被动式多功能下肢康复训练器

由于疾病或运动损伤造成的下肢运动障碍的患者很多，患者的康复过程多数都要经过从被动运动训练到主动运动训练。目前用于下肢被动训练的器械大多都是只具有单一冠状面上运动功能的训练器，该类训练器仅适用于下肢骨科患者手术后的关节功能恢复训练。对于属于球铰关节的下肢关节来说，如果要保持或恢复基本运动功能，还应当做矢状面上的训练。以使患者下肢关节的运动功能得到保持和恢复。     

脑卒中偏瘫的关节活动范围训练

对于偏瘫早期及肌张力亢进的脑卒中患者 ,应进行维持和改善关节活动范围的训练 ,其形式有被动、辅助主动和主动 3种 ,训练前应评定患者的关节活动范围。对患侧肢体的关节多采用被动方式 ,训练时患者取舒适体位、肌肉放松 ,治疗者手法要轻柔、缓慢 ,由近端大关节到远端小关节依次进行。关节的活动应在正常活动范围内进行时 ,避免引起疼痛。关节活动范围训练可每天做 2— 3次 ,一般先从被动运动开始 ,随着运动功能的恢复逐渐减少辅助量 ,直至患者能完成主动运动。若患者的运动功能已不能完全恢复时 ,有必要坚持被动关节运动 ,以避免因缺乏运动…     

MOTO-med对脑卒中患者下肢运动及平衡功能恢复的作用

目的观察MOTO-med智能运动训练系统结合神经肌肉促进技术、运动再学习方法、推拿技术、关节活动范围训练、肌力训练、平衡功能训练、物理治疗、电针等综合康复训练,对脑卒中患者下肢运动功能及平衡功能改善的作用.方法脑卒中患者90例,随机分为对照组(45例)和治疗组(45例),对照组接受神经肌肉促进技术、运动再学习方法、推拿技术、关节活动范围训练、肌力训练、平衡功能训练、物理治疗、电针等综合康复训练,治疗组在综合康复训练的基础上,增加MOTO-med智能运动训练系统进行训练.分别在治疗前、治疗8周后评定两组患者下肢功能和平衡功能.结果治疗8周后,治疗组患者下肢功能和平衡功能改善较对照组患者明显,差异有统计学意义(P<0.05).结论 MOTO-med智能运动训练结合综合康复训练可改善偏瘫患者下肢功能及平衡功能.     

运动训练对骨关节炎患者肌肉的影响及其研究进展

骨关节炎是中老年人最常见的关节疾病,严重影响患者的运动功能和生活质量。骨关节炎患者关节周围肌肉的变化是当前研究热点之一,本文就骨关节炎患者关节周围肌肉的变化特点以及运动训练对肌肉的影响及其在骨关节炎中的作用机制进行阐述,旨在为运动训练用于骨关节炎的治疗提供一定的参考依据。     

强直性脊柱炎康复功能训练的护理

强直性脊柱炎是以骶髂关节和脊柱慢性炎症为主的疾病。炎症病变由关节韧带逐渐进展 ,累及关节软骨及软骨下骨质 ,最后出现脊柱的纤维强直和骨性强直。 1998-2 0 0 3年我科对收治的 60例强直性脊柱炎患者施行康复功能训练及康复护理 ,收到较好效果。我们的方法为 :1指导康复功能训练训练内容包括扩胸运动、转体运动、后踢腿运动、小燕飞等运动项目。根据患者受累关节的部位选择训练重点。每天上、下午指导患者各做 1次 ,每次 2 0 -3 0min ,2 0d为 1个疗程 ,疗程结束后休息 3d ,继续下 1个疗程。运动量宜循序渐进 ,以运动后第 2天不感疲劳和疼…     

肢体多功能训练箱的设计及临床适应证

研制一种使用方便、符合人体潜能开发训练和增强肌力要求的、便携式关节主动活动的自我训练器具,组装成箱.根据肢体各关节屈伸训练的要求,采用不同弹力的弹力带和不同固定方式,运用中医导引术的调神和调息基础上的调形方法,通过关节的主动屈伸拉伸弹力带进行训练.肢体多功能训练箱携带方便、适应于肢体关节各肌肉的训练.由于弹力带的弹性回缩力可调范围大,故便于达到肌肉最佳训练量和最大训练量下的持续训练,从而有利于维持和提高肌力和关节的运动功能.2006-06/2008-02首都医科大学附属北京同仁医院将这种肢体多功能训练箱应用于30例足下垂患者,临床应用结果提示,肢体多功能训练箱设计合理,操作方便,有利于患者出院后的日常自我功能训练,正确的使用和持之以恒的训练,有利于维持和提高肌力及肢体的运动功能.     

