不同时机介入综合康复对颅脑外伤患者运动功能和日常生活活动能力的影响

目的:研究不同时机介入综合康复训练对颅脑外伤(TBI)患者运动功能和日常生活活动能力(ADL)的影响。方法:选择颅脑损伤患者80例,随机分为康复1组(TBI病程<15d时康复介入)和康复2组(TBI病程≥15d时康复介入)各40例,采用综合康复治疗。于治疗前、后以运动功能评定量表(FMA)、功能独立性测评量表(FIM)进行运动功能和ADL能力评分。结果:两组TBI患者康复治疗1个月、2个月和3个月的FMA、FIM评分与康复前比较,均有明显改善(P<0.01),治疗第1个月变化速率最快;而康复1组较康复2组的改善更明显(P<0.05)。结论:综合康复治疗有利于TBI患者运动功能和ADL的改善,而TBI<15d时介入康复疗效优于≥15d时介入康复。     

脑梗死短期住院患者康复效益研究

目的:应用功能独立性评价量表(FIM)探讨脑梗死短期住院患者康复效益。方法:本研究为随机对照研究。选择65例脑梗死患者,随机分为康复治疗组和对照组,两组药物治疗基本相同。治疗组每天进行以Bobath法为主的康复训练,对照组只进行关节活动度训练和物理因子治疗,两组患者均采用FIM量表进行测量,将两组患者入院、出院值,住院期间获得值,以及康复效益进行配对分析。结果:①两组患者入院、出院时功能独立检查运动分、认知分、总分无显著性差异(P>0.05),康复组、对照组住院期间功能独立检查改变均有显著性差异(P<0.05),两组患者FIM改变值比较仅运动项有显著性差异(P<0.05)。②两组患者住院效率分别为:0.43分/天和0.37分/天,两者相比无显著性差异(P>0.05)。结论:脑梗死短期住院患者进行早期康复治疗只能提高FIM中的“运动项”得分,但在提高患者整体ADL功能上并无积极意义,强调住院时间过短并不利于脑梗死患者康复效益的提高。     

脊髓损伤患者躯体功能恢复与心理护理的相关性研究

目的应用功能独立性评价量表(Functionalindependentmeasures,FIM)评估住院脊髓损伤(SCI)患者躯体功能恢复情况,同时进一步分析SCI患者躯体功能恢复与心理、直接护理的相关性。方法将39例SCI患者随机分成实验组18例和对照组21例,两组患者均进行常规的康复训练及康复护理,实验组另予以心理护理。并在入院时、出院时以及随访时对两组患者进行FIM评分,同时记录护理接触时间。结果实验组FIM评分较对照组有显著性差异(P<0.05),且入院时FIM评分与心理、直接护理所需时间呈显著负相关;出院时FIM评分与心理护理所需时间呈显著负相关,与给药、提供治疗等直接护理所需时间无显著负相关;随访时FIM评分与心理、直接护理所需时间均不存在显著相关。结论通过FIM评分可以预测护理工作需要量,躯体功能恢复和护理时间的关系不是线性关系,做好患者的心理疏导对提高康复治疗疗效,改善患者的生存质量有着积极的意义。     

功能独立性评价量表作为康复治疗前后和随访的功能评价指标

目的　应用功能独立性评价 (FIM )量表评定美国某医疗单位康复医学科 1年中住院患者康复治疗的疗效 ,以及随访情况 ;同时与美国康复医学统一数据系统 (UDSMR) 1995年和 1996年资料相比较。方法　统计 1999年 7月 1日至 2 0 0 0年 6月 30日美国华盛顿大学附属HarborviewMedicalCenter(HMC)康复医学科 2 87例患者的资料 ,包括 :患者入院、出院和随访 (出院 3个月 )FIM的评分 ,FIM效率(每天进步的分数 )及FIM进步程度等。结果　HMC康复医学科患者住院期间FIM进步程度为 37.7% ,UDSMR为 31.6 % ( 1995 )和 32 % ( 1996 ) ;HMC随访期间进步 7.8% ,UDSMR为 10 .5 % ( 1995 )和 10 .1%( 1996 ) ;HMC的FIM效率为 1.6 ,UDSMR为 1.7( 1995 )和 1.8( 1996 )。结论　各种功能障碍患者经过康复治疗 ,功能情况都有较大提高 ,出院后功能情况仍有一定程度进步。FIM量表作为康复治疗患者住院期间和随访期间功能评价指标 ,是一种较理想的评价指...     

