Objective:To investigate the effect of network-based transcranial direct current stimulation(tDCS)based on specific brain networks on the working memory of older adults. Method:The study was a double-blind,randomized,crossover design.Healthy older adults were randomly as-signed to receive either tDCS or sham stimulation,with a minimum one-week interval between stimulation.The tDCS protocol aimed to enhance DAN excitability while inhibiting DN excitability,with a stimulation du-ration of 20 minutes.Sham stimulation lasted only 1 minute(30 seconds each at the beginning and the end of stimulation).Working memory performance was evaluated using the N-back task.Primary outcome measures included d-prime scores and reaction times.A two-way repeated-measures analysis of variance was conducted to assess the impact of stimulation on working memory. Result:Twenty-eight participants completed the experiment,with no significant side effects reported.Analysis revealed significant interaction effects for the d-prime scores(F=4.288,P=0.043,η2p=0.074)and the reaction times(F=5.836,P=0.019,η2p=0.098)in the 1-back task.Post-hoc analysis demonstrated the significant enhancements in the d-prime scores(P=0.012)and significant reductions in the reaction times(P＜0.001)for the 1-back task following tDCS. Conclusion:Network-based tDCS significantly enhances working memory performance in older adults,and presents a promising avenue for non-pharmacological interventions in age-related cognitive decline.
Objective:To explore the alteration of irisin in chronic obstructive pulmonary disease(COPD)patients before and after pulmonary rehabilitation(PR)treatment and to analyze the prognostic value of irisin in COPD pa-tients with acute exacerbations. Method:A total of 68 COPD outpatients from department of respiratory and critical care medicine in the Sec-ond Hospital of Hebei Medical University from February 2022 to August 2022 were enrolled and 35 healthy participants were admitted as controls.ELISA was applied to detect the expression of irisin in the serum of the patients.The difference between the COPD group and the health control group and the difference between before and after PR treatment were compared.The correlation analysis was used to analyze the relationship be-tween irisin and 6MWD(6 minutes walking distance)and IL-6(interleukin-6).In addition,K-M survival curve was used to differ the one-year cumulative risk of acute exacerbation-free risk ratio between the low irisin and the high irisin expression group. Result:①The expression of irisin in serum of the COPD patients and the health control group were(16.79±5.83)ng/ml and(34.89±8.68)ng/ml,respectively(P<0.05,t=12.55).②The concentration of irisin in the COPD patients before and after 8 weeks of PR treatment were(17.72±4.56)ng/ml and(19.55±4.25)ng/ml(P<0.05,t=4.43),respectively.③The level of Irisin in the COPD patients was positively correlated with the 6MWD(R=0.475,P<0.05)and negatively related with IL-16 level(R=﹣0.39,P<0.05).④K-M survival curve demonstrated that the median time without AECOPD(acute exacerbations of chronic obstructive pulmo-nary disease)in the low-level irisin and high-level irisin groups were(6.17±0.68)month and(9.58±0.82)month,respectively.Moreover,the cumulative acute exacerbation-free rate in 1 year was 30.0%and 68.12%,respectively(F=11.1 P<0.05). Conclusion:The expression of irisin in serum of the COPD patients was lower than that in the health control group and its level increased after PR treatment.The reduction of irisin might be a poor prognostic indicator for acute exacerbation in patients with COPD.
康复医疗是重要民生工程,也是连续性医疗服务体系的重要组成部分,及时有效的康复治疗介入能够有效缓解疾病带来的痛苦,减少功能障碍和残疾发生率,提高患者生活质量和适应社会的能力[1].我国康复医学的发展起步较晚,康复医疗体系的资源供应、服务能力等方面存在诸多问题,康复服务整体规模较小,尤其是在人口老龄化加剧、慢性病致残率上升以及疾病诊断相关分组(diagnosis related groups,DRG)和按病种分值付费(Diagnosis-Intervention Packet,DIP)支付制度改革的推动下,供需存在较大缺口,数量庞大的具有神经康复、骨科康复等需求的患者急性期治疗出院后由于缺乏延续性的康复护理服务而导致再住院,或发展为永久性的功能残疾,生活质量无法得到保证,也致使急性医疗、长期护理体系负担过重,医疗卫生资源被过度使用和浪费.我国康复医疗体系发展不充分的原因有多个方面,其中现行的医疗保障制度对康复医疗服务保障水平不高,特别是缺乏符合康复医疗特点的、合理的医保支付制度,是制约康复医疗服务体系发展的重要因素[1].
