脑卒中是一种高死亡率、高致残率、高复发率的疾病,卒中后的偏瘫患者容易出现一侧下肢肌力不足及异常的运动模式,使得站立平衡和步行能力下降,也使患者步态异常,步行时不仅步行速度减慢,而且体力消耗增加,严重影响患者的日常活动和生活质量[1].因此,改善患者姿势控制和平衡能力,提高患者步行功能成为亟需解决的问题,也是当前康复治疗的关键[2].

脑性瘫痪(以下简称脑瘫)是大脑先天性的发育缺陷或各种获得性因素所致的非进行性脑损伤,主要表现为运动障碍,伴或不伴感知觉和行为障碍等[1].据统计,每1000个活产儿中约有2.0-3.5个脑瘫患儿,其中痉挛型占比最大[2].脑瘫患儿的治疗方案取决于患儿的年龄、严重程度、功能状态等,常规治疗是神经发育学方法结合物理因子、针灸、推拿等[3].目前,经颅磁刺激、肉毒毒素注射、巴氯芬鞘内泵入、选择性脊神经后根切断术等新兴技术取得一定进展,但各有利弊,除费用问题外,有创也是限制使用的重要原因.近年来,体外冲击波治疗(extracorporeal shock wave therapy,ES-WT)作为一种无创的治疗方法在康复领域得到越来越广泛的认同,有学者认为ESWT可以作为脑瘫儿童痉挛管理的重要工具[4],但目前循证证据不多且治疗剂量差别较大,我们在工作中发现脑瘫儿童对较大剂量的ESWT不能耐受且个体也有一定差异.本研究旨在观察个性化剂量的ESWT对痉挛型脑瘫患儿小腿三头肌痉挛的疗效及随访治疗结束3个月后的持续效应.

目的:探讨脑卒中痉挛性患者经颅磁刺激联合物理治疗后上肢功能改善状况的临床观察.方法:选取我院2018年1月到2020年1月共收治的80例脑卒中患者,所有患者均出现不同部位痉挛现象,将患者随机分为观察组与对照组,每组40例.给予对照组患者常规治疗与康复训练,观察组患者在常规治疗基础上应用低频重复经颅刺激联合肌电生物反馈模式下的康复训练.对比两组患者的治疗效果与上肢功能改善情况.结果:观察组治疗总有效率95.00％,高于对照组72.50 ％(P＜0.05);治疗前两组患者的NIHSS评分应用神经功能缺损量表(Neurological deficit scale,NIHSS)、MMSE评分应用认知功能量表(Cognitive function scale,MMSE)、ADL评分应用日常生活能力量表(Activities of daily living scale,ADL)评分对比无显著差异(P＞0.05),治疗后,观察组的NIHSS评分低于对照组,ADL评分高于对照组(P＜0.05);治疗前两组患者的肱二头肌和肱三头肌均方根值(Root mean square,RMS)对比无显著差异(P＞0.05),治疗后,观察组患者的肱二头肌RMS低于对照组,肱三头肌RMS高于对照组(P＜0.05);治疗前两组患者的运动功能评估表中的上肢功能部分(Upper limb function in motor function assessment table,FMA-UE)、手部精细化动作及上肢功能测量表(Measurement table of hand fine movement and upper limb function,Carroll)评分对比无显著差异(P＞0.05),治疗后,观察组患者的FMA-UE、Carroll评分高于对照组(P＜0.05).结论:对脑卒中上肢痉挛患者在常规治疗与康复训练的基础上应用低频重复经颅刺激联合肌电生物反馈模式下的康复训练,虽然对患者的认知功能无明显影响,但是能提升患者上肢痉挛的治疗效果,促进患者上肢功能恢复,提高生活能力,值得临床应用推广.

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:探讨低频电刺激联合间歇导尿及Motomed运动训练对脊髓损伤致神经源性膀胱患者膀胱内压力及膀胱容量的影响.方法:选取我院2015年12月～2018年2月收治的脊髓损伤致神经源性膀胱患者92例,根据随机数字表法将其分为对照组(n=46)与研究组(n=46).两组均给予间歇性导尿、盆底肌训练、膀胱功能训练等常规干预,对照组在此基础上采取低频电刺激,研究组于对照组基础上采取Motomed运动训练,两组均干预2个月.比较两组的临床疗效、治疗前及治疗2个月后的排尿情况(日均单次排尿量、日单次最大排尿量、日均排尿次数)、尿动力学情况(最大尿流率、膀胱容量、残余尿量、膀胱内压力)、LUTS(国际下尿路症状评分)及USDS(泌尿症状困扰评分).结果:治疗后,研究组总有效率(93.48％)显著高于对照组(78.26％)(P＜0.05);治疗2个月后,两组日均单次排尿量、日单次最大排尿量、日均排尿次数、最大尿流率、膀胱容量、膀胱内压力均较治疗前显著增多,且研究组以上指标均明显高于对照组(P＜0.05);两组LUTS及USDS分值均较治疗前显著降低,且研究组以上指标均显著低于对照组(P＜0.05).结论:间歇导尿联合低频电刺激与Motomed运动训练可有效改善脊髓损伤致神经源性膀胱患者尿动力学状态及排尿情况,增大膀胱容量及膀胱内压力等,缓解下尿路症状及泌尿症状困扰程度,提高治疗效果.

