早期训练对急性期脑卒中患者步行功能的影响

为探讨早期训练对急性期脑卒中患者步行功能的影响，对68例病后1月内的患者随机分成2组进行临床观察。康复组在接受神经内科的常规治疗后加以运动疗法为主的综合康复训练。结果表明：急性期脑卒中患者在病后3月内的步行功能恢复（包括独立和需人帮助行走）为94．12％，其中康复组的独立行走恢复率为52．94％，明显优于对照组（P＜0．005）。     

减重支持系统训练对脑卒中患者步行能力的影响

脑卒中后患者负重及平衡能力均差,致步行能力受到较大影响,有报道脑卒中后有1/3—1/2的患者在3个月内不能恢复独立步行[1]。偏瘫患者的步行质量与他们的独立生活能力紧密相关,恢复步行能力是偏瘫患者的主要康复目标,采取积极有效的训练方法促进患者步行能力的恢复是非常重要的。减重支持系统训练目前在临床上已得到广泛应用,已有大量     

脑卒中偏瘫患者119例介入早期康复干预后独立步行能力观察

将脑卒中患者分为两组，康复组在临床用药治疗的同时进行早期康复训练。对照组给予临床治疗及非早期康复训练。观察患者的独立步行能力恢复情况。至第15，30天时，康复治疗组独立步行人数比对照组分别增加了11．5％和20．4％。证明脑卒中患者早期康复训练有利于独立步行能力的恢复。     

急性期入院脑卒中患者神经内科与康复综合治疗探讨：（附52例临床分析）

对52例急性期入院的脑卒中患者进行了神经内科与康复综合性治疗。对所有病例进行了3～6个月疗效评估,对部分病例进行了近1年随访。根据患者入院时偏瘫下肢运动功能障碍的程度,将患者分轻、中、重3组。用步行能力、步态质量、生活自理能力作疗效评估。结果表明,在8～12周内,轻组患者90％以上可达独立步行,优良步态和生活自理;在16～20周内,中组患者90％以上达独立步行,72％达优良步态、67％达生活自理;在22～24周内,重组患者50％达独立步行,12％达优良步态和生活自理。说明3组患者在综合治疗后都有一定疗效,但在达到这些功能的水平或所需时间方面则有明显差异性(P<0.001)。中风后24周内是各项功能恢复的关键时期,从急性期开始,应抓紧时机对患者进行神经内科与康复综合性治疗。     

偏瘫康复治疗中下肢功能与能力改善的关系(附101例报告)

对101例偏瘫患者在治疗前后的下肢运动功能障碍与活动能力障碍的关系,以及经系统康复治疗后功能恢复与能力改善的关系,应用上田式12级偏瘫恢复等级法及下肢基本动作水平的评价法进行探讨;同时观察合并踝关节活动度受限对步行能力的影响。结果表明:(1)康复治疗前的下肢功能障碍及能力障碍的等级对治疗后偏瘫的恢复有预测作用;(2)本组患者在治疗前后以及治疗后改善程度上,偏瘫功能级别与下肢基本动作水平均呈显著正相关,意味着功能恢复与能力改善成正比;(3)本组病例显示踝关节活动度受限的发生率为45.5％。偏瘫发病1个月内即有踝关节活动受限的可能,且病程越长,踝关节受限的发生率越高、程度越重,而踝关节活动受限对训练后弃杖步行有阻碍作用。     

三阶段康复治疗后脑卒中偏瘫患者上下肢运动功能评估

目的探讨3阶段康复治疗对急性脑卒中患者肢体运动功能的影响。方法80例脑卒中患者,随机分为康复组和对照组,每组40例。康复组给予正规的3阶段康复治疗,对照组不给予康复治疗。两组在入选时、发病后1,3,6个月时进行Fugl-Meyer运动功能及改良Barthel指数评定。结果①发病后上、下肢Fugl-Meyer运动功能评分及改良Barthel指数评分康复组均明显高于对照组(P<0.001)。②3个月时康复组上肢的评分增加值明显高于1个月及6个月,下肢1个月时的评分增加值明显高于3个月及6个月(P<0.05)。结论规范的3阶段康复治疗可提高脑卒中患者运动功能及日常生活能力,其中上肢运动功能在发病后3个月内、下肢在发病后1个月内恢复最快。     