分期运动训练联合健康指导对类风湿关节炎患者关节疼痛和功能恢复的影响

目的:探讨分期运动训练联合健康指导对类风湿关节炎患者关节疼痛和功能恢复的影响。方法:选择我院收治的82例中早期类风湿性关节炎患者作为研究对象,将患者随机等分为对照组和观察组,对照组给予常规治疗、护理和保健;观察组则在对照组的基础上给予分期运动训练联合健康指导干预,比较治疗前和治疗后3周两组患者的关节疼痛和关节障碍情况。结果:治疗后3周,观察组患者的疼痛关节总数、VAS评分以及关节功能障碍分级均低于对照组(P0.05)。结论:分期运动训练联合健康指导能够有效的降低类风湿性关节炎患者关节疼痛程度和促进患者的关节功能恢复,值得临床推广应用。     

肩关节受损患者的康复训练

康复的目标之一就是维持患者健侧部分的身体功能。最大限度地恢复患肢功能,协助患者完成独立自我照顾训练。肩关节是人体功能最多、最灵活的关节,肩关节受损必将导致关节的功能障碍。对肩关节受损患者进行康复功能训练,就是采用与日常生活、活动有密切联系的运动治疗、作业治疗等帮助患者提高自理生活能力的护理方法。适时对肩关节受损患者进行康复功能训练,对保持关节正常生理状态、恢复关节正常生理功能具有重要的意义。现将1例肩关节受损患者的康复训练报告如下。     

功能性作业疗法

<正> 作业疗法的含义就是功能训练,它常包含一种手工作业劳动,与一种行为过程联系在一起.供我们做功能训练的有滑橇编织椅和自行车锯。滑橇编织椅作为一种医疗体操支持疗法,用于膝伸展和屈曲运动的训练。它还用于骨折、假肢置换、肌腱韧带损伤以及挛缩的治疗。这意味着一台编织练习机能用于不同的训练治疗.将病人的脚固定在溜冰鞋上,然后作膝关节伸展与屈曲运动。滑橇确定了运动的方     

运动方式对膝关节骨性关节炎患者运动功能及关节液中NO、MMPs-9水平影响的研究

目的:观察不同运动训练方式对膝关节骨性关节炎患者运动功能以及关节液中NO、MMPs的影响。方法:96例确诊膝关节骨性关节炎患者分成3组,治疗A组(n=33)采用股四头肌多点等长训练,治疗B组(n=28)采用有氧踏车运动训练,对照C组(n=35)进行日常步行训练,3组均予以常规关节腔注射玻璃酸钠治疗,每周1次,共5周。在治疗前,治疗后第1周及第5周,分别检测关节液中NO、MMPs-9的含量;同时评估患者治疗前后疼痛指数VAS以及膝关节运动功能LKSS、Lysholm膝关节功能评分量表(Lysholm knee score,LKSS)结果:3组患者治疗前无明显差异。治疗后第1周,关节液NO均有下降(P0.05),各组患者疼痛均有缓解(P0.05);组间比较无显著差异(P0.05);治疗后第5周,关节液中MMPs-9水平A、B两组间比较有显著性差异(P0.05),A和B组的运动功能较C组有显著差异(P0.05)。结论:有氧踏车运动能够降低膝关节骨性关节炎患者关节液中MMPs、NO含量,提高膝骨性关节炎患者的运动功能,减轻症状。     

Rising from a chair. Influence of age and chair design

We studied the effect of age on the act of rising from a standard armchair in a younger (means = 24 years) and an older (means = 75 years) group of healthy adult women. Rising from a standard armchair and an armchair specially designed for comfort in sitting of the elderly was studied in the older group to determine the influence of the special chair. We used electrogoniometry, EMG, and videotape analysis to record the activity for both groups. The older group placed their feet farther back and showed greater vastus lateralis muscle activity than did the younger group to rise from the standard chair. These results suggest that rising from the standard chair was more difficult for the older than for the younger group. In the special chair, the older subjects showed even more vastus lateralis muscle activity, greater knee flexion, and greater trunk forward lean. Rising from the special chair, therefore, appeared to be more difficult than rising from a standard chair; this finding suggests that both comfort and function must be considered in chair selection for certain groups.     

