智能化手功能评定系统用于脑卒中患者手功能评定的可信性分析

摘要 目的：分析智能化手功能评定系统在脑卒中患者手功能评定的信度。 方法：共收集了30例初发单侧脑卒中偏瘫患者,年龄（53.83±2.02）岁,男18例,女12例。应用智能化手功能评定系统测量脑卒中偏瘫手最大握力、捏力和夹指压力,每个项目均测量3次,取最大值作统计学分析;再予以Brunnstrom（手部）,FM-UE运动评测和Barthel指数法评定手功能。 结果：智能化手功能评定系统测定最大握力、捏力及夹指压力结果与其他常用上肢功能评定之间存在直线相关关系,Pearson相关系数为0.670—0.888（P值均小于0.05）;最大握力与FM-UE和Brunnstrom（手部）的相关性优于最大捏力和夹指压力。 结论：智能化手功能评定系统检测出的最大握力、捏力及夹指压力可反映脑卒中患者上肢功能,能对患者上肢功能进行客观、精确和量化的评定。     

三种类型手夹板在预防和治疗烧伤后手畸形中的应用

目的：研究三种类型手夹板对烧伤后手畸形的预防和治疗作用。方法：在烧伤后的不同时间，为20例烧伤手分别制作并使用保护位夹板、动态夹板和掌指屈曲手套，观察早期及使用3个月后手功能改善的情况。采用Carroll上肢功能评定标准对上肢及手的整体功能进行定量评定。结果：治疗3个月后烧伤手的诸关节活动度均增大，20例烧伤患者均未出现爪形手等典型的手畸形，上肢及手的功能评定显示功能等级明显增高。结论：手烧伤后不同时间使用不同的手夹板，对预防和治疗烧伤后由瘢痕挛缩引起的手关节强直及关节畸形有良好的效果，可改善手功能。     

手康复系列讲座（续五）

手夹板主要用于保持不稳定的肢体于功能位．提供牵引力以防止挛缩．预防或矫正肢体畸形以及补偿失去的肌力,帮助无力的肢体运动等．从而达到减少残疾程度．增进功能的目的。夹板按其功能可分为固定性(静止性)和功能性(动力性)两类。固定性手夹板没有可动的组成部分．主要用于固定肢体于功能位．限制异常运动,故常用于治疗手部骨折脱位、关节炎、手术后哲时性止动等。功能性夹板允许肢体有一定程度的活动．从而达到治疗目的。手夹板是手外科治疗的重要组成部分．被广泛应用于临床。下面仅介绍临床常用的各种手夹板用逾及适用症。     

肌电触发机器手对脑卒中早期患者手功能康复的影响

目的 观察肌电触发康复机器手对脑卒中早期患者手运动功能的影响。 方法 选取符合入组标准的脑卒中患者30例,采用随机数字表法分为对照组（n=15）和试验组（n=15）,对照组患者接受常规康复训练,试验组在常规康复训练基础上给予肌电触发康复机器手训练。于治疗前、治疗4周后（治疗后）采用Fugl-Meyer量表（FMA）评定2组患者腕、手的运动功能,采用改良Ashworth量表（MAS）评定2组患者四指（示指、中指、环指、小指）的痉挛程度,并采用康复机器手自带的表面肌电系统评估2组患者四指、拇指和全指伸肌、屈肌的肌力。 结果 治疗后,2组患者的腕、手以及总FMA评分与组内治疗前比较,差异均有统计学意义(P<0.01）,且治疗后试验组的腕、手以及总FMA评分均显著优于对照组治疗后,差异均有统计学意义（P<0.05）。治疗后,试验组患者四指屈肌MAS评分为（0.47±0.13）分,较组内治疗前和对照组治疗后均显著改善,差异均有统计学意义（P<0.05）,治疗后,2组患者四指、拇指、全指屈伸肌的平均肌电幅值较组内治疗前均显著改善,差异均有统计学意义（P<0.05）,且试验组治疗后四指、拇指、全指屈伸肌的平均肌电幅值与对照组治疗后比较,差异均有统计学意义（P<0.05）。 结论 肌电触发康复机器手联合常规康复可改善早期脑卒中患者患手的运动功能、痉挛程度和肌力。     