颅脑外伤患者高压氧介入时间对FIM评分的影响

目的：观察颅脑外伤患者高压氧介入时间对功能独立性评定（FIM）评分的影响,为探讨综合康复治疗最佳介入时机提供临床依据。方法选择中重型颅脑外伤患者130例,根据受伤时间分为对照组25例,综合康复1组（TBI〈15d）与综合康复2组（15d≤TBI≤30d）各40例,综合康复3组（TBI〉30d）25例,均给予药物治疗和康复措施,综合康复各组在前述的基础上行高压氧治疗共40次,以治疗前和治疗第30天、60天的FIM评分进行疗效评价。结果资料完整、实际纳入组TBI患者共123例,各组临床资料有可比性。各组内TBI患者在治疗第30天、60天的FIM评分差异有统计学意义（P〈0.05）。各组间TBI患者第1天FIM评分差异无统计学意义（P〈0.05）,对照组与综合康复1、2组在第30天、60天差异有统计学意义（P〈0.05）。结论三组TBI患者2个月内FIM评分改善呈匀速好转趋势,30d内的高压氧综合康复1、2组对认知与运动功能改善作用明显优于对照组,优于综合康复3组患者。     

早期综合康复干预颅脑外伤的多中心临床研究

目的观察和比较早期综合康复干预颅脑外伤(TBI)的多中心临床疗效。 方法选取多中心TBI患者321例,按中心分层区组随机法,将321例TBI患者随机分为康复1、2、3、4、5、6、7和8组。8组患者均在手术、常规药物治疗及护理的基础上,进行综合康复干预措施。康复1、2、3和4组康复介入时间为TBI后3～14d,康复5、6、7和8组康复介入时间为TBI后15～30d;康复1、2、5和6组的综合康复干预频率为每日1次,康复3、4、7和8组为每日2次;康复1、3、5和7组给予高压氧治疗,康复2、4、6和8组无高压氧治疗。于入院后康复治疗前和治疗1、2和3个月后分别采用改良的Barthel指数(MBI)、简易精神状况量表（MMSE）、功能独立性评定量表（FIM）和简式Fugl-Meyer运动功能评定量表（FMA）评定8组患者的认知功能、日常生活活动能力、功能独立性和运动功能,并对其计量资料进行2×2×2×4析因设计方差分析。 结果8组TBI患者康复治疗后第1、2、3个月的MBI、MMSE、FIM、FMA的各项评分较组内治疗前均有显著提高(P<0.05),且均以治疗3个月后评分最高,与组内各时间点比较,差异均有统计学意义(P<0.05)。8组TBI患者MBI、MMSE、FIM、FMA平均值经比较后发现,以康复3组疗效最佳（P<0.05）。经析因分析发现,康复治疗的介入时机、治疗频度、高压氧治疗以及治疗持续时间四因素均对患者的MBI、MMSE、FIM、FMA评分有显著影响,差异均有统计学意义（P＜0.01）,其中MBI、FIM、FMA评分在介入时机与治疗频度以及介入时机、治疗频度和高压氧治疗之间均有交叉效应（P<0.05）,MMSE评分在介入时机和高压氧治疗之间有交叉效应（P＜0.01）。 结论早期适量提高康复训练的频率并配合高压氧治疗可更为显著地改善TBI患者的认知功能、日常生活活动能力、功能独立性和运动功能,促进其机体功能的全面恢复。     

