目的:分析康复医学团体标准培训前后的认知差异,评价团体标准编制培训工作的即时教学效果.方法:采用统一编制的康复医学团体标准问卷,对2021年3月-2022年4月参加中国康复医学会组织的康复医学团体标准编制培训班的第1-4期全体学员进行调查.在每一期培训班正式培训前和培训结束后即刻分别采用问卷星进行问卷调查,限时回收问卷.采用Wilcoxon配对样本秩和检验分析培训前和培训后的教学效果.结果:参加康复医学团体标准4期培训班的学员共有441人,发放问卷882份(培训前及培训后),回收问卷763份,剔除无效问卷后,实际纳入统计分析的有效问卷622份.问卷分析结果发现,与培训前比较,培训后的学员对团体标准的"知""信""行"三个维度的调查总分均有显著提高,差异有显著性意义(P＜0.05).问卷中,对知识维度中的"团体标准的作用",信念维度中的"团体标准制定的必要性、团体标准对工作的帮助作用",以及行为维度中的"是否有组织/计划参与申报团体标准"这3部分内容的认知水平,培训前后的调查结果具有高度一致性,差异无显著性意义(P＞0.05).结论:团体标准编制培训有助于提升学员对团体标准的内涵及细则(知信度)的认识及理解,增强参与团体标准编制工作的执行力.

目的:为脑损伤后肩关节半脱位的防治设计一款新型矫形器.方法:利用3D打印技术设计和打印一套防治肩关节半脱位的新型矫形器——肘前臂托,并将此肘前臂托与传统的肩吊带应用于脑卒中后伴有肩关节半脱位的患者.采用自身对照的设计方法,对患者分别佩戴肘前臂托与传统的肩吊带,并分别在佩戴前、佩戴后即刻以及佩戴后30min拍摄半脱位肩关节坐位下的正位X线片,测量X线片肩峰下缘至肱骨头中心的垂直距离和水平距离,比较这2种矫形器对肩关节半脱位的复位效果.结果:对于脑卒中后出现肩关节半脱位患者,佩戴这2种矫形器后的即刻均可以达到复位目的,30min后传统肩吊带的复位作用明显减弱,佩戴肘前臂托的复位仍然有效.肘前臂托支撑稳定,持续时间长,佩戴舒适.结论:基于3D打印技术研制的此款肘前臂托设计可行,测试效果好,为脑卒中后肩关节半脱位的临床治疗提供了新的思路.

Objective:To compare the immediate effectiveness of elbow forearm support with that of a traditional shoulder sling in reducing glenohumeral subluxation (GHS) after a stroke.Methods:Eight stroke survivors with GHS were randomized to receive either 30 minutes of intervention of an elbow forearm support treatment or a traditional shoulder sling treatment twice within 24 hours. Their healthy and affected shoulders were X-rayed before and right after the treatment is ongoing as well as after the end of the 30 min of treatment. The vertical (VD) and horizontal (HD) distances from the lower edge of the acromion to the center of the humeral head were measured. The satisfaction of the patients and their relatives was surveyed.Results:The average VD and HD improved significantly more after wearing the elbow forearm support. Moreover, the patients and their relatives expressed greater satisfaction with the elbow forearm support.Conclusion:Either an elbow forearm support or a traditional shoulder sling will have an immediate effect in reducing shoulder subluxation, but the elbow forearm support is more effective and gives greater satisfaction.

ObjectiveTo observe the effect of transcranial direct current stimulation (tDCS) synchronized with normal walking pattern based on multi-channel functional electrical stimulation (FES) on lower limb motor and balance function in patients with traumatic brain injury hemiplegia.MethodsA total of 56 patients with TBI and hemiplegia were divided into synchronous group (n=21), FES group (n=20), and tDCS group (n=15) by using sealed-envelope randomization. The tDCS group was given head tDCS treatment and lower extremity sham FES treatment, the FES group was given head sham tDCS treatment and lower extremity FES treatment, and the synchronous group was given head tDCS treatment and lower extremity FES treatment. The treatment was 20 min/time, 1 time/d, for 12 days. Before treatment, after 6 days treatment and after 12 days treatment, the following scales were used to evaluate: Fugl-Meyer assessment of lower extremity (FMA-LE), Berg balance scale (BBS), and Neurocom Balance Manager System.ResultsThere was no significant differences among the evaluation results of the three groups before treatment. After treatment, compared with those before treatment, the FMA-LE scores of three groups were significantly different (P<0.05), but there was no significant differences in FMA-LE among the three groups (P>0.05). Compared with the three groups before and after treatment, BBS scores of the three groups were significantly different respectively (P<0.05). Compared the tDCS group with the FES group, the differences in BBS scores of the synchronization group were significant (P<0.05). In balance assessment, compared with those before treatment, visual cues (VIS), vestibular cues (VEST), sensory organization test composite (SOTC) and motion control test composite (MCTC) were significantly different in the synchronous group after treatment (P<0.05); MCTC was significantly different in the FES group (P<0.05); VIS and SOTC was significantly difference in the tDCS group (P<0.05). Compared among the three groups, the change rate of MCTC was significantly difference (P<0.05); there were no significant differences in other indicators (P>0.05).ConclusionThe three methods can effectively improve the lower limb motor and balance function of patients with traumatic brain injury in chronic period. The treatment of tDCS with FES is better than the treatment of tDCS or FES alone in terms of some evaluation indicators.

