can accelerate recovery of limb function and decrease temperature of axilla of patients with ischemic stroke. ② The lower the difference in temperature is, the better the functional recovery is.

基于莱温守恒模式的护理对急性脑梗死患者自我管理能力及神经功能的干预效果

目的探讨基于莱温守恒模式的护理干预对急性脑梗死患者自我管理能力及神经功能的影响。方法选择医院2021年3月—2022年6月收治的138例急性脑梗死患者,按照组间基线资料可比的原则分为对照组和观察组,各69例。对照组实施常规护理模式干预,观察组在对照组基础上采用基于莱温守恒模式的护理干预,干预6周。比较两组护理满意度、自我管理能力、神经功能[神经功能缺损评分表(NIHSS)]、肢体运动功能[运动功能评分量表(Fugl-Meyer)]及心理状态[焦虑自评量表(SAS)、抑郁自评量表(SDS)]。结果护理干预后,观察组患者护理满意率为92.75%,与对照组的79.71%对比,差异有统计学意义(P<0.05)。护理干预前,两组自我管理能力、神经功能、肢体运动功能及心理状态比较,差异无统计学意义(P>0.05);护理干预后,观察组自我管理能力各维度评分、肢体运动功能评分均高于对照组,差异有统计学意义(P<0.05);而观察组患者神经功能评价量表各项评分、SAS评分、SDS评分则低于对照组,差异有统计学意义(P<0.05)。结论基于莱温守恒模式的护理干预对急性脑横死患者效果更佳,可使患者负性情绪得到有效缓解,自我管理能力得到提高,还可有效改善患者神经功能,提高护理满意度。

经颅直流电刺激对慢性期脑卒中偏瘫患者上肢运动功能的疗效分析

目的:研究双侧经颅直流电刺激(dual-hemispheric transcranial direct current stimulation,Dual-tDCS)对慢性期脑卒中患者上肢运动功能的影响,为治疗慢性期脑卒中上肢功能障碍提供基于神经机制的理论依据。方法:选取某院24例慢性期脑卒中上肢运动功能障碍患者,按照随机数字表法将其分为研究组(n=13)和对照组(n=11)。对照组采用tDCS伪刺激联合常规康复治疗,研究组采用Dual-tDCS联合常规康复治疗。治疗前后,采用Fugl-Meyer运动功能评定量表上肢部分(Fugl-Meyer assessment upper limb scale,FMA-UL)及日常生活活动能力(activities of daily living,ADL)测评量表对患者活动能力进行评估。对比治疗前后初级运动皮层(M1区)与全脑功能连接(functional connectivity,FC)的变化。使用SPSS 24.0统计学软件进行数据分析。结果:治疗后,2组患者的FMA-UL、ADL评分比治疗前均显著提高,且研究组评分明显高于对照组,差异有统计学意义(P<0.05)。M1区与全脑FC分析显示,治疗后对照组健侧M1区到患侧枕中回、健侧舌回、健侧角回FC降低(P<0.01);患侧M1区未见FC变化脑区。治疗后研究组健侧M1区到健侧小脑、健侧小脑蚓部FC降低,到患侧中央前回FC增加(P<0.01);患侧M1区到患侧小脑、患侧颞中回FC增加,到健侧中央前回FC降低(P<0.01)。结论:Dual-tDCS对大脑的神经调控作用可改善慢性期卒中患者运动和非运动相关脑区的FC,可能是慢性期脑卒中上肢运动功能障碍的康复机制。