Objective:To investigate the test-retest reliability and criterion validity of the Robotic Brace for Dynamic Trunk Support System(RoboBDsys)in evaluating seated trunk control function in patients with spinal cord in-jury(SCI). Method:From October to December,2022,20 patients with spinal cord injury who were unable to walk were recruited.All participants completed RoboBDsys trunk control test including static control test and dynam-ic control test on the seated platform.The evaluation indexes were the supporting torque regression slope exert-ed by the robot platform on the direction of x,y,α,and θ,recorded as Kx,Ky,Kθ,Kα;the average sup-porting torque recorded as Fx,Fy,Mθ,Mα in the static control test;and the the Range of Motion(ROM)of trunk in four directions in the dynamic control test.All the participants completed Trunk Control Test(TCT)as criterion assessment.The test interval was one week,intraclass correlation coefficient(ICC)values were calculated between two RoboBDsys trunk control test. Result:There were 13 participants completed two tests.In the static control test,the ICCs of four indexes were 0.418-0.742 between 2 tests;the ICCs of all indexes in dynamic control test were 0.633-0.848,which all showed moderate to high test-retest reliability.In regards of criterion validity,there was low to mod-erate correlation between Ky,Mθ,Mα in static control test and TCT(|r|=0.467-0.561,P＜0.05);all indexes except right lateral flection ROM in dynamic control test showed moderate to high correlation with TCT(r=0.559-0.758,P＜0.05). Conclusion:RoboBDsys is a reliable and valid tool for evaluating seated trunk control function in patients with SCI.
第七次全国人口普查显示,我国60岁及以上人口为26402万人,占比18.70％(其中,65岁及以上人口为19064万人,占13.50％),人口老龄化程度进一步加深[1].研究指出,我国约有15.5％的人存在轻度认知功能障碍(mild cogni-tion impairment,MCI),更有约6％的老年人患有痴呆[2],认知功能障碍会降低老年人的生存质量,增加其长期护理需求,给家庭、社会和国家带来沉重负担,已经成为我国公共卫生挑战,但目前并未有治疗认知功能衰退的特效药物.
1复杂性区域疼痛综合征 复杂性区域疼痛综合征(complex regional pain syn-drome,CRPS)是一种以自主神经变化和炎症为特征的疼痛综合征,表现为区域分布性疼痛、自主神经功能障碍、感觉异常、运动障碍及皮肤、营养改变[1].CRPS分为Ⅰ型和Ⅱ型,CRPS Ⅰ型常见于骨折损伤、四肢手术及脑卒中后,一般认为没有周围神经损伤,又称反射性交感神经营养不良;CRPSⅡ型发生在周围神经损伤之后,又称为灼性神经痛.
目的:针对目前康复辅助器具服务过程中服务内容不完整、不规范问题,通过创建康复辅助器具服务云平台,规范辅具服务,实现流程一体化的康复辅助器具服务模式. 方法:提出一种新型全体系康复辅助器具服务模式,包含两个维度:一是整合民政、残联、医疗卫生等现有资源建立康复辅助器具服务体系;二是针对辅具需求、评估、配置、辅具供应、训练、使用、反馈等全链条流程,建立覆盖全流程技术层面的康复辅助器具服务体系.云平台采用工作流模型驱动技术将相关服务部门的业务逻辑进行整合,利用人工智能规则引擎技术对患者进行康复辅助器具的智能化评估和配置. 结果:建立面向患者、医疗卫生、民政、残联、辅具厂商的辅具服务云平台,可有效支持各机构部门的协同工作.功能覆盖从辅具申请、评估、到配置的各类康复辅助器具服务. 结论:该平台具有流程、辅具配置规则可配置等特点,可使不同部门间实现资源共享、服务协同、供需互动,提高康复辅助器具配置服务工作的高效性和便捷性,减轻工作人员负担.
