脑小血管病患者步态障碍与认知功能的关系研究

目的：探讨脑小血管病（CSVD）患者步态能力与认知功能之间的关系。方法：收集脑小血管病患者59 例,分为跌倒组 27 例、非跌倒组 32 例。运用神经心理量表进行认知功能评定;采用起立-行走计时测试 （TUG）、简明运动试验（SPPB）评分及Berg平衡量表（BBS）进行运动功能评价。运用皮尔逊相关分析比较 CSVD患者总体运动功能与认知功能的关系,运用多元线性回归分析比较CSVD患者SPPB评分与注意/执行 功能评分的关系。结果：59例患者的总体运动功能与认知功能均存在减退。皮尔逊相关分析发现：入组患者 MMSE、MoCA总分与BBS评分及SPPB评分显著正相关,多元线性回归分析发现CSVD患者SPPB评分与注 意功能相关。结论：CSVD患者跌倒组步态与认知功能的障碍程度更严重,且步态障碍与认知功能障碍的严 重程度相关,CSVD患者注意功能下降与其运动功能减退相关。     

脑小血管病总负荷评分联合磁敏感加权血管造影预测急性腔隙性脑梗死卒中复发的临床价值

目的 探讨脑小血管病（CSVD）总负荷评分联合磁敏感加权血管造影（SWAN）预测急性腔隙性脑梗死卒中复发的临床价值。方法 选取88例首次发病的急性腔隙性脑梗死患者临床资料,随访3个月,无失访病例,将31例脑卒中复发的患者设为观察组,57例脑卒中未复发的患者设为对照组。所有患者入院后行头部核磁共振（MRI）检查和SWAN检查,评估CSVD总负荷评分与SWAN检查的不对称性皮质静脉征（ACVS）情况,并收集两组相关临床资料,利用多因素logistic回归分析急性腔隙性脑梗死卒中复发的危险因素,并采用受试者工作特征曲线（ROC）评价分析CSVD总负荷评分、SWAN检查对急性腔隙性脑梗死卒中复发的预测价值。结果 经多因素logistic回归分析结果显示,美国国立卫生院卒中表量（NIHSS）评分高、CSVD总负荷评分≥3分、ACVS阳性是急性腔隙性脑梗死卒中复发的危险因素（OR分别=1.24、1.87、2.12,P均<0.05）。ROC曲线结果显示CSVD总负荷评分、SWAN检查两者单项与两者联合预测急性腔隙性脑梗死卒中复发的AUC分别为0.71、0.79、0.85,灵敏度分别为71.00...     

红细胞分布宽度、中性粒细胞与淋巴细胞比值和脑小血管病影像学总负荷的相关性分析

目的 探讨脑小血管病（cerebral small vessel disease, CSVD）患者红细胞分布宽度（red blood cell distribution width, RDW）、中性粒细胞与淋巴细胞比值（neutrophil to lymphocyte ratio, NLR）与CSVD影像学总负荷的相关性。预测RDW、NLR及其联合指标对CSVD影像学高负荷的临床诊断价值。方法 回顾性收集2018年10月—2022年10月在包头市中心医院神经内科住院治疗的CSVD患者的病历资料。通过评估头颅MRI得出CSVD影像学总负荷并将纳入患者分为低负荷组和高负荷组。比较两组间的一般临床资料、既往病史、血生化指标水平，使用相关性分析方法分析相关指标与CSVD影像学总负荷的关系，使用logistic回归分析方法分析CSVD影像学总负荷的危险因素，绘制受试者操作特征曲线评估检测指标对于临床的诊断价值。结果 共纳入患者320例。其中，低负荷组201例（62.81%），高负荷组119例（37.19%）。除年龄、性别、高血压病史、RDW、NLR外（P<0.05），其余指标两组间的比较差...     

