目的:探讨醒脑开窍针刺联合吞咽功能康复训练、神经肌肉电刺激对老年脑卒中后吞咽困难患者康复效果的影响.方法:选取 2019年 6 月至2021年 3 月我院收治的 98 例年龄＞60 岁的脑卒中后吞咽困难患者作为研究对象进行回顾性分析,按照康复治疗方案不同,分为针刺组和常规康复组,各 49例.常规康复组采取吞咽功能康复训练和神经肌肉电刺激康复治疗,针刺组在常规康复组治疗的基础上增加醒脑开窍针刺治疗.康复治疗 4 w后,比较两组疗效和舌骨喉复合体动度,分别以洼田饮水试验(Water swallowing test,WST)、美国国立卫生院研究卒中评分量表(National Institutes of Health Stroke Scale,NIHSS)、渗透-误吸评定量表(Penetration-aspiration scale,PAS)、吞咽障碍特异性生命质量量表(Swallowing disorder specific quality of life,SWAL-QOL)检测患者的吞咽功能、神经功能、误吸情况、生活质量;并检测患者胰岛素样生长因子-1(Insulin-like growth factor-1,IGF-1)和脑源性的神经营养因子(Brain derived neurotrophic factor,BDNF)这两种神经修复因子的水平.结果:针刺组总有效率明显高于常规康复组(P＜0.05).康复治疗后,针刺组WST评分、NIHSS评分、PAS评分明显低于常规康复组,SWAL-QOL评分、骨上移、舌骨前移、舌甲状软骨上移、血清IGF-1、BDNF水平明显高于常规康复组(P＜0.05).结论:老年脑卒中后吞咽困难患者采用醒脑开窍针刺联合吞咽功能康复训练、神经肌肉电刺激康复治疗具有较好的康复效果,可改善患者的吞咽功能、误吸情况、生活质量,提升下颌舌和颏舌骨肌的肌力,通过调节患者血清IGF-1、BDNF水平,促进患者神经功能康复.

Objective:To explore any effect of on the limb and cardiopulmonary functioning of stroke survivors of combining new Bobath technique with cardiopulmonary rehabilitation.Methods:A total of 160 stroke survivors with limb disorders were randomly divided into an observation group and a control group, each of 80. Both groups were given routine rehabilitation and the new version of Bobath training, but the observation group was additionally provided with 12 weeks of cardiopulmonary rehabilitation. Before and after the treatment the limb functioning of both groups was evaluated along with their ability in the activities of daily living and the recovery of damaged nerve function, using the simplified Fugl-Meyer (FMA) motor function scoring, the modified Barthel index (MBI) and the Chinese stroke scale (CSS). Peak oxygen uptake (VO 2peak), peak metabolic equivalent (METpeak), peak heart rate (HRpeak) and anaerobic thresholds (ATs) were documented. Results:After the treatment the average FMA, MBI and CSS scores and cardiopulmonary indexes had improved significantly in both groups. All were then significantly better in the observation group than in the control group.Conclusions:Combining the new Bobath technique with cardiopulmonary rehabilitation can significantly improve the limb and cardiopulmonary functioning of stroke survivors, as well as their skill in the activities of daily living and the recovery of the damaged nerve functionality. This combination is therefore worthy of clinical promotion and application.

目的:探究经颅电刺激(Transcranial direct current stimulation,tDCS)联合口肌生物反馈训练在中风后吞咽障碍患者治疗中的应用价值.方法:选取2019年5月～2021年2月我院神经科收治的86例中风后吞咽障碍患者作为研究对象,根据就诊序号采用随机数字表法分为对照组和观察组,各43例.对照组采用基础西药治疗联合口肌生物反馈训练,观察组于此基础上采用tDCS治疗.两组均治疗3 m后评估临床效果、对比治疗前及治疗3 m后神经营养指标水平、吞咽功能、吞咽障碍严重程度、神经损伤程度及生活质量.结果:治疗3 m后,观察组总有效率高于对照组,神经营养指标水平、改良曼恩吞咽功能量表(Modified Mann Assessment of Swallowing Ability,MMASA)评分、吞咽障碍的结局与严重度量表(Dysphagia outcome and severity scale,DOSS)评分、吞咽功能生活质量量表(Swallowing quality of life questionnaire,SWAL-QOL)评分均高于对照组,美国国立卫生研究院卒中量表(National institute of health stroke scale,NIHSS)评分低于对照组(P<0.05).结论:对中风后吞咽障碍患者实施tDCS联合口肌生物反馈训练治疗效果确切,能调节神经营养因子水平,减轻神经功能损伤程度,有助于改善吞咽功能,且能提高患者生活质量.

目的:观察音乐运动疗法对帕金森病(PD)患者步态及运动功能的影响。方法:采用随机数字表法将67例PD患者分为观察组(34例)及对照组(33例)。2组患者均给予常规抗PD药物治疗及护理，对照组辅以常规运动治疗，观察组则给予音乐运动治疗，2组患者均每天治疗1次，每周治疗5 d。于治疗前、治疗8周后评估对比2组患者步态时空参数、PD综合量表(UPDRS-Ⅲ)、Berg平衡量表(BBS)及改良Barthel指数(MBI)量表评分。结果:治疗前2组患者步态时空参数、UPDRS-Ⅲ、BBS及MBI评分组间差异均无统计学意义( P>0.05)。治疗后发现观察组步长[(47.31±7.66)cm]、步频[(117.32±18.04)步/分钟]、步幅[(77.63±15.43)cm]、摆动相时间[(42.79±7.41)%]、双支撑相时间[(8.24±2.06)%]、总支撑相时间[(54.19±8.13)%]、步长变异系数(6.08±3.14)、步速变异系数(4.29±1.84)、UPDRS-Ⅲ评分[(27.74±5.96)分]、BBS评分[(31.79±6.31)分]及MBI评分[(53.78±7.58)分]均较训练前及对照组显著改善( P<0.05)。 结论:音乐运动治疗能进一步改善PD患者步态，提高其运动功能及平衡能力，对改善患者生活质量具有重要意义。

目的观察脑卒中踝关节痉挛患者行踝关节矫正板站立训练对踝关节痉挛及步行能力的影响。方法选取2012-07-09在我科诊治的存在踝关节痉挛的脑卒中患者40例,按随机数字表法分成对照组和治疗组,每组20例。2组均给予基础治疗:康复科脑卒中偏瘫常规治疗,包括神经发育疗法、主/被动牵伸、ADL训练、传统中医治疗等,同时对照组和治疗组分别行直接站立训练、踝关节矫正板站立训练。治疗前及治疗4周后采用改良Ashworth痉挛量表、Berg平衡量表(BBS)、踝关节活动角度、6min步行测试(6MWT)对患者进行康复评价。结果行踝关节矫正板站立训练患者的踝关节痉挛程度较直接站立训练的患者改善明显,且步行能力得以提高。结论踝关节矫正板站立训练可使脑卒中患者的踝关节痉挛程度明显降低,并提高其步行能力,较常规的直接站立训练更具优势。