基于IMB模型的康复干预对老年脑梗死患者上肢功能运动功能及神经功能的影响

目的探讨信息-动机-行为技巧(IMB)下的康复干预在老年脑梗死患者中的应用效果。方法将符合本研究纳入及排除标准的116例脑梗死患者随机分成2组各58例,对照组采用常规康复,观察组采用基于IMB模型的康复干预。2组患者均在院内进行为期1个月的康复训练,院外监督患者继续进行2个月的康复训练并线上汇报每日康复训练情况,共连续干预3个月后评估2组患者上肢功能、运动功能、神经功能、生活质量及并发症发生情况。结果干预后2组患者Fugl-Meyer评估量表(FMA)及上肢Wolf(沃尔夫)运动功能测试量表(WMFT)评分均增加,且观察组增加幅度更显著[FMA:(25.91±4.42)分比(29.37±4.58)分,t=4.140,P<0.05;WMFT:(30.42±3.56)分比(34.29±4.05)分,t=5.466,P<0.05]。干预后2组患者FCA及BBS评分均增加,且观察组分值增加幅度更显著[FCA评分:(50.08±8.21)分比(57.63±8.58)分,t=4.842,P<0.05;BBS评分:(31.98±5.36)分比(37.41±5.79)分,t=5.241,P<0.05]。干预后2组患者NIHSS评分均降低,ADL评分均增加,且观察组分值变化幅度更显著[NIHSS评分:(9.60±1.73)分比(6.83±1.55)分,t=9.082,P<0.05;ADL评分:(75.33±5.56)分比(80.74±5.82)分,t=5.119,P<0.05]。干预后2组患者WHOQOL-BREF量表各维度评分及总分均升高,且观察组患者WHOQOL-BREF量表各维度评分及总分值变化幅度更显著(P<0.05)。观察组并发症发生率(1.72%)与对照组(18.97%)相比显著降低(P<0.05)。结论基于IMB模型的康复干预有效改善了老年脑梗死患者上肢功能、运动功能及神经功能,提高了患者生活质量,降低了并发症发生率。

关节镜下关节清理联合微骨折技术对膝关节骨折患者肢体运动功能的影响

目的 探讨关节镜下关节清理联合微骨折技术治疗膝关节骨折患者的效果。方法 70例膝关节骨折患者随机分为两组,对照组采用关节镜下关节清理手术治疗,观察组在对照组基础上采用微骨折技术治疗,比较两组的膝关节功能、疼痛反应和下肢运动功能。结果 观察组治疗后的HSS评分、下肢Fugl-Meyer评分均高于对照组,治疗后1周内的VAS评分均低于对照组(P <0.05)。结论 关节镜下关节清理联合微骨折技术治疗膝关节骨折可提升患者的膝关节功能,减轻术后疼痛,提升下肢运动能力。

间歇性Theta节律刺激联合床旁康复训练治疗在急性重症脑卒中患者上肢运动障碍恢复中的应用

目的 探讨间歇性Theta节律刺激联合康复训练治疗在急性重症脑卒中患者上肢运动障碍恢复中的应用。方法 我院收治的94例急性重症脑卒中偏瘫患者,根据单双号法分为训练组(常规康复训练)与电刺激组(间歇性Theta节律刺激联合康复训练)各47例。对比两组临床疗效(NIHSS)、治疗前后上肢运动情况[Fugl-Meyer评分(FMA)、改良Barthel指数(MBI)、上肢运动指数(MI)]、电刺激指标[中枢运动传导时间(CMCT)、运动诱发电位(MEP)]、表面肌电信号及脑血流动力学指标(外周阻力、平均血流速度、平均血流量)变化。结果 治疗第1、2、4周,两组NHISS逐渐下降,且各时间段电刺激组低于训练组(P<0.05);治疗后两组FMA、MBI、MI评分均上升,且电刺激组均高于训练组(P<0.05);两组CMCT、MEP均下降,且电刺激组均低于训练组(P<0.05);两组肱二头肌屈肘、肱三头肌伸肘时表面肌电信号上升,且电刺激组均高于训练组(P<0.05),肱二头肌伸肘、肱三头肌屈肘时组内或组间比较差异均无统计学意义(P>0.05);两组外周阻力下降,平均血流速度与血流量提高,且电刺激组外周阻力低于训练组,平均血流速度与血流量高于训练组(P<0.05);两组均未发现明显不良反应。结论 间歇性Theta节律刺激联合康复训练可恢复急性重症脑卒中偏瘫患者上肢运动功能,改善肌电信号与脑血流动力学指标,疗效显著,值得推广。

