目的 探究早期上肢简单动作与脑卒中不同时间段上肢运动功能恢复情况的相关性及预测指标的预测概率.方法 首发脑卒中患者102例,观察患者在患病第3、5、7、9、15天能否做手指伸展(FE)、肩外展(SA)以及耸肩(SS),在患病1、3、6个月后使用上肢动作研究量表(ARAT)、改良巴氏指数(MBI)和Fugl-Meyer上肢评定量表(FMA-UE)评定上肢运动功能.结果 ①Pearson相关分析表明FE、SA、SS与ARAT、MBI、FMA-UE存在相关关系(r:0.757～0.913,P＜0.001).②多重线性回归表明SA和SS与ARAT、MBI、FMA-UE无相关性(P＞0.05).患病第3、5天的FE与患病1个月后的ARAT、MBI、FMA-UE和3个月后的ARAT、MBI存在相关关系(P＜0.05).7d后的FE与患病1、3、6个月后的ARAT、MBI具有相关性(P＜0.05),但与3、6个月的FMA-UE无相关性(P＞0.05).③二元Logistic回归显示,第7天后出现FE的患者,6个月后运动功能恢复一定灵敏性的概率为98％,未出现FE的患者6个月后运动功能恢复一定灵敏性的概率为38％.第15天出现FE的患者,6个月后运动功能恢复一定灵敏性的概率仍为98％,未出现FE的患者,6个月后运动功能恢复一定灵敏性的概率降为28％.结论 SA、SS不可作为脑卒中运动功能恢复情况的预测指标;患病7d后FE可作为脑卒中患者偏瘫上肢短、中、长期的运动功能(ARAT、MBI)恢复情况的预测指标,FE出现的时间越晚,运动功能的恢复概率越低.

目的 观察脑电仿生电刺激小脑顶核对脑梗死后认知功能障碍的影响,并探讨其可能的机制.方法 选取脑梗死后并发认知功能障碍患者50例,随机分成治疗组与对照组各25例.2组患者均接受康复治疗及认知功能训练,治疗组同时加用脑电仿生电刺激进行干预.2组患者分别于治疗前后应用蒙特利尔认知评估量表(MoCA)、简易精神状态量表(MMSE)评定认知功能变化,采用经颅多普勒超声(TCD)评估颅内动脉血流动力学改变.结果 治疗后2组患者MoCA评分、MMSE评分均较组内治疗前提高(P<0.05),且治疗组评分明显较对照组高,差异有统计学意义(P<0.05).治疗后2组患者颅内动脉血流动力学较组内治疗前改善(P<0.05),且治疗组较对照组改善更显著,差异有统计学意义(P<0.05).治疗组与对照组总有效率分别为92％和64％,差异有统计学意义(P<0.05).结论 脑电仿生电刺激小脑顶核可有效改善脑梗死患者的认知功能,其可能机制是通过改善患者的脑循环进一步改善认知功能.

目的 比较手部外骨骼机器人辅助双侧对称性训练与镜像疗法对脑卒中偏瘫患者手功能的康复效果.方法 选取2018年6月至2019年7月在安徽医科大学第一附属医院康复医学科住院的脑卒中偏瘫患者36例,采用随机数字表法分为外骨骼组与镜像组,每组18例.外骨骼组患者利用手部外骨骼机器人进行双手同步对称性训练,镜像组给予镜像疗法.观察两组患者治疗前后手功能及日常生活活动能力的变化,比较两组患者治疗方法的疗效差异.结果 治疗后,两组患者Fugl-meyer运动功能量表评分(FMA)及改良Barthel指数均较治疗前提高,差异有统计学意义(P<0.001).治疗后,外骨骼组患者的FMA评分高于镜像组,差异有统计学意义(P=0.034).治疗2周后,外骨骼组患者治疗有效率高于镜像组,差异有统计学意义(P=0.044),两组患者治疗显效率差异无统计学意义(P>0.05);治疗3、4周后,两组患者治疗有效率差异均无统计学意义(P>0.05),外骨骼组治疗显效率高于镜像组,差异均有统计学意义(P=0.035,P=0.022).结论 基于手部外骨骼机器人的双侧对称性训练能加速脑卒中患者手功能的恢复进程,对于手功能的改善程度优于镜像疗法.

