目的:研究任务导向性功能性活动训练对脑卒中偏瘫患者步行和日常生活活动能力的影响.方法:将64例符合纳入标准的脑卒中偏瘫患者随机分为试验组(n=32)和对照组(n=32);试验组采用常规的运动康复训练和任务导向性功能性活动训练,对照组仅进行常规运动康复训练.两组训练时间都是40 min/次,2次/d,5d/周,连续训练4周.采用Fugl-Meyer评定量表下肢部分(Fugl-Meyer scale,FMA-L)、Berg平衡量表(Berg balance scale,BBS)、Holden步行功能分级(functional ambulation category,FAC)、Barthel指数(Barthel index,BI)对两组患者的下肢运动功能、平衡能力、步行能力、日常生活活动能力进行训练前后的评估,比较两组训练前后各指标的变化.结果:训练4周后,两组评估指标均显著高于训练前(P＜0.05),且试验组FMA-L、BBS、FAC和BI评分均显著高于对照组,差异有统计学意义(P＜0.05).结论:任务导向性功能性活动训练对脑卒中偏瘫患者下肢运动功能、平衡功能、步行和日常生活活动能力有显著影响.它可以帮助患者尽快实现行走,改善日常生活活动,促进患者自理,值得临床推广应用.

目的:探讨镜像治疗对于脑卒中偏侧忽略患者功能的影响.方法:脑卒中偏侧忽略患者24例,随机分为对照组12例和镜像组12例,2组患者均接受常规的针对偏侧忽略的康复训练,镜像组在此基础上增加镜像治疗.治疗前和治疗3周后采用中国行为性忽略测试-香港版(CBIT-HK)量表进行评估,并分别比较常规测试评分、行为测试评分及总评分.结果:治疗3周后,2组患者CBIT-HK常规测试评分、行为测试评分及总评分均较治疗前有显著提高(均P<0.01),且观察组3项评分均更高于对照组(均P<0.01).结论:镜像治疗结合常规康复训练短期可以明显改善脑卒中偏侧忽略症状.

目的:探讨日常活动管理对脑卒中患者生活能力恢复的影响.方法:将40例脑卒中患者随机分为观察组和对照组各20例.2组患者均给予常规康复训练,在非治疗时间内对观察组患者的日常活动进行管理.2组患者均于治疗前和治疗6周后采用Brunnstrom分期和改良Barthel指数(MBI)中的穿衣、转移、步行、上下楼梯评分项目进行评估.结果:治疗6周后,2组患者的Brunnstrom分期,MBI中穿衣、转移、步行、上下楼梯评分均较治疗前明显提高(P＜0.01),且观察组下肢Brunnstrom分级及MBI指标改善幅度均优于对照组(P＜0.05).结论:日常活动管理可进一步促进脑卒中患者日常生活能力的提高,该方法简单,便于推广应用.

目的:探讨上肢康复机器人辅助训练对脑卒中偏瘫患者上肢运动功能及日常活动能力的影响.方法:将44例符合入组标准的患者随机分成治疗组(n=22)和对照组(n=22),对所有患者进行为期4周的康复治疗,对照组患者采用传统作业训练40min/次,1次/天,6天/周;治疗组每天在20min传统作业训练的基础上增加上肢机器人辅助训练20min/次,1次/天,6天/周.采用简式Fugl-Meyer量表上肢部分(FMA-UE)、香港手功能评估(FTHUE-HK)和改良Barthel指数(MBI)分别于治疗前和治疗后对两组患者进行评估.结果:两组患者治疗前后的FMA-UE、 FTHUE-HK评分和MBI评分比较均有显著性差异(P＜ 0.01);治疗后两组间对比无显著性差异(P＞ 0.05).结论:上肢康复机器人辅助治疗对脑卒中偏瘫患者上肢运动功能及ADL能力的提高和传统的作业治疗一样有效.

