上肢功能评定量表对脑卒中偏瘫患者上肢功能评价的信效度研究

目的 探讨上肢功能评定量表评定脑卒中偏瘫患者上肢功能的信度和效度.方法 采用上肢功能评定量表、Fugl-Meyer量表上肢部分和Barthel指数,对35例脑卒中偏瘫患者相隔2周进行2次评定,分析上肢功能评定量表、Fugl-Meyer量表上肢部分、Barthel指数评定结果,并验证上肢功能评定量表的标准效度;采用探索性因子分析方法,验证上肢功能评定量表的结构效度;分析2次上肢功能评定量表的评定结果,验证上肢功能评定量表的重测信度和评价者间信度.结果 上肢功能评定量表的重测结果和组间结果高度相关,其重测组内相关系数在0.884以上,组间相关系数在0.965以上.两位评价者上肢功能评定量表评定结果与Fugl-Meyer量表上肢部分和Barthel指数总分具有高度相关性,r值分别在-0.918和-0.771以上.通过条目筛选和探索性因子分析,共得出4个公因子.结论 上肢功能评定量表具有较好的信度和效度,可以用于脑卒中偏瘫患者上肢功能的评定.     

侧卧位血压变化的研究

目的 观察侧卧位时左右臂血压的变化.方法 随机抽取50人进行平卧、左侧卧、右侧卧双上肢血压测量,对数据进行统计学处理.结果 侧卧位双上肢血压有明显差异;平卧位双上肢血压无明显差异;左侧卧左上肢、右侧卧右上肢的收缩压与平卧位双上肢收缩压无明显差异.结论 患者不得不侧卧位时,测血压应测位于下方的上肢,并标明体位及肢体.     

侧卧位血压变化的研究

目的观察侧卧位时左右臂血压的变化。方法随机抽取50人进行平卧、左侧卧、右侧卧双上肢血压测量,对数据进行统计学处理。结果侧卧位双上肢血压有明显差异;平卧位双上肢血压无明显差异;左侧卧左上肢、右侧卧右上肢的收缩压与平卧位双上肢收缩压无明显差异。结论患者不得不侧卧位时,测血压应测位于下方的上肢,并标明体位及肢体。     

上肢机器人在脑卒中上肢本体感觉评估中应用的研究进展

本体感觉障碍在脑卒中患者中十分常见但易被忽视,本体感觉障碍可加重患者的上肢运动障碍,并影响运动功能预后。本文从脑卒中上肢本体感觉障碍、临床采用的简易和成套评估工具以及机器人评估等方面,对上肢机器人在脑卒中上肢本体感觉评估中应用的研究进展进行综述,旨在为上肢机器人在脑卒中上肢本体感觉的评估提供参考依据。     

上肢康复机器人在脑卒中的临床应用进展

脑卒中是导致上肢功能障碍的重要原因,上肢康复机器人可弥补目前脑卒中康复训练的部分缺陷。本文简述上肢康复机器人的发展和理论基础。目前上肢康复机器人主要以大剂量、高重复的方式提供特定任务训练,提高偏瘫患者上肢肌力,促进运动分离,但对减少上肢痉挛和提高日常生活能力作用尚不明确。上肢康复机器人训练与一些康复手段相结合,效果更佳。虽然上肢康复机器人具有无疲劳、定量化、个体化、客观评价等优点,但也存在训练不具有整体性、不能纠正代偿动作、无同理心等缺点。目前上肢康复机器人缺乏大样本高质量临床研究,治疗频率和时间尚无统一标准。     

健侧代偿对偏瘫患者上肢恢复的影响

目的研究健侧代偿对偏瘫患者上肢恢复的影响。方法对49例颅脑损伤所致四肢瘫和偏瘫患者的患侧上肢按同样的康复训练课程和技术治疗后,比较四肢瘫和偏瘫之间在患侧上肢运动功能的恢复和减轻肌挛程度方面的差异。结果在运动功能和肌痉挛程度改善方面,四肢瘫双上肢都远较偏瘫患侧上肢好。分析其原因可能为偏瘫患上肢受到健侧上肢代偿的不良影响,造成习惯性弃用所致。结论健侧代偿是影响偏瘫患侧上肢功能恢复的重要因素。     