早期康复对脑卒中患者偏瘫步态的影响

目的：探讨早期康复可否减轻脑卒中患者偏瘫步态模式的程度。方法：120例60岁以下的卒中偏瘫患者被随机分为康复组(60例)和对照组(60例)。康复组从病后平均第8天开始进行床边康复训练,每日1次,每次30min,其余时间由家属协助训练,训练过程中强调股内收肌群,屈髋、屈膝肌群,胫前肌群及躯干肌的训练。对照组只接受神经科常规治疗。结果：经过平均72d的观察,康复组患者独立步行时不伴有明显的偏瘫步态模式(髋关节外旋、外展、“划圈”)38例(63．3％),而对照组仅11例(18．3％);康复组髋关节活动度及下肢运动功能Fugl-Meyer得分明显高于对照组;康复组坐位平衡和站位平衡达Ⅱ级和Ⅲ级者分别是56例(93．3％)和39例(65％),对照组分别是39例(65％)和18例(30％)。结论：早期有针对性的康复训练可减轻偏瘫步态模式的程度,提高卒中患者的运动能力。     

脑卒中患者步行功能的恢复

目的：探讨康复治疗对脑卒中患者行步功能恢复的影响，方法：采用以Ｂｏｂａｔｈ和Ｂｒｕｎｎｓｔｒｏｍ方法为主的康复治疗技术，并配合传统按摩疗法和功能性电刺激，对急性脑卒中患者进行了临床对照性研究，对恢复期患者进行了临床观察。结果康复治疗后，病程在１个月的患者的独立步行恢复率为７２．００％，与对照组（１４．７１％）相比差异显著（Ｐ〈０．００１）；恢复早期（病后１～３月）患者的独立步行恢复率为７７．７８％     

减重步态机器人对脑卒中偏瘫患者步行功能的影响

目的研究步态机器人训练对脑卒中偏瘫患者运动功能的影响。方法将50例偏瘫患者分为2组,综合康复组行常规康复及减重步态机器人治疗,普通康复组行单纯康复治疗,疗程均为一个月,采用Carr-Shepherd运动功能评定(MAS)中的步行评定法对两组步行能力及临床疗效进行评定并且比较。结果综合康复组患者步行能力较普通康复组改善明显,总有效率明显高于普通康复组(P<0.05)。结论减重步态机器人对偏瘫患者的恢复步行能力及改善异常步态有积极的作用。     

急性脑卒中患者独立步行能力的预测

目的　预测急性脑卒中患者独立步行能力的恢复。方法　采用以神经发育疗法和运动疗法为主的综合康复治疗技术 ,并配合传统的按摩疗法和功能性电刺激 ,以及躯干控制试验、站立平衡检测、功能独立性评定量表中的步行能力检测和巴氏指数的残疾程度评定 ,对急性脑卒中患者进行临床观察和研究。结果　急性脑卒中患者的躯干控制能力、站立平衡功能与独立步行能力的恢复呈高度正相关 (rs 分别为 0 .764和 0 .82 6)。康复组的独立步行能力恢复率为 72 .63 % ,与对照组 ( 14 .94% )相比差异有显著性 (P<0 .0 0 1)。经综合康复治疗 ,中度功能残疾和轻度功能残疾者中有 77.3 6%和 85 .72 %恢复独立步行 ,明显优于重度功能残疾者 ( 2 8.5 7% ) ,P <0 .0 0 1。结论　早期进行康复治疗 ,加强躯干控制能力和站立平衡功能训练 ,可以促进急性脑卒中患者独立步行能力的恢复 ,轻度和中度功能残者的独立步行能力恢复较好。     

Clinical correlation between motor evoked potentials and gait recovery in poststroke patients

