脑卒中上肢功能常用评价方法及临床应用

脑卒中偏瘫的上肢功能在临床治疗中康复速度慢，结局差，这与上肢承担人体复杂、精细、灵巧的动作有关。而偏瘫手功能的预后能反映脑卒中患者本质的康复。运用偏瘫上肢最初神经缺失的变化预测脑卒中患者的运动功能结局，能使治疗师确定最后的整体康复目标以及选择适合的治疗方案，提高康复效率。所以上肢功能的评定在脑卒中临床康复中占有很重要的地位。     

上肢机器人辅助脑卒中患者上肢功能恢复的效果观察

目的：观察上肢机器人系统对于脑卒中上肢功能障碍训练的疗效观察。方法将60例脑卒中康复期住院患者随机分为治疗组和对照组。两组患者均给予常规康复训练,治疗组增加上肢机器人训练。结果实施上肢机器人训练后,治疗组患者肢体运动功能FMA评分及改良Barthel指数MBI评分指标均优于对照组(P＜0.05)。结论上肢机器人训练能加速肢体功能恢复,提高日常生活活动能力。     

上肢假肢功能评价的新方法

假肢的作用是代偿肢体伤残者所失去的肢体的部分功能,使其恢复一定的生活自理能力和工作能力。为了鉴别假肢的性能,需要建立一套完整的功能评价方法。这对于改进假肢的设计、完善假肢的功能有重要作用。人类下肢的作用主要是站立和行走,因此下肢假肢的功能比较易于特征化,可以用步态     

上肢康复训练系统在脑卒中偏瘫患者上肢功能康复中的应用

目的:观察上肢康复训练系统对脑卒中患者上肢功能康复的临床疗效。方法:脑卒中偏瘫上肢功能障碍患者42例,分为观察组22例和对照组20例。2组患者均接受常规药物治疗和康复训练。观察组在此基础上加用Rejoyce上肢康复训练。治疗前后采用Fugl-Meyer量表上肢部分(FMA-UE)、Rejoyce手功能测试(RAHFT)和功能独立性评定(FIM)评定2组疗效。结果:治疗4周后,2组FMA-UE、RAHFT及FIM评分治疗前后及组间比较均差异无统计学意义;治疗8周后,2组FMA-UE、RAHFT及FIM评分均较治疗前及治疗4周时明显提高(P0.05,0.01),且观察组更高于对照组(P0.05)。结论:Rejoyce上肢康复训练结合常规康复作业治疗能更好地改善脑卒中恢复期患者偏瘫上肢及手的功能,更有效地提高患者日常生活活动能力。     

上肢康复机器人治疗脑卒中患者上肢功能的临床疗效研究

目的观察上肢康复机器人对脑卒中患者上肢功能的康复效果。方法选取2019年12月至2021年8月宁夏第五人民医院康复中心收治的98例脑卒中患者为研究对象,采用随机数字表将受试者随机分为康复机器人组(n=49)及常规康复组(n=49)。所有受试者均接受常规康复治疗,康复机器人组在此基础上增加上肢康复机器人辅助训练。于治疗前、治疗8周后分别进行Fugl-Mayer运动功能量表上肢部分(FMA-UE)评定,改良Barthel指数(MBI)评价两组患者上肢功能及日常生活能力。结果康复机器人组治疗后FMA-UE评分(47.49±7.84)分,常规康复组FMA-UE评分(33.29±9.53)分,康复机器人组治疗后MBI评分(52.49±9.45)分,常规康复组MBI评分(39.81±12.19)分,康复机器人组均高于常规康复组,差异有统计学意义(P<0.05);同时进一步实验分析发现,组间两两比较,康复机器人组肩关节前屈评分、肩关节外展评分、肩关节内旋评分均明显优于常规康复组,差异有统计学意义(P<0.05)。结论在常规功能训练的基础上应用上肢康复机器人辅助训练系统可以明显改善患者的上肢功能,提高日常生活能力。     

上肢康复机器人训练对偏瘫患者上肢功能恢复的影响

摘要 目的：观察上肢康复机器人训练对偏瘫患者上肢功能康复的临床疗效。 方法：将56例偏瘫上肢功能障碍患者按分层随机方法分为治疗组(28例)和对照组(28例),两组均给予常规肢体功能训练,对照组进行运动疗法和作业疗法训练各45min,共90min,每天1次,每周5次,6周共30次。治疗组同样进行运动疗法和作业疗法训练各30min,同时给予上肢康复机器人训练30min,每天1次,每周5次,6周共30次。采用Brunnstorm分期上肢及手功能评定、简化Fugl-Meyer上肢运动功能评分法及改良Barthel指数进行疗效评价,比较两组疗效。 结果：治疗前,两组在Brunnstorm分期上肢及手功能评定比较、Fugl-Meyer上肢运动功能评分比较、改良Barthel指数评定比较差异均无显著性意义(P>0.05),均具有可比性。治疗后,Brunnstorm分期上肢及手功能评定比较：治疗组较治疗前均有明显改善(P<0.01),对照组较治疗前也均有改善(P<0.05),治疗组与对照组相比,治疗组改善均更明显(P<0.01);两组Fugl-Meyer及改良Barthel指数均较治疗前有改善(P<0.05),治疗组均优于对照组(P<0.05)。 结论：上肢康复机器人训练能够有效促进偏瘫患者上肢功能的恢复。     

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。     

500例正常人上肢功能评价初探

500例30～79岁正常人分年龄组进行上肢功能测定,特别是运动速度的测定,结果40～49岁组以下与50～59岁组以上之间存在显著差异;50～59岁组与50～59岁以上各组间亦存在显著差异,说明50岁以后上肢功能退化较快,且随着年龄增加而更明显.     