早期综合康复治疗对颅脑损伤患者预后的影响

目的:探讨早期综合康复治疗对颅脑损伤(TBI)患者预后的影响.方法:中、重型TBI患者90例,随机分为观察组和对照组各45例.2组均予以常规药物、针灸、物理因子等治疗,观察组加用综合康复锻炼、认知功能训练及高压氧治疗.治疗前后给予简明精神量表(MMSE)、改良巴氏指数(MBI)、运动功能评定量表(FMA)及平衡Berg量表(BBS)评定.结果:治疗1个月后,2组患者MMSE、MBI、FMA、BBS等各项评分较治疗前均明显提高,观察组更高于对照组(均P＜0.01);观察组并发症的发生率明显低于对照组(P＜0.05).结论:TBI患者早期进行综合康复治疗,有利于改善患者运动功能及认知功能,减少并发症,提高患者生活自理能力.     

FCA量表在重型颅脑损伤患者康复治疗与护理效果评价中的应用

目的：运用功能综合评定量表（FCA）评价重型颅脑损伤患者的综合功能，比较早期、个体化、程序化的综合性康复治疗与护理与神经外科常规护理的效果。方法：将51例重型颅脑损伤患者随机分为实验组（26例）和对照组（25例），进行临床对照性研究，两组均常规进行神经外科的手术治疗及药物治疗，实验组在急性期患者生命体征平稳24h后即介入运动、营养、认知、心理、日常生活能力等个体化、程序化的综合性康复治疗与护理，对照组执行神经外科护理常规。结果：FCA总评分，实验组出院时为81．81±22．83，对照组为64．06±25．81，两组比较有显著性差异（P〈0．05）；实验组出院1个月后及出院3个月后分别为101．15±9．66、106．68±4．03，对照组为85．47v19．76、93．18±18．04，两组比较有极显著性差异（P〈0．01）：两组患者入院及出院时FCA分项评分比较，实验组较对照组运动功能评分提高22．83％，认知功能评分提高45．32％，综合功能评分提高27．71％；实验组综合功能的恢复优于对照组。结论：重型颅脑损伤患者生命体征平稳24h后早期介入个体化、程序化的综合性康复治疗与护理对重型颅脑损伤患者运动、认知综合功能的恢复有良好的促进作用．     

LOX-1和OX-LDL水平与中重度创伤性颅脑损伤患者病情及神经功能预后的相关性

目的探讨氧化低密度脂蛋白(OX-LDL)和氧化型低密度脂蛋白受体-1(LOX-1)与中重度创伤性颅脑损伤(TBI)患者病情及神经功能预后的相关性。方法纳入该院2018年9月至2020年4月收治的90例中重度TBI患者为研究对象,收集患者性别、年龄、受伤至入院时间、基础疾病(高血压、糖尿病、冠心病、脑卒中)、颅脑损伤部位、入院时格拉斯哥昏迷评分(GCS)、创伤严重度评分(ISS)等一般临床资料,采用抗体酶联免疫法检测患者血清OX-LDL和LOX-1水平。出院后3个月时采用功能性独立评定量表(FIM)评分对患者神经功能进行评价,以中位FIM评分为界值将患者分为功能良好组和功能不良组,比较2组患者临床资料。采用Pearson线性相关分析OX-LDL、LOX-1水平与ISS及FIM评分的相关性,采用多因素线性回归分析影响TBI患者神经功能预后的相关因素。结果出院后3个月时FIM评分为31~87分,FIM评分的中位数为49分,据此将患者分为功能良好组(45例)和功能不良组(45例)。功能良好组GCS高于功能不良组,年龄、ISS、OX-LDL、LOX-1水平低于功能不良组,差异有统计学意义(P<0.05)。Pearson线性相关分析显示,OX-LDL、LOX-1水平与ISS呈正相关(r=0.469、0.524,P<0.05),与FIM评分呈负相关(r=-0.729、-0.755,P<0.05)。多因素线性回归分析显示,GCS低及血清OX-LDL、LXO-1水平高是TBI患者神经功能预后不良的独立危险因素(P<0.05)。结论TBI患者病情越严重,其血清LOX-1、OX-LDL水平越高,且2种指标的水平变化与神经功能预后高度相关,值得临床注意。     