OBJECTIVE: To evaluate, in patients with a stroke in the area of the middle cerebral artery, whether transcranial magnetic stimulation values from the affected lower limb correlated with the degree of gait recovery. DESIGN: The prognostic evaluation in subjects with complete lower-limb palsy, inability to walk, and dependence in the activities of daily living, 1 month after vascular injury. SETTING: University-affiliated rehabilitation hospital. PARTICIPANTS: Twenty consecutive patients (12 women, 8 men) were enrolled 1 month poststroke (30+/-5 d); all patients concluded the rehabilitation program, which lasted 6 months. INTERVENTION: Barthel Index score, Hemiplegic Stroke Scale (HSS) score, and motor evoked potentials (MEPs) from the tibialis anterior muscle were performed 1, 4, and 7 months poststroke. The Wilcoxon signed-rank test, Mann-Whitney U test, and Spearman rank-order correlation coefficient were employed. MAIN OUTCOME MEASURES: The independence of gait defined as an HSS gait score of 3 or less (ability to walk without assistance apart from a stick or cane). RESULTS: Patients with no recordable MEPs 1 month poststroke never regained walking ability; patients with MEPs of 8% or more (13.11+/-5.95) regained independent gait at discharge. It was not possible to predict walking capacity in patients with MEPs less than 8% (4.0+/-1.41). Four months postinjury, walking capacity was achieved only by the patients with MEPs of 18% or more (23.1+/-6.2). CONCLUSIONS: In the postacute phase of stroke, the lower-limb MEP amplitudes could be a supportive tool for prognosis of lower-limb motor outcome.     

下肢功率自行车运动对脑卒中偏瘫患者步行能力的影响

目的探讨功率自行车运动对恢复期脑卒中患者步行能力的影响。方法将具有一定步行能力的70例病程为3～6个月的脑卒中患者随机分为治疗组和对照组,各35例。对照组患者采用常规康复训练方法,治疗组在此基础上,增加功率自行车运动训练。治疗前和治疗6周后分别评定患者的下肢运动功能(采用简化Fugl-Meyer评分)、平衡功能(采用Berg平衡量表)、步行能力(采用10m步行时间和6min内步行距离测定、Holden步行功能评定)、肌张力变化(采用改良Ashworth量表),以及日常生活活动(ADL)能力(采用改良Barthel指数)。结果两组患者的下肢运动功能、平衡功能、步行能力和ADL能力治疗后均有改善(P<0.05),但治疗组患者的效果优于对照组(P<0.05)。结论功率自行车运动可改善恢复期脑卒中偏瘫患者的运动功能、平衡功能和ADL能力,提高其步行能力。     

胫神经腓肠肌运动分支乙醇溶解术治疗脑卒中后痉挛性垂足的初步研究

目的观察胫神经运动神经分支乙醇溶解术对脑卒中患者腓肠肌痉挛和步行功能的影响。方法符合条件的18例患者被收入本研究，应用BTL公司的5000e型电诊断仪在体表探测定位，然后应用无水乙醇进行运动分支神经溶解术。每一点的最大剂量不能超过1ml。结果注射后腓肠肌痉挛的各项指标均立即好转，疗效至少维持6个月；10m步行速度观察，在治疗后1个月有所改善，但没有达到统计学意义，治疗后3个月步行速度显著好于治疗前，疗效至少维持到治疗后6个月。不良反应的发生率很低，且多数为可恢复的。结论腓肠肌胫神经运动分支乙醇溶解术治疗脑卒中后腓肠肌痉挛安全有效，能显著缓解痉挛，改善患者步行功能。     

Effects of lower limb intensive mass practice in poststroke patients: single-subject experimental design with long-term follow-up

OBJECTIVE: To investigate the effects of two weeks of intensive mass practice with a constraint-induced movement therapy approach for the lower extremity in five chronic poststroke patients, and the persistence of effects at three and six months. DESIGN: A single-subject experimental design (SSED) was used with an AB design and follow-ups three and six months later. SETTING: Outpatient rehabilitation at Torsby Hospital in Sweden. MAIN MEASURES: Motor function in lower extremity, mobility, dynamic balance, weight-bearing symmetry and walking ability were measured on six occasions during two weeks (A phase), with the Fugl-Meyer assessment for lower extremity, the Timed Up and Go, the Step Test, the Timed Walking Test and the Six-Minute Walk Test. During the intervention's B phase, six measurements were performed with the same time intervals as in the A phase. There were follow-ups three and six months later. INTERVENTION: The intervention (B phase) consisted of bicycling, training in water, strength training, standing weight-bearing, walking up and down stairs, walking indoors and outdoors and flexibility training of the lower extremity, on all weekdays, 6 h a day for two weeks. RESULTS: The results showed improvements in 23/30 variables (77%), 12 of them statistically significant (52%). At follow-up, 22/23 improvements persisted. For example, three of five subjects walked significantly further after the intervention and the follow-ups showed that they still walked further than before the intervention. CONCLUSION: Intensive mass practice with constraint-induced movement therapy for the lower extremity can improve motor function, mobility, dynamic balance, weight-bearing symmetry and walking ability in chronic poststroke patients. Long-term follow-up showed that the effects persisted for these five subjects.     

