脑卒中偏瘫的早期心理护理

目的:探讨心理护理措施对脑卒中偏瘫的影响.方法:通过对本院2008年1月-2011年1月本院神经外康复科收治的脑卒中偏瘫患者80例,随机分成2组,观察组40例,对照组40例,两组均进行神经外康复科常规治疗、护理和脑卒中康复训练,观察组在此基础上对患者进行心理护理,以2个月为一疗程,对两组患者均进行治疗前后的日常生活活动能力(ADL)、改良Barthel指数(MBI)、Fugl- Meyer指数的评定.结果:观察组治疗后(ADL)、Fugl- Meyer评分均高于对照组(P＜0.05).结论:心理护理在脑卒中偏瘫中具有重要意义,对偏瘫患者的运动功能和日常生活活动能力方面的恢复具有明显的促进作用.     

早期护理干预对脑卒中偏瘫患者日常生活能力的影响

目的：探讨早期护理干预对脑卒中偏瘫患者日常生活能力的影响。方法选取2013年3月～2014年3月来我院治疗的脑卒中偏瘫患者106例,随机分为两组,观察组及对照组各53例,对照组实施常规护理,观察组在常规护理的基础上实施早期护理干预,比较两组患者治疗效果及格率、日常生活能力评分变化。结果观察组治疗效果及格率为90.57%,对照组为71.70%,与对照组比较,观察组治疗效果及格率更高,两组比较差异有统计学意义（P＜0.05）。对照组及观察组护理后生活能力评分与护理前比较均出现明显升高,观察组护理后生活能力评分升高程度更大,与对照组比较差异有统计学意义（P＜0.05）。结论脑卒中偏瘫患者实施早期护理措施后临床效果显著,患者日常生活能力明显提高,可以在临床推广应用。     

早期护理干预对脑卒中病人偏瘫肢体康复的影响

目的:探讨早期护理干预对脑卒中偏瘫病人肢体康复的影响.方法:将136例脑卒中偏瘫病人随机分为干预组和对照组,每组68人,干预组采取早期护理干预,对照组采取一般的护理常规护理.结果:干预组中患者的Brunnstrom分级较对照组有明显改善,经统计学分析,均高于对照组(P＜0.05)具有统计学意义.结论:对脑卒中偏瘫病人进行早期护理干预能提高脑卒中偏瘫病人日常生活能力和运动能力.     

超早期康复护理改善脑卒中患者偏瘫肢体功能的效果分析

目的分析超早期康复护理改善脑卒中患者偏瘫肢体功能的效果。方法随机将105例脑卒中患者进行分组,对照组给予常规护理干预,实验组在对照组基础上配合超早期康复护理干预,分析两组干预效果。结果实验组提高ADL评分、提高FMA评分和降低临床神经功能缺损评分幅度明显高于对照组（P〈0.01）;实验组干预后总有效率92.45%明显高于对照组75.00%（P〈0.05）;实验组肩手综合征和足外翻发生率低于对照组（P〈0.05）。结论超早期康复护理能够改善脑卒中患者偏瘫肢体功能,促进中枢神经功能重建,在提高日常生活活动能力和生活质量方面具有积极的作用。     

脑卒中后偏瘫患者康复护理体会

目的:探讨早期实施康复护理对脑卒中偏瘫患者肢体功能康复的临床效果.方法:选在我院住院诊断开治疗脑卒甲忠有120例.由康复治疗师每周1次应用Barthe1指数和Fugl-Meyer积分评定康复护理对脑卒中患者肢体功能恢复的疗效.结果:脑卒中患者治疗总有效率达93％.结论:脑卒中患者心理护理在机体全面康复中起主导作用.早期、及时、合理的康复护理能明显改善患肢肢体功能,有效提高患者生活质量.     