运动功能状态量表效度研究

目的研究运动功能状态量表（MSS）与上肢Fugl-Meyer运动功能评定量表（FMA）的效度。方法对22例脑外伤和脑卒中患者的上肢运动功能进行MSS与上肢FMA的效度比较研究。结果MSS与上肢FMA高度相关，Pearson相关系数为0．961（P〈0．01）。结论MSS反映脑损伤后上肢运动功能有很好的有效性，可做为脑损伤上肢康复的评定指标。     

基于上肢康复机器人的任务导向性训练对急性期脑卒中患者上肢本体感觉功能的影响

正脑卒中患者约有50%存在偏瘫上肢本体感觉下降或缺失[1],本体感觉障碍是制约患者上肢运动功能恢复的重要因素之一[2],影响进食、穿衣、修饰等以上肢功能为主的日常生活活动能力。较多临床研究表明[3—5],上肢康复机器人对脑卒中患者偏瘫上肢运动功能有明显改善作用,然而,罕有上肢机器人对脑卒中患者偏瘫上肢本体感觉功能影响的报道。本研究观察了基于上肢康复机器人的任务导向性训练对急性期脑卒中患者偏瘫上肢本体感觉功能恢复的作用,并对治疗前后患者的日常生活活动能力等相关因素进行分析,探讨上肢康复机器人对急性期脑卒中患者偏瘫上肢本体感觉功能康复的影响。     

脑卒中患者上肢功能障碍的预后因素分析

脑卒中患者上肢功能障碍发病率呈逐年上升趋势,发病后严重影响患者的日常生活活动能力和生存质量,对脑卒中上肢功能障碍患者进行系统康复训练能明显改善上肢运动功能[1],但国内对影响脑卒中患者上肢功能障碍预后的因素研究较少,本研究拟通过收集脑卒中上肢功能障碍患者相关资料,对影响脑卒中上肢功能障碍预后的相关因素进行分析研究,进而探讨影响脑卒中患者上肢功能障碍预后主要因素,为制订脑卒中患者上肢功能的恢复方案提供科学依据.     

上肢运动操改善乳腺癌淋巴水肿患者上肢功能的效果观察

目的探讨上肢运动操改善乳腺癌术后淋巴水肿患者上肢功能的效果。方法选取52例乳腺癌术后淋巴水肿行压迫治疗的患者,采用自编的上肢运动操指导患者进行上肢锻炼,运动操包括手指、肘部及肩关节的运动以及联合器具的锻练,在锻炼的同时绑定胸式呼吸训练。比较干预前后患者上肢功能和淋巴水肿的程度。结果干预后上肢功能评定得分下降(t=3.771,P0.001);干预后1例重度水肿减轻至中度,9例中度水肿减轻至轻度。结论运用上肢运动操,可能改善乳腺癌术后淋巴水肿患者行压迫治疗期间的上肢功能,并利于水肿缓解。     

Impact of upper limb complex regional pain syndrome type 1 on everyday life measured with a novel upper limb-activity monitor

Complex regional pain syndrome type 1 (CRPS1) often leads to serious activity limitations in everyday life. To date, however, limitations in patients with CRPS1 of an upper limb have not been objectively measured.Therefore, the aim of this study was to determine the long-term impact of upper limb CRPS1 on general mobility and upper limb usage during everyday life, as measured with a novel upper limb-activity monitor (ULAM). In ten female chronic CRPS1 patients and ten healthy control subjects, 24-h activity patterns were measured with the ULAM. This ULAM consists of body-fixed acceleration sensors, connected to a recorder worn around the waist. The ULAM automatically detects upper limb activity during mobility-related activities. Several outcome measures related to general mobility and upper limb usage were compared between patients and controls. The results showed that CRPSI in the dominant upper limb had modest impact on general mobility; i.e. on the percentages spent in body positions and body motions and on mean intensity of body activity. For upper limb usage outcome measures during sitting, there was a marked difference between CRPS1 patients and controls. Especially patients with dominant side involvement clearly showed less activity of their involved limb during sitting, indicated by significant differences for the mean intensity (P=0.014), percentage (P=0.004), and proportion (P=0.032) of upper limb activity. It is concluded that these ten chronic CRPS1 patients still had limitations in upper limb usage during everyday life, 3.7 years (average) after the causative event.     