弹力带抗阻运动对老年脑小血管病伴步态障碍患者姿势稳定性及下肢力量的影响

目的制定符合老年脑小血管病（cerebral small-vessel disease,CSVD）伴步态障碍患者弹力带抗阻运动方案,评价其对患者姿势稳定性及下肢力量的影响。方法 便利选取南宁市某三级甲等综合医院老年神经内科2021年2月至2022年2月收治80例的老年CSVD伴步态障碍患者,采用随机数字表法分为对照组和试验组,每组各40例。对照组患者给予常规治疗护理及步态康复锻炼,试验组在对照组基础上给予12w弹力带抗阻运动训练,比较两组患者的姿势稳定性（采用Tinetti平衡与步态总分、平衡得分、步态得分和起立-行走-计时测试时间评价）和下肢力量。结果 干预后试验组患者的Tinetti平衡与步态总分、平衡得分、步态得分均高于对照组,起立-行走-计时测试时间少于对照组,两组比较,差异具有统计学意义（均P<0.05）。干预后试验组患者的下肢力量优于对照组,两组比较,差异有统计学意义（P<0.05）。结论 弹力带抗阻运动不仅能提高老年CSVD伴步态障碍患者姿势稳定性,有效改善患者下肢力量,提高患者运动与平衡功能。     

计时起立行走和最大步行速度评估脑卒中患者功能的对比分析

目的:比较计时起立行走(TUG)和最大步行速度测试(MWST)在评估脑卒中患者功能方面的异同,为临床应用提供试验基础。方法:由同一名康复医师对50例脑卒中患者进行TUG、MWST、Berg平衡量表(BBS)、Barthel指数(BI)、Fugl-Meyer运动功能评估(FMA)。采用Pearson相关系数分析TUG、MWST与BBS、BI、FMA之间的相关性,ROC曲线分析TUG和MWST的预测效能。结果:TUG、MWST与Berg、BI、FMA上肢得分、FMA下肢得分、FMA总分之间呈显著负相关(P0.05),TUG各项相关系数均大于MWST。TUG预测生活自理、跌倒风险的ROC曲线下面积均显著大于MWST(P0.05)。结论:TUG评估与脑卒中患者平衡功能、运动功能、日常生活活动能力的相关性更佳,在预测患者跌倒风险以及日常生活自理能力方面也优于MWST。     

剖宫产孕妇认知功能障碍风险预测模型的构建

目的 探讨剖宫产孕妇发生认知功能障碍的影响因素，构建风险预测模型。方法 于2020年9月—2021年12月选取在西安市某三级甲等医院妇产科行剖宫产的孕妇212例，将其分为认知功能障碍组（n=68）和无认知功能障碍组（n=144）。采用单因素分析和二分类Logistic回归模型分析剖宫产孕妇发生认知功能障碍的影响因素，构建风险预测模型并进行内部验证。结果 术后镇痛时间是剖宫产孕妇发生认知功能障碍的保护因素（OR=0.164），顺产转剖宫产（OR=2.827）、术中失血量（OR=3.947）、焦虑/抑郁（OR=5.272）、妊娠期高血压疾病（OR=5.475）、妊娠合并糖尿病（OR=10.111）是危险因素。风险预测模型具有良好的拟合度（Hosmer-Lemeshow检验：χ2=13.961,P=0.083）。模型内部验证显示，ROC曲线下面积为0.800，具有良好的区分度；校准曲线实际值与预测值间的平均绝对误差为0.043，具有良好的准确度；决策曲线风险阈值>0.130时，模型提供显著的临床净收益。结论 剖宫产孕妇认知功能障碍风险预测模型具有科学性和实用性，能够帮助医护人员识别剖宫...     

