改良Ashworth量表在痉挛型脑瘫儿童下肢肌张力评定中的信度研究

目的探讨改良Ashworth量表(MAS)在痉挛型脑瘫儿童下肢肌张力评定中的信度。方法31例痉挛型脑瘫患儿纳入研究,其中男性19例,女性12例;平均(51.3±26.8)个月;双瘫20例,四肢瘫7例,偏瘫4例;采用MAS评定患儿左右两侧下肢的内收肌、腘绳肌及比目鱼肌的肌张力。通过比较2名不同评定者评定结果之间以及同一评定者前后评定结果之间的相关性确定MAS测试的信度。结果不同评定者间的信度较低,总体ICC值为0.68;而同一评定者内的信度较高,总体ICC值为0.83。结论MAS用于评定痉挛型脑瘫儿童下肢肌张力时需谨慎。     

改良Ashworth量表用于痉挛评定的信度研究

目的:检验改良的Ashworth量表(MAS)评定肌痉挛患者肌张力时的信度。方法:共收集了23例肌张力增高的患者,其中16例为偏瘫患者,5例为截瘫患者,2例为四肢瘫患者。由两名医生用MAS分别测量偏瘫患者患肢的屈肘肌、屈腕肌和股四头肌的肌张力,而对截瘫患者只测股四头肌,以检验MAS的评定者间和评定者内信度。结果:屈肘、屈腕肌和股四头肌的评定者间和评定者内信度较高(Kendall′s tau-b为0.621-0.862),符合率也较高(≥50%)。结论:MAS是一种可靠的评估肌痉挛的方法,具有临床应用价值。     

改良的Ashworth分级应用于上下肢肌张力评估时的比较

目的:比较应用改良的Ashworth分级(MAS)评估上、下肢肌肉张力的信度.方法:收集上运动神经损伤致肌张力增高患者23例,其中偏瘫16例,截瘫5例,四肢瘫2例.采用MAS评定偏瘫和四肢瘫患者患肢的屈肘肌、屈腕肌、股四头肌、胭绳肌、腓肠肌和比目鱼肌的肌张力;截瘫患者评定双下肢肌肉,将所得数据资料进行统计学处理分析,以评估MAS应用的信度.结果:被评估的患者上肢肌肉以及膝屈和伸肌的信度较高(0.582～0.832),而下肢比目鱼肌和腓肠肌的信度较低(0.095～0.486).结论:MAS用于评定下肢肌特别是下肢远端肌群时应慎重.     

不同剂量A型肉毒毒素注射缓解脑性瘫痪患儿腘绳肌痉挛的前瞻性研究

目的:观察常规康复治疗与不同剂量A型肉毒毒素(BTX-A)注射缓解痉挛型脑瘫患儿腘绳肌痉挛的临床疗效、肌肉形态改变及不良反应。方法:按随机数字表法分组,最终纳入78例腘绳肌痉挛脑瘫患儿。常规康复组为A组,21例;BTX-A注射组为B、C、D组,分别为19、18、20例,注射剂量分别为3U/kg、4U/kg、5U/kg。治疗前后1、3、6、12个月,采用改良Ashworth痉挛分级量表(MAS)、表面肌电图被动状态积分肌电值(i EMG)评定腘绳肌的痉挛程度;彩色多普勒超声仪测量腘绳肌的肌肉形态;粗大运动评定量表(GMFM)评定运动功能。结果:在MAS分级、i EMG数值方面,BTX-A注射组治疗后各时间点低于常规康复组(P0.05),不同剂量组之间无显著性意义(P0.05);在GMFM评分方面,BTX-A注射组与常规康复组在各时间点之间差异有显著性意义(P0.05);在肌肉形态方面,不同剂量组与常规康复组治疗后各时间点半腱肌的横截面积及肌纤维长度无差异(P0.05)。不同剂量组治疗后均无明显不良反应。结论:BTX-A注射组缓解脑瘫患儿腘绳肌痉挛优于常规康复组且未影响肌肉发育,不同注射剂量在临床疗效、肌肉形态改变和不良反应上均无显著差异。     