中重型颅脑损伤患者的康复治疗

目的 :研究中重型颅脑损伤患者综合康复治疗效果及影响因素。方法 :6 4例中重型颅脑损伤患者采用综合康复措施进行治疗 ,并运用Glasgow昏迷量表 (GCS)、简易精神状态检查量表 (MMSE)、平衡功能量表、运动功能 (Fugl Meyer)量表及日常生活活动能力 (ADL)进行疗效评定。结果 :6 4例患者平均治疗 12 0d ,其认知功能、平衡功能、运动功能及ADL均有明显改善。ADL的恢复主要受损伤程度和治疗时间的影响 (P <0 .0 5 ) ,认知功能的恢复与GCS和病程有关 (P <0 .0 5 )。结论 :中重型颅脑损伤患者ADL及认知能力恢复受颅脑损伤程度影响 ,综合康复治疗可降低颅脑损伤的残疾率 ,提高ADL。     

Influence of medical comorbidities and complications on FIM change and length of stay during inpatient rehabilitation

OBJECTIVE: This study was performed to evaluate the influence of medical problems on functional outcome measures of patients admitted for comprehensive inpatient rehabilitation. DESIGN: In this retrospective database review of patients, demographic information, length of stay, FIM scores at admission and discharge, and FIM efficiency were collected and analyzed. Preexisting comorbidities and acute medical complications of all patients were identified, tabulated, and analyzed. RESULTS: A total of 175 patients were categorized into three major groups. In the postorthopedic surgery group, the presence of preexisting medical comorbidities did not significantly affect admission or discharge FIM scores. In contrast, traumatic brain injury patients with preexisting medical comorbidities had a tendency to be admitted and discharged with lower FIM scores. However, traumatic brain injury patients with acute medical complications still made reasonable functional improvement during their extended stay, so that their FIM efficiency was adequately maintained. In the cerebrovascular accident group, almost all patients had preexisting medical issues. CONCLUSIONS: The rehabilitation population is diverse, and functional outcome measures for distinct disease entities may be differentially affected by factors such as preexisting medical comorbidities and acute medical complications. Except for life-threatening medical emergencies, rehabilitation patients may benefit by staying on the acute rehabilitation unit, where both medical management and a comprehensive rehabilitation program are provided with continuity.     

A follow-up study of older adults with traumatic brain injury: taking into account decreasing length of stay

OBJECTIVE: To examine age-related differences in rehabilitation outcomes following traumatic brain injury (TBI). DESIGN: Retrospective collaborative study. SETTING: Patients received acute neurotrauma and inpatient rehabilitation services at 1 of the 17 National Institute on Disability and Rehabilitation Research-designated Traumatic Brain Injury Model Systems (TBIMS) centers. PARTICIPANTS: A sample of 273 older patients (> or =55y) admitted for TBI were taken from the TBIMS National Database. Older patients were matched with subjects 44 years of age or younger, based on severity of injury (Glasgow Coma Scale score, length of coma, intracranial pressure elevations). Due to decreasing length of stay (LOS), only patients admitted from 1996 through 2002 were included. INTERVENTION: Inpatient interdisciplinary brain injury rehabilitation. MAIN OUTCOME MEASURES: Acute care LOS, inpatient rehabilitation LOS, admission and discharge FIM instrument and Disability Rating Scale (DRS) scores, FIM and DRS efficiency, acute and rehabilitative charges, and discharge disposition. RESULTS: One-way analyses of variance demonstrated a statistically significant difference between older and younger patients with respect to LOS in rehabilitation but not for acute care. Total rehabilitative charges, and admission and discharge DRS and FIM scores also showed statistically significant differences between groups. Older patients progressed with significantly less efficiency on both the DRS and FIM scales. Significantly more charges were generated per unit for older patients to improve on the DRS scale, but not the FIM scale. Using chi-square analysis, a statistically significant difference in rate of discharge to home was identified between older (80.5%) and younger (94.4%) patients. CONCLUSIONS: Results in this study are similar to those in earlier studies with smaller sample sizes. Major differences observed include significantly slower and more costly progress in inpatient rehabilitation for older patients with TBI, as well as a significantly lower rate of discharge to community for older patients. However, even with decreasing LOS in both settings, community discharge rate is still encouraging for older patients with TBI.     