机械通气患者发生谵妄的影响因素分析

目的 探讨ICU机械通气患者发生谵妄的影响因素,并对其发生风险进行预测。方法 收集2016年6月—2017年6月转入综合ICU的患者资料,用Logistic回归模型分析机械通气患者谵妄发生的危险因素,采用ROC曲线计算危险因素的曲线下面积及最佳截断值。结果共纳入398例患者,ICU机械通气患者发生谵妄163例,发生率为41.0%。Logistic回归模型结果显示,使用约束（OR=3.084）、镇静药（OR=2.255）、机械通气时长（OR=1.146）和入住ICU时长（OR=1.111）是ICU机械通气患者谵妄发生的独立预测因子。ROC曲线结果显示,使用约束、镇静药、机械通气时长、入住ICU时长的曲线下面积分别为0.580、0.566、0.787和0.774,其中机械通气时长和ICU时长的最佳截断值分别为7d和8d。结论ICU机械通气患者谵妄发生率仍处于较高水平,使用约束、镇静药、机械通气时长＞7d和入住ICU时长＞8d易诱发谵妄。     

老年住院患者跌倒伤害的危险因素研究

目的探讨老年住院患者跌倒伤害的危险因素,为跌倒预防提供依据。方法采用回顾性研究方法收集161例发生跌倒的老年住院患者临床资料及跌倒伤害程度,对临床资料进行跌倒伤害程度危险因素的单因素分析,同时进行二分类Logistic回归分析。结果跌倒伤害程度中无伤害或轻度伤害106例,中重度伤害55例,Logistic回归分析显示导致中重度伤害的主要因素:年龄(OR=1.773,95%CI为1.186～2.650)、意识状态改变(OR=6.575,95%CI为3.082～14.029)、步态虚弱及平衡改变(OR=3.192,95%CI为1.857～5.486)。结论老年住院患者发生跌倒伤害程度较轻,多为无伤害或轻度伤害。而低龄、意识状态改变、步态虚弱及平衡改变是导致老年住院跌倒患者中重度伤害的危险因素。     

血清GLU 和尿液mALB 水平检测对白内障发生的预测价值评价

目的 采用Logistic 回归及受试者工作特征（ROC）曲线综合评价实验室常规检测项目对白内障发生的预测价值。方法 收集2018 年1~12 月于南京宁益眼科中心就诊的50 例白内障患者及同期50 例非白内障患者,检测分析实验室常规检测项目尿素（BUN）、肌酐（CREA）、总胆固醇(total cholesterol,TC)、三酰甘油(triglyceride ,TG)、血糖（GLU）、纤维蛋白原（fibrinogen, FIB）、活化部分凝血活酶时间（APTT）、超敏C 反应蛋白（hs-CRP）和尿微量清蛋白(mALB)的水平,对有统计学意义的指标, 先采用多因素Logistic 回归模型分析,再进行ROC 分析模型的预测价值。结果 ①白内障患者组GLU 及mALB 均高于非白内障组,差异具有统计学意义（t=3.68, P=0.000; t=2.06,P=0.042）。② Logistic回归分析,GLU (OR=2.532, 95% CI:1.224~5.237) 和 mALB (OR=1.155, 95% CI:1.070~1.247) 与白内障发生发展存在相关性（P<0.05）。据此构建的白内障发生的风险预测模型为Y=1/[1+e- (0.929X1+0.144X2-7.852) ]。③两者联合诊断白内障的ROC曲线下面积（AUC）大于GLU 和mALB 单项检测的AUC。结论 GLU 和mALB 与白内障疾病发生发展显著相关, 白内障风险预测模型有一定的预测价值。     

基于现实环境的功能性步态训练对社区卒中后康复期老人步态特征及害怕跌倒的影响

目的 探讨在现实环境下运用功能性步态训练来分析社区卒中后康复期老人步态特征的改变,以及对其害怕跌倒的影响。方法 选取在南京市某三级甲等医院康复出院的卒中患者进行追踪,采用随机数字表法分为干预组30例和对照组29例,对照组给予常规出院康复训练,而干预组在此基础上增加现实环境中的步态训练,分别在出院前,出院后8周采用便携式步态分析仪采集患者常速行走10 m的步态参数,同时采用单条目问题法和修订版跌倒效能量表分析老人跌倒恐惧的状况。结果 干预前,2组老人各项步态参数、跌倒效能得分比较无统计学意义（P>0.05）,经过干预8周后2组患者在患侧站立相、患侧摆动相、摆动强度、落脚强度、落脚时脚角度、步频、跨步时间变异性差异有统计学意义（P<0.05）,跌倒效能干预组差异有统计学意义（P<0.05）。干预前对照组害怕跌倒的老人为14例（48.28%）,干预组为13例（43.33%）;8周后对照组害怕跌倒老人为11例（37.93%）,干预组为5例（16.67%）,差异有统计学意义（P<0.05）。结论 基于现实环境的功能性步态训练对社区卒中后康复期老人步态特征及害怕跌倒有积极的改善效果。     

