强化蹬踏训练对偏瘫患者下肢功能恢复的影响

目的探索强化蹬踏训练对偏瘫患者下肢功能恢复的影响。方法60 例脑卒中后偏瘫患者分为对照组(n=30)和治疗组(n=30),均接受常规运动治疗、作业治疗、针灸治疗和电刺激治疗,治疗组在此基础上增加强化蹬踏训练。于治疗前及治疗8 周后分别采用Berg 平衡量表(BBS)、Fugl-Meyer 下肢运动功能评分量表(FMA-L)、改良Barthel 指数(MBI)、功能性步行分级(FAC)、改良Ashworth 量表(MAS)进行评定。结果治疗后,两组患者的BBS、FMA-L、MBI、FAC、MAS 评分较治疗前均明显改善(P<0.01),治疗组改善情况均优于对照组(P<0.05)。结论强化蹬踏训练可明显改善偏瘫患者下肢功能。     

运动想象疗法结合生物反馈治疗脑卒中偏瘫的疗效

目的：观察应用下肢康复机器人对早期偏瘫患者进行步行训练对于改善患者步行能力的有效性。方法：脑卒中偏瘫患者46例随机分为观察组和对照组各23例。2组均给予常规康复治疗,观察组加用下肢康复机器人进行步行训练。训练前后采用功能性步行量表（FAC）、患肢运动功能（FMA）及平衡量表（BBS）评定。结果：治疗8周后,2组独立步行率及BBS、FMA下肢评分均较治疗前明显提高（P〈0．01,0．05）,且观察组更高于对照组（P〈0．05）。结论：偏瘫患者早期运用下肢康复机器人进行步行训练能够较好地提高患者的步行能力。     

下肢机器人结合本体感觉神经肌肉促进技术对脑卒中患者下肢功能的临床疗效研究

目的:研究下肢机器人结合本体感觉神经肌肉促进技术(PNF)针对脑卒中偏瘫患者下肢功能的临床疗效。方法:68例脑卒中偏瘫患者,随机分为常规组(A组,进行常规康复训练)23例,PNF组(B组,在常规康复治疗的基础上结合PNF技术治疗)22例,下肢机器人结合PNF技术组(C组,在B组治疗的基础上,配合下肢机器人训练)23例,共治疗4周。治疗前、治疗2周后、治疗4周后分别采用Berg量表评估平衡能力(BBS),功能性步行量表(FAC)评价患者步行能力,Fugl-Meyer下肢运动功能量表(FMA-L)和10m最大步行速度测试(MWS)评估下肢运动功能和步行速度。结果:治疗2周后,C组在FMA-L、FAC和MWS方面显著优于A组(P0.01)和B组(P0.05)。治疗4周后,C组在FMA-L、BBS、FAC和MWS方面显著优于A组(P0.05)和B组(P0.05),B组在FMA-L、BBS、MWS方面优于A组(P0.05);组内比较治疗4周后与治疗前均具有显著性差异(P0.05)。结论:下肢机器人结合PNF技术对改善脑卒中偏瘫患者下肢功能的疗效显著,有助于提高患者的步行能力和平衡功能。     

下肢运动控制强化训练对脑卒中患者下肢功能的影响

目的观察下肢运动控制强化训练对脑卒中患者下肢运动功能、平衡功能和步行功能的影响。方法 40例脑卒中患者随机分入治疗组(n=20)和对照组(n=20)。对照组接受常规康复,治疗组在此基础上接受下肢运动控制训练,共6周。治疗前后采用Fugl-Meyer下肢运动功能评定(FMA-L)、Berg平衡量表(BBS)、Holden步行功能分级(FAC)进行评定;足印步态分析法测量患者步行参数。结果治疗后,两组患者FMA-L、BBS、FAC及平均步长、步宽及步速较治疗前显著改善(P0.001),且治疗组均优于对照组(P0.05)。结论运动控制强化训练能进一步促进偏瘫患者下肢运动功能、平衡功能、步行能力的恢复。     