Objective To compare the accuracy of weight-bearing training using biofeedback with conventional training for partial weight-bearing patients,and the factors influencing the accuracy.Methods Seven healthy volunteers were recruited to practice on a treadmill with their body weight partially supported on paired elbow crutches.The weight reduction was controlled by the subjects by means of verbal prompting from an experienced therapist,or by using a bathroom scale or a sound-vibrating biofeedback from the PierenStep gait quantization system.The PierenStep gait quantization system was also used to collect the data.All the subjects were instructed to reduce 20％ of their body weight on their appointed leg.The accuracy of weight reduction on the appointed leg after training under the three methods was compared and the factors influencing the accuracy were analyzed.Results Significant differences were found among the three methods in terms of the average deviations observed,the maximum and minimum values.Sex,height and exercise time per day all were significantly correlated with the accuracy.Conclusions Biofeedback can help healthy young persons control the weight borne by their lower limbs accurately with obvious short-time subsequent effects.This should be helpful in the rehabilitation of fracture patients.

Objective To investigate the effect of knee-controlling orthosis on lower limb function recovery in the quinquagenarian and elderly patients with stroke suffering from severe hemiplegics.Methods Twenty-eight patients with proprioceptive sense affected and/or with unilateral spatial neglect after stroke were randomly divided into orthosis group and control group with 14 cases in each group.All patients received routine rehabilitation therapy in upright position,and the patients in the orthosis group dressed orthosis while they received standing or walking therapy.Assessment of Fugl-Meyer scale(FMAL) for affected lower limb,brunel balance assessment (BBA),holden functional ambulate classification (FAC),cancellation task (CT) and modified barthel index (MBI) were carried out before and 1 month after therapy.Results One month later,both groups showed excellent improvement in all items (P＜ 0.05) except CT (P＞ 0.05).The scores of BBA,FAC,MBI in the orthosis group were better than those of the control group (P＜0.05 or P＜0.01),while no significant difference was found in the score of CT and FMAL(P＞0.05).Conclusions Knee-controlling orthosis can improve the functional ability of the affected lower limbs in the quinquagenarian and elderly patients with stroke suffering from severe hemiplegics.

Objective To compare the effects of repetitive transcranial magnetic stimulation (rTMS) at various low frequencies on upper limb function after cerebral infarction.Methods Fifty patients were randomly assigned to a control group (10 cases),a sham rTMS group (10 cases) or an rTMS group which had three sub-groups treated at 0.25 Hz,0.5 Hz and 0.75 Hz with 10 cases in each.All of the patients were treated with conventional medical treatment and rehabilitation training.The sham and true rTMS groups received rTMS applied over the M1 area of the unaffected hemisphere,5 days per week for 4 weeks.Motor evoked potential (MEP) cortical latency,and central motor conduction time (CMCT) were measured and the Fugl-Meyer assessment (FMA),motricity index (MI) and a Hong Kong functional test for the hemiplegic upper extremity (FTHUE-HK) were evaluated beforehand and at Post 1 after 2 weeks of treatment and Post 2 after 4 weeks of treatment.Results The average CMCT and FMA scores of the control and sham rTMS groups both had improved significantly at Post 2.There was no significant difference in any of the indices between those 2 groups at any time point.At Post 1,the average MEP cortical latencies of the 0.25 Hz and 0.5 Hz subgroups had improved to be significantly better than those of the control and sham rTMS groups.The average CMCTs of the 0.25 Hz and 0.5 Hz rTMS subgroups were significantly shorter after treatment,and significantly better than those of the control and sham rTMS groups.At Post 2,the average MEP cortical latency of all groups except the control group showed significant improvement compared with pre-treatment.The 2 indices of the 0.25 Hz and 0.5 Hz subgroups were again significantly shorter than those of the control and sham rTMS groups,and the average CMCTs were significantly better than that of 0.75 Hz subgroup.At Post 1 the average FMA and MI scores of the rTMS subgroups had all improved significantly.In the 0.25 Hz and 0.5 Hz subgroups the average MI scores were significantly higher than those of the control and sham rTMS groups.The FTHUE-HK scores of those 2 subgroups had also improved significantly.At Post 2,the average FMA and MI scores of all groups and the FTHUE-HK scores of rTMS group had improved significantly.In the 0.25 Hz and 0.5 Hz subgroups,all of the indices were significantly better than in the control and sham rTMS groups.The average FTHUE-HK score of the 0.25 Hz subgroup was significantly superior to that of the 0.75 Hz subgroup.In the 0.75 Hz subgroup the average MI score was significantly higher than in the control and sham rTMS groups.Conclusions rTMS at either 0.25 Hz or 0.5 Hz applied to the unaffected hemisphere provides effective treatment for enhancing the excitability of the motor cortex and the motor function of a paretic upper limb after stroke.Compared with others,the total number of stimulus pulse in 0.25 Hz subgroup was the least,and priority consideration should be given to the frequency of 0.25 Hz when using rTMS in clinical treatment of cerebral infarction.

