BACKGROUND： Clinical diagnosis of various neurological disorders involving the sensory nerves depends primarily on subjective description, which cannot be quantitatively evaluated, and is also less reproducible and s...BACKGROUND： Clinical diagnosis of various neurological disorders involving the sensory nerves depends primarily on subjective description, which cannot be quantitatively evaluated, and is also less reproducible and specific. Quantitative sensory testing methods can overcome these shortcomings and is currently used to identify the function of the C- and A-fibers. OBJECTIVE： To apply the quantitative sensory testing method for analyzing changes in temperature sensation, cryalgesia, thermalgesia, and vibration sense on the skin surface of hemiplegic patients with post-stroke shoulder-hand syndrome, and to analyze the relationship between these changes and shoulder-hand syndrome. DESIGN, TIME AND SETTING： A non-randomized, concurrent, control study was performed at the Clinic and Inpatient Department of the Third Xiangya Hospital, Central South University, between June 2000 and April 2001. PARTICIPANTS： Thirty post-stroke, hemiplegic patients were divided into shoulder-hand syndrome and control groups, according to whether patients exhibited shoulder-hand syndrome, with 15 patients in each group. METHODS： A TSA2001 quantitative sensory testing device （Medoc, Israel） was used for quantitative sensory testing. All sensory testing employed limits, testing temperature sense on the palm thenar eminence and vibration sense on the thumb metacarpal. Cold threshold was ≤ 28 ℃, warmth threshold was ≥ 36 ℃, cold-evoked pain threshold was ≤ 5 ℃, heat-evoked pain threshold was ≥ 51 ℃, vibration threshold was ≥ 5 μm/s; if a patient met one of these items, he/she was considered to be hypoanesthesia. MAIN OUTCOME MEASURES： Cold, warm, cold-evoked pain, heat-evoked pain and vibration threshold changes on skin from the paralyzed upper extremity was measured in the shoulder-hand syndrome and control groups. RESULTS： Incidence of sensory disability in the shoulder-hand syndrome group increased more significantly than in the control group （P 〈 0.05）, with the primary manifestations being decreased cold threshold （P 〈 0.05） and increased warmth threshold （P 〈 0.05）. The value differences between cold and cold-evoked pain thresholds, as well as between warmth and heat-evoked pain thresholds, decreased significantly in the shoulder-hand syndrome group （P 〈 0.05）. There were no significant differences between the two groups in cold-evoked pain, heat-evoked pain, or vibration thresholds. CONCLUSION： The primary manifestations of sensory impairment in hemiplegic patients with post-stroke shoulder-hand syndrome were displayed as thermohypesthesia and hyperalgesia. Functional impairments of nerve fibers that control pain and temperature sense may play an important role in the pathogenesis of post-stroke shoulder-hand syndrome.展开更多
目的观察电针结合运动想象疗法对脑卒中后肩手综合征Ⅰ期患者的临床疗效。方法将60例符合纳入标准脑卒中后肩手综合征Ⅰ期患者随机分配为运动想象疗法组(A组)、电针治疗组(B组)和电针结合运动想象疗法组(C组),每组20例。3组都给予常规...目的观察电针结合运动想象疗法对脑卒中后肩手综合征Ⅰ期患者的临床疗效。方法将60例符合纳入标准脑卒中后肩手综合征Ⅰ期患者随机分配为运动想象疗法组(A组)、电针治疗组(B组)和电针结合运动想象疗法组(C组),每组20例。3组都给予常规的康复治疗,A组增加运动想象治疗,B组增加电针治疗,C组增加电针联合运动想象疗法。治疗2周后,比较数字疼痛评定量表(numeric rating scale,NRS)、患手肿胀程度评定、关节被动活动度(passive range of motion,PROM)、Fugl-Meyer运动功能评定量表上肢部分(upper fugl-meyer assessment,U-FMA)、Barthel指数(Barthel index,BI)和临床疗效。结果(1)治疗后,3组患者在NRS评分、手部肿胀程度均较治疗前降低(P<0.05);C组NRS评分低于A组(P<0.05),C组较B组在NRS评分的差异无统计学意义(P>0.05);C组手部肿胀程度低于B组(P<0.05),C组较A组手部肿胀程度的差异无统计学意义(P>0.05);A、B两组间NRS评分、手部肿胀程度差异无统计学意义(P>0.05)。(2)治疗后,3组在肩关节各被动活动度较治疗前增大(P<0.01);C组在肩关节前屈、后伸、外展和内外旋的被动活动度较A、B组增大(P<0.01);A、B两组间差异无统计学意义(P>0.05)。(3)治疗后,3组的U-FMA评分和BI评分较治疗前升高(P<0.05);3组的U-FMA和BI评分结果显示,C组较A、B组更高(P<0.05),A、B两组间差异无统计学意义(P>0.05)。(4)A组总有效率是85%,B组总有效率是90%,C组总有效率是95%,C组较A、B组差异有统计学意义(P<0.05),A、B两组间差异无统计学意义(P>0.05)。结论3组患者经治疗在疼痛、手部肿胀、上肢运动功能和日常生活活动能力方面均得到明显改善;且与单独的电针和运动想象疗法相比,电针联合运动想象治疗肩手综合征有明显的疗效优势。展开更多