运动想象疗法结合下肢康复机器人训练对脑卒中亚急性期偏瘫患者下肢运动功能的影响

目的:探讨运动想象疗法结合下肢康复机器人训练对脑卒中亚急性期偏瘫患者下肢运动功能的影响。方法:选取亚急性期脑卒中偏瘫患者50例,随机分为对照组和观察组各25例。两组患者均采用常规康复治疗(45min/次,每周6次)和下肢康复机器人的功能训练(20min/次,每周6次),一共6周。观察组在常规康复治疗的基础上,在训练结束后进行运动想象疗法(15min/次,每周6次)。两组患者均在治疗前、治疗6周后采用下肢FuglMeye(rFMA)运动功能量表、Berg平衡量表(BBS)、功能性步行量表(FAC)进行评估。结果:治疗前对照组和观察组在Fugl-Meyer(FMA)运动功能量表、Berg平衡量表(BBS)、功能性步行量表(FAC)的评分无显著差异(P0.05)。治疗6周后,两组患者FMA,BBS,FAC的评分较治疗前均有明显改善(P0.05),且观察组较对照组提高更明显(P0.05)。结论:运动想象疗法结合下肢康复机器人对亚急性期脑卒中患者下肢的运动功能、平衡功能及步行能力有所提高。     

肌电生物反馈联合膝关节控制训练对脑卒中偏瘫患者下肢运动功能的临床疗效

目的：探讨肌电生物反馈联合膝关节控制训练对脑卒中偏瘫患者下肢运动功能的临床疗效。方法：选取符合标准的脑卒中偏瘫患者60例随机分为观察组和对照组,各30例。2组患者均接受常规康复治疗,观察组在对照组的基础上,另行肌电生物反馈联合膝关节控制训练,每日1次,每周5次,治疗4周。于治疗前和治疗4周后分别采用简化Fugl-Meyer量表评定患者下肢运动功能,Berg平衡量表（BBS）评定平衡功能,Holden步行功能分级（FAC）评估步行能力。结果：治疗4周后,2组患者的Fugl-Meyer、BBS、FAC评分较治疗前比较均显著提高（P＜0.05）,观察组上述评分均显著高于对照组（P＜0.05）。结论：肌电生物反馈联合膝关节控制训练能够改善脑卒中患者的下肢运动功能,提高平衡能力和步行能力。     

悬吊运动疗法结合针刺夹脊穴对脑卒中偏瘫患者平衡功能的效果

目的观察悬吊运动疗法结合针刺夹脊穴对脑卒中偏瘫患者平衡功能的影响。方法 2013年10月至2015年10月,40例存在平衡功能障碍的脑卒中偏瘫患者随机分为对照组(n=20)和治疗组(n=20)。两组均行常规康复治疗,治疗组联合应用悬吊运动疗法结合针刺夹脊穴。治疗前后,采用Berg平衡量表(BBS)、10米最大步行速度(10MWS)、下肢Fugl-Meyer评定量表(FMA-L)和改良Barthel指数(MBI)进行评定。结果治疗4周后,两组BBS评分、10MWS、FMA-L评分和MBI评分均较治疗前提高(t2.249,P0.05),治疗组明显优于对照组(t2.954,P0.01)。结论悬吊运动疗法结合针刺夹脊穴能进一步改善脑卒中偏瘫患者的平衡功能,提高步行功能及日常生活活动能力。     

功能性电刺激辅助步行设备配合减重训练对脑卒中患者下肢功能的影响

摘要 目的：探讨功能性电刺激辅助步行设备配合减重训练对脑卒中恢复期患者下肢功能的影响。 方法：60例脑卒中恢复期患者随机分为治疗组及对照组。对照组(30例)在常规康复治疗基础上,辅以减重支持步行训练;治疗组(30例)在常规康复治疗基础上,佩戴功能性电刺激辅助步行设备进行减重支持步行训练。两组患者均在治疗前、治疗4周后采用Fugl-Meyer下肢运动功能量表（FMA-L）、Berg平衡量表（BBS）、功能性步行量表（FAC）进行评定。 结果：治疗前两组患者的一般资料及FMA、BBS、FAC各项评定结果无显著性差异（P>0.05）;治疗4周后与治疗前比较,两组患者的FMA、Berg、FAC评定结果较治疗前均有明显提高,差异有显著性意义（P<0.05）;试验组的FMA、BBS、FAC评分改善情况明显优于对照组,差异有显著性意义（P<0.05）。 结论：功能性电刺激辅助步行设备配合减重训练能改善脑卒中恢复期患者的下肢运动功能、平衡功能及步行功能,较传统方法结合减重训练更有利于促进脑卒中患者下肢功能恢复。     

