目的 探讨改良五禽戏对老年脑卒中病人呼吸功能的影响.方法 将2021年6月至2022年6月住院进行康复治疗的40例老年脑卒中病人纳入本试验,随机分为试验组和对照组,每组各20例.对照组接受常规康复训练,试验组在此基础上接受改良五禽戏训练.干预前后采用FEV1、FVC、呼气峰值流速(PEF)评估病人肺通气功能;采用吸气峰值流速(PIF)和最大吸气压(MIP)评估病人吸气肌功能;采用用力呼吸膈肌活动度(DE)以及膈肌增厚分数(DTF)评估膈肌功能.结果 干预前,2组病人FEV1、FVC、PEF、PIF、MIP、DE以及DTF比较差异均无统计学意义(P>0.05);干预后,试验组病人FEV1、FVC、PEF、PIF、MIP、DE以及DTF均较干预前显著提高,且除DTF外均显著高于对照组(P<0.05).结论 改良五禽戏训练可以改善老年脑卒中病人肺通气功能、吸气肌功能以及膈肌活动度,有利于促进病人呼吸康复.

前庭康复治疗(vestibular rehabilitation therapy,VRT)是一种高度专业化设计的训练方法,通过反复地刺激前庭系统,促进前庭代偿的出现,显著改善前庭疾病患者的眩晕、头晕等不适症状[1].由于前庭神经问题较为普遍且手术治疗成本高昂,对于VRT的需求是显而易见的.近年来,越来越多的证据表明VRT能够显著改善前庭功能减退患者的前庭动眼反射(vestibule-ocular reflex,VOR)、平衡功能、姿势控制、头晕、眩晕、运动敏感性、焦虑等问题,从而改善预后,提高患者的生活质量[2].

姿势控制是指个体根据任务需求维持身体在空间位置中的方向性与稳定性的能力[1].垂直感知是指个体从嘈杂和模糊的感觉信号(包括视觉、前庭觉、触觉和本体感觉等)中估计自身相对于重力线的方向,以及判断他物是否与重力线对齐的能力,对个体的空间定向有重要意义,是姿势控制的重要组成部分[2].姿势控制障碍是在脑卒中后最严重的持续性问题之一,严重影响患者的日常生活,并显著增加患者的跌倒风险[3].研究表明,脑卒中患者在急性期、亚急性期和慢性期均存在垂直感知的改变,且与患者的姿势控制障碍密切相关[4-6].目前,国内外鲜有研究从垂直感知的角度定量分析脑卒中患者的姿势控制障碍.本文旨在梳理近年来垂直感知在脑卒中患者姿势控制中的研究进展,以帮助临床及科研工作者更好地进行脑卒中患者姿势控制障碍的定量研究,通过对于垂直感知障碍的积极干预来改善患者的姿势控制,为进一步的科研及临床工作奠定基础.

目的 调查江苏省"十三五"期间康复医疗资源配备的情况及其发展.方法 通过卫生健康委系统对江苏省13个地级市医疗卫生机构统一发放电子版调查表,回顾性调查2015年至2019年康复资源的发展.结果 与2015年相比,2019年末江苏省设置康复医学科的二级及以上综合医院占比提高3.42个百分点;开展康复服务的基层医疗机构占比提高5.67个百分点;每百万人口拥有康复科编制床位数增加127张,实有床位数增加142张;临床早期康复介入每百万人口增长4326人次;每百万人口拥有康复专业技术人员增加91人,其中康复医师增加25人,康复治疗师增加31人,康复护士增加29人,其他康复行业从业人员增加6人;康复从业人员中,副高级及以上职称比例增高1.65个百分点,硕士及以上学历比例增高1.27个百分点.结论 "十三五"以来,江苏省各类康复资源配置均有所提高.

Objective:To observe the effect of gaze stabilization exercises on the balance of stroke patients.Methods:Forty stroke patients were randomly divided into an experimental group ( n=20) and a control group ( n=20). Both groups were given conventional rehabilitation therapy, while the experimental group was additionally provided with gaze stabilization exercises, once a day, five days a week, for a total of four weeks. Each session lasted 30 minutes. Before and after the four weeks, both groups were evaluated in terms of their envelope ellipse area and the plantar pressure distribution on the affected side in static standing and using the anterior-posterior center of pressure displacement velocity (AP-COPV). They were also assessed using the Berg Balance Scale (BBS), the timed up-and-go test (TUGT), and the Activities-specific Balance Confidence Scale (ABC). Results:After the gaze stabilization exercises, the average envelope ellipse area, the plantar pressure distribution of the affected side with the eyes open and closed, AP-COPV, BBS score, TUGT time and ABC score of the experimental group were significantly superior to the control group′s averages and to the results four weeks previously.Conclusions:Gaze stabilization exercises can improve balance, weight shifting and one-leg standing after a stroke. That should enhance balance confidence and reduce the risk of falling.

This study aims to explore the effects of gaze stabilization exercises (GSEs) on gait, plantar pressure, and balance function in post-stroke patients (≤6 months). Forty post-stroke patients were randomly divided into an experimental group (n = 20) and a control group (n = 20). The experimental group performed GSEs combined with physical therapy, while the control group only performed physical therapy, once a day, 5 days a week, for 4 weeks. The Berg Balance Scale (BBS) was used to test the balance function and the risk of falling, which was the primary outcome. The Timed Up and Go test (TUGT) evaluated the walking ability and the fall risk. The envelope ellipse area and the plantar pressure proportion of the affected side were used to measure the patient’s supporting capacity and stability in static standing. The anterior–posterior center of pressure displacement velocity was used to test the weight-shifting capacity. Compared to the control group, the swing phase of the affected side, swing phase’s absolute symmetric index, envelope ellipse area when eyes closed, and TUGT of the experimental group had significantly decreased after GSEs (p < 0.05); the BBS scores, TUGT, the anterior–posterior COP displacement velocity, and the plantar pressure proportion of the affected side had significantly increased after 4 weeks of training (p < 0.05). In conclusion, GSEs combined with physical therapy can improve the gait and balance function of people following stroke. Furthermore, it can enhance the weight-shifting and one-leg standing capacity of the affected side, thus reducing the risk of falling.

目的 分析慢性非特异性腰痛(CNLBP)患者竖脊肌的收缩特性,探讨其与疼痛和功能障碍的相关性.方法 2020年1月至6月,采用肌张力描记技术对24例老年康复科门诊和病房CNLBP患者(CNLBP组)以及26例无症状志愿者(对照组)进行竖脊肌收缩特性测量,包括径向最大位移(Dm)、收缩时间(Tc)、延迟时间(Td)、持续时间(Ts)、放松时间(Tr)和双侧对称性(LS),根据相应测量指标计算收缩速度(VC).CNLBP患者的肌张力描记技术参数与患者的疼痛视觉模拟评分(VAS)和功能障碍指数(ODI)进行相关性分析.结果 与对照组右侧比较,CNLBP组疼痛侧和非疼痛侧竖脊肌Td、Ts、Tc、Tr和LS无显著性差异(P>0.05),Dm和VC均降低(t>2.058,P<0.01),且Dm、VC与VAS、ODI均无显著性相关(P>0.05).结论 CNLBP患者双侧竖脊肌的僵硬程度和疲劳程度高于无症状人群,但与患者的疼痛与功能障碍程度不相关.肌张力描记技术可为CNLBP患者的精准诊疗提供依据.