失语症是卒中后常见的并发症,是由脑部器质性损伤导致大脑语言区域及相关区域(语言中枢)受损,而造成原语言功能受损或者丧失、缺失的一种语言障碍综合征[1].随着医学技术的发展、脑卒中治疗水平的提高以及患者寿命的延长,中枢神经系统损伤导致的成人语言障碍呈逐年上升趋势.据报道,在欧美国家,每10万人中就有43～ 60人出现卒中后失语症,而且随着老年人数的增加,失语症的发病率也越来越高[2].而我国每年因脑卒中而新增失语症患者至少约21万[3].失语症引起的言语及沟通障碍严重影响了患者的生活质量,阻碍卒中患者的康复.本研究发现1例脑卒中后经皮质运动性失语的患者可流畅唱歌,特报道如下.

目的:探讨早期应用淋巴引流手法结合持续被动活动(CPM)对膝关节周围骨折术后膝关节功能康复的临床疗效.方法:41例膝关节周围骨折术后患者随机分为观察组21例和对照组20例,对照组予常规康复治疗(包括关节松动 、肌力训练 、冰敷等),观察组在常规康复治疗的基础上应用淋巴引流手法及CPM治疗.治疗前及治疗4周后测量患肢膝关节周径评定水肿情况,采用关节活动度及lysholm膝关节功能评分(LKSS)评定膝关节功能.结果:治疗4周后,2组膝关节周径较治疗前均降低(均P<0.01),其中观察组降低更明显(P<0.01);2组ROM、LKSS评分较治疗前均提高(均P<0.01),其中观察组提高更明显(P<0.01).结论:膝关节周围骨折术后早期应用淋巴引流手法结合CPM能减轻膝关节肿胀 、改善膝关节活动度及膝关节功能.

Objective To explore the effect of bilateral hand function training on the hand function of stroke survivors.Methods Thirty-one patients with unilateral hand dysfunction after stroke were randomly divided into an experimental group of 16 and a control group of 15.Both groups were given 60 minutes of hand function training of their affected hands daily,five days a week for 4 weeks.The experimental group was additionally provided with 40 minutes of bilateral hand training on the basis of the aforementioned intervention.Before the treatment and after the 4 weeks,integrated surface electromyography (iEMG) signals were recorded from both hands' flexor and extensor muscles.Both groups were also assessed using the Fugl-Meyer motor assessment for the upper extremities (FMA-UE).Results After the treatment,the average iEMG of the flexor and extensor muscles during flexion and extension were significantly better than before the treatment in both groups.There was no significant difference between the two groups in their average iEMGs before the treatment,but afterward significant differences were observed in all the iEMG measurements.After the treatment the average total FMA-UE score of the experimental group was significantly higher than that of the control group.Conclusion Bilateral hand function training is significantly more effective than unilateral training in promoting the recovery of flexor and extensor muscle function after a stroke.

骨化性肌炎( myositis ossification,MO)是一种异位性骨化[1]. 在外伤等多种诱因下,于骨骼系统以外的组织、骨骼肌、韧带、肌腱、关节旁、腹膜腔内发生的异常异位骨化,常表现为局部肿块、肿胀疼痛、受累关节活动受限,是一种自限性良性的局限性骨化性软组织肿块[2]. 而神经源性骨化性肌炎( neurogenic ossifying fibromyopathy )指患者持续遭受严重大脑或脊髓损伤后在肌肉组织、皮肤、皮下组织、筋膜、肌腱骨膜、血管壁、肌腱、韧带及关节附近的纤维组织内发生,通常发生在四肢肌肉及关节连接部,以髋关节最多见,其次为肘、肩及膝关节部位多见[3]. 常见于男性. 病程长短不一,发病范围逐渐波及全身,临床上较为少见,易与多种疾病混淆,为康复科少见疾病[4].

Objective To study the protective effect of scalp acupuncture combined with exercise training on neurons in rats with ischemic brain damage.Methods The experiment contained five groups:negative control group,positive control group,acupuncture group,rehabilitation group and experimental group.The behavioral score of rats was evaluated by modified Bederson's neurological score.The expression of BDNF protein was detected by immunohistochemistry and the expression of BDNF mRNA was detected by RT-PCR.Results Compared with the acupuncture group and the rehabilitation group,the neurological function scores of the experimental group were significantly decreased (P ＜0.05) 7 days and 14 days after operation.The numbers of BDNF positive cells in experimental group were significantly increased compared with that of rehabilitation group and acupuncture group (P ＜0.05) 3 days and 21 days after operation.The expression of BDNF mRNA was significantly increased compared with that of the acupuncture group and the rehabilitation group (P ＜0.05) 7d and 14d after operation.Conclusion Scalp acupuncture combined with exercise training can increase the synthesis of BDNF with up-regulating the expression of BDNF mRNA,and protect the injured neurons and improve the behavior of rats.

BACKGROUND:Asthma is a chronic disease involving an immune response, which is characterized by non-specific inflammation and airway remodeling. Glucocorticoids are clinically beneficial in controlling asthma, but further options are needed. In our study, fastigial nucleus electrostimulation (FNS) was applied in a rat asthma model for the first time to investigate the effects of pre-intervention.OBJECTIVE:To observe the effects of FNS on airway inflammation and remodeling in asthmatic rats.METHODS:Forty rats were assigned randomly to the normal control (CON), model (MDL), FNS, or budesonide (BUD) groups. Asthma was induced with chicken egg (OVA). The animals in the CON and MDL groups were treated with normal saline. The animals in the other two groups received FNS or budesonide, respectively.RESULTS:The results indicated that IgE in the serum and airway fiber areas were higher in the MDL group than in other groups. After treatment for 3 weeks, collagen fibers in the bronchial wall in the FNS group were significantly lower compared with the MDL group.CONCLUSION:FNS significantly reduced IL-4, IL-13, TNF-α, OVA-IgE and TGF-β1 in serum and BALF, and increased IFN-γ. Our results suggest that FNS may ameliorate asthma symptoms and induce changes of cytokines in the serum and lung milieu.