下肢智能康复机器人对脑卒中偏瘫患者下肢运动功能的影响

目的:观察下肢智能康复机器人训练对脑卒中偏瘫患者下肢运动功能、平衡功能及步行能力的影响。方法:将80例脑卒中偏瘫患者随机分成对照组和干预组,各40例。2组均采用常规康复治疗,干预组在此基础上加用下肢智能康复机器人训练。采用简式Fugl-Meyer评分法(FMA)、Berg平衡量表(BBS)、功能性步行分级(FAC)、10 m最大步行速度、改良Barthel指数(MBI)、胫骨前肌表面肌电积分(iEMG)进行结局指标评价。结果:治疗12周后,2组患者BBS、FMA、MBI和iEMG评分均较治疗前明显升高(P=0.000),治疗后干预组评分明显高于对照组(P=0.000)。治疗后干预组FAC步行功能分级3级及以上者所占比例、10 m最大步行速度均优于对照组。结论:下肢智能康复机器人结合常规康复训练能明显提高脑卒中偏瘫患者的下肢运动功能、平衡功能及步行能力。     

改良强制性运动疗法对脑卒中偏瘫患者下肢功能恢复的影响

目的观察改良强制性运动疗法对脑卒中偏瘫患者平衡功能及下肢运动功能的影响。方法采用随机数字表法将45例脑卒中偏瘫患者分为治疗组及对照组。治疗组患者采用改良强制性运动疗法对其下肢功能进行强化训练,对照组患者则给予常规康复干预,包括牵张训练、躯干肌控制训练、髋关节控制训练、膝关节控制训练、踝背屈诱发训练及日常生活活动能力训练等,两组患者均持续治疗8周。于治疗前、治疗8周后分别采用Berg平衡量表(BBS)及简式Fugl-Meyer下肢功能量表(FMA-LE)对两组患者下肢功能恢复情况进行评定。结果两组患者分别经8周治疗后,发现其BBS评分及FMA-LE评分均较治疗前明显改善(P0.05);并且治疗组BBS评分(48.2±5.7)分亦显著优于对照组(P0.05);而FMA-LE评分(27.9±4.4)分与对照组间差异仍无统计学意义(P0.05)。结论改良强制性运动疗法能进一步改善脑卒中偏瘫患者下肢平衡能力,对促进患者下肢运动功能恢复具有重要意义。     

改制强制性运动疗法对脑卒中上肢运动功能的影响

目的研究改制的强制性运动疗法(mCIMT)对脑卒中偏瘫患者上肢运动功能障碍的疗效。方法选取脑卒中偏瘫患者30例,分成mCIMT组和对照组,每组15例。mCIMT组不限制健手的使用,患肢接受重复、密集的行为再塑的技术强化训练,6 h/d,5 d/周,连续训练2周。对照组采用常规治疗方法进行训练。疗效评测使用运动活动日志(MAL)和简易上肢功能检查(STEF),分别于治疗前、治疗后2周、1个月和3个月进行疗效评定。结果两组治疗2周后MAL指数和STEF分数均明显高于治疗前(P<0-01);mCIMT组在治疗结束1个月和3个月的MAL指数和STEF分数较治疗前均明显提高(P<0-01);治疗组与对照组疗效比较有显著性差异(P<0-05);对照组治疗后1和3个月的MAL指数和STEF分数与治疗前比较均无显著性差异(P>0-05)。结论mCIMT能显著提高脑卒中偏瘫患者的上肢运动功能,其疗效明显优于常规康复方法。     