脑卒中偏瘫的康复护理进展

目前脑卒中的诊断与治疗水平有了明显的提高,但是由于存在着重视抢救生命,忽视功能恢复,重治疗,轻康复的倾向[1],使许多病人未得到早期功能锻炼,后遗症的发生率仍很高.据统计其致残率为86.5%,其中15%的病人日常生活不能自理[2],给家庭和社会带来沉重的负担.近年来国内学者主张在发病后尽早进行康复训练,最大程度的促进功能恢复,减轻残疾[2].现将脑卒中的康复护理进展综述如下.     

运动想象疗法结合康复训练治疗脑卒中偏瘫疗效分析

目的:研究运动想象疗法结合康复训练对脑卒中偏瘫患者运动功能、日常生活活动能力的影响.方法:特46例脑卒中偏瘫患者随机分为两组,治疗组采用常规神经内科药物治疗及康复训练,对照组在治疗组基础上增加想象运动疗法,将两组治疗后运动功能及日常生活活动能力进行比较.结果:两组治疗后运动功能评分比较,差异有显著性意义.结论:应用运动想象疗法结合康复训练对脑卒中偏瘫患者运动功能及日常生活活动能力的恢复有较好疗效.     

脑卒中偏瘫患者早期康复临床路径的构建与应用研究

目的基于康复指南构建早期康复临床路径,并探讨其应用于缺血性脑卒中患者中的效果。方法选取2019年1～10月符合标准的缺血性脑卒中患者共112例,将1～5月入院者设为对照组,6～10月入院者设为干预组,每组各56例。两组分别在住院期间给予干预,对照组采用常规早期康复模式;干预组实施早期康复临床路径模式,即实施基于文献研究结合早期康复相关证据形成的偏瘫患者早期康复临床路径与流程。采用美国国立卫生研究院卒中量表(NIHSS)、Fugl-Meyer评定量表(FMA)、Barthel指数(BI)、患者出院满意度评分量表评价效果。结果干预后,干预组NIHSS评分显著低于对照组(P0.01);FMA评分显著高于对照组(P0.01);干预组出院时、出院1、3、6个月的BI评分显著高于对照组(均P0.01);干预组患者出院满意度评分显著高于对照组(P0.01)。结论基于康复指南构建早期康复临床路径,并应用于缺血性脑卒中患者,可有效改善其肢体功能障碍,提高患者日常生活活动能力,提高患者满意度。     

分阶段康复护理对脑卒中后偏瘫患者的影响

目的:探计分阶段康复护理对脑卒中偏瘫患者生存质量的影响.方法:将80例脑卒中偏瘫患者随机分为康复护理组和对照组,对照组患者只接受常规治疗和护理,康复护理组患者在此基础上接受分阶段康复护理措施,分别在干预后40天和60天进行生存质量评价,进行统计学比较.结果:康复护理组的生活质量高于对照组,具有统计学差异(P＜0.05).结论:分阶段康复护理能够提高脑卒中后偏瘫患者的生活质量,促进疾病康复.     

中药酒浴促进脑卒中偏瘫患者康复的效果观察

目的观察中药酒浴疗法对康复期脑卒中偏瘫患者的应用效果。方法将200例偏瘫患者分为两组。治疗组（140例）采用中药酒浴液进行坐浴，每周3次，4周为1个疗程；对照组（60例）除浴液中不加入白酒外，余均同治疗组。结果治疗组总有效率91．43％，对照组53．33％，治疗组显著高于对照组（χ^2=38．10，P〈0．01）。结论中药酒浴治疗脑卒中偏瘫，可使药物在药力和酒力的推动下直接而全面地起到通达和疏导作用，从而提高疗效。     

偏瘫病人腹部外科手术的探讨

目的本文旨在探讨此类患者的外科处理问题。方法我科7年内对17例此类病人施行手术。17例手术的偏瘫病人中消化道肿瘤占12例;肺部感染2例,泌尿系感染1例。结果无1例死亡,术后偏瘫肢体肌力及语言障碍明显恢复。结论由此我们认为:偏瘫病人发生腹部外科疾病时应该施行手术;无论病变位于偏瘫侧还是健侧,手术切口均应选择在健侧腹部切口;重视围手术期的护理资料;手术同时,应加强对偏瘫的治疗。     

The application of matrix rhythm therapy as a new clinical modality in burn physiotherapy programmes

Purpose

The aim of the present study was to investigate the use of matrix rhythm therapy (MRT) as one of the electrotherapeutic modalities in clinics.