Leg muscle activation patterns of sit-to-stand movement in stroke patients

OBJECTIVE: To describe the characteristics of leg muscle activation patterns in hemiplegic stroke patients during the movement of rising from a chair and to determine the differences of leg muscle activation patterns between stroke fallers and nonfallers. DESIGN: Subjects stood up from an armless chair at a comfortable, self-paced speed. Leg muscle activation time and patterns during the sit-to-stand movement were analyzed using multichannel surface electromyography and a force platform. The differences between stroke fallers and nonfallers were compared. RESULTS: The mean onset time of muscle activity in the affected limbs of stroke fallers was markedly delayed for the tibialis anterior muscle and earlier for the soleus muscle. The muscle activation patterns in the affected side of the stroke fallers exhibited a wide range of variation. Seventy percent of our stroke fallers exhibited no or merely low-amplitude activity in their tibialis anterior muscle when the patients were rising from a chair. Half of the stroke fallers exhibited premature or excessive activation of their soleus muscle when the rising activity was initiated. CONCLUSIONS: Stroke patients who exhibited no or low-amplitude muscle activity in the tibialis anterior, associated with premature or excessive activation of the soleus muscle in their hemiplegic limbs, when rising from a chair were prone to falling. The compensatory excessive tibialis anterior and quadriceps muscle activation in the unaffected limbs of stroke patients might have a role in preventing them from falling.     

Effects of the Ball-backrest Chair Combined with an Accelerometer on the Pain and Trunk Muscle Endurance of a Computer Worker with LBP

[Purpose] This study examined the effects of a ball-backrest chair combined with an accelerometer on the pain and trunk muscle endurance of a computer worker with low-back pain (LBP). [Subject and Methods] A 36-year-old male with a flat back who complained of LBP at the L3–5 level was the subject. He used the ball-backrest chair when working at a computer for 1 week. [Results] After using the ball backrest, the trunk extensor and flexor muscle endurance times had increased compared with the baseline and the VAS score had decreased from 7 to 4. [Conclusion] Combining exercises with information on motion is a useful common treatment approach for improving trunk muscle endurance in LBP.Key words: Ball-backrest chair, Biofeedback, Trunk muscle endurance     

Chair configuration and balance control in persons with spinal cord injury

OBJECTIVE: To study whether chair configuration influences sitting balance in persons with spinal cord injury (SCI). DESIGN: Cross-sectional group study. SETTING: Rehabilitation centers and hospital rehabilitation departments. PATIENTS: Ten complete high thoracic SCI (level T2-T8) patients, 10 complete low thoracic SCI (T9-T12) patients, and 10 matched able-bodied controls. SCI participants had completed their active rehabilitation at least 6 months before the study. INTERVENTIONS: A balance-changing (forward) reaching task while seated in four differently configured chairs. Tilt angle (7 degrees and 12 degrees) and reclination angle (22 degrees) were varied relative to a standard chair configuration (10 degrees reclination). MAIN OUTCOME MEASURES: Maximal unsupported reaching distance, center-of-pressure displacement and muscle activity. RESULTS: Although no significant difference in actively controllable reach was found in controls or in subjects with low SCI, sitting balance improved in all chairs relative to the standard chair. Ability to control displacement of arms and trunk during reaching improved. No apparent need for additional postural muscle activity was found. Persons with high SCI did not improve their sitting balance. They were unable to control a shift in body mass larger than the one induced by arm movement. However, they had less muscle activity after backrest reclination or tilting the chair backwards. CONCLUSIONS: The tested chairs had an overall positive effect. However, for individually tailored chair configurations factors other than those investigated should be considered.     

Sitting on a chair or an exercise ball: various perspectives to guide decision making

BACKGROUND: Prolonged sitting is recognized as a risk factor for the reporting of low back troubles. Despite the use of exercise balls in replacement of the office chair, little quantitative evidence exists to support this practice and hence motivated this research. Given the potential for several biological effects and mechanisms this study was approached with several layers of instrumentation to quantify differences in muscle activation, spine posture, spine compression and stability while sitting on an exercise ball versus a stable seat surface. Also, differences in the pressure distribution at the seat-user interface were quantified for the different seat surfaces to provide an objective perspective on the mechanism influencing perceived comfort levels. METHODS: Eight male subjects volunteered to sit for 30 min on an exercise ball and on a wooden stool. Muscle activity and spine position were used to model spine load and stability. An additional seven sat on an exercise ball and chair to examine pressure distribution over the contact area. FINDINGS: There was no difference in muscle activation profiles of each of the 14 muscles between sitting on the stool and ball. Calculated stability and compression values showed sitting on the ball made no difference in mean response values. The contact area of the seat-user interface was greatest on the exercise ball. INTERPRETATION: The results of this study suggest that prolonged sitting on a dynamic, unstable seat surface does not significantly affect the magnitudes of muscle activation, spine posture, spine loads or overall spine stability. Sitting on a ball appears to spread out the contact area possibly resulting in uncomfortable soft tissue compression perhaps explaining the reported discomfort.     