新型感知提醒疗法与改良限制诱导运动疗法对偏瘫上肢功能疗效的对照研究

目的:对照研究改良限制-诱导运动疗法(modified constraint-induced movement therapy, mCIMT)与感知提醒疗法(sensory cueing treatment, SCT)对慢性期脑卒中患者上肢运动功能的疗效差异。方法:招募60名符合入选标准的脑卒中患者,随机分成mCIMT组(20例)、SCT组(20例)与对照组(20例)。三组均接受常规康复训练,mCIMT组与SCT组在此基础上分别接受连续3周的单侧和双侧上肢强化训练。所有患者均接受治疗前和治疗后的上肢功能评估,包括Fugl-Meyer上肢功能评定(FMA-UE)、上肢动作研究测试(ARAT)、运动活动日志(MAL)、改良Barthel指数(MBI)。结果:治疗前三组患者各项评定指标差异无显著性意义(P0.05)。与治疗前相比,治疗后mCIMT组与SCT组FMA-UE、ARAT、MAL与MBI得分均明显增加,其差异均有显著性意义(P0.05)。治疗后,mCIMT组MAL使用数量与活动质量评分均优于SCT组,其疗效差异具有显著性意义(P0.05)。治疗后,SCT组ARAT与MBI得分优于mCIMT组,其疗效差异具有显著性意义(P0.05)。结论:重复性单侧肢体强化训练(如m CIMT)与双侧上肢强化训练(如SCT)均能够有效提高脑卒中后偏瘫上肢的运动功能、日常使用频率与运动质量,以及功能性活动表现和日常生活自理能力。     

Efficacy of modified constraint-induced movement therapy in chronic stroke: a single-blinded randomized controlled trial

OBJECTIVE: To determine efficacy of a modified constraint-induced movement therapy (mCIMT) protocol for patients with chronic stroke. DESIGN: Multiple-baseline, pre-post, single-blinded randomized controlled trial. SETTING: Outpatient clinic. PARTICIPANTS: Seventeen patients who experienced stroke more than 1 year before study entry and who had upper-limb hemiparesis and learned nonuse. INTERVENTION: Seven patients participated in structured therapy sessions emphasizing more affected arm use in valued activities, 3 times a week for 10 weeks. Their less affected arms were also restrained 5d/wk for 5 hours (mCIMT). Four patients received regular therapy with similar contact time to mCIMT. Six patients received no therapy (control). MAIN OUTCOME MEASURES: The Fugl-Meyer Assessment of Motor Recovery (FMA), Action Research Arm (ARA) Test, and Motor Activity Log (MAL). RESULTS: The mCIMT patients exhibited greater motor changes on the FMA and ARA (18.4, 11.4) than regular therapy (6.0, 7.1) or control (-2.9, -4.5). Statistical analyses showed significant differences in motor improvement on the FMA (F(2,12)=11.2, P=.002) and the ARA (F(2,12)=14.0, P=.001). Post hoc analyses showed that, when pretreatment motor differences are controlled, mCIMT resulted in substantially higher posttreatment FMA and ARA scores. Amount and quality of arm use, measured by the MAL, improved only in mCIMT patients. CONCLUSIONS: mCIMT may be an efficacious method of improving function and use of the more affected arms of chronic stroke patients. Findings further affirm that repeated, task-specific practice is critical to reacquisition of function, whereas practice schedule intensity is less critical.     

A randomized controlled trial of modified constraint-induced movement therapy for elderly stroke survivors: changes in motor impairment, daily functioning, and quality of life

OBJECTIVE: To examine the benefits of modified constraint-induced movement therapy (mCIMT) on motor function, daily function, and health-related quality of life (HRQOL) in elderly stroke survivors. DESIGN: Two-group randomized controlled trial, with pretreatment and posttreatment measures. SETTING: Rehabilitation clinics. PARTICIPANTS: Twenty-six elderly stroke patients (mean age, 72 y) with 0.5 to 31 months postonset of a first-ever cerebrovascular accident. INTERVENTIONS: Twenty-six patients received either mCIMT (restraint of the unaffected limb combined with intensive training of the affected limb) or traditional rehabilitation for a period of 3 weeks. MAIN OUTCOME MEASURES: Outcome measures included the Fugl-Meyer Assessment (FMA), FIM instrument, Motor Activity Log (MAL), and Stroke Impact Scale (SIS). The FMA evaluated the severity of motor impairment; the FIM instrument and MAL reported daily function; and the SIS detected HRQOL. RESULTS: The mCIMT group exhibited significantly greater improvements in motor function, daily function, and the physical domain of HRQOL than the traditional rehabilitation group. Patients in the mCIMT group perceived significantly greater percent of recovery after treatment than patients in the traditional rehabilitation group. CONCLUSIONS: These findings suggest mCIMT is a promising intervention for improving motor function, daily function, and physical aspects of HRQOL in elderly patients with stroke. The mCIMT was well tolerated by the elderly patients even though it is a rigorous training program.     