3D打印腕手矫形器辅助腕关节骨折术后康复的疗效观察

目的：设计并研发一种适用于腕关节骨折治疗的3D打印腕手矫形器，并观察其腕关节骨折外固定术后康复中的疗效。方法：自行设计并研制一种3D打印腕手矫形器。将70例腕关节骨折随机分成研究组与对照组各35例。研究组患者佩戴3D打印腕手矫形器，对照组患者佩戴高分子石膏夹板。由患者佩戴3D打印矫形器与高分子石膏夹板外固定8周后，填写调查功能评估量表与满意度评估量表。结果：研究组与对照组Mayo功能分值比较，治疗前<佩戴后第1周<佩戴后第2周<佩戴后第4周<佩戴后第8周（P<0.05），研究组治疗后每一个时间段Mayo功能评分明显高于对照组（P<0.05）；研究组满意度各项分值均明显高于对照组（P<0.05）。结论：基于3D打印的腕手矫形器对比高分子石膏夹板外固定组治疗效果更好，满意度更高。     

多模态镜像疗法对脑卒中患者上肢及手功能的效果

目的 探讨多模态镜像疗法对脑卒中患者上肢及手功能的效果。方法 选取2021年4月至2022年8月浙江省人民医院康复医学科住院治疗的脑卒中患者60例,随机分为A组、B组和C组,各20例。3组均予常规康复,B组增加镜像疗法,C组增加多模态镜像疗法,共6周。治疗前后采用Fugl-Meyer评定量表上肢部分(FMA-UE)、Carroll手功能评定(UEFT)、患手最大握力和捏力、改良Barthel指数(MBI)进行评定。结果 治疗后,3组FMA-UE评分、UEFT评分、患手最大握力和捏力、MBI评分均显著提高(|t|> 7.878, P <0.001),C组各项成绩均最优(F> 12.563, P <0.001)。结论 多模态镜像疗法能进一步改善脑卒中患者上肢运动功能和手功能,提高患手肌力和患者日常生活活动能力。     

功能支具在烧伤后畸形手功能恢复中的作用及其效果评价

目的：观察经系统康复后特别是使用支具、功能支具对烧伤后手畸形功能康复的临床疗效。方法：1992-01／2002-12对整复外科1880例烧伤后手畸形患进行手法治疗，分别给予蜡疗、超声波治疗仪治疗、并辅以特定的中药处方以药离子导人方式治疗，重要的是对每位患特制支具或功能支具，佩戴2周～8个月，并制订了严重烧伤手畸形治疗后的评估标准。结果：随访10年，随访189例患，其中158例手畸形患手功能恢复，每个手动作基本正确，外形明显改善。结论：烧伤后手畸形通过手术治疗同时必须通过3个月以上的综合康复治疗，其中功能支具的使用对于手功能恢复是必不可少的一环。     

手康复系列讲座（待续）

1 手康复治疗概论.手是运动器官．在生活和劳动中最易遭受创伤，其发病率约占创伤总数的三分之一以上。剖伤后，遗留的功能障碍与创伤的类型程度有密切的关系，如：切割伤．切面较整齐．早期修复后遗留功能障碍较轻；而压砸、撕脱、碾挫伤，虽经清创修复，伤口愈合后仍遗留严重的伤残。手外伤后的功能障碍是因瘢痕挛缩、肌腱粘连、肿胀、关节僵硬、肌肉萎缩、组织缺损、伤口长期不愈合等造成的运动和感觉功能障碍。     

气动式手康复设备对痉挛型偏瘫脑性瘫痪儿童手功能的效果

目的 将气动式手康复设备应用于痉挛型偏瘫脑瘫患儿手功能综合康复训练并观察疗效。方法 2020年1月至2021年9月,南通大学附属妇幼保健院儿童康复医学中心就诊的痉挛型偏瘫脑瘫患儿58例随机分为对照组和试验组各29例。两组均行常规综合康复训练,试验组增加气动式手康复设备训练,共6个月。训练前后,采用Peabody精细运动发育量表(PDMS-FM)、精细运动评定量表(FMFM)和儿童功能独立性评定量表(Wee-FIM)进行评定。结果 训练后,两组PDMS-FM、FMFM和Wee-FIM评分均显著改善(|t|> 16.310, P <0.001);试验组各项评分均明显高于对照组(t> 2.795, P <0.01)。结论 气动式手康复设备能有效提高综合康复训练对痉挛型偏瘫脑瘫患儿手功能的训练效果。     