“运动想像”疗法对脑卒中患者上肢功能恢复的影响：2例报告

目的：探讨“运动想像”疗法对脑卒中后遗症期患者患侧上肢功能恢复的影响。方法：对2例发病9个月的脑卒中后遗症患者进行单病例实验设计，给予14周常规康复训练，分为三个阶段：2周基线期，6周干预期（联合应用“运动想像”疗法）和6周撤消期：采用简易E肢功能评定（STEF）及Fugl—Meyer运动功能评定（FMA）对每阶段治疗前、后进行评测：结果：基线期2例患者STEF及上肢FMA评分无明显变化；联合应用“运动想像”治疗后2例患者STEF评分明显增高（P〈0．001），上肢FMA评分增高但差异无显著性意义；撤消期2例患者STEF仍有增高，但增高幅度小于干预期，其中1例差异有显著性意义（P〈0.05），上肢FMA评分无明显变化。结论：“运动想像”疗法结合常规康复训练有可能促进脑卒中后遗症期患者患侧上肢功能恢复。     

乳腺癌根治性手术后的上肢功能观察

目的 从切口、术式、肩部功能等方面比较乳腺癌根治术后上肢功能的合理处置方法。方法 同一术者6年所做乳腺癌根治性手术157例：改良根治98例，标准根治59例。取Meyer切口11例，取Halsted切口37例，取Stewart切El109例。术后3个月做上肢功能测定比较。结果 （1）Meyer切El上举、外展功能与术前比较，P〈0．01。（2）Halsted切口外旋运动与术前比较，P〉0．05。（3）标准根治术的内收功能在无负重情况下与改良根治术比较，P〉0．05；但在负重时P〈0．05。（4）术后肩部的制动和积液比较：标准根治术和改良根治术后不制动者的引流量及引流天数均几乎为制动者的一倍，但以平均每日引流量计，则二者几乎相等。结论（1）Meyer切口瘢痕挛缩引起上肢功能受限；Halsted切口影响外旋功能．但P〉0．05；Stewart切口与术前相比功能最接近。（2）改良根治术在负重时上肢内收功能明显优于标准根治术（P〈0．05）。（3）术后肩部制动1周有利于减少引流的总量及引流天数，不影响肩功能的最终恢复。     

Guideline for Prescribing Opioids for Chronic Pain

Improving the way opioids are prescribed through clinical practice guidelines can ensure patients have access to safer, more effective chronic pain treatment while reducing the number of people who misuse, abuse, or overdose from these drugs. The Centers for Disease Control and Prevention (CDC) developed and published the Guideline for Prescribing Opioids for Chronic Pain to provide recommendations for the prescribing of opioid pain medication for patients 18 and older in primary care settings. Recommendations focus on the use of opioids in treating chronic pain (pain lasting longer than 3 months or past the time of normal tissue healing) outside of active cancer treatment, palliative care, and end-of-life care.     

Requirements for human antibody cocktails for oncology

Cancer patients receiving antibodies as monotherapy have benefited from these treatments. However, significant improvements can be made that should make the therapy more effective. Applying lessons learned from the natural oligoclonal antibody response that cancer patients mount to their own tumours suggests that cocktails of monoclonal antibodies could be formulated, which may be more effective in treating cancers. The next phase of antibody immunotherapy will include cocktails of monoclonal antibodies. Various requirements for human antibody cocktails are discussed, as well as potential limitations of this approach.     

An Argument for Colloid Resuscitation for Shock

A focused review of the physiologic mechanisms of colloid and crystalloid fluid resuscitations for acute critical illness is presented. This review suggests that postresuscitation plasma volume, cardiac output, left ventricular mechanical performance, and global and microcirculatory O₂ supplies are more favorable with colloid therapy. Conversely, crystalloid may adversely affect microcirculatory blood flow and resultant O₂ supply and use by ischemic tissues in shock. Poor relief of global and regional hypoxia may persist in critically ill patients after resuscitation with crystalloid.     

Challenges for computer-aided diagnosis for CT colonography

Computer-aided diagnosis for computed tomographic colonography is in its infancy but has the potential to improve sensitivity and decrease costs for colonic polyp detection. This article reviews the current state of research in this nascent field and explores major challenges and avenues for future work.     

Recommendations for surveillance priorities for healthcare-associated infections and criteria for their conduct

Surveillance and feedback of results to clinical teams is central to performance improvement in managing healthcare-acquired infections. A major role of the Advisory Committee on Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) is to advise on surveillance priorities. A sub-committee was set up to systematically review existing UK surveillance schemes. The following three systems were examined in detail: mandatory reporting of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia and Clostridium difficile infection to the HPA; surveillance of surgical site infection undertaken by the HPA; and surgical site infection surveillance undertaken at University College London Hospital. Recommendations included the extension of mandatory reporting to include bacteraemia due to Escherichia coli and methicillin-susceptible S. aureus (MSSA), post-discharge surveillance of surgical site infection, the need for validation of surveillance systems and mandatory reporting of Caesarean section wound infections. Mandatory reporting of bacteraemia due to E. coli and MSSA were introduced during 2011 and further extension of surveillance is likely.