Functional outcome following traumatic brain injury: the Turkish experience

The objectives of this study were to describe the demographic characteristics and the nature of the functional recovery in a group of Turkish survivors of traumatic brain injury (TBI) who were referred for inpatient rehabilitation and identify variables correlated with discharge functional status as measured by the Functional Independence Measure (FIM). There were 40 patients in the study, 32 (69.6%) male and eight (17.4%) female, mean age 28+/-9.8 years. Motor vehicle accidents accounted for 62.5% of injuries, 22.5% of injuries occurred from violence and 15% resulted from falls. The mean durations of acute hospital stay, coma, and rehabilitation stay was 68, 26.7, and 78.4 days, respectively. Extracranial injuries including bone fractures were the most common associated injuries and medical complications such as spasticity and contractures were present in more than half of the patients.TBI survivors in this study made statistically significant functional improvements. Discharge FIM were significantly correlated with the admission FIM, durations of acute hospital stay and coma, and time since TBI. Multiple regression analysis of the data disclosed that FIM score obtained at the time of discharge from rehabilitation service was best predicted by two variables, time since brain injury and the FIM score at admission (multiple R=0.78, R=0.60, P<0.001). This sample of Turkish TBI survivors showed significant functional improvements after rehabilitation and admission functional status and the time since TBI had the most impact on discharge functional outcome.     

Functional outcomes from inpatient rehabilitation after traumatic brain injury: how do Hispanics fare?

OBJECTIVE: To examine the relation between Hispanic ethnicity and rehabilitation outcome in traumatic brain injury (TBI) survivors. DESIGN: Retrospective study. SETTING: Longitudinal dataset of the Traumatic Brain Injury Model Systems national database. PARTICIPANTS: Persons (N=3056; 2745 whites vs 311 Hispanics) with moderate to severe TBI hospitalized between 1989 and 2003. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Functional outcomes at discharge and 1-year follow-up (Disability Rating Scale [DRS], FIM instrument). Glasgow Outcome Scale-Extended (GOS-E), and the Community Integration Questionnaire (CIQ) were measured at follow-up only. RESULTS: At admission, Hispanics were less educated (P相似文献   

Poster 7: Impact of balance deficits after traumatic brain injury on inpatient rehabilitation functional outcome: a multicenter study