中文版上肢技巧质量量表在脑性瘫痪患儿上肢功能评定中的信度和效度

目的:评估中文版上肢技巧质量量表(quality of upper extremity skills test,QUEST)在痉挛型脑瘫患儿上肢功能评定中的信度和效度。方法:将英文版QUEST翻译并完善成中文版,研究对象为75例在我院就诊的痉挛型脑瘫儿童,检测其重测信度及评定者间信度。同时进行Peabody运动发育量表的精细运动部分(peabody developmental motor scale fine motor,PDMS-FM),精细运动能力(fine motor function measure scale,FMFM),分析PDMS-FM原始分、FMFM各区分数与中文版QUEST各分测试项原始分之间的相关性,评估量表的平行效度。结果:中文版QUEST分测试项得分及总分具有优良的重测信度及评估者间信度(ICC值均0.890),中文版QUEST分测试项原始分与PDMS-FM、FMFM各区原始分间具有较好的平行效度(Pearson/Spearson秩相关系数分别为r1=0.563—0.816、r2=0.389—0.830)。结论:中文版QUEST量表具有良好的信度和效度,可以作为评估痉挛型脑瘫患儿上肢运动功能的首选方法。     

Berg平衡量表对痉挛型脑瘫儿童平衡功能评定的信度研究

目的:检验Berg平衡量表对痉挛型脑性瘫痪儿童平衡功能评定的信度,为Berg平衡量表在脑瘫儿童的临床应用提供客观依据。方法:选取20例脑瘫儿童,每例在1周内分别同时接受2位治疗师2次Berg平衡量表测试评分;并使用等级间相关系数(ICC)检验Berg平衡量表的组间及组内信度。结果:Berg平衡量表的组间信度ICC=0.941-0.977,组内信度ICC=0.963-0.988,且95%可信区间集中(P0.001)。结论:Berg平衡量表用于评定痉挛型脑性瘫痪儿童的平衡功能时具有较好的信度。     

A型肉毒毒素对踝跖屈痉挛型脑瘫儿童运动功能恢复的早期作用

目的：探讨A型肉毒毒素对踝跖屈肌群痉挛型脑瘫儿童下肢肌肉痉挛和运动功能恢复的早期治疗作用及其量效关系。方法：选择20例踝跖屈肌群痉挛型脑瘫患儿采用电刺激引导下局部肌肉注射A型肉毒毒素，观察治疗前及治疗后7d病变下肢肌张力、痉挛状态和运动功能的改变，以及注射剂量与疗效之间的关系。结果：A型肉毒毒素注射后7d，肌肉张力及肌痉挛程度明显降低（P〈0．01），躯干及下肢运动功能显著改善（P〈0．01），但均未发现明显的量效关系。运动能力的提高与肌张力及肌痉挛的降低程度无显著相关性。结论：A型肉毒毒素可以有效降低痉挛型脑瘫儿童的肌张力及肌痉挛程度。迅速提高运动能力，但量效关系不明确。     

手持式电子肌力测定仪在痉挛型脑瘫儿童下肢肌力测定中的信度研究

目的探讨手持式电子肌力测定仪在痉挛型脑瘫儿童下肢肌力测定中的信度。 方法以2009年2月至11月在复旦大学附属儿科医院康复中心接受康复治疗的28例3岁以上的痉挛型脑瘫患儿为研究对象,采用手持式肌力测定仪（HHD）标准化操作方法测定患儿下肢髋、膝、踝等部位肌群的肌力,任意选取20例患儿在接受第1次HHD测定后休息10 min,再由同一测试者进行重复测试,通过比较前后测试结果间的相关性来确定HHD的重测信度;在非同一天任意选取15例患儿在接受第1次HHD测定后休息10 min,再由不同测试者进行重复测试,通过比较前后测试结果间的相关性来确定HHD的不同测试者间信度。 结果HHD在测定痉挛型脑瘫患儿下肢肌群时有良好的重测信度（ICC值在0.74～0.97之间）和不同测试者间信度（ICC值在0.63～0.97之间）,其中髋屈曲、足跖屈和膝伸展肌群的重测信度最高（ICC值在0.94～0.97之间）,髋屈曲、足背屈的不同测试者间信度最高（ICC值在0.90～0.97之间）。 结论采用标准化的测试方法,手持式电子肌力测定仪在痉挛型脑瘫儿童下肢肌力测定中具有良好的重测信度和不同测试者间信度,可以良好地评价脑瘫患儿的下肢肌力。     