目的:观察不同贴扎方式下肌内效贴的回缩力特征,及贴扎后对健康成人受试者皮下间隙的即刻影响.方法:按测试及干预要求制备肌内效贴(kinesio taping,KT)及具相同颜色、形状及大小的无弹性安慰贴布(placebo taping,PT).采用济南蓝光XLW型电子拉力机分析施加不同拉力各形状贴布的力学特征.同时选取40例健康成年人,随机配对分为肌内效贴组(KT试验组)与安慰贴扎(PT对照组)各20例.对健康受试者前臂施以不同拉力、回缩方向的Y形贴扎,采用美国通用公司logiq 9型彩超比较贴扎处理前、贴扎后即刻的皮下间隙(subcutaneous space,SS).结果:①肌内效贴布在施加一定范围的拉力下,回缩力具有等比上升的趋势,但接近极限拉力,会影响其材质的正常特性.贴布长度变长后其整体回缩力反而有所降低.②特定拉力下试验组方法的组内前后比较SS有显著差异(P＜0.01),对照组各方法前后比较未见显著差异,与试验组组间比较,SS值也有显著差异(P＜0.01).试验组拉力增加到100％时,SS组内前后比较未见显著性差异.在相同拉力条件下,贴扎方向并没有明显影响SS.结论:肌内效贴材料的回缩力与外在拉力、贴布形状及长度有关.特定的拉力大小下,肌内效贴可影响局部贴扎处的皮下间隙,但力学因素可能大于方向因素.

Dyskinetic cerebral palsy is the general type of cerebral palsy. This review discussed the pathogenesis, functional disorders, assessment and rehabilitation for it in the past years.

Objective To apply the theory and model of International Classification of Functioning, Disability and Health (Children and Youth Version) (ICF-CY) in rehabilitation for children with cerebral palsy. Methods A case accepted rehabilitation in the framework of ICF-CY was reported. Results and Conclusion The framework of ICF-CY can be used in rehabilitation for children with cerebral palsy.

目的:评估由儿童康复诊疗管理系统(ICR 2.0)软件辅助制定的运动疗法优化方案对脑瘫患儿粗大运动功能的康复疗效.方法:61例GMFCS分级为Ⅱ-Ⅲ级的痉挛型脑瘫患儿,随机分为对照组和试验组,试验组31例,对照组30例,以前瞻性自身对照研究方法,分别接受两个阶段的运动治疗.两组患儿第一阶段根据治疗师个人经验制定治疗方案并训练;第二阶段试验组用ICR2.0软件辅助治疗师综合分析患儿及家长的现实性愿望、功能情况、家庭环境等因素,制定治疗方案并优化后进行训练;对照组仍由治疗师凭个人经验制定治疗方案并训练;两个阶段的治疗时间均为3个月.治疗前后分别采用远城寺式·婴幼儿发育检查表、粗大运动功能评估量表(GMFM)对患儿功能进行测评.结果:治疗前,两组患儿发育月龄、移动运动和GMFM评分无显著性差异(P＞0.05).两个阶段治疗后,两组患儿各项指标较治疗前均有提高(p＜0.05).其中第一阶段治疗后,两组间比较差异无统计学意义(P＞0.05);第二阶段治疗后,两组间比较有显著性差异(P＜0.05).结论:运用ICR 2.0软件辅助制定的运动疗法优化方案可显著提高脑瘫患儿的粗大运动功能.

Glenohumeral subluxation is one of the most frequent complications in patients with post-stroke hemiplegia.This paper reviewed the recent advances in research on post-stroke Glenohumeral subluxation from the epidemiology,pathogenesis and related factors,diagnosis,treatment and so on.

目的:整合病历、诊断、评估、治疗方法及家庭康复指导等信息,以软件数据库的形式,辅助医生或治疗师为患者制定一个全面有效的中西医结合康复治疗方案.方法:软件使用Microsoft Visual Studio2008开发工具和SQL Server2008数据库引擎,系统采用C/S架构,可在局域网范围内允许多个用户同时使用.操作系统选择Windows2000/Windows XP/Vista/Win7.总体结构设置病历管理、康复管理、诊疗管理、人事管理、系统指南、系统维护、系统操作和帮助等功能模块.结果:软件从2007年上海交通大学附属第一人民医院院级课题《小儿脑瘫诊疗管理系统的研发》开始,在本院康复医学科儿童康复部调试和临床应用,到2008-2010年由上海市第一人民医院康复医学科、上海市残疾人康复培训中心共同承担,上海交通大学附属新华医院参与的上海市残联局级课题《小儿脑瘫诊疗管理系统的研发》完成.除在这三家单位临床应用外,还在虹口区密云学校、惠馨儿童康健院进行临床应用.在此基础上,2011年由我院康复医学科研制出的“儿童康复诊疗管理系统”在儿童康复部进行临床应用,并以康复管理模块为系统核心申报了上海市科委重点攻关课题《脑瘫的中西医结合康复优化诊疗方案的研究》.结论:儿童康复诊疗管理系统(ICR 2.0)在对脑瘫、自闭症治疗的整体过程中具有操作简便、数据处理智能、治疗流程全面、方法库优化、治疗实施规范、家庭康复指导便捷等特点,对儿童康复的疗效有积极作用,协助主管医生对康复机构诊疗康复进行管理,值得推广应用.