Methods

This study was carried out in the Burn and Wound Treatment Department of Dr. Lütfi K?rdar Kartal Education and Research Hospital in Istanbul between October 2010 and August 2011. A treatment protocol including whirlpool, MRT and exercise was applied to a group of patients who had burn injury of upper extremity. The evaluation of each patient included assessment of pain, range of motion, muscle strength, skin flexibility and sensory function at pre- and post-treatment.

Results

There was no significant difference in values of pain, muscle strength and flexibility between pre- and post-treatment assessments (p > 0.05). A significant increase was found in the range of motion and sensory function at pre-treatment according to post-treatment (p < 0.01).

Conclusion

The usage of MRT in order to maintain and improve the range of motion and to minimise the development of scar tissue was investigated in this study. We suggest conducting randomised controlled studies that carry out a comparison of the MRT with other treatment modalities with more cases and investigate the long-term effects of MRT.     

人工关节置换治疗老年脑血管意外偏瘫侧股骨颈骨折

目的观察和分析人工关节置换治疗老年脑血管意外患者偏瘫侧股骨颈骨折的疗效。方法自1990年5月～2000年5月,共采用人工关节置换治疗老年股骨颈骨折189例,其中老年脑血管意外患者偏瘫侧股骨颈Garden Ⅲ、Ⅳ型骨折29例,随访2年3个月～8年2个月,平均4年11个月。随机抽取同期行人工关节置换的无偏瘫股骨颈骨折患者30例作为对照,随访2年3个月～8年6个月,平均4年10个月。比较两组患者的年龄、住院时间、手术时间、手术出血量、输血量、围手术期并发症、早期并发症和患者的行走功能;比较偏瘫组中全髋关节置换与人工股骨头置换的早期并发症。结果两组患者均安全渡过围手术期。两组患者的年龄、住院时间、手术时间、手术出血量及输血量比较,差异无显著性(P >0.05);围手术期的并发症比较,差异有显著性(P< 0.05);手术后11个月～5年内偏瘫组5例死亡,死亡率为17.2%,非偏瘫组2例死亡,死亡率为6.7%。偏瘫组早期并发症与非偏瘫组比较差异无显著性(P >0.05)。偏瘫组中全髋关节置换比人工股骨头置换的早期并发症少,差异有显著性(P< 0.05)。结论老年脑血管意外患者偏瘫侧发生股骨颈Garden Ⅲ、Ⅳ型骨折后,人工关节置换是积极而可靠的治疗措施,在完善术前准备的前提下,患者可安全渡过围手术期。偏瘫患者在身体状况允许且患肢     