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:探讨社区康复配合家居环境改造对脑卒中患者生活能力的影响.方法:选择在我社区就诊的脑卒中患者72例,随机分为2组.对照组仅进行社区康复训练,观察组在社区康复训练基础上配合家居环境的改造.分别在2组患者刚入组时,训练3个月后、6个月后,采用Barthel指数评分法及工具性日常生活活动能力量表(IADL)对其进行疗效评定.结果:训练3个月和6个月后,2组Bathel指数及IADL评分均逐渐提高(P<0.01, 0.05),且观察组高于对照组(P<0.05).结论:社区康复配合家居环境改造对脑卒中患者生活能力的提高效果显著,值得临床推广.

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.

Objective To explore the dietary structure and exercise behavior of non-obese patients with polycystic ovary syndrome (PCOS).Methods Eighty PCOS patients were selected from the hospital as case group from January 2009 to December 2015,then they were divided into obese group and non-obese group according to body mass index (BMI).Forty age-matched healthy women receiving healthy physical examination during the same period in the hospital were selected as control group.The levels of testosterone (T),fasting blood glucose (FBG),andfasting insulin (FINS) were detected;insulin resistance index (HOMA-IR) was calculated.The dietary structure and exercise behavior of study objects were surveyed and analyzed using diabetes/obesity comprehensive evaluation and rehabilitation prescription system developed by the department.Results Hyperandrogenism was found among the non-obese patients with PCOS.The breakfast ratio and carbohydrate intake in non-obese group were significantly lower than those in control group,while the intake of lipid was higher than that in control group.Compared with obese group,exercise energy consumption in non-obese group was higher.There was no statistically significant difference in daily activities and professional activities among the three groups.Conclusion Both non-obese PCOS patients and obese PCOS patients have obvious irregular diet and unreasonable nutritional status,but they have no significant difference in exercise.

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 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 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.

Objective: To study the effect of passive stepping of lower limbs in two different positions on spasticity of lower hemiplegia extremities in stroke patients.Methods: Sixty-six stroke patients were randomly divided into the vertical(n=35) and sitting(n=31) passively stepping training groups.Both groups received conventional rehabilitation,and the passively stepping in the sitting or upright positions.The muscle(triceps surae,quadriceps and hamstrings) of each group was assessed with the Modified Ashworth Scale before,30 min and 4 weeks after training.Results: Thirty min after training,the Modified Ashworth scores of the triceps surae in both groups were decreased significantly(P0.05).There was no significant difference between two groups.Four weeks after training,the scores of all muscles in two groups except quadriceps in sitting group were decreased obviously(P0.05).The scores of triceps surae in vertical group were decreased more significantly than those of sitting group(P0.05).Conclusion: Both positioned training could relieve the muscle spasticity of hemiplegic lower limbs in stroke patients,and passive stepping training in upright position had better effect in alleviating the spasticity of triceps surae muscle.

脑卒中患者的行走训练往往需先进行长时间的直立训练和下肢肌力训练,再进行独立站立和平衡训练,完成上述训练后方可进行行走训练,而且一般需要2-3人搀扶.这样的训练耗时长,效率低,加重治疗师工作负担.

<正>脑卒中是导致偏瘫的主要原因,卒中后上肢功能恢复最佳时间是发病后3个月,超过这个时期,上肢恢复将很困难[1],强制性运动疗法(constraint-induced movement therapy,CIMT)的出现,为卒中后上肢运动的恢复提供了一种新的有效康复方法。Wolf进行了前瞻性、大样本,多中心的随机临床实验[2],研究表明,强制性运动可明显促进患侧上肢的恢复,提高患肢的运动功能,提高患者的日常生活活动能力[3]。

Objective:To determine the effect of cognitive-behavior therapy on Motor function and scores of activities of daily living(ADL) among Hemiplegia with cognitive impairment.Methods:46 Hemiplegia with scores of MMSE lower than 24 and another 70 Hemiplegia without such problems were recruited as cognitive therapy group and controlled group.All patients were hospitalized and educated about the disease.They received function training for one or two hours everyday each by one therapist while patients in the cognitive therapy group were trained with cognitive and behavior therapy combined with constrain therapy and group medical gymnastics.Cognitive state,comprehensive motor function and activities of daily living were measured from MMSE and index of Barthel respectively before and after rehabilitation.Results:Both groups showed significant gains in comprehensive motor function and activities of daily living,while higher Scores of them were observed in the controlled group without any Statistics differences.Conclusions:Cognitive impairment should be an important factor that may effect the patients rehabilitation outcomes.So positive psycho-therapy would promote hemiplegia ambulatory rehabilitation and guarantee the smooth process of it.In all,Psycho-therapy is a necessary part of rehabilitation which should be included all along.