基金This study belongs under the sub-topic of"Treatment and assessment of stroke under biol-ogy-psychology-society pattern" that has received the Third-class Award of Medical Science and Technology of Hu’nan Province, No. 200203-U-08
文摘BACKGROUND： Clinical diagnosis of various neurological disorders involving the sensory nerves depends primarily on subjective description, which cannot be quantitatively evaluated, and is also less reproducible and specific. Quantitative sensory testing methods can overcome these shortcomings and is currently used to identify the function of the C- and A-fibers. OBJECTIVE： To apply the quantitative sensory testing method for analyzing changes in temperature sensation, cryalgesia, thermalgesia, and vibration sense on the skin surface of hemiplegic patients with post-stroke shoulder-hand syndrome, and to analyze the relationship between these changes and shoulder-hand syndrome. DESIGN, TIME AND SETTING： A non-randomized, concurrent, control study was performed at the Clinic and Inpatient Department of the Third Xiangya Hospital, Central South University, between June 2000 and April 2001. PARTICIPANTS： Thirty post-stroke, hemiplegic patients were divided into shoulder-hand syndrome and control groups, according to whether patients exhibited shoulder-hand syndrome, with 15 patients in each group. METHODS： A TSA2001 quantitative sensory testing device （Medoc, Israel） was used for quantitative sensory testing. All sensory testing employed limits, testing temperature sense on the palm thenar eminence and vibration sense on the thumb metacarpal. Cold threshold was ≤ 28 ℃, warmth threshold was ≥ 36 ℃, cold-evoked pain threshold was ≤ 5 ℃, heat-evoked pain threshold was ≥ 51 ℃, vibration threshold was ≥ 5 μm/s; if a patient met one of these items, he/she was considered to be hypoanesthesia. MAIN OUTCOME MEASURES： Cold, warm, cold-evoked pain, heat-evoked pain and vibration threshold changes on skin from the paralyzed upper extremity was measured in the shoulder-hand syndrome and control groups. RESULTS： Incidence of sensory disability in the shoulder-hand syndrome group increased more significantly than in the control group （P 〈 0.05）, with the primary manifestations being decreased cold threshold （P 〈 0.05） and increased warmth threshold （P 〈 0.05）. The value differences between cold and cold-evoked pain thresholds, as well as between warmth and heat-evoked pain thresholds, decreased significantly in the shoulder-hand syndrome group （P 〈 0.05）. There were no significant differences between the two groups in cold-evoked pain, heat-evoked pain, or vibration thresholds. CONCLUSION： The primary manifestations of sensory impairment in hemiplegic patients with post-stroke shoulder-hand syndrome were displayed as thermohypesthesia and hyperalgesia. Functional impairments of nerve fibers that control pain and temperature sense may play an important role in the pathogenesis of post-stroke shoulder-hand syndrome.
文摘目的观察电针结合运动想象疗法对脑卒中后肩手综合征Ⅰ期患者的临床疗效。方法将60例符合纳入标准脑卒中后肩手综合征Ⅰ期患者随机分配为运动想象疗法组(A组)、电针治疗组(B组)和电针结合运动想象疗法组(C组),每组20例。3组都给予常规的康复治疗,A组增加运动想象治疗,B组增加电针治疗,C组增加电针联合运动想象疗法。治疗2周后,比较数字疼痛评定量表(numeric rating scale,NRS)、患手肿胀程度评定、关节被动活动度(passive range of motion,PROM)、Fugl-Meyer运动功能评定量表上肢部分(upper fugl-meyer assessment,U-FMA)、Barthel指数(Barthel index,BI)和临床疗效。结果(1)治疗后,3组患者在NRS评分、手部肿胀程度均较治疗前降低(P<0.05);C组NRS评分低于A组(P<0.05),C组较B组在NRS评分的差异无统计学意义(P>0.05);C组手部肿胀程度低于B组(P<0.05),C组较A组手部肿胀程度的差异无统计学意义(P>0.05);A、B两组间NRS评分、手部肿胀程度差异无统计学意义(P>0.05)。(2)治疗后,3组在肩关节各被动活动度较治疗前增大(P<0.01);C组在肩关节前屈、后伸、外展和内外旋的被动活动度较A、B组增大(P<0.01);A、B两组间差异无统计学意义(P>0.05)。(3)治疗后,3组的U-FMA评分和BI评分较治疗前升高(P<0.05);3组的U-FMA和BI评分结果显示,C组较A、B组更高(P<0.05),A、B两组间差异无统计学意义(P>0.05)。(4)A组总有效率是85%,B组总有效率是90%,C组总有效率是95%,C组较A、B组差异有统计学意义(P<0.05),A、B两组间差异无统计学意义(P>0.05)。结论3组患者经治疗在疼痛、手部肿胀、上肢运动功能和日常生活活动能力方面均得到明显改善;且与单独的电针和运动想象疗法相比,电针联合运动想象治疗肩手综合征有明显的疗效优势。
