Study on the Effect of Early Oral Motor Intervention in Preterm Infants in Neonatal Intensive Care Unit

Objective:To study the effective value of introducing the concept of early oral exercise in the process of nursing intervention for preterm infants in the neonatal intensive care unit(NICU).Methods:96 cases of preterm infants diagnosed from January 2022 to August 2022 were selected and randomly divided into two groups:the general practice group(general nursing intervention),and the early practice group(early oral exercise intervention),and the effect of intervention on preterm infants in the two groups was observed.Results:After nursing care,the mean value of the non-nutritive sucking ability assessment(76.54±5.82),the mean value of the intellectual development degree assessment(104.57±8.45),the mean value of the psychomotor development degree assessment(102.33±6.74),and the mean value of behavioral neural reflexes ability assessment(38.71±2.40)in the early practice group were better than that as compared to the general practice group(P<0.05);the mean value of oral feeding start time of preterm infants in the early practice group(35.42±7.63)weeks,the mean value of all oral feeding time(34.12±5.28)weeks,and the mean time of hospital intervention(15.33±4.25)days were lesser than compared to those of the general practice group at 37.4±5.82 weeks,37.46±3.55 weeks,and 20.46±2.91 days,respectively(P<0.05);the rate of adverse reactions in preterm infants in the early practice group significantly lower than that of the general practice group(P<0.05).Conclusion:The introduction of the concept of early oral exercise intervention among NICU nurses improved the feeding effect,sucking ability of preterm infants,and intellectual development.Hence,early oral motor care should be popularized.

Efficacy of early intervention of motor relearning program on post-stroke hemiplemia:A randomized controlled observation

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.

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.