基于脑电图的脑机接口技术在脑卒中患者上肢运动功能康复中的应用

背景:目前的康复方案对脑卒中后遗症的干预已取得不错的疗效,但治疗周期较长且人工成本较高。脑机接口技术通过特殊设备提取大脑神经活动信号,并将此信号转换处理为计算机可以识别的指令,可用于脑卒中后遗症的治疗。目的:分析和总结近些年脑机接口技术在脑卒中患者上肢运动功能康复中的应用,探讨脑机接口技术在脑卒中患者上肢功能康复中的临床应用价值。方法:以“脑卒中、脑电图、脑机接口、上肢、虚拟现实技术、功能性电刺激、外骨骼”为中文检索词,在中国知网进行相关文献检索;以“stroke、brain-computer interface、computer assistance、upper limb、virtual reality technology、functional electrical stimulation、exoskeleton”为英文检索词,在PubMed数据库进行相关文献检索,检索时间范围为2000-2022年。结果与结论:脑机接口对脑卒中患者上肢运动功能恢复具有良好的应用前景,并且被证明可以产生常规治疗无法实现的效果,非常值得进一步研究和推广,但是其机制尚未被完全阐释清楚。同时从脑机接口系统采集患者脑电信号的角度来看,准确地解码上肢运动的所有自由度以提供灵活和自然的控制能力仍然是一个挑战。未来的研究应该集中在阐明脑机接口技术促进脑卒中上肢运动恢复的特定神经机制,并确定脑机接口与外接设备相结合等康复方案,以促进脑卒中患者上肢运动功能恢复。

针刺联合镜像疗法治疗脑卒中患者上肢运动功能障碍临床疗效观察

目的观察针刺联合镜像疗法治疗脑卒中患者上肢运动功能障碍的临床疗效。方法将90例脑卒中上肢运动功能障碍患者按随机数字表法分为对照1组(30例,给予针刺治疗)、对照2组(30例,给予镜像疗法治疗)和观察组(30例,给予针刺联合镜像疗法治疗),疗程均为2周。比较3组患者治疗前后Fugl-Meyer评估量表上肢板块(Fugl-Meyer assessment upper extremity,FMA-UE)评分,Wolf运动功能测试(Wolf motor function test,WMFT)量表评分,改良Barthel指数(modified Barthel index,MBI),国际功能、残疾和健康分类(international classification of functioning,disability and health,ICF)评分及伸腕主动运动范围(active range of motion,AROM)和基于FMA-UE评分判定临床疗效。结果观察组临床疗效优于对照1组和对照2组(P<0.05);治疗后3组患者FMA-UE评分、WMFT评分、MBI均较治疗前显著增加(P<0.05),ICF评分显著减少(P<0.05),且观察组FMA-UE评分、WMFT评分、MBI增加程度,ICF评分减少程度显著大于对照1组和对照2组(P<0.05);治疗后观察组患者伸腕AROM显著大于对照1组和对照2组(P<0.05)。结论针刺联合镜像疗法能有效改善脑卒中患者上肢运动功能障碍。

早期康复治疗联合家庭康复训练在小儿脑损伤及脑瘫患儿中的应用效果

目的探讨早期康复治疗联合家庭康复训练干预对小儿脑损伤及脑瘫患儿的临床效果。方法选取2020年2月至2022年9月泰安市妇幼保健院收治的52例小儿脑损伤及脑瘫患儿为研究对象,采用投掷硬币法将其分为参照组(n=26)和研究组(n=26)。参照组采用家庭康复训练方式;研究组采用早期康复治疗联合家庭康复训练方式,两组均保持为期2周的干预。比较两组小儿脑损伤及脑瘫患儿的护理总有效率、生存质量评分(社交功能评分、情感功能评分及生理功能评分)、日常生活能力量表(ADL)评分及肢体运动功能评定量表(FMA)评分。结果研究组小儿脑损伤及脑瘫患儿护理总有效率高于参照组,差异有统计学意义(P<0.05)。护理后,两组小儿脑损伤及脑瘫患儿社交功能评分、情感功能评分及生理功能评分高于护理前,且研究组高于参照组,差异有统计学意义(P<0.05)。护理后,两组小儿脑损伤及脑瘫患儿ADL评分及FMA评分高于护理前,且研究组高于参照组,差异有统计学意义(P<0.05)。结论临床给予小儿脑损伤及脑瘫患儿早期康复治疗联合家庭康复训练干预,对于患儿护理效果、生存质量、日常生活能力及肢体运动功能的提升具有显著效果。