基于虚拟现实技术手功能康复训练系统的设计及临床应用

摘要 目的：根据手外伤后手功能障碍的特点,基于虚拟现实技术研制出一种增强手部肌力和协调性的手功能康复训练系统。 方法：通过贴片式压力传感器实时采集患手的力学信息,将其输入到虚拟现实环境中驱动虚拟环境的运行,该系统能够智能设置虚拟环境中执行任务的难度,根据采集到的力学信息作出相应的康复评价。本文从总体构思,系统的组成和功能设计,系统实现所采用的力传感器模块、采集模块、虚拟现实模块和评估模块开发等方面进行介绍,并进行了初步的临床对照试验。 结果：研制出基于虚拟现实技术的手功能康复系统;通过2周的临床试验,试验组在侧捏力（0.64±0.75N vs 0.09±0.21N）、握力（2.14±1.57N vs 0.81±1.00N）、ADL评分（3.44±2.45 vs 0.67±2.82）方面改善均优于对照组(P<0.05)。 结论：该系统具有成本低、结构简单、易于维护、安全性高等特点,有助于推动虚拟现实技术在手功能康复治疗领域中的应用。     

Comparison of Task Performance,Hand Power,and Dexterity with and without a Cock-up Splint

[Purpose] The purpose of this study was to investigate the difference in task performance, grip and pinch strength, and dexterity with and without cock-up splints, which are widely used in occupational therapy practice. [Methods] Twenty-three participants performed Jebsen-Taylor hand function test and grooved pegboard for task performance and dexterity. The power grip and pinch strength was measured using Jamar hydraulic hand dynamometer and pinch gauge. [Results] In the result of the Jebsen-Taylor hand function test, task performance with the cock-up splint was slower compared to without the splint for all items. Men’s grip power with the cock-up splint was found to be significantly decreased compared to without the splint. Women’s grip and palmar pinch strength with the splint decreased significantly compared to without the splint. In the grooved pegboard test, the dexterity of both men and women with the cock-up splint decreased significantly compared to without the splint. [Conclusion] To assist patients to make wise decisions regarding the use of splints, occupational therapists must have empirical knowledge of the topic as well as an understanding of the theoretical, technical, and related research evidence. The results of this study will be useful in the analysis and understanding of changes in hand function in splint applications for people with hand dysfunction.Key words: Dexterity, Hand power, Splint     

Factors that influence the duration of splint wear in peripheral nerve lesions

OBJECTIVE: To assess the weekly frequency and overall duration of wear for splints used to treat peripheral nerve lesions and factors that possibly influence splint wear. DESIGN: A total of 78 patients (23 women, 55 men) who had been treated with a hand splint for peripheral nerve palsy were interviewed by telephone, based on a preformulated questionnaire. The duration of wear, reasons for terminating use, the effect of the splint, the patients' assessment of splint treatment, the patients' instruction, and the patients' level of education were recorded. Survival analysis for the entire period of wear and logistic regressions to determine factors that influence splint wear were performed. Comparison of effect scores between lesions in the dominant those in the nondominant hand were carried out with a test. RESULTS: The median duration of wear was 6 mo for daytime and 4 mo for nighttime splints. Daytime splints were worn by 85% and nighttime splints by 84% of patients for 5-7 days per week. The reported effect of the splint was the only significant factor that influenced the frequency of wear. The splint was reported to be significantly more effective in the dominant hand than in the nondominant hand. Numerically, radial nerve lesions and cock-up wrist splints were most common. CONCLUSION: Regular splint wear was registered in the majority of patients and was positively influenced by a good effect of the splint, which was reported to be better in the dominant hand.     

Have you tried the sandwich splint? A method of preventing hand deformities in children

The prevention of contractures of the burned hand is an arduous problem in the young pediatric burn patient. Difficulty in applying splints, along with the time-consuming fabrication of complex splints, led to the development of the "sandwich" splint. This easily produced splint provides a means of preventing and treating hand deformities in this patient age group. Positive results have been noted with the use of this splint in conjunction with the patient's usual active physical therapy program.     

Brief or new: two pronation splints

For two years we have made pronation splints to assist quadriplegic patients who lack adequate forearm pronation but who have enough upper extremity strength to feed themselves and perform other self-care or functional activities. We have found the splints to be an appropriate alternative to the MAS. The first pronation splint fits underneath the arm, is simple in design and fabrication, and is hidden. However, occasionally the lever of the splint hangs up in the shirt, catches on the post of the wheelchair, or slips out from underneath the arm when the patient reaches away from the body. To eliminate these problems, we designed a second splint. But, this splint requires more time to make and adjust, has two parts to put on instead of one, and is more noticeable because it is worn on top of the arm rather than underneath it. When a patient uses either splint, the degree of pronation may be adjusted according to the activity by slightly rotating the splint either way when strapping it on. For example, full pronation may be required for feeding, but only half the range is necessary to operate the keyboard of a computer or typewriter. Once the Velcro straps are applied, the splints do not slip. The splints are not interchangeable from left to right and assistance is always needed to put them on. For patients with "weak" or "absent" wrist extensors, a wrist support and cuff splint may be used along with the pronation splint or a universal cuff, if wrist extension is adequate. The pronation splints are appropriate for those patients whose forearms supinate when they reach their hand to or near their mouth.     