ICF-CY自理项量表应用于脑性瘫痪儿童评定的信度和效度研究

目的研究《国际功能、健康和残疾分类儿童青少年版》(ICF-CY) 自理项量表在脑瘫儿童评定中的信度和效度。方法选择50 例脑瘫儿童,采用ICF-CY自理项量表、功能性独立测量量表(WeeFIM)和儿童能力评估量表(PEDI)进行评定。ICF-CY自理项量表信度检验采用kappa 一致性分析方法;ICF-CY自理项量表与WeeFIM 和PEDI 同步效度采用Spearman 相关分析。结果ICF-CY自理项8 个类目重测信度kappa 值为0.806~0.932,信度优;ICF-CY自理项8 个类目评定者间信度kappa 值为0.690~0.882,信度中到优;ICF-CY自理项评分与WeeFIM 和PEDI 评分的Spearman 相关系数为-0.832 和-0.767(P<0.01)。结论采用ICF-CY自理项量表对脑瘫儿童进行日常生活自理评定可靠、有效。     

体外冲击波联合肌电生物反馈对痉挛型脑瘫患儿下肢运动能力的影响

目的探讨体外冲击波(ESWT)联合肌电生物反馈对痉挛型脑瘫患儿下肢运动能力的影响。方法选取2～7岁痉挛型脑瘫患儿50例, 按照随机数字表法将其分为对照组和实验组, 每组25例。两组患儿均接受肌电生物反馈和常规康复治疗, 实验组在此基础上给予低能量ESWT治疗。治疗前及治疗8周后(治疗后), 采用肌电设备采集两组患儿胫骨前肌的积分肌电值(iEMG)和均方根值(RMS), 利用改良Ashworth量表(MAS)、改良Tardieu量表评定法(MTS)、粗大运动功能评定量表(GMFM-88)D区与E区分别评定两组患儿的下肢痉挛程度及运动能力。结果治疗前, 两组患儿胫骨前肌表面肌电iEMG和RMS, MAS、MTS、GMFM-88结果比较, 差异无统计学意义(P>0.05)。治疗后, 两组患儿胫骨前肌表面肌电iEMG和RMS, MAS、MTS中R1、MTS中R2与R1的差值、GMFM-88 D区和E区结果均较组内治疗前改善(P<0.05)。实验组治疗后胫骨前肌表面肌电iEMG[(67.04±12.84)μV·s]和RMS[(69.32±12.84)μV], MAS[(1.98±0....     

Clinical utility of the modified trunk impairment scale for stroke survivors

Objective: The present study aimed to determine the discriminant power of the modified Trunk Impairment Scale (mTIS) in stroke survivors versus healthy adults.

Design: Cross-sectional.

Setting: Inpatient rehabilitation center.

Participants: Fifty-five subjects with stroke and 29 healthy adults.

Methods: Subjects were examined using the mTIS, Berg Balance Scale, and Timed Up and Go test for balance; 5-m Walk Test and Functional Ambulation Category for gait; Fugl-Meyer Assessment for motor function; Postural Assessment Scale for Stroke-Trunk Control and Trunk Control Test for trunk control; and Modified Barthel Index for activities of daily living performance.

Results: The mTIS results differed significantly between stroke survivors and healthy adults (p?r?=?0.82), Timed Up and Go test (r?=?–0.70), 5-m Walk Test (r?=?0.73), Functional Ambulation Category (r?=?0.54), Fugl-Meyer Assessment (r?=?0.37–0.80), Postural Assessment Scale for Stroke-Trunk Control and Trunk Control Test (r?=?0.55–0.63), and Modified Barthel Index score (r?=?0.56) results (p?10.5 points, while the area under the curve had a moderate accuracy of 73%.