Can we reduce the effort of maintaining a neutral sitting posture? A pilot study

Neutral sitting postures encouraging lumbar lordosis have been recommended in the management of sitting-related low back pain (LBP). However, prolonged lordotic sitting postures can be associated with increased fatigue and discomfort. This pilot study investigated whether changing the type of chair used in sitting can reduce the effort of maintaining a neutral sitting posture. The muscle activation of six trunk muscles was recorded using surface electromyography in 12 painfree participants. Participants were facilitated into a neutral sitting posture for 1 min on both a standard backless office chair and a dynamic, forward-inclined chair (Back App). Lumbar multifidus activity was significantly lower on the Back App chair (p = 0.013). None of the other five trunk muscles measured demonstrated a significant difference in activity between the chairs. There was no significant difference (p = 0.108) in the perceived effort of maintaining the neutral sitting posture on the two chairs. This study suggests that the lumbar multifidus activation required to maintain a neutral sitting posture can be reduced by considering the type of chair used. The mechanism through which the Back App chair reduces lumbar multifidus activation is unclear, but the greatest difference between chairs is the degree of hip flexion. The ability to maintain a neutral lumbar posture with less lumbar multifidus activation is potentially advantageous during prolonged sitting. Further investigations of the effects of chair design on longer duration sitting, and among LBP subjects, are warranted.     

The response of the transverse abdominis and internal oblique muscles to different postures

The purpose of this study was to consider how the deep abdominal muscles responded to alterations in seated stability. The thickness of the right transverse abdominis (TrA) and internal oblique (IO) muscles were measured with ultrasound imaging in 30 healthy human subjects (mean age 27.7, years 22 females) in supine lying, relaxed sitting on a chair with both feet on the ground, relaxed sitting on a gym ball with both feet on the ground and sitting on a gym ball lifting the left foot off the floor. Measurements were taken at the end of both inspiration and expiration. The results showed that muscle thickness expressed as a percentage of the actual muscle thickness in supine lying did not differ between relaxed sitting on a chair and sitting on a gym ball for either muscle (P=0.012-0.054) where Bonferroni corrected P-value for significance=0.002. Raising the foot off the floor produced a significant increase in thickness for TrA and IO, when compared with the other seated postures (P<0.001). It was also found that both muscles were thicker at the end of expiration (P<0.001) which has also been established by other authors. These findings suggest that both deep abdominal muscles respond in the same way to postural changes. It also demonstrates that these muscles are automatically targeted by significantly decreasing the base of support, but in normal subjects sitting on a gym ball is not sufficient to increase their activity.     

The Effect of Respiratory Phase on Abdominal Muscle Activity During Stable and Unstable Sitting Positions in Individuals With and Without Chronic Low Back Pain

ObjectiveThe aim was to assess the abdominal muscle activities during inspiration and expiration at different sitting positions in individuals with and without chronic low back pain (CLBP).MethodsThis study was conducted on 36 participants (18 with CLBP and 18 healthy controls). Ultrasound imaging was used to assess thickness changes of the transverse abdominis, internal oblique, rectus abdominis, and external oblique muscles. Muscle thickness was measured during inspiration and expiration under 3 different stability levels: sitting on a chair, sitting on a gym ball, and sitting on a gym ball with lifting the left foot. The muscle thickness measured in these positions was normalized to the actual muscle thickness at rest in supine lying and presented as a percentage of thickness change.ResultsBoth groups displayed greater abdominal muscle activities as the stability of the surface decreased during both respiratory phases. However, compared with the healthy controls, the CLBP group showed smaller muscle thickness changes in all abdominal muscles, except the external oblique, in both respiration phases while sitting on a gym ball with lifting the left foot. The CLBP group displayed overactivity of the rectus abdominis muscle relative to the healthy controls while sitting on a chair in both respiratory phases.ConclusionThe findings of the study indicate that as the stability of the support surface decreases, individuals with CLBP had more difficulty activating all abdominal muscles in a similar manner compared to healthy controls in both respiratory phases, which might affect both respiration and postural stability.