经颅直流电刺激联合改良强制性使用技术在脑卒中患者中的疗效观察

目的:探索经颅直流电刺激联合改良强制性使用对脑卒中患者上肢运动功能和日常生活能力的影响。方法:84名脑卒中患者随机分为A、B、C3组,A组采取常规康复方案,B组在A组基础上增加改良强制性使用技术,C组在B组基础上增加经颅直流电刺激,对3组患者在治疗前(T1)、治疗2周(T2)、治疗4周(T3)、出院后1个月(T4)、出院后2个月(T5)时进行改良Barthel指数(MBI)、Fugl-Meyer上肢运动功能评估表(FMA-UE)和Wolf运动功能评分(WMFT)并进一步分析。结果:3组患者MBI、FMA-UE、WMFT结果显示组别与时间存在交互作用(F=28.96,F=16.64,F=56.11,均P<0.01)。3个结局指标中各组组间比较显示:B组较A组,在T1、T2时差异无统计学意义,在T3、T4、T5时,B组3项评分均高于A组,差异有统计学意义(P<0.05);C组较A组,在T1时差异无统计学意义,在T2、T3、T4、T5时,C组3项评分均高于A组,差异具有统计学意义(P<0.05);C组较B组,在T1、T2时差异无统计学意义,在T3、T4、T5时C组3项评分均高于B组,差异有统计学意义(P<0.05)。结论:经颅直流电刺激联合改良版强制性使用技术能有效改善脑卒中患者上肢运动功能和日常生活能力,且疗效在疗程结束后可以继续保持。     

改良和传统强制性运动疗法对脑卒中偏瘫患者上肢运动功能疗效的临床观察

目的观察改良强制性运动疗法和强制性运动疗法对脑卒中偏瘫患者手功能和日常生活能力的影响。方法选取58例符合入选标准的脑卒中偏瘫患者,随机分为改良组(27例)和强制组(31例)。强制组和改良组采用限制健侧肢体动作,在治疗期间要求患者穿戴吊带和夹板,每天清醒时固定时间不少于90%,强制组每日6 h,每周训练5d,连续2周;改良组在治疗环境中进行,每日2 h,每周3次,其它时间在日常生活活动中进行训练,连续10周。治疗前、后分别采用简易上肢机能检查量表(STEF)和Barthel指数(BI)评价患者的上肢运动功能。结果两组患者在治疗前,STEF和Barthel指数中的10项评分差异均无统计学意义(P>0.05)。经过治疗后,组内评分比较,差异均有统计学意义(P<0.05);组间比较,STEF差异无统计学意义(P>0.05),BI差异有统计学意义(P<0.01)。结论改良强制性运动疗法和强制性运动疗法可以有效提高偏瘫患者上肢的灵活性和运动速度。改良强制性运动疗法在改善日常生活活动能力方面明显优于强制性运动疗法。     

Back from the brink: electromyography-triggered stimulation combined with modified constraint-induced movement therapy in chronic stroke

OBJECTIVE: To determine the efficacy of a regimen that combines electromyography-triggered neuromuscular stimulation (ETMS) with modified constraint-induced movement therapy (mCIMT) in patients with chronic stroke. DESIGN: Pre-post, case series. SETTING: Outpatient rehabilitation hospital. PARTICIPANTS: Six subjects who had had a stroke more [corrected] than 1 year before the study and who had upper-limb hemiparesis. All subjects were only able to activate the affected wrist extensors. INTERVENTION: Subjects underwent ETMS twice every weekday in 35-minute increments during an 8-week period. One week after they completed the ETMS regimen, and after the outcome measures were readministered, subjects participated in mCIMT, which consisted of structured therapy sessions that emphasized use of the more affected arm in valued activities. The sessions were held 3 times a week for 10 weeks. The less affected arms were also restrained 5 days a week for 5 hours. MAIN OUTCOME MEASURES: The Fugl-Meyer Assessment (FMA) of motor recovery, Action Research Arm Test (ARAT), and goniometry. RESULTS: Subjects had nominal changes on the ARAT (mean change, 0.3), and no functional changes after ETMS. However, they had a mean increase of 21.5 degrees in affected wrist extension and an improved ability to perform the wrist items of the FMA (reflected by a mean increase of 4.1 points on the FMA), which qualified them for mCIMT. After mCIMT, subjects had a 15.5-point change on the FMA, an 11.4-point change on the ARAT, and a new ability to perform valued activities. CONCLUSIONS: ETMS alone does not result in functional changes. However, it may elicit sufficient active affected wrist and finger extension increases to permit possible participation in mCIMT, which can result in marked functional gains. This study is among the first to show improved function in stroke patients who initially had little hand motor control, and it is among the first to effectively combine 2 singularly efficacious regimens.     