Conclusion: The mTIS can be used to examine the degree of trunk control or the level of trunk impairment, which is seen as a prerequisite for balance, gait, motor function, and activities of daily living performance in stroke survivors.

• Implications for Rehabilitation

• The modified Trunk Impairment Scale can be used as an assessment tool to classify the degree of trunk control or its level of impairment in stroke survivors.

• The modified Trunk Impairment Scale may have a favorable correlation with assessing physical functions such as balance, gait, motor function, and ADL in stroke survivors.

     

The COMFORT behavioural scale and the modified FLACC scale in paediatric intensive care

Aims and objectives: To evaluate the concurrent validity and reliability of the behavioural COMFORT and a modified version of the FLACC scale for assessment of pain and sedation in intubated and ventilated children and to evaluate the construct validity of the FLACC scale for assessment of pain. Background: Few instruments are available for assessment of pain/sedation in paediatric intensive care. Design: A prospective observational study was performed postoperatively in 40 children aged 0–10 years. Methods: Two trained nurses observed the child simultaneously and assessing COMFORT behavioural (COMFORT‐B) and FLACC scores. In comparison, two bedside nurses concurrently scored pain using an observational visual analogue scale (VAS_obs) and sedation using the Nurse Interpretation of Sedation (NIS) score: oversedated, adequately or insufficient sedated. In 20 additional patients, one nurse assessed FLACC scores before and after analgesics. Results: The majority of patients were <1 year. A moderate but significant correlation was found between each scale and both sedation and VAS_obs. COMFORT‐B differentiated better than FLACC between the three sedation levels. For those assessed to be in pain (VAS_obs > 3), both COMFORT‐B and FLACC scores were significantly different compared with VAS_obs < 3. The interrater reliability was high for COMFORT‐B and FLACC (kappa 0·71 and 0·63, respectively). For bedside nurses’ assessment of pain, the interrater reliability was high (kappa 0·63) but low for the level of sedation (kappa 0·20). After administration of analgesics, the FLACC median score decreased significantly from 5 to 0. Conclusions: The COMFORT‐B scale was a more reliable measure of children’s sedation than bedside subjective assessment and gives more substantial information about sedation than the FLACC scale. Concurrent validity for assessment of pain was supported for both scales. The modified FLACC showed construct validity for measuring pain. Relevance to clinical practice: The use of validated scales may improve the assessment and management of pain and sedation in intubated children.     

Assessing predictive validity of the modified Braden scale for prediction of pressure ulcer risk of orthopaedic patients in an acute care setting

Aims and objectives. To assess and compare the predictive validity of the modified Braden and Braden scales and to identify which of the modified Braden subscales are predictive in assessing pressure ulcer risk among orthopaedic patients in an acute care setting. Background. Although the Braden scale has better predictive validity, literature has suggested that it can be used in conjunction with other pressure ulcer risk calculators or that some other subscales be added. To increase the predictive power of the Braden scale, a modified Braden scale by adding body build for height and skin type and excluding nutrition was developed. Design. A prospective cohort study. Method. A total of 197 subjects in a 106‐bed orthopaedic department of an acute care hospital in Hong Kong were assessed for their risk for pressure ulcer development by the modified Braden and Braden scales. Subsequently, daily skin assessment was performed to detect pressure ulcers. Cases were closed when pressure ulcers were detected. Results. Out of 197 subjects, 18 patients (9·1%) developed pressure ulcers. The area under the receiver operating characteristic curve for the modified Braden scale was 0·736 and for the Braden scale was 0·648. The modified Braden cut‐off score of 19 showed the best balance of sensitivity (89%) and specificity (62%). Sensory perception (Beta = ?1·544, OR=0·214, p = 0·016), body build for height (Beta = ?0·755, OR = 0·470, p = 0·030) and skin type (Beta = ?1·527, OR = 0·217, p = 0·002) were significantly predictive of pressure ulcer development. Conclusion. The modified Braden scale is more predictive of pressure ulcer development than the Braden scale. Relevance to clinical practice. The modified Braden scale can be adopted for predicting pressure ulcer development among orthopaedic patients in an acute care setting. Specific nursing interventions should be provided, with special attention paid to orthopaedic patients with impaired sensory perception, poor skin type and abnormal body build for height.     