脊髓损伤(spinal cord injury,SCI)是青壮年长期残疾的主要原因.一项基于人群的回顾性研究报告称,2011-2020年每百万人中约有27人患有SCI.SCI最常见原因包括跌倒、暴力、道路交通事故和运动[1].SCI通常会导致生产力下降、生活质量下降和高昂的医疗保健费,从而给个人和公众带来沉重的经济负担.然而,由于其复杂的病理生理机制,目前尚无可用于SCI恢复的最佳治疗方法.因此,寻找安全有效的治疗手段促进功能恢复仍是治疗的关键.电刺激已被广泛用于SCI后的康复训练.本文总结近年来电刺激在SCI中应用的最新进展,为后续相关研究提供理论依据.
随着我国人口老龄化的加剧,脑卒中发病率以每年8.7％的速度增长,卒中导致我国人群的残疾率高达75％[1].卒中后患者遗留的功能障碍及生活质量的降低给家庭和社会带来了巨大的负担.卒中后有70％以上的患者存在认知功能障碍,即卒中后认知障碍(post-stroke cognitive impair-ment,PSCI)[2].PSCI是脑卒中后主要并发症之一,是指由脑卒中引起的从轻度认知障碍到痴呆等一系列综合征[3].
Objective:To investigate the effect and mechanism of treadmill training on Purkinje cells in the cerebellum of the rats with spinal cord injury(SCI). Method:Total of 108 female SD rats were randomly divided into 3 groups:the sham-operated group,the SCI group,and the SCI+treadmill training(TT)group.The rats in the SCI exercise group started treadmill train-ing after surgery,and BBB scores were used to assess the hindlimb motor function of rats with spinal cord in-jury.The cerebellum tissues were collected on the 3,7 and 14 day after surgery respectively,and the number and morphological changes of Purkinje cells in the cerebellum were detected by HE staining and Nissler stain-ing.The expression of caspase-9 and mGluR1 in Purkinje cells was detected by immunohistochemistry;the ex-pression of caspase-3 and mGluR1 was detected by immunofluorescence;the expression of apoptosis-related proteins Bax,Bcl-2,Cyt-C,caspase-9 and caspase-3 in cerebellar tissue was detected by Western Blot. Result:Compared with the sham-operated group,the BBB scores in SCI and SCI+TT groups were significant-ly decreased(P＜0.05).The number of Purkinje cells in cerebellum was reduced,and the size was reduced and lost the normal morphology.The expression levels of apoptosis-related proteins Bax,Cyt-C,activated caspase-9,and activated caspase-3 proteins in cerebellum were significantly increased(P＜0.05),and Bcl-2 expression was significantly decreased;caspase-9 and caspase-3 expression was increased and mGluR1 expression was decreased in Purkinje cells(P＜0.05).Compared with the SCI group,there was no significant difference in the BBB scores of the SCI+TT group(P＞0.05);the number and normal morphology of Purkinje cells in cerebellum increased;the expression levels of apoptosis-related proteins Bax,Cyt-C,activated caspase-9 and activated caspase-3 de-creased(P＜0.05),and the expression of Bcl-2 increased;the expression levels of caspase-9 and caspase-3 in Pur-kinje cells were decreased,and the expression level of mGluR1 was significantly increased(P＜0.05). Conclusion:Treadmill training can reduce the apoptosis of Purkinje cells in the cerebellum of the rats with spi-nal cord injury through the mitochondrial apoptosis pathway.
第七次全国人口普查结果显示,我国60岁及以上人口为26402万人,占18.70％,其中65岁及以上人口为19064万人,占13.50％[1].人口老龄化程度持续加深.与人口老龄化、高龄化伴随而来的生活照料、健康管理等社会问题日益凸显,更多的老年人选择入住养老机构,期望得到高质量的养老服务,实现"幸福养老".
Objective:To screen out the core sets of neurogenic bladder in patients with spinal cord injury. Method:The basic databases related to neurogenic bladder were screened out from the international SCI data sets database provided by ISCOS,and each variable of these databases was sorted out.Using the principle of linkage and matching between ICF and outcome measurement tools developed by the ICF research group of WHO-FIC collaborating center,the selected variables were linked and matched with ICF comprehensive mea-surement items using the method of qualitative linking and matching of content by professionals.Collate match-ing ICF items to generate neurogenic bladder ICF core sets. Result:By comparing the same variables with two investigators,combining similar variables,and excluding variables unrelated to neurogenic bladder,85 items were included.A total of 60 concepts with clear meaning were extracted,and 46 concepts could be linked and matched with ICF.A total of 40 core sets of neurogenic bladder ICF were finally obtained after contact and matching with ICF,including 16 physical functions,8 body structures,9 activities and participation,and 7 environmental factors and personal factors. Conclusion:The systematic retrospective study method preliminarily screens the core sets of neurogenic blad-der in patients with spinal cord injury,which provides a more comprehensive framework for the evaluation and treatment of neurogenic bladder.