Objective To investigate the effects of mirror therapy supplemented with motor imaging training on the upper extremity functions of hemiplegic stroke patients and on their ability in the activities of daily living (ADL).Methods Forty-four stroke patients were divided into a control group and an experimental group with 22 patients in each.All were given routine rehabilitation treatment.In addition,the experimental group was given 30 minutes of mirror therapy daily supplemented with 15 minutes of motor imaging training.The control group was given routine occupational therapy.All the patients were assessed with Brunnstrom staging,the functional test for the hemiplegic upper extremity-Hong Kong (FTHUE-HK) and the Barthel index (BI) scale before therapy and after 6 weeks.Results After 6 weeks of treatment,both groups showed significant improvements in upper limb function,hand function,and ADL ability.There were significant intra-group differences and significant differences between the experimental and control groups in terms of Brunnstrom staging,FTHUE-HK scores and BI scores.Conclusions Mirror therapy supplemented with motor imaging training can benefit patients suffering hemiplegia in improving their upper limb functioning and their ADL ability.

一、临床资料 患者,男,35岁,胸椎骨折致脊髓损伤,伴左侧上下肢截肢术3月余.患者3个月前被电击后从3 m高处跌落地面,送至南昌市人民医院,诊断为T2～T6椎体骨折,左侧上下肢电击伤,先后行左前臂中下段截肢术、T4、T5椎体固定术和左小腿中下段截肢术,当时胸T2、T3、T6椎体压缩小于1/3且未移位,未做固定.现收住本院康复医学科拟行综合康复治疗.

Objective To study the effects of dynamic,support-inducing exercise on the support,balance and gait ability of patients with moderate-to-severe hemiplegia after stroke.Methods Fourteen stroke patients were randomly assigned to an experimental or a control group (7 cases to each).The patients in the experimental group received both dynamic,support-inducing exercise and routine exercises,while the patients in the control group received routine exercises only.Before training and after 40 and 60 days of training,their functional capacity was evaluated with the Chinese stroke scale (CSS) for neurological deficits,Berg's balance scale (BBS) and using functional ambulation categories (FACs).Results Before training there was no inter-group difference in average CSS or BBS scores or in FACs.For the experimental group there were significant intra-group differences compared with 0th day in all three items at both time points.At days 40 and 60 there were also significant intra-group differences in BBS scores and FACs in the control group,and CSS scores improved significantly only in the experimental group.At day 40 there were significant inter-group differences in average CSS,BBS and FAC results.However,by day 60 a significant difference persisted only in average CSS scores.Conclusions Dynamic,support-inducing exercise can improve support,balance and gait in patients with moderate-to-severe hemiplegia after stroke.

偏瘫是脑损伤患者最常见的症状,上肢和手功能障碍的恢复是目前偏瘫患者康复训练的难点[1],而肌力的训练在偏瘫患者康复治疗中一直存在争议.本研究重点观察了应用生物反馈技术对28例偏瘫患者进行握力训练的情况,现报告如下.

Objective:To explore the effect of comprehensive functional rehabilitation evaluation and motional feedback training system on the upper limb function of stroke patients with hemiplegia.Method:Fifty-eight patients with hemiplegia were divided into two groups:twenty cases in the general exercise group and thirty-eight cases in the motional feedback group.Two groups were compared 3 times:before the exercise;instantly after the exercise and six weeks after the training.Assessment indexes were the rotation activity of forearm and the movement range of extension of wrist.Result:① The rotation activity of forearm improved significantly(141.33°±19.31°;161.00°±17.09° and 75.83°±12.83°,respectively,P0.05);②The range of extension of wrist got much improvement (0.71°±20.36°;27.43°±25.07° and 43.29°±19.21°,respectively,P0.05);③The two groups showed no distinctive difference before training,and there was highly significance after six weeks of training (P0.05).Conclusion:The integrated evaluation and exercise training system combines rehabilitation and entertainment for patients,can induce patients to do active movements by different kinds of games.It makes more effectiveness and attracts patients' attentions.Patients can receive interesting training and learn from lively activities with satisfactory rehabilitation.