不同频次无抽搐电休克联合抗精神病药物对精神分裂症住院患者阳性和阴性症状量表评分和认知功能的影响

目的:探讨不同频次无抽搐电休克(modified electro-convulsive therapy,MECT)联合抗精神病药物对精神分裂症住院患者阳性和阴性症状量表(Positive and Negative Symptom Scale,PANSS)评分和认知功能的影响。方法:将符合入选标准的90例精神分裂症住院患者按区组随机化法分成治疗A组(n=30)、治疗B组(n=30)和治疗C组(n=30),治疗A组给予单一抗精神病药物治疗,治疗B组、C组均给予MECT联合单一抗精神药物治疗,MECT治疗频次分别为1次/周和2~3次/周,均观察8周。比较3组治疗前后PANSS评分和精神分裂症认知功能成套测试共识版(MATRICS Consensus Cognitive Battery,MCCB)评分变化。结果:治疗B组、C组治疗4周、8周后PANSS评分均明显低于治疗A组(P<0.05),PANSS减分率、临床总有效率均高于治疗A组(P<0.05),治疗B组、C组上述指标比较无明显差异(P>0.05);治疗B组、C组治疗8周MCCB量表5项评分明显高于治疗A组(P<0.05),治疗B组“言语学习和记忆”“视觉学习和记忆”2项评分明显高于治疗C组(P<0.05)。结论:不同频次MECT联合抗精神病药物均能有效降低精神分裂症患者PANSS评分和改善患者的认知功能,临床疗效相当,但1次/周MECT对改善患者早期认知功能的效果可能更佳。     

A Dutch version of the modified reasons for smoking scale: factorial structure, reliability and validity

Aims The Modified Reasons for Smoking Scale (MRSS) is a widely accepted scale that measures psychological functions of smoking. The scale has been translated in Dutch and has been validated, in order to be used in clinical smoking cessation practice in the Dutch‐speaking part of Belgium. This study examined the factorial structure, reliability and validity of the scale in a sample of smokers, who are characterized by a high level of dependence and an explicit motivation to stop smoking. Method The participants were 383 smokers, who volunteered at the stop‐smoking clinic of a Belgian university hospital, and completed the translated scale. They were administered the translated MRSS, the Fagerstrom Test for Nicotine Dependence (FTND). Through a clinical interview, smoking behaviour and smoking history was assessed (daily smoking consumption, years smoking, number of quit attempts, weeks stopped, alcohol and coffee consumption, CO level). Exploratory factor analysis was performed. Internal consistency was studied in order to examine the reliability. The concurrent validity was assessed by means of manova , anova and correlation analysis. Results Factor analysis identified four factors, named stimulation, pleasure of smoking, social smoking and automatism of smoking. Cronbach's alpha ranged from 0.65 (automatism) to 0.72 (stimulation). manova indicated the influence of the variables age, sex, daily consumption and the FTND (the latter two variables showed a dose‐dependent association with each subscale). Regression analysis revealed a relationship with dependence indicators, namely: the daily consumption, the number and duration of previous quit attempts, FTND, CO level and daily coffee intake. Conclusions The Dutch translation of the MRSS identified four factors and revealed acceptable validity and reliability. The adapted version of the translated scale as a component of the psychological assessment procedure in a smoking cessation treatment in Dutch‐speaking areas should be implemented.     