Three-talk决策模式干预对急性脑梗死病人神经功能恢复和心理状态的影响

目的:探讨Three-talk决策模式干预对急性脑梗死病人神经功能恢复和心理状态的影响。方法:选取急性脑梗死病人80例,随机分为对照组和观察组,各40例。对照组给予常规护理,观察组在常规护理基础上给予Three-talk决策模式(包括团队会谈、选择会谈、决策会谈)干预,比较2组病人干预前和干预1个月后的负性情绪、肢体肌力、运动功能、吞咽功能和自我护理能力(ESEA)评分。结果:干预前,2组病人焦虑、抑郁、肢体肌力、运动功能、吞咽功能和ESEA评分差异均无统计学意义(P>0.05);干预1个月后,观察组焦虑、抑郁和吞咽功能评分均明显低于对照组(P<0.01),肢体肌力、运动功能、ESEA评分均明显高于对照组(P<0.01)。结论:Three-talk决策模式干预有助于缓解急性脑梗死病人的焦虑、抑郁情绪,帮助病人实现肢体肌力、运动及吞咽功能的恢复,进而提高其自我护理能力。

针灸联合精细化体位管理治疗脑卒中后肩手综合征Ⅰ期患者的效果

目的探讨针灸联合精细化体位管理治疗脑卒中后肩手综合征Ⅰ期患者的效果。方法选取2021年7月至2023年1月于江西省人民医院康复医学科就诊的128例脑卒中后肩手综合征Ⅰ期患者为研究对象,按照随机数字表法分为对照组与观察组,每组各64例。对照组患者给予西药联合精细化体位管理治疗,观察组患者实施针灸联合精细化体位管理治疗,两组均治疗4周。比较两组患者的临床疗效、疼痛程度、上肢运动功能、生活自理能力。结果观察组的临床疗效优于对照组,差异有统计学意义(P<0.05)。治疗前,两组患者的Fugl-Meyer评测法(FMA)、关节活动度、改良巴氏指数(BI)、视觉模拟评分法(VAS)评分比较,差异无统计学意义(P>0.05);治疗后,观察组的FMA[(59.44±5.82)分]、关节活动度[(90.35±13.14)°]、BI[(84.79±8.44)分]均高于对照组[(50.14±5.03)分、(80.52±11.97)°、(65.18±7.21)分],观察组的VAS评分[(1.14±0.22)分]低于对照组[(2.36±0.35)分],差异有统计学意义(P<0.05)。结论针灸联合精细化体位管理可有效缓解脑卒中后肩手综合征Ⅰ期患者患肢肿胀、疼痛症状,有利于提升患者的上肢运动功能,促进患者生活自理能力提升。

Bobath康复训练改善脑卒中后肩手综合征患者上肢运动功能效果分析

目的 探讨Bobath康复训练改善脑卒中后肩手综合征(SHS)患者上肢运动功能效果。方法 采用便利抽样方法选取2022年4月至2023年1月南通市第三人民医院(南通大学附属南通第三医院)康复科收治的110例脑卒中后SHS患者作为研究对象,根据随机数字表法分为研究组和对照组,各55例。2组患者均实施基础护理,对照组实施常规康复锻炼,研究组同时联合Bobath康复训练。干预前后,对比2组患者Fugl-Meyer量表(FMA)评分、肩关节活动度评分、肩手综合征评定量表(SHSS)评分及患侧上肢Ashworth分级。结果 干预后,2组患者FMA评分及肩关节前屈、后伸、外展角度均大于干预前,且研究组大于对照组(P<0.05)。干预后,2组患者SHSS评分均低于干预前,且研究组低于对照组(P<0.05)。干预前,2组患者中不同Ashworth分级患者占比差异无统计学意义(P>0.05);干预后,研究组Ashworth分级0~Ⅰ+级患者占比高于对照组(P<0.05)。结论 对脑卒中后SHS患者实施Bobath康复训练可提高上肢功能及肩关节活动度,可改善患者患侧上肢痉挛情况。