Objective To explore any changes in the surface electromyography (sEMG) signals measured on the spastic upper limb muscles of stroke parents during maximum isometric voluntary contraction and to analyze any abnormal synergy patterns quantitatively in order to design better rehabilitation programs for developing coordination.Methods Ten stroke survivors with hemiparesis were selected into a patient group and ten healthy counterparts were recruited into a control group.sEMG signals were recorded bilaterally from the flexor carpi ulnaris (FCU),biceps brachii (BB),triceps brachii (TB) and deltoid (D) during maximum isometric voluntary contractions involving wrist flexion and extension,elbow flexion and extension,and shoulder abduction.The two groups' co-contraction ratios (CR) and co-activation ratios were calculated and compared.Results During elbow flexion and extension the average CR of the BB on the affected side was significantly higher than that on the unaffected side and also significantly higher than the control group average.The average CR of the TB on the affected side was significantly higher than that of the healthy controls.In all cases the average CR of the BB was larger than that of the TB.The difference in CR between the TB and the BB on the affected side was significantly larger than on the unaffected side and the control group average.During elbow flexion,the co-activation ratio of the FCU,TB and D on the affected side was significantly higher than on the unaffected side and among the healthy controls,and the co-activation ratio of the FCU on the affected side was significantly higher than that of the D and TB.During elbow extension,the co-activation ratio of the FCU,BB and D on the affected side was significantly higher in the same way,and the co-activation ratio of the FCU on the affected side was again significantly higher than that of the D and BB.During wrist flexion,the average co-activation ratio of the BB and D on the affected side was significantly greater than that on the unaffected side and among the healthy controls,and the co-activation ratio of the BB on the affected side was significantly higher than that of the D and TB.During shoulder abduction,the co-activation ratio of the BB on the affected side was significantly larger than on the unaffected side and among the healthy controls.Conclusion After a stroke the upper limbs often show flexor spasticity and abnormal synergy patterns.Rehabilitation strategy should be adopted to tackle these so as to enhance overall limb coordination.

Objective To investigate coactivation patterns of upper extremity flexors by comparing their surface electromyographic signals ( sEMG) between stroke patients and healthy controls when they performed elbow flexion and wrist flexion at a maximum isometric voluntary contraction level , and to examine whether abnormal coactivation was related to motor dysfunction after stroke .Methods Eighteen stroke patients and eighteen age-matched healthy control subjects participated in the study .For each subject , sEMG signals were recorded simultaneously from bi-ceps brachii and flexor carpi radialis muscles when the subject was asked to perform elbow flexion and wrist flexion tasks respectively .The coactivation level for each of biceps brachii and flexor carpi radialis muscles was derived by processing their sEMG signals .Such resultant coactivation levels were also compared among the unimpaired side and the impaired side of stroke subjects and the dominant side of control subjects .Moreover , a correlation analysis&nbsp;was performed between the coactivation levels and clinical assessment of motor function .Results Coactivation lev-els of wrist flexors and of elbow flexors during the elbow flexion and the wrist flexion tasks respectively were signifi -cantly higher in the paretic upper extremity than those in the unaffected side .For the wrist flexion tasks , coactiva-tion levels of elbow flexors were significantly higher in the unaffected side than those in the control group .Levels of coactivation of elbow flexors during the wrist flexion task were negatively correlated with both Fugl -Meyer scores and coordination scores , and were positively correlated with degrees of spasticity .Conclusion Abnormal coactivation patterns of upper extremity flexors appeared in the both sides of hemiplegic patients .The motor impairment of paret-ic upper extremity is associated with the abnormal coactivation .The changes of spinal pathways may participate in the abnormal coactivation of elbow and wrist flexors .