Objective:To determinate the effects of 3-phase rehabilitation intervention on turnover of muscle tone and recovery of motor function of limbs in hemiplegia after stroke. Method:80 hemiplegic patients(less than 3 weeks) were randomly divided into rehabilitation group and control group. Modified Ashworth was used to assess the muscle tone and Brunnstrom grade was applied to evaluate the motor function of limbs at pre-treatment and 1,3,6 month post-treatment. Result:①muscle tone: in rehab group,muscle tone of 69.2% and 90.5% patients in upper and lower extremity with Ashworth grade 0 developed to grade 1 or more from pre-treatment to 1 month post-treatment. With elongation of time course of treatment to 3 and 6month post-treatment,muscle tone of these patients showed a trend to decrease to grade 0. Up to 6 months post-treatment,the percents of the patients with grade 1 or more reduced to 38.4% and 42.9% respectively in upper and lower extremity. In rehabilitation group,muscle tone in upper and lower extremity with grade 1 or more turnover continuously to grade 0 during the whole course of treatment.Up to 6 months post-treatment,muscle tone of 64.3% and 68.4% patients decreased from grade 1 or more to grade 0 respectively. But in control group,only 23.1% and 15.8% reduced to grade 0 at 1 month post-treatment. Afterwards,there were no significant changes in muscle tone with elongation of treatment course. ②Motor function of limbs: Brunnstrom Grade of rehab group increased more significantly at 1,3 and 6 months post-treatment than pre-treatment(P0.05),but there was a little increase in control group at 1 month after treatment,and there was no trend to increase at 3 months and 6 months. Conclusion: The early training of rehabilitation intervention can induce occurrence of muscle tone of hemiplegic extremities. The continuous rehabilitation can inhibit high muscle tone and promote muscle tone turnover to normal,and improve ADL and motor function of extremities.

Objective:To explore the effects of 3-phase rehabilitation on functional outcome in patients with hemiplegia after stroke. Method: 80 hemiplegia patients were randomly divided into rehabilitation group and control group. The patients in control group only received medication treatment,and the patients in rehabilitation group were given regularly physical training except medication. Motor function and the ability of daily activities (Barthel Index) were compared pre-treatment and 1mon,3mon,6mon post-treatment.Result:①The motor function of upper extremities,hand and lower extremities had no significant difference between two groups(P0.05).After 1mon rehabilitation,motor function of upper and lower extremities in rehabilitation group improved significantly than control group(P0.05),and more significantly after 3 and 6 months training(P0.01). The motor function of hand in rehabilitation group had significant difference compared with the control group after 6mon training.② ADL had no difference between two groups pre-treatment.After 1mon training,ADL in rehabilitation group improved significantly than control group(P0.05).After 3-6mon rehabilitation,the difference was more significant(P0.01). Conclusion:3-phase rehabilitation can improve effectively the motor function of extremities and ADL of hemiplegia patients after stroke and reduce rate of complication.

Objective:To observe the effect of anti-spasm skills on hemiplegia patients′ spasticity of upper limb. Method:We observed seventy-two hemiplegia subjects with spasticity, their Ashworth′s scales were between one and three scale. They were divided into rehabilitation training group(36 cases) and contrast group(36 cases). The training group received training with anti-spasm skills mainly,1-2 hours per day,for 3 months. Bobath method was one of the main anti-spasm skills.Severe spasmodic upper limbs of those patients had a fixation with splint and continuous stretching. The contrast cases didn′t receive these training.The two groups were evaluated with Ashworth scale before and after the treatment.Result:There was remarkable difference in Ashworth′s scales of the training cases before and after the treatment(P0.05), while no remarkable difference in the contrast cases(P05).There was significant difference in Ashworth′s scales between the two groups after the treatment(P0.05), while no significant difference before the treatment(P05).Conclusion:The anti-spasm skills in the rehabilitation training is very effective for the patients with hemiplegia spasticity, especially in the early period of spasm.Author′s address Department of Rehabilitation Medicine,the First Affililated Hospital of Nanjing Medical University,Nanjing,210029