随着脑血管疾病发病率的不断增长,脑卒中是老年人残疾的主要原因,约有2/3的脑卒中幸存者遗留不同程度的功能障碍[1].脑卒中的高致残率不仅降低了患者的生存质量,还给患者家庭及社会带来巨大的负担.卒中后,大脑会经历不同的恢复阶段,中枢神经系统可以自发地以及在非侵入性刺激的帮助下重组神经回路,具有一定的神经可塑性[2].
重症监护技术的进步提高了 ICU患者的生存率,危重患者接受的治疗措施增加,卧床休息的时间随之延长[1].84％-95％患者在出院后5年伴随持续的功能障碍,导致生存质量下降,再人院风险及医疗服务成本增加[2].早期活动和锻炼计划能够提高患者出院时的功能状态,改善其预后[3].早期活动(early mobility,EM)是指患者血流动力学和呼吸循环稳定后开始进行活动,常于转入ICU后的24-48h内开始.
Objective:To observe the effect of rich environmental rehabilitation training on the physical system and ner-vous system development of newboms with hypoxic-ischemic encephalopathy(HIE). Method:Sixty-one HIE newboms were divided into the observation group(n=31)and the control group(n=30).The control group was given the routine clinical treatment and care,and the observation group was supplemented with enriched environmental rehabilitation training on the basis of the control group for 3 weeks.The body length and weight,and the head circumference of the two groups were measured to assess the physical development at admis-sion and 3 weeks after the intervention,and the neonatal behavioral neurological assessment(NBNA)and test of in-fant motor performance(TIMP)were used to evaluate the neurological development and motor function. Result:After the intervention,the changes of body length and weight changes in the observed group were bet-ter than the control group(P＜0.05),no significant difference in head circumference(P＞0.05),and the NB-NA score and TIMP score were higher than those of the control group(P＜0.05). Conclusion:The application of rich environmental rehabilitation training can promote the rapid development of physique and nervous system of the newboms with HIE and improve the motor function.
Objective:To investigate the psychosocial behavior status and related factors in patients with adolescent idio-pathic scoliosis(AIS),in order to pay attention to the mental health and provide an empirical evidence of mental health service and rehabilitation for AIS patients. Method:Fifty participants with AIS and 50 matched healthy adolescents were selected.General information of the participants in the two groups was collected.The Scoliosis Research Society-22(SRS-22),the strengths and difficulties questionnaire-self-report(SDQ-S),self-rating anxiety scale(SAS),nine-item patient health ques-tionnaire(PHQ-9)were used to evaluate the quality of life,anxiety,depression and other psychosocial behav-ior of all subjects.Statistical analysis was conducted to determine whether psychosocial behavior was difference between two groups.The correlation between the type and degree of scoliosis and the quality of life and psy-chosocial behavior was further analyzed. Result:The SAS results indicated that the number of participants with different degrees of anxiety in the AIS group was significantly higher than that in the control group(Z=-3.998,P＜0.001);SDQ-S results showed that the scores of partner interaction problems(t=3.168,P=0.002)and prosocial behavior(t=2.529,P=0.013)in AIS group were significantly higher than those in control group.The scores of pain in double-bend patients were lower than those in single-bend patients(t=2.824,P=0.007);The degree of lateral bending(Cobb Angle)was correlated with the mobility(r=-0.283,P=0.008)and psychological status(r=-0.300,P=0.047)of SRS-22,and was positively correlated with the score of PHQ-9(r=0.356,P=0.011). Conclusion:AIS patients have different levels of anxiety,peer interaction problems and poor prosocial behav-ior.It is necessary to be high valued and screened,evaluated and intervened as soon as possible.