沈阳地区青少年上肢长的生长发育特征

目的了解沈阳地区青少年上肢长的生长发育规律。方法采用邵象清的人体测量方法,调查了沈阳地区7～17岁的1134名(男551名,女583名)青少年的上肢长,并与上海及大连的资料进行了比较。结果沈阳青少年的上肢长随年龄的增长而增长,上肢长/身高指数男性从15岁,女性从13岁以后呈递减趋势。在7～12岁年龄组,男、女性上肢长/身高指数沈阳地区均小于上海地区,与大连地区比较无显著差异。结论上肢长有明显的性别差和地区差,且生长发育有随年龄增长而增长的规律性。亦可能与体育锻炼有关。     

What is the functional outcome for the upper limb after stroke?

The Motor Assessment Scale (MAS) and the Functional Independence Measure (FIM) are commonly used in Australian rehabilitation centres but there have been few systematic studies using them to measure recovery after stroke, especially with regard to upper limb function. The aims of this study were to provide a profile of upper limb recovery in a non-surgical stroke population using measures of impairment and disability. The records of 153 subjects were audited for upper limb MAS sub-scores, the FIM sub-score for upper body dressing, and the total FIM score at admission and discharge from rehabilitation. Significant improvement occurred for all outcome measures. There was no relationship between the MAS scores and the functional task of upper body dressing. The results emphasize the importance of using outcome measures that assess both impairment and disability, and indicate that substantial improvements in upper limb function frequently occur after stroke. Although the MAS has limitations, it is a valuable tool for measuring upper limb outcome after stroke because it provides a more accurate profile of true upper limb recovery than the FIM.     

康复机器人训练对脑卒中偏瘫患者上肢功能的影响

目的:探讨上肢康复机器人训练结合常规康复治疗对脑卒中偏瘫患者上肢功能的影响。方法:80例脑梗死患者随机分为2组,均接受基础药物治疗和常规康复治疗;观察组增加上肢康复机器人训练。治疗前后分别进行上肢肌张力改良Ashworth量表(MAS)评分、上肢运动功能(FMA)评分及改良Barthel指数(MBI)评定。结果:治疗1个月后,2组患者上肢MAS评分均较治疗前明显下降(P<0.05),且观察组更低于对照组(P<0.05);FMA及改良Barthel指数(MBI)评分均较治疗前明显提高(P<0.05),且观察组较对照组更加显著(P<0.05)。结论:上肢康复机器人训练结合常规康复治疗不仅能改善脑梗死患者上肢功能,而且能促进日常生活活动能力的恢复。     

压力衣治疗对乳腺癌术后上肢淋巴水肿的影响

目的:观察压力衣佩戴治疗对乳腺癌术后并发上肢淋巴水肿患者的长期疗效和对上肢功能的影响。方法:60例乳腺癌术后并发上肢淋巴水肿的患者随机分为2组各30例。观察组患者穿戴治疗师为其量身订制的压力衣进行治疗,每天佩戴时间不少于23h,同时在治疗师或护士指导下在家中进行上肢的向心性按摩及功能锻练;对照组患者只在治疗师或护士指导下在家中进行上肢的向心性按摩及功能锻练。分别在治疗前和治疗6个月后采用上肢淋巴水肿程度分级和上肢功能指数(UEFI)评分进行评估。结果:治疗6个月后,观察组水肿程度较治疗前及对照组均有下降(P0.01,0.05),对照组治疗前后差异无统计学意义。治疗后,2组UEFI评分均较治疗前明显提高(P0.01),且观察组优于对照组(P0.01)。结论:长期佩戴压力衣可明显减轻乳腺癌术后上肢淋巴水肿程度,并更有利于上肢功能的恢复。     