视觉模拟量表和语言评价量表用于术后疼痛评估的比较

目的探讨是否可以使用简单的语言评价量表代替视觉模拟量表进行手术后疼痛的评估。方法将美国麻醉医师协会(ASA)Ⅰ -Ⅲ级的120例患者依其受教育程度的高低分2组 :初中及初中以下文化程度组(Ⅰ组 ,n=45) ,高中及高中以上文化程度组 (Ⅱ组 ,n=75)。患者于术后进行视觉模拟量表(VAS)和语言评价量表(VRS)的填写。麻醉医生对如何进行量表的填写向患者进行解释 ,并记录以下数据 :每位患者VAS和VRS的数值 ,填写VAS和VRS量表前向患者解释的次数 (Nvas和Nvrs)。结果Ⅰ组和Ⅱ组的VAS和VRS评分均有显著相关性 (P<0.01) ,其相关系数分别为0.936和0.901。在Ⅰ组中Nvas较Nvrs高 (P<0.05) ,同时Nvas在Ⅰ组中较Ⅱ组中高 (P<0.05) ,但在Ⅱ组中Nvas和Nvrs无显著差异(P>0.05)。结论在对患者进行术后疼痛评定时VRS和VAS具有良好的相关性 ,而VRS更适用于文化程度低及抽象概念理解有困难的患者 ,如老人     

Assessing reliability and validity of the Chinese version of the stroke scale: scale development

BACKGROUND: The National Institutes of Health Stroke Scale (NIHSS) is a systematic, 15-point evaluation tool, designed to assess neurological deficit in acute stroke patients and written in English. It is used to support important medical and nursing decisions. OBJECTIVES: To translate the NIHSS into Chinese and establish its psychometric properties using Chinese evaluators. DESIGN: Methodological research design. SETTING: One medical centre. Participants: Using convenience sampling, 48 subjects admitted with acute ischemic stroke were selected. METHODS: In this study, six clinicians from the Department of Neurology (3 nurses, 3 doctors) assessed the 48 patients using the C-NIHSS, the Glasgow Coma Scale and the Barthel index. RESULTS: The C-NIHSS content validity index reached 1.00, and the Cronbach's alpha coefficient for internal consistency was 0.92. Of the 15 scale items, two (facial palsy and limb ataxia) had low inter-rater values (k values below 0.39). Kappa (kappa) values were substantial (over 0.60) for all other items. The C-NIHSS has a significantly negative correlation with both Glasgow Coma Scale (r = -0.824, p < 0.01), and Barthel index (r = -0.683, p < 0.01) scores. CONCLUSIONS: The C-NIHSS is a reliable and valid scale for the clinical assessment of neurological deficit in acute stroke patients.     

Development of a constipation risk assessment scale

Duffy J, Zernike W. International Journal of Nursing Practice 1997; 3: 260–263
Development of a constipation risk assessment scale
This clinical report details a project conducted to facilitate nurses in their assessment of patients who were 'at risk' of becoming constipated and to inform and guide nurses of appropriate strategies of intervention based on their assessment.     

状态-特质量表临床应用研究

目的为护士正确评估患者的心理状态提供简便、易行的方法，以便为患者提供生理、心理整体护理。方法对2005年3月15～18日我院10个科室273例住院患者采用状态一特质量表（STAI—Form Y）进行心理状态评估。由各病区专业护士仔细阅读评估指导语后，对住院超过3天的患者进行评估记分。评估结果中状态焦虑阳性数用百分率表示，状态与特质焦虑评分进行相关性分析。结果状态焦虑阳性数的科室共8个，有2个科室超过50％（30／51），1个科室超过40％（6／15），3个科室超过20％（21／87），2个科室在20％（9／66）以下，2个科室无阳性例数；总阳性率24．18％（66／273）；有阳性例数科室患者的阳性率30．14％（66／219）。患者总体状态与特质焦虑评分相关性分析显示两者之间关系密切，呈直线正相关关系（r=0．8643，P=0．0000）。结论该量表可以评定短暂的焦虑状态和人格特征性焦虑倾向，是护士评估住院患者有关焦虑问题及心理护理效果评价较好的工具。     

脑室引流量标尺的研制与应用

<正>脑室引流术是神经外科的常用技术。脑积水、脑出血破入脑室的患者术后需要脑室引流1周左右,根据患者的颅内压及引流量,要随时调整脑室外引流管的高度[1],脑室引流袋悬挂的高度通常为引流袋内引流管顶点距离脑室穿刺点约15~20 cm,既可充分引流,又能维持正常颅内压[2]。引流护理质量直接关系到手术成败及术后并发症的发生,对治疗和挽救患者的生命起关键性的作用[3]。为了方便而准确地放置