Mental practice as a gateway to modified constraint-induced movement therapy: a promising combination to improve function.

Modified constraint-induced movement therapy (mCIMT) is a reimbursable regimen that improves the use and function of more-affected arms in patients who have had a stroke. To participate in this regimen, however, patients must exhibit active extension of the more-affected wrists and fingers, which renders many people ineligible. This study determined the efficacy of a mental practice program that preceded mCIMT in improving more-affected arm function in 4 patients with a stroke. Patients received therapy emphasizing activities of daily living (ADLs), followed by sessions of mental practice of the ADL. One week after completing mental practice, patients participated in mCIMT. After mental practice, patients exhibited marked changes on assessments and increased active wrist and finger extension, which qualified them for mCIMT. After mCIMT, participants exhibited additional functional gains, sustained 3 months later. Data suggest that mental practice provides a pathway whereby patients can participate in mCIMT, realize additional gains, and again perform valued ADLs.     

基于家庭环境使用改良强制性运动疗法对慢性脑卒中后上肢功能恢复的探讨

目的:进行家庭使用改良强制性运动疗法(mCIMT)治疗慢性脑卒中后上肢功能恢复的探讨。方法:选择在社区康复机构接受治疗的脑卒中后上肢功能障碍的成年患者64例,随机分为观察组和对照组各32例,2组均接受常规康复训练,观察组加用强制性运动疗法治疗;运动功能评定采用Fugl-Meyer量表上肢部分(FMA-UE),日常生活活动能力评价采用改良Barthel指数(MBI);在治疗前、后及治疗后12周时进行效果评定。结果:治疗后以及12周后随访,2组FMA-UE评分及MBI评分均较治疗前明显提高(P0.05),且观察组2项评分高于对照组(P0.05)。结论:家庭mCIMT有助于脑卒中偏瘫患者上肢功能的恢复。     

The impact of transcranial direct current stimulation (tDCS) combined with modified constraint-induced movement therapy (mCIMT) on upper limb function in chronic stroke: a double-blind randomized controlled trial

Purpose: This pilot double-blind sham-controlled randomized trial aimed to determine if the addition of anodal tDCS on the affected hemisphere or cathodal tDCS on unaffected hemisphere to modified constraint-induced movement therapy (mCIMT) would be superior to constraints therapy alone in improving upper limb function in chronic stroke patients. Methods: Twenty-one patients with chronic stroke were randomly assigned to receive 12 sessions of either (i) anodal, (ii) cathodal or (iii) sham tDCS combined with mCIMT. Fugl–Meyer assessment (FMA), motor activity log scale (MAL), and handgrip strength were analyzed before, immediately, and 1 month (follow-up) after the treatment. Minimal clinically important difference (mCID) was defined as an increase of ≥5.25 in the upper limb FMA. Results: An increase in the FMA scores between the baseline and post-intervention and follow-up for active tDCS group was observed, whereas no difference was observed in the sham group. At post-intervention and follow-up, when compared with the sham group, only the anodal tDCS group achieved an improvement in the FMA scores. ANOVA showed that all groups demonstrated similar improvement over time for MAL and handgrip strength. In the active tDCS groups, 7/7 (anodal tDCS) 5/7 (cathodal tDCS) of patients experienced mCID against 3/7 in the sham group. Conclusion: The results support the merit of association of mCIMT with brain stimulation to augment clinical gains in rehabilitation after stroke. However, the anodal tDCS seems to have greater impact than the cathodal tDCS in increasing the mCIMT effects on motor function of chronic stroke patients.

• Implications for Rehabilitation

• The association of mCIMT with brain stimulation improves clinical gains in rehabilitation after stroke.

• The improvement in motor recovery (assessed by Fugl–Meyer scale) was only observed after anodal tDCS.

• The modulation of damaged hemisphere demonstrated greater improvements than the modulation of unaffected hemispheres.