A mechanized gait trainer for restoring gait in nonambulatory subjects

OBJECTIVE: To construct an advanced mechanized gait trainer to enable patients the repetitive practice of a gaitlike movement without overstraining therapists. DEVICE: Prototype gait trainer that simulates the phases of gait (by generating a ratio of 40% to 60% between swing and stance phases), supports the subjects according to their ability (lifts the foot during swing phase), and controls the center of mass in the vertical and horizontal directions. PATIENTS: Two nonambulatory, hemiparetic patients who regained their walking ability after 4 weeks of daily training on the gait trainer, a 55-year-old woman and a 62-year-old man, both of whom had a first-time ischemic stroke. INTERVENTION: Four weeks of training, five times a week, each session 20 minutes long. MAIN OUTCOME MEASURES: Functional ambulation category (FAC, levels 0-5) to assess gait ability and ground level walking velocity. Rivermead motor assessment score (RMAS, 0-13) to assess gross motor function. RESULTS: Patient 1: At the end of treatment, she was able to walk independently on level ground with use of a walking stick. Her walking velocity had improved from .29m/sec to .59m/sec. Her RMAS score increased from 4 to 10, meaning she could walk at least 40 meters outside, pick up objects from floor, and climb stairs independently. Patient 2: At end of 4-week training, he could walk independently on even surfaces (FAC level 4), using an ankle-foot orthosis and a walking stick. His walking velocity improved from .14m/sec to .63m/sec. His RMAS increased from 3 to 10. CONCLUSION: The gait trainer enabled severely affected patients the repetitive practice of a gaitlike movement. Future studies may elucidate its value in gait rehabilitation of nonambulatory subjects.     

A mechanized gait trainer for restoration of gait

The newly developed gait trainer allows wheel-chair-bound subjects the repetitive practice of a gait-like movement without overstressing therapists. The device simulates the phases of gait, supports the subjects according to their abilities, and controls the center of mass (CoM) in the vertical and horizontal directions. The patterns of sagittal lower limb joint kinematics and of muscle activation for a normal subject were similar when using the mechanized trainer and when walking on a treadmill. A non-ambulatory hemiparetic subject required little help from one therapist on the gait trainer, while two therapists were required to support treadmill walking. Gait movements on the trainer were highly symmetrical, impact free, and less spastic. The vertical displacement of the CoM was bi-phasic instead of mono-phasic during each gait cycle on the new device. Two cases of non-ambulatory patients, who regained their walking ability after 4 weeks of daily training on the gait trainer, are reported.     

Improving spatiotemporal gait parameters in spastic diplegic children using treadmill gait training

BackgroundEven though several physiotherapy techniques help to improve the spatiotemporal gait parameters of diplegic children, the efficacy of treadmill gait training together with conventional treatment techniques on spatiotemporal parameter improvement needs more investigation.ObjectiveThis study's main purpose is to investigate the effect of treadmill gait training as an adjunct to conventional physiotherapy treatment on the spatiotemporal gait parameters of diplegic children.MethodsTwenty diplegic children were distributed randomly into two equal groups (a control group of ten children who received a traditional treatment and an experimental group of ten children who received the traditional treatment together with treadmill gait training). Gait data were collected using a Vicon three-dimensional motion analysis system during regular walking.ResultsWalking speed, cadence, step length, stride length, and single limb support were enhanced in both groups (p < 0.05). Cadence and walking speed increased by 6.5 steps/min and 0.2 m/sec respectively in the experimental group, compared to the control group. Also, step length, stride length and single limb support time increased by 0.13 m, 0.27 m, and 0.07 s respectively in the experimental group, compared to the control group.ConclusionThe use of treadmill gait training together with conventional physical therapy treatment enhances the walking performance of diplegic children by improving several spatiotemporal gait parameters. Furthermore, walking balance is improved by increasing the single-leg support time.     