目的:了解国内康复从业人员对康复医学团体标准的知信行现状,推动康复医学团体标准的建设与发展.方法:调查对象为参加2021年～2022年中国康复医学会团体标准编制4期培训班的所有学员.采用基于知信行理论设计的调查问卷,在每期培训班开班前通过问卷星线上调查,限时提交.共有441名学员参加了 4期培训班培训,其中387名学员完成了问卷,54人(占总培训人数的12.2％)未在规定的时间内提交;剔除2份无效问卷,获得有效问卷385份(占提交问卷的99.48％).采用非参数Kruskal Wallis检验,两变量间的相关性采用非参数Spearman分析,对有效问卷的的知识、信念、行为三个方面的差异性进行统计分析.结果:不同职称等级的知识总分、行为总分、问卷总分差异具有统计学意义(均P＜0.05);知识总分分别与行为总分、问卷总分呈正相关(ρ值分别为0.276、0.541,P值均＜0.01),信念总分与问卷总分呈正相关(ρ=0.682,P＜0.01),行为总分分别与知识总分、问卷总分呈正相关(ρ值分别为0.276、0.586,均P＜0.01).结论:康复从业人员对康复医学团体标准的态度较为积极,但对团体标准的相关知识掌握程度不足,且缺少参与团体标准编制相关行为.应加强康复医学团体标准的知识普及与相关的培训,提高康复医学团体标准的知信行水平.

目的:观察经颅直流电刺激(transcranial direct current stimulation,tDCS)同步基于正常行走模式的下肢多通道功能性电刺激(functional electrical stimulation,FES)对脑卒中偏瘫恢复期患者下肢运动功能的影响.方法:66例符合入组条件的脑卒中偏瘫患者,分层后随机分成3组:tDCS组(n=22)、FES组(n=22)、同步组(n=22).tDCS组给予头部tDCS治疗同步下肢安慰FES治疗;FES组给予头部安慰tDCS治疗同步下肢FES治疗;同步组给予头部tDCS治疗同步下肢FES治疗.治疗20min/次、1次/d、连续治疗12d.在治疗前(T0)、治疗6次(T1)及治疗12次(T2)后分别采用下列量表评估:脑卒中患者姿势评分(PASS)、Fugl-Meyer下肢运动功能评定(FMA-L)、Berg平衡量表(BBS)、计时"起立-行走"测试(TUGT)、改良Barthel指数(MBI).结果:治疗前3组患者各评定结果之间的差异无显著性.治疗12次后,三组患者的BBS、TUGT、MBI(下肢)及FES组和同步组的PASS较治疗前差异有显著性(P＜0.05).变化率比较,治疗12次后三组患者FMA-L、BBS、TUGT、MBI(下肢)及FES组和同步组的PASS的变化率,较治疗6次时变化率差异均有显著性.tDCS组与FES组比较,MBI(下肢)差异有显著性(P＜0.05);同步组与tDCS组比较,PASS、MBI(下肢)差异有显著性(P＜0.05);同步组与FES组比较BBS变化率差异有显著性(P＜0.05).其余变化差异无显著性.结论:三种方法均可有效改善脑卒中后恢复期偏瘫患者的下肢功能,tDCS同步FES的治疗在部分评估指标方面的疗效优于单用tDCS或单用FES治疗.

目的:观察经颅直流电刺激(tDCS)同步多通道功能性电刺激(FES)的治疗模式对脑卒中偏瘫患者平衡与行走功能的影响.方法:将脑卒中偏瘫步行障碍患者随机分为tDCS组(20例)和伪tDCS组(18例).tDCS组采用1×1 tDCS治疗仪,阳极置于脑初级运动皮层偏瘫下肢代表区,阴极置于健脑额前区,电流强度:2mA.伪tDCS组患者电极放置位置相同,但仅在开始治疗和结束前30s有电流输出.两组均同步接受FES治疗.治疗时间:20min/次,1次/天,5天倜,连续治疗2周.治疗前、1周后、2周后分别给予Berg平衡量表(BBS)、Holden步行功能量表的临床评估,并在治疗前和2周后进行三维步态分析.结果:治疗组1周后BBS变化率、2周后Holden等级较伪刺激组增加,差异具有显著性(P＜ 0.05);治疗组步态的特征性参数、时空参数、对称性参数与伪刺激组比较,差异无显著性.结论:tDCS同步FES治疗可能提高脑卒中偏瘫患者的平衡功能,可以显著提高其行走功能,但三维步态分析的步态参数变化不明显.

目的：探讨综合性护理干预对腹腔镜胆总管切开探查取石术患者心理应激反应及术后并发症的影响。方法：将2014年7月~2015年6月期间临床确诊且择期拟行腹腔镜胆总管切开探查取石术的90例患者采用双盲法随机分为对照组和观察组各45例，对照组给予常规护理，观察组给予综合性护理干预，比较两组心理状态变化及术后并发症情况。结果：观察组干预后焦虑、抑郁自评评分与同组干预前和对照组干预后比较均明显降低（ P﹤0.05）；患者术后主要出现出血、切口感染、胆汁漏、胆道狭窄、胆石残留等并发症，观察组并发症发生率明显低于对照组（ P﹤0.05）。结论：综合性护理干预用于腹腔镜胆总管切开探查取石术患者能够减轻其心理应激，减少并发症的发生，临床应用价值高。