不同水平每搏量变异度指导下的液体治疗对老年手术患者预后的影响

目的观察不同水平每搏量变异度(SVV)指导下的液体治疗方案对老年手术患者短期预后产生的影响。方法选择老年腹部手术患者110例,男67例,女43例,年龄65~80岁,ASAⅠ或Ⅱ级。随机将患者分为三组:11%≤SVV≤14%组(H组,n=37)、7%≤SVV≤10%组(M组,n=37)和3%≤SVV≤6%组(L组,n=36),并按相应分组实施不同的补液方案。记录围术期出入量相关指标,通过术后随访记录胃肠道功能恢复情况,记录住院总时间及术后住院时间等短期预后指标。记录术后至出院前并发症及不良反应发生情况。结果随SVV水平降低,三组患者术中输注晶体量及胶体量依次增加(P0.05);三组患者术后下床活动时间、进流食时间、胃肠减压及留置导尿管时间差异无统计学意义;H组排气时间明显短于L组(P0.05);M组进半流质饮食及饮食过渡时间短于H组和L组,但差异无统计学意义;M组一级以上护理时间、术后住院时间、住院总时间明显短于L组(P0.05)。L组术后感染发生率明显高于H组和M组(P0.05);H组吻合口漏发生率明显高于L组(P0.05);L组在并发症的复杂及严重程度上均超过H组和M组。结论3%≤SVV≤6%可能增加术后感染的风险,延长住院时间。7%≤SVV≤10%可能使患者恢复质量更高,可以作为围术期液体治疗的最佳目标。     

Rapid long-term bone loss following stroke in a man with osteoporosis and atherosclerosis

Bone loss in humans has been reported where there is reduced mechanical loading such as in space flight, spinal cord injury, and stroke. Whether osteoporotic patients are susceptible to further bone loss in states of underloading such as hemiparesis is unknown. Here we report the case of a 64-year-old man with established idiopathic osteoporosis and atherosclerosis who presented with a right middle cerebral artery territory stroke. Annual bone mineral density measurements were made at the left hip and spine before and after left hemiparesis. The left total hip T-score was –3.2 before the stroke. Following stroke, there was rapid and sustained bone loss with a reduction in bone mineral density (BMD) of 21.6% over 3 years despite oral bisphosphonate therapy. There was also an unexpected decline in vertebral BMD after the stroke. This is the first report of the accelerated effect of hemiplegia on bone loss in an already osteoporotic skeleton.     

偏瘫侧股骨颈骨折关节置换手术的研究进展

随着我国进入老龄化社会,脑血管意外遗留偏瘫的患者也逐渐增多,而这类患者发病后第1年内髋部骨折的风险比普通人高4倍且多发生在偏瘫侧。对于老年性股骨颈骨折,人工关节置换术几乎是首选治疗方案,手术技术成熟且有很好的疗效。目前认为,脑血管意外后遗留偏瘫的患者在发生偏瘫侧股骨颈骨折后,偏瘫侧肌力如能达到Ⅲ级,则可首选髋关节置换手术治疗。但是手术中偏瘫患者的情况较常人不同,其偏瘫侧肢体可能存在肌肉萎缩、肌力失衡、骨质疏松等问题,为手术方案的制定带来了困难。本文主要针对手术入路的选择问题、使用全髋关节置换还是半髋、使用骨水泥型假体还是非骨水泥型假体以及如何降低术后脱位的发生率这几方面进行讨论,其中针对术后脱位的问题又从假体选择、软组织技术、下肢长度及偏心距的恢复以及髋臼杯外展角几方面出发进行了分析,目的是为骨科医生在临床决策中提供更多的参考证据。     

A randomised clinical trial of activity-focussed physiotherapy on patients with distal radius fractures

Introduction: Physiotherapy is considered by some authorities to be an important aspect of management in patients following distal radius fractures. There is evidence of improvement in impairment with physiotherapy; however, there is no evidence to support early return of functional activity. Traditional physiotherapy management has focussed on improving impairment; however, there are no trials with emphasis on skill acquisition via motor re-learning principles. Materials and methods: Forty-one participants with conservatively managed distal radius fractures were studied in a randomised, single-blinded, prospective trial. Two treatment options were compared: exercise and advice versus activity-focussed physiotherapy with measurement periods of 6 weeks after removal of cast and follow-up at 24 weeks. Results: Participants allocated to the exercise and advice group consulted a physiotherapist an average of 0.9 (SD 0.4) times, while the participants allocated to the more intensive activity-focussed group consulted with physiotherapy a mean of 4.4 (SD 2.3) times. At both 6 and 24 weeks there were no significant differences between the groups for change in impairment (as measured by grip strength, range of motion of wrist flexion and extension and pain intensity), activity limitation and participation restriction, as measured by the Patient-Rated Wrist Evaluation (PRWE). Exercise and advice given by a physiotherapist were equally as effective as activity-focussed physiotherapy in recovery both at 6 and 24 weeks. Conclusion: The results suggest that after removal of cast from fracture of distal radius, patients may routinely require no more than a single session of advice and exercise provided by a physiotherapist.     