以针康法为主的中医整合康复技术对脑卒中偏瘫肢体肌力、运动功能的干预效果分析

目的探讨以针康法为主的中医整合康复技术对脑卒中后偏瘫患者的干预效果及对患者肢体肌力、肢体运动功能的影响。方法将医院针灸科、康复科收治的脑卒中后偏瘫患者90例纳入研究,随机分为对照组与中医整合康复组,各45例。两组均给予脑卒中常规西药治疗,对照组在此基础上给予常规康复训练,中医整合康复组在常规治疗基础上给予针康法、易筋经联合推拿治疗,共治疗8周后判定疗效。比较两组的中医证候积分,比较治疗前后患者肢体肌力[徒手肌力检查(Manual muscle testing,MMT)]、肌张力[改良Ashworth分级标准(MAS)]、肢体运动功能[Fug-Meyer运动功能量表(Fugl-Meyer assessment scale,FMA)]、神经功能[美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)]及生活质量[脑卒中专用生活质量量表(Stroke Specific Quality of Life,SS-QOL)]。彩色多普勒超声测定颈总动脉收缩期最大流速(Peak systolic velocity,PSV)、舒张末期最低流速(End diastolic velocity,EDV)及阻力指数(Resistance index,RI)等脑血流动力学参数。结果两组治疗后半身不遂、偏身麻木、口舌歪斜、言语謇涩、步履不稳、气短乏力等中医证候积分及总积分均较治疗前显著降低(P<0.05),中医整合康复组显著低于对照组(P<0.05)。中医整合康复组的显效率(51.1%,23/45)和有效率(95.5%,43/45)均明显优于对照组[24.4%(11/45)和82.2%(37/45)],组间比较差异有统计学意义(P<0.05)。两组治疗后MMT、FAM、SS-QOL评分及PSV、EDV值均较治疗前显著升高(P<0.05),中医整合康复组显著高于对照组(P<0.05);两组治疗后MAS、NIHSS评分及RI值均较治疗前显著降低(P<0.05),中医整合康复组显著低于对照组(P<0.05)。结论以针康法为主的中医整合康复技术治疗脑卒中后偏瘫效果显著,能够明显增强患者肢体肌力,降低肌张力,改善患者的肢体运动功能和神经功能,提高患者生活质量。

重复经颅磁刺激提高脑卒中后上肢功能靶点选择和定位的应用进展

脑卒中是一种常见的脑血管疾病,具有高发病率、高死亡率、高致残率、高复发率等特点,给我国的社会经济带来了严重负担。脑卒中后约30%~60%的患者遗留有不同程度的上肢运动功能障碍。目前国内外改善脑卒中后上肢运动功能的康复技术主要为运动功能训练,而重复经颅磁刺激(rTMS)因为能够通过调节皮层兴奋性和诱导神经可塑性来促进脑卒中患者的上肢运动功能恢复,在脑卒中康复中的应用逐渐增多,已被指南列入A级推荐。但是相关临床研究还存在较大异质性,治疗效果受到靶点选择不同以及靶点定位准确性等因素影响。近年来关于新的刺激靶点及不同定位方法的研究逐渐增加,本文对rTMS作用于初级运动皮层(M1区)、前运动皮层(PMC)等脑区的rTMS方案、疗效、作用机制及刺激靶点的定位方法进行综述,旨在为rTMS在脑卒中后上肢运动功能康复的临床应用提供指导。