Objective:To observe the effects of repetitive transcranial magnetic stimulation combined with divergent shock wave on muscle spasm in patients with traumatic spinal cord injury,and to explore a new clinical treatment method for the disease. Method:Fifity-nine patients with traumatic spinal cord injury with muscle spasm from January 2017 to June 2021 were selected and randomly divided into the observation group(n=30)and the control group(n=29)with the method of random number table.The patients in the observation group received repeated transcranial magnet-ic stimulation combined with divergent shock wave therapy,while the patients in the control group received ba-clofen treatment.Both groups received conventional rehabilitation therapy,including exercise therapy,acupunc-ture and massage.The treatment time was 8 weeks.The modified Ashworth score,Barthel index and SF-36 score of the patients in the observation group and the control group were compared before and after treatment. Result:After treatment,the effective rate of the observation group was 86.67％,which was significantly high-er than that of the control group(P＜0.05).The total score of Barthel index and SF-36 score of the two groups were significantly increased compared with those before treatment(P＜0.05).The Barthel index and SF-36 score in the observation group were significantly higher than those in the control group(P＜0.05). Conclusion:Repetitive transcranial magnetic stimulation combined with divergent shock wave can effectively im-prove the symptoms of muscle spasm in patients with traumatic spinal cord injury and can fully improve their ability of daily life and quality of life,which has achieved good clinical efficacy.
Objective:To explore the effects of whole-body fatigue on the balance and ankle proprioception during drop landing of individuals with functional ankle instability(FAI)by comparing the differences in balance and pro-prioception between the FAI group and the control group before and after fatigue. Method:A total of 31 participants with unilateral FAI and 31 healthy participants were included in this study.A static balance test,dynamic balance test,and ankle proprioception test were conducted before and after fa-tigue.Sway distance(D)of the center of pressure(COP),root mean square of the COP(RMS),95％confi-dence ellipse area of the COP movements(95％AREA),normalized reach distance,and the area under the curve(AUC)were calculated and analyzed. Result:Before whole-body fatigue,the static balance,dynamic balance,and ankle proprioception during drop landing in FAI group were significantly lower than those in control group.After whole-body fatigue,the static balance,dynamic balance,and ankle proprioception during drop landing in the FAI group and control group decreased significantly(P＜0.05),and the increase of D,RMS and 95％AREA in FAI group were significant-ly larger than those in control group(P＜0.05),and the decrease of normalized reach distance in the postero-medial and posterolateral directions and AUC were significantly larger than those in control group(P＜0.05). Conclusion:Whole-body fatigue reduced the static balance,dynamic balance,and ankle proprioception,and the reduction was larger in FAI individuals than in healthy individuals.Therefore,whole-body fatigue may in-crease the risk of recurrent ankle sprain by reducing posture control and proprioception in FAI individuals.
《作业治疗学》是康复治疗学专业的核心课程,提倡"以治疗对象为中心"和"以作业为本"的课程理念,注重培养学生观察和分析患者在其所处环境中的作业表现,从而提出个性化的作业治疗目标和方案,具有很强的创新性和实操性[1].其中,日常生活活动(activity of daily living,ADL)功能的评定和训练是该门课程的授课重点,也是学生在该门课程中必须掌握的一项作业治疗技能[2].
Objective:To compare the effect of whole body vibration training with different frequencies on lower limb function of stroke patients. Method:A total of 60 stroke patients were randomly divided into 10Hz group(n=20),20Hz group(n=20)and 30Hz group(n=20).Three groups received routine rehabilitation training.In addition the 10Hz group re-ceived 10Hz whole-body vibration training,20Hz group received 20Hz whole-body vibration training and the 30Hz group received 30Hz whole-body vibration training.Before and after 4 weeks training,Fugl-Meyer assess-ment scale-lower extremity(FMA-LE),the Berg balance scale(BBS),timed up and go test(TUGT)and 10-me-ter maximum walking speed(10mMWS)were used to assess the lower limb function of patients. Result:After 4 weeks treatment,The results of FMA-LE,BBS,TUGT and 10mMWS assessment from three groups exhibited significant improvements compared with those before treatment(P＜0.05).Moreover,the im-provements of FMA-LE,BBS,TUGT and 10mMWS assessment in the 30Hz group and the 20Hz group were significantly better than those in the 10Hz group(P＜0.05),and the improvements of various indexes in the 30Hz group were the most significant(P＜0.05). Conclusion:Three groups of whole body vibration training with different frequencies can improve lower limb function,balance and walking ability of stroke patients,and the effect of 30Hz whole body vibration training was the most obvious.