Immediate and long-term functional impact of repetitive locomotor training as an adjunct to conventional physiotherapy for non-ambulatory patients after stroke

PURPOSE: The aim of the present study was to assess the heart rate intensity during gait training and to evaluate the relationship between heart rate intensity during gait training and walking ability of patients after stroke. METHODS: We included non-ambulatory patients within six weeks after first stroke. Over four weeks patients were trained five times a week, with either 20 minutes of repetitive locomotor training and 25 min of physiotherapy (RLT-PT), or 45 min of PT alone. We assessed the heart rate intensity during training period. Additionally we assessed walking ability (Functional Ambulation Categories) and the rate of independent ability to perform activities of daily life (Barthel Index) at the end of study and six months and three years later on. RESULTS: We included 30 patients in each group. Patients in RLT-PT group exercised longer in the HR target zone than in the PT group (16.1+/-11.8 min vs. 5.3+/-5.6 min, p<0.001). Higher heart rates were associated with independent walking at the end of study, at six months and at three years after the end of study (Fishers exact test, p=0.014, p=0.012 and p=0.017, respectively). CONCLUSIONS: Higher heart rate intensities during gait-training of non-ambulatory post-stroke patients may improve walking function.     

Durchhaltestrategien—ein in Schmerzforschung und Therapie vernachlässigtes Phänomen?

Within a prospective longitudinal study of 111 patients with acute radicular pain and lumbar disc prolapse who underwent conservative or surgical treatment, we examined the importance of specific pain coping strategies, which have received little attention in psychological pain research: appeals to "stick it out" on the cognitive level and endurance strategies on the behavioural level. Prior to treatment we conducted a psychological and neurological examination. The psychological tests included the Kiel Pain Inventory (KPI) and the Beck Depression Inventory (BDI). Based on these scales we allocated patients to three groups: A (endurance strategies and positive mood;n=16), B (appeals to stick it out and depressive mood;n=20) and C (no psychological risk factors;n=40). The outcome variable was the intensity of pain (8-point self-rating scale), which was assessed prior to treatment, at the time of discharge, 1 week later and 6 months later. Additionally, 6 months later we assessed the ability to work and the attitude to application for early retirement. Results showed that patients in groups A and B had significantly more pain at the 6-month follow up than the patients in group C, who were painfree. Patients in group A were a specially high risk group: at the time of discharge they had no pain, but from the first week after discharge up to the 6-month follow up they had increasing pain. Additionally at the 6 month follow up they seemed less likely to return to work and 8 times more of them had applied for early retirement than in the groups of patients without psychological risk factors. The results suggested several suggestions for modification of medical and psychological therapy for chronic pain patients.     

The effect of an ankle-foot orthosis on walking ability in chronic stroke patients: a randomized controlled trial

OBJECTIVE: Regaining walking ability is a major goal during the rehabilitation of stroke patients. To support this process an ankle-foot orthosis (AFO) is often prescribed. The aim of this study is to investigate the effect of an AFO on walking ability in chronic stroke patients. DESIGN: Cross-over design with randomization for the interventions. METHODS: Twenty chronic stroke patients, wearing an AFO for at least six months, were included. Walking ability was operationalized as comfortable walking speed, scores on the timed up and go (TUG) test and stairs test. Patients were measured with and without their AFO, the sequence of which was randomized. Additionally, subjective impressions of self-confidence and difficulty of the tasks were scored. Clinically relevant differences based on literature were defined for walking speed (20 cm/s), the TUG test (10 s). Gathered data were statistically analysed using a paired t-test. RESULTS: The mean difference in favour of the AFO in walking speed was 4.8 cm/s (95% CI 0.85-8.7), in the TUG test 3.6 s (95% CI 2.4-4.8) and in the stairs test 8.6 s (95% CI 3.1-14.1). Sixty-five per cent of the patients experienced less difficulty and 70% of the patients felt more self-confident while wearing the AFO. CONCLUSIONS: The effect of an AFO on walking ability is statistically significant, but compared with the a priori defined differences it is too small to be clinically relevant. The effect on self-confidence suggests that other factors might play an important role in the motivation to use an AFO.     

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.