Objective:To formulate a set of systematic position-control approach against the muscles spasticity by analysing the some changes of spastic muscles in hemiplegic patients after doing some functional activities.Method:The incidence of spasticity of flexor at affected-side upper limb and extensor in lower-limb were observed in forty-one hemiplegic patients.They received functional activities,including body transfer,balance and strengthening.The spasticity in the hemiplegic limbs was inhibited by against spasticity position about one month later.Result:Flexor spasticities of upper limb was easily induced by the activities of daily living such as supination to siting(73%),turnning towards unaffected side(68%),up-down stair(66%/59%),walking and siting to standing(59%).Extensor spasticities of lower-limb was induced by later supination to siting(54%),supination to sitting(49%),resistance flexion of unaffected knee(44%).Position control antagonizing spasticity could reduce immidiately the incidence of spasticity in upper limb flexor(83%)and in lower limb extensor(62%).Long term position control could increase the rate of spasticity control of upper limb(42%)and lower-limb(38%).Conclusion:Functional activities during early stages of hemiplegic rehabilitation can result in muscle spasticity.The inhibition position can control spasticity in partial patientes with hemiplegia.

目的采用He-Ne激光直接照射大鼠颅骨缺损部位的脑组织,观察He-Ne激光对脑损伤早期组织形态学、代谢、功能的影响.方法 66只Wistar大鼠随机分为A、B、C、D、E、F六组,均在麻醉下去除部分颅骨制作脑损伤模型.采用波长为632.8 nm,输出功率25 mW的He-Ne激光照射脑组织,光斑直径2 cm,照射距离70 cm.A、B、C为即刻观察组;E、F为1周观察组.取损伤侧脑组织和血浆分别测定损伤侧脑组织及血浆中丙二醛(MDA)的含量和超氧化物岐化酶(SOD)的活性;光镜观察脑组织形态学变化;评定1周观察组大鼠处理前后平衡及支撑时间的改变.结果即刻观察组中各激光照射组与对照组形态观察未见明显差异;经组间配对t检验发现,A、B、C组与D组之间进行比较血浆中MDA值明显降低(P=0.000) ,血浆中SOD值无显著性差异;1周观察组中治疗组血浆MDA值较对照组明显减少(P=0.001),SOD值较对照组明显增高(P=0.001),治疗组损伤侧脑组织中MDA值也明显低于对照组(P=0.001),大鼠平衡时间(P=0.02)和支撑时间(P=0.0016)较对照组有明显提高.结论不同剂量He-Ne激光的即刻照射对大鼠脑组织的形态学改变、脑组织中的MDA/SOD和血浆中的SOD改变影响不大;1周He-Ne激光直接照射可降低脑损伤大鼠血浆和脑组织MDA含量,增强血浆中SOD的活性,改善肢体平衡和支撑功能.

人工关节技术发展迅速,国外的人工关节现在已经包括髋、膝、肘、肩、桡骨头、掌指关节等,其中全髋关节置换术(total hip arthroplasty, THA)已逐渐成为一项常规手术.我国于1958年开始研究与应用.

目的初步探讨简易精神状态测定法(STMS)是否适用于脑损伤患者认知功能的评估.方法运用STMS对54例脑损伤患者进行不同病程时期及不同损伤半球之间的比较,并与正常组对照.结果脑损伤患者随时间推延,认知功能可逐步提高,差异有显著性,P＜0.05;脑损伤患者后期认知总分与正常组比较无显著性差异,但在某个分项上仍存在不同程度的差异,P＜0.05;左、右半球损伤对认知的影响在定向力和理解力方面有显著性差异,P＜0.05.结论 STMS是一种简单有效的评定方法,可用于脑损伤后患者的认知功能评定.