Ataxic gait

Ataxia as the main complaint in a young patient prompts to diagnose neurodegenerative diseases. Not all ataxias are irreversible. We present a video of a patient in the clinic with ataxia diagnosed as subacute combined degeneration of the cord.

Ataxia as the main complaint in a young patient prompts to diagnose neurodegenerative diseases. Not all ataxias are irreversible. We present a video of a patient in the clinic with ataxia diagnosed as subacute combined degeneration of the cord.

The young man presented with unsteadiness, lethargy, and tingling for 3 months. He was pale with cognitive impairment (Montreal Cognitive Assessment score 25/30). He underscored in repeating the digits backward, serial seven subtraction, and delayed recall. He had ataxic gait, increased deep tendon reflexes, bilateral positive Babinski, impaired vibration and joint position sense, and positive Romberg''s sign (Video S1). He had macrocytic anemia, low serum B12, positive intrinsic factor, and anti‐parietal antibodies. MRI is described in Figure 1. Therefore, sensory ataxia due to subacute combined degeneration of the cord and pernicious anemia was diagnosed. He improved with B12 therapy. ¹ Video S2.Open in a separate windowFIGURE 1Sagittal T2‐weighted images reveal an intraspinal hyperintensity of the cervical and thoracic spinal cord with no mass effect     

人体起步过程的实验研究——平地行走的起步步态特征

目的：研究人体平地行走的起步过程步态特征,方法：使用基于CCD和三维测力平台的人体运动分析系统,研究正常人水平地面起步过程的步态特征,结果：描述,分析了完整起步过程各步相的特征以及地面对足的三维反作用力规律,结论：／起步过程在第二次摆动腿触地时结束,开始进入稳定步行状态,起步时支撑腿对起步驱动力贡献最大。     

In-toeing gait in children.

Torsional deformities in the lower extremities, resulting from constrained intrauterine position, tend to spontaneously correct toward the adult configuration during growth. Internal tibial torsion, metatarsus adductus and femoral anteversion are clinically evident conditions that occur because of arrested normal postnatal development. An understanding of the dynamics of spontaneous correction permits assessment of the child with in-toeing gait as well as the selection of proper treatment.     

Kinematic effects of different gait speeds during gait initiation movement

[Purpose] We investigated the influence of gait speed on the movement strategy during gait initiation. [Participants and Methods] This study included 21 young healthy individuals (11 males and 10 females; mean age, 21.7 ± 0.5 years; mean height, 166.1 ± 9.8 cm; and mean weight, 57.3 ± 11.2 kg). A three-dimensional motion analyzer and strain gauge force platform were used in this study. The measurement task consisted of gait initiation from the quiet stance; the two measurement conditions were normal gait and the highest speed. The analysis interval was from the start of the center of pressure migration to the heel contact at the first step of the swing limb. The center of gravity, center of pressure, joint movements, step length, and step time during the anticipatory postural control (from the start of center of pressure migration to swing leg-heel off) and swing (swing leg-heel off to swing leg-heel contact) phases were analyzed. [Results] Significant differences were observed in the center of gravity, center of pressure, hip flexion, abduction movement, stance-limb ankle dorsiflexion movement during the anticipatory postural control phase, and step time during the anticipatory postural control and swing phases. The stance-limb ankle plantar flexion movement and step length did not differ significantly in the swing phase. [Conclusion] When the gait speed increases, fluctuations in the joint movements increase as the center of pressure displacement increases, thus requiring complex control.