Objective: To evaluate how sitting and standing balance ratings of patients with traumatic brain injury (TBI) on admission to rehabilitation impacts functional outcome, rehabilitation charges, and rehabilitation length of stay (LOS). Design: Multicenter analysis of consecutive admissions to designated Traumatic Brain Injury Model Systems (TBIMS). Setting: TBIMS centers. Participants: 908 adults with TBI were included in the study. Interventions: Not applicable. Main Outcome Measure: FIM™ instrument admission and discharge scores, FIM change and efficiency; rehabilitation LOS and charges; and discharge disposition. Results: Persons with grossly impaired sitting balance on admission to rehabilitation had lower discharge FIM scores and greater rehabilitation charges than those with normal or mildly impaired sitting balance. Persons with mildly impaired sitting balance had lower discharge FIM scores and greater rehabilitation charges than those with normal sitting balance. Subjects with grossly impaired standing balance compared with normal or mildly impaired standing balance had greater rehabilitation charges and LOS and lower discharge FIM scores and FIM efficiency. Subjects with grossly impaired balance on admission to rehabilitation had significantly lower motor FIM items compared with those who had normal or mildly impaired balance. Subjects with grossly impaired sitting balance were discharged from rehabilitation to someplace other than their home more than twice as often as those with normal sitting balance (11.7% vs 23.3%). Subjects with grossly impaired standing balance were discharged from rehabilitation to someplace other than their home more than 3 times as often as subjects with normal standing balance (6.7% vs 21.5%). Conclusion: In patients with TBI, sitting and standing balance ratings on admission to rehabilitation are useful indicators of functional impairment and not returning home at discharge from rehabilitation.     

Functional outcomes in patients with brain tumor after inpatient rehabilitation: comparison with traumatic brain injury

OBJECTIVE: To compare the functional outcome, length of stay, and discharge disposition of individuals with brain tumor versus those with acute traumatic brain injury. DESIGN: In this study, 78 brain tumor patients were one-to-one matched by location of lesion and age with 78 acute traumatic brain injury patients. Outcome was measured by using the Functional Independence Measure (FIM 228) on admission and discharge. The FIM change and FIM efficiency were also calculated. FIM data were analyzed in three subsets, i.e., activities of daily living, mobility, and cognition. Discharge disposition and rehabilitation length of stay were also compared. RESULTS: Demographic variables of race, marital status, and payer source were comparable for the two groups. No significant difference was found between the brain tumor and the traumatic brain injury populations with respect to total admission FIM, total discharge FIM, and FIM efficiency. The brain injury population had a significantly greater change in FIM. The tumor group had a significantly shorter rehabilitation length of stay and a greater discharge to community rate. CONCLUSIONS: Thus, individuals with brain tumor can achieve comparable functional outcome and have a shorter rehabilitation length of stay and greater discharge to community rate than individuals with brain injury.     

Postacute predictors of functional and cognitive progress in traumatic brain injury: somatosensory evoked potentials

OBJECTIVE: To investigate the prognostic value of electrophysiologic studies performed during the postacute phase after traumatic brain injury (TBI). DESIGN: A prospective comparative study in which 26 patients with TBI participated. Patients were grouped according to their admission short-latency somatosensory evoked potential (SEP) results. Nonparametric Kruskal-Wallis and Mann-Whitney U tests were applied to different SEP groups to determine the differences among them in specific functional and cognitive outcome measures. SETTING: An inpatient brain injury rehabilitation unit. PARTICIPANTS: Twenty-six patients with TBI who were admitted to the rehabilitation center at the postacute phase for a late inpatient rehabilitation program and 15 age-matched healthy subjects who served as a control group for the electrophysiologic comparison. MAIN OUTCOME MEASURES: Motricity Index, Barthel Index, Disability Rating Scale, Mini-Mental Status Exam, and Rancho Los Amigos Scale. RESULTS: Disability Rating Scale scores at discharge and rate of change of Barthel Index scores differed between median nerve SEP classification groups (p<.05 for both). Disability Rating Scale scores at admission (p<.05) and at discharge (p<.01), Barthel Index scores at discharge (p<.05), and rate of change of Barthel Index scores (p<.05) differed between tibial nerve SEP classification groups. There was a relation between Motricity Index side scores at discharge and the different body side SEP response groups (p<.0001). Cognitive results showed no relation to the SEP groups. CONCLUSIONS: Postacute SEP scores after a late admission to a rehabilitation center showed a relation to measures of functional and motor progress. Patients with better SEP responses were more likely to experience greater functional and motor improvement. Cognitive functions were not related to SEP results.