Web-based E-survey in identifying current physiotherapy practices in paediatric burns

IntroductionPhysiotherapy practices in pediatric burns involves relaxation techniques and exercise training for attaining physical fitness, improving quality of life and, thereby to prevent primary and secondary complications. Physical activity and exercise act as a meaningful and purposeful tool for attaining physical fitness after burn injury.AimThe aim of this e-survey is to identify the current practices of physiotherapy interventions in pediatric burn rehabilitation among physiotherapy students and professionals.MethodsThe e-survey was created with validated questionnaire using a Google Forms to gather the information related to current physiotherapy practices in pediatric burns. After the sample size estimation, survey link were sent to identified 144 physiotherapy students and professionals using social networking sites which includes, WhatsApp, Facebook and Instagram for this cross-sectional e-survey. The frequency and percentage of survey responses were analyzed.ResultsAmong 144 identified participants, 62 participants completed the survey, resulting in the response rate of (43.0%). The findings of this study revealed that> 50% of physiotherapy students, and professionals, are performing pain and scar assessment, along with their regular physiotherapy management in children with burns. In addition to these, they also practice physiotherapy for burn conditions in pediatric intensive care units (PICU), pediatric wards, and clinical outpatient department (OPD) settings.ConclusionPhysiotherapy students and professionals have sufficient knowledge regarding pediatric burns complications, and also, they are well aware regarding recent physiotherapy practices in pediatric burn care management.     

Determinants of bone mineral density in immobilization: A study on hemiplegic patients

Osteoporosis that develops during immobli-zation is a severe condition that confers increased risk of fractures with their burden of mortality and disability. The aim of this study was to investigate the determinants of immobilization osteoporosis. As a model of this condition we studied hemiplegic subjects, measuring bone mineral density in the paralyzed lower limb as compared with the non-paralyzed one. In spite of the limits related to the loss of nervous stimulation, this model offers the advantage of a proper control for the complex genetic and environmental cofactors involved. We examined 48 hemiplegic subjects (31 men, 17 women in menopause) admitted consecutively over a 9-month period. Mean length of immobilization was 10.9 months for men (range 1–48 months) and 7.8 months for women (range 1–40 months). The average time since menopause was 14.9 years (range 1.7–23.9 years). For each subject the following were performed: questionnaire, medical examination, anthropometric measurements, evaluation of the scores for spasticity and for lower limb motor capacity in order to account for the different degrees of disability among patients. Bone mineral density was measured using dual-energy X-ray absorptiometry (DXA) at both femoral necks. For each patient we defined a percentage difference in bone loss between the paralyzed and non-paralyzed limb. Regression coefficient were calculated by multiple logistic regression. There was significant bone loss in the paralyzed limb in both sexes, accounting for up to 6.3% in women. Multiple regression analysis showed that the degree of bone loss depends significantly and directly on the length of immobilization, even when controlling for age and sex in the regression model (R=0.193,p=0.034). However, when time since menopause was included in the regression model, with length of immobility as a covariate, it was the only significant determinant of bone loss (R=0.312,p=0.039). No additional factors were observed among men. No differences were shown with regard to anthropometric measurements or functional scores. Length of immobilization accounts only for a small fraction of bone loss, which does not exceed 5% of the total variance. Our data show that postmenopausal women should be considered at highest risk for osteoporosis in cases of immobility and that different factors, other than length of immobility, might come into play in determining bone loss in this condition.