Hand splinting for infants in the intensive care and special care nurseries

Infants in intensive care nurseries often have hand deformities and hand dysfunction. The traditional therapeutic approaches to hand care used in the treatment of adults, young children, and older infants are not always adequate to prevent progressive deformity in preterm and neonatal infants. Medical instability, time constraints, lack of family participation in the therapeutic program, the complexity of the treatment program, and fear of harming the infant are considerations that may indicate the need for splinting as an adjunctive therapeutic intervention. A number of factors are particularly important in making splints for infants, including splint alignment and padding, strap attachment, and thermoplastic malleability.     

Comparison of Muscle Activation while Performing Tasks Similar to Activities of Daily Livings with and without a Cock-up Splint

[Purpose] This study investigated changes in the activation of the main elbow muscle while performing tasks similar to activities of daily living (ADL) with and without a cock-up splint. [Methods] Sixteen participants performed a simulated feeding task and picked up light and heavy cans in the Jebsen-Taylor hand function test. The activation of the biceps brachii, the triceps brachii, and the brachioradialis with and without the cock-up splint was measured using a BTS FreeEMG 300 wireless electromyography system (BTS, Inc., Milan, Italy). [Results] The activation of the biceps brachii and the brachioradialis was significantly higher while performing the simulated feeding task with the cock-up splint than without the splint. While picking up the light and heavy cans, the activation of the brachioradialis was significantly decreased by wearing the cock-up splint. In the heavy cans task, the activation of the triceps brachii was significantly higher with the cock-up splint than without the splint. [Conclusion] This study showed that diverse muscles'' activation was increased or decreased when wearing the cock-up splint while performing tasks similar to ADL. The results of this study can be used as an educational resource for therapists teaching patients about splint application and splint compliance in ADL.Key words: Cock-up splint, Jebsen-Taylor hand function test, Muscle activation     

The Kleinert modified dorsal finger splint for mallet finger fracture

Injuries to the hand and digits are commonly seen in the emergency department. Lacerations, contusions, puncture wounds, and fractures comprise the bulk of these injuries. A fracture to the dorsum of the distal phalanx can result in a mallet finger deformity. These fractures must be accurately diagnosed with the proper initial treatment begun. There is some disagreement over the best treatment approach and multiple different splints have been described in the literature. Conservative treatment with a finger splint is most commonly effective. We recommend a modified dorsal finger splint for these injuries. We describe a splint to properly treat the fracture, prevent complications, maximize patient comfort during rehabilitation, and prevent mallet finger deformity.     

渐进式牵伸矫形器对创伤性肘关节僵硬患者功能康复的疗效分析

目的:探讨渐进式牵伸矫形器对创伤性肘关节僵硬患者躯体功能、日常生活能力及生活质量的影响。方法:将73例创伤性肘关节僵硬患者随机分为矫形器组(36例)和对照组(37例)。对照组接受常规康复治疗,矫形器组患者接受常规治疗后穿戴渐进式牵伸矫形器。治疗前后分别评估肘关节的主动活动范围、疼痛、握力、捏力、日常生活能力(MBI、FIM、家务能力)、手及上肢功能问卷(DASH)和生活质量(QOL-BRIEF)。结果:治疗8周后,2组的肘关节主动活动范围、疼痛、握力、捏力、FIM、家务能力、DASH和QOL较治疗前均有显著改善(均P0.05),MBI项治疗前后差异无统计学意义。2组间比较,矫形器组的肘关节主动活动度范围、疼痛、DASH-ADL、QOL(生理和人际关系项)功能改善较对照组显著(P0.05),MBI、FIM、家务能力、握力和捏力组间差异无统计学意义。结论:渐进式牵伸矫形器和(或)常规康复训练可改善肘关节的功能障碍,提高ADL能力及QOL,但渐进式牵伸矫形器在增加肘关节主动活动范围、缓解疼痛、改善DASH-ADL功能和提高患者QOL(生理和人际关系)方面效果更显著,值得临床推广应用。     

Application of the CPM splint in the continuing care of patients with injuries to the cervical and thoracic spine

The paper presents the authors' experience in the application of CPM (continuous passive motion) splints in the rehabilitation of patients with injuries to the cervical and thoracic spine. The observation period averages 3-4 weeks. The authors discuss the construction principles of the splint, the relevant treatment methods, and the advantages if the CPM splint. The results achieved by patients with para- and tetraplegia are presented.