动脉搏动消失法在气囊止血带有效压测定中的应用

目的 探讨动脉搏动消失法在气囊止血带有效压测定中的应用。方法 选择骨科四肢手术患者152例，将上肢和下肢患者分层抽样，再简单随机分组。观察组的充气压力：上肢为桡动脉搏动消失的压力加2～3kPa，下肢为足背动脉搏动消失的压力加3～5kPa；对照组的充气压力：采用气囊止血带使用说明书上提示的数值，上肢为25～30kPa，下肢为40～50kPa。结果 观察组患者上肢、下肢及对照组患者下肢的止血效果满意，对照组上肢的止血效果不满意；观察组与对照组的止血带副损伤比较，差异有统计学意义。结论 动脉搏动消失法可用于气囊止血带有效压的测定。     

充气夹板结合渐进性上肢运动训练对脑卒中偏瘫患者上肢功能及日常生活活动的影响

目的:观察充气夹板结合渐进性上肢运动训练对脑卒中偏瘫患者上肢功能及日常生活活动的影响。方法:40例脑卒中偏瘫患者随机分为对照组和观察组各20例,2组患者均给予常规康复治疗,对照组再行渐进性上肢运动训练,观察组在常规康复治疗上用充气夹板控制上肢各关节活动的自由度进行渐进性上肢运动训练。在治疗前和治疗6周后,采用Fugl-Meyer上肢运动功能量表(FMA-UE)、运动力指数(MI)及Barthel指数(BI)进行评估。结果:治疗6周后,2组FMA-UE、MI及BI评分较治疗前均明显提高(均P<0.05),且观察组以上评分均更高于对照组(均P<0.05)。结论:充气夹板结合渐进性上肢运动训练能提高脑卒中偏瘫患者上肢运动功能,改善日常生活活动。     

上肢神经损伤患者功能恢复的动态评估与干预

目的 通过上肢神经损伤患者功能恢复的动态评估与干预促进患肢功能恢复.方法运用上肢功能评定表(Disability of Arm-Shoulder-Hand,DASH),对36例上肢神经损伤患者在术后第1天、术后8周每周末、3个月末、6个月末、12个月末进行上肢功能评估,术后8周根据评估的DASH值水平进行相应护理干预,以后继续评估,跟踪调查患肢功能恢复的程度.结果本组DASH评分在3个月末为37.59±2.04,6个月末为22.56±2.07,12个月末为4.30±3.50,32例治愈,4例好转,治愈率为88.89％.结论应用DASH评定表对上肢神经损伤患者进行动态评估和及时的护理干预,促进了患者的上肢功能恢复.     

Effect of force-feedback treatments in patients with chronic motor deficits after a stroke

OBJECTIVE: To assess the effects a motor reeducation approach based on static dynamometers used to provide feedback on the force produced. DESIGN: The study design was a single-blind, randomized, controlled trial. Chronic stroke subjects participated in a 6-wk, thrice-weekly, force-feedback program of either the upper paretic limb (n = 13) or the lower paretic limb (n = 12). Baseline and postintervention assessments of the performance of both the upper and the lower limb were measured for each subject, the untreated paretic limb of each group serving as a control for the other group. RESULTS: With the exception of the handgrip force, strength measurements of the treated limb increased after completion of the treatment. The outcome measurements of the upper limb of the subjects included in the upper paretic limb were not significantly different after treatment from those measured in the lower paretic limb. In contrast, gait velocity and the distance walked in 2 min increased after treatment in the lower paretic limb as compared with the upper paretic limb, whereas the scores in the Fugl-Meyer test for the lower limb and the timed up-and-go test did not increase for either group after treatment. CONCLUSION: The results indicate that treatment of the lower limb based on force feedback produces an improvement of gait velocity.