进行性假肥大性肌营养不良患者康复现状调查

目的 调查进行性假肥大性肌营养不良(DMD)患者康复情况与需求。 方法 对2018年10月至2022年3月就诊于安徽医科大学武警总医院DMD门诊患者进行基本信息和康复情况问卷调查。 结果 共发放问卷963份,回收有效问卷944份(98.0%)。患者均为男性,年龄5~27岁,平均(9.24±0.184)岁;710例可独立行走;140例定期到专业机构进行康复训练,618例规律进行有氧运动,416例规律进行关节拉伸训练,292例规律使用辅助器具。538例对康复效果不满意,658例存在康复知识获取困难。Logistic回归显示,规律进行康复锻炼的患者丧失独立行走能力的风险下降(OR < 0.61, P < 0.05)。 结论 DMD患者有较为广泛的康复需求,但有氧运动锻炼率、关节拉伸训练率和辅助器具使用率较低,可能影响患者运动功能和生活质量。     

智能牵伸改善脑卒中偏瘫患者踝关节痉挛及步行功能的应用研究

目的：探讨机器人辅助智能牵伸技术在改善脑卒中患者踝关节痉挛及步行功能方面的疗效。方法：将脑卒中患者40例,随机分为智能牵伸组和对照组各20例。在常规康复训练基础上,智能牵伸组进行智能被动牵伸和主动训练,对照组接受徒手牵伸和抗阻训练,训练均为30min/d,5d/周,共6周。治疗前后评估：踝关节主动和被动背伸及跖屈角度、改良Ashworth量表（MAS）、起立-行走计时试验（TUGT）、6min步行距离测试（6MWT）、改良Barthel指数（MBI）。结果：治疗6周后,2组主动和被动跖屈角度、被动背伸角度、6MWT均较治疗前增加（P＜0.05）,智能牵伸组主动背伸、跖屈角度、MAS、TUGT、6MWT改善程度优于对照组（P＜0.05）。结论：机器人辅助智能牵伸技术能改善脑卒中患者踝关节痉挛及步行功能,优于常规牵伸治疗。     

小腿三头肌低强度离心收缩与跟腱牵伸训练治疗跟腱挛缩的疗效对比研究

目的:对比常规康复基础上分别辅以小腿三头肌低强度离心收缩训练或跟腱牵伸训练对制动引起的跟腱挛缩的影响。方法:选取踝关节骨折后制动引起跟腱挛缩的患者40例,随机将患者分为牵伸组和离心组,每组20例。2组均接受常规康复治疗,牵伸组在常规治疗基础上增加站斜板训练,离心组在常规治疗基础上增加小腿三头肌低强度离心收缩训练。比较治疗前和治疗8周后,2组患者的踝关节背伸活动度(ROM)、美国矫形外科足踝协会踝-后足评分(AOFAS)、疼痛视觉模拟评分(VAS)和闭眼单腿站立时间。结果:治疗后,2组患者踝关节背伸活动度、AOFAS评分、闭眼单腿站立时间较治疗前均明显提高(均P<0.05),VAS评分均降低(均P<0.05)。离心组的踝关节背伸活动度、AOFAS评分和闭眼单腿站立时间均较牵伸组提高更明显(均P<0.05),2组治疗后VAS评分比较差异无统计学意义。结论:常规康复方案辅以小腿三头肌低强度离心收缩训练治疗制动引起的跟腱挛缩疗效优于辅以跟腱牵伸训练。     

康复护理在创伤性脊髓损伤并发肢体肌痉挛患者中的应用

目的:探讨康复护理在创伤性脊髓损伤并发四肢肌痉挛患者中的应用方法及效果。方法:将68例颈、胸段脊髓损伤患者随机分为康复组和对照组各34例,康复组采用早期综合康复护理方法,包括正确肢体摆放、关节ROM运动、牵张训练等;对照组采用骨科常规护理措施。在护理前及护理后1、2个月对两组患者采用改良Ashwoorth评分法进行肢体肌痉挛程度及护理期间并发症发生情况评定。结果:康复组并发症发生情况少于对照组,康复组护理后痉挛评分明显低于护理前及对照组护理后(P0.01),康复组护理有效率明显高于对照组(P0.01)。结论:对创伤性脊髓损伤并发四肢肌痉挛患者实施综合康复护理能有效减轻或缓解肌痉挛,促进患者康复。     

膝关节挛缩的康复预防与治疗

本文介绍了膝关节损伤至关节强直的生物力学机制和病理学基础 ;创伤后膝关节挛缩康复早期介入时机和主要康复治疗手段 (连续被动运动、恒力持续牵引法 ,静态进展伸展法 ) ;分析了各种治疗手段和生物力学机理     

改良牵伸康复方案治疗下肢骨折后膝关节僵硬临床研究

目的：探讨改良牵伸康复方案对下肢骨折后膝关节僵硬患者关节活动度及功能状态的影响。方法：回顾性纳入我院2018年1月-2020年3月收治下肢骨折后膝关节僵硬患者共146例,根据康复方案差异分组,其中采用常规康复干预治疗患者共86例（对照组）,在此基础上加用改良牵伸康复方案治疗患者共60例（观察组）;比较2组治疗前后膝关节主动活动度、HSS评分及近期疗效。结果：2组治疗后较治疗前膝关节主动活动度和HSS评分均显著增加（P<0.05）,且观察组显著高于对照组（P<0.05）;观察组近期治疗显效率显著高于对照组（P<0.05）。结论：改良牵伸康复方案用于下肢骨折后膝关节僵硬患者可有效缓解临床症状,提高关节活动度,并有助于改善关节功能状态。     

SPR术后康复治疗对痉挛性脑瘫患儿运动功能的影响

目的：探讨脑瘫ＳＰＲ术后的运动功能康复效果。方法：收集自１９９６年１２月到１９９７年１０月在我院显微外科手术的痉挛性脑瘫患者共２０例。训练方法以Ｂｏｂａｔｈ法为基础,加上作业治疗。结果：手术后与康复训练后之间的肌力改变统计结果有显著差异（Ｐ＜０．０５）。手术前、手术后与康复治疗后三者之间关节活动度改变在统计学上都有显著性差异（Ｐ＜０．０５）。１８例随诊显示坐位、直跪及站立姿势均有明显改善。结论：针对术后解除痉挛,康复治疗应着重加强肌力训练,牵伸挛缩,并按照正常的生理发育过程,培养正确的姿势控制,抑制异常的运动模式,逐渐建立正常的运动模式     

Eastern movement therapies.

Tai chi, qigong, and yoga represent a class of exercise that differs from the routine strengthening and stretching programs currently employed in physical medicine. These techniques incorporate a "mind-body" approach to the rehabilitation of disorders commonly seen by physical medicine and rehabilitation clinicians. Research into the efficacy of these techniques clearly is in the beginning stages. What little has been conducted thus far is promising. These methods may serve to add valuable contributions to the continuity of care of ambulatory and non-ambulatory patients.     

The effect of prolonged static and cyclic stretching on ankle joint stiffness,torque relaxation,and gait in people with stroke

BACKGROUND AND PURPOSE: Continuous passive motion (cyclic stretching applied to the subject's limb) has been used for the rehabilitation of some orthopedic impairments; however, few researchers have considered its application in the management of neurological disorders such as stroke. The purpose of this study was to examine the short-term effects of prolonged static and cyclic calf stretching on passive ankle joint stiffness, torque relaxation, and gait in people with ischemic stroke. SUBJECTS: Ten community-dwelling people (mean age=64.6 years, SD=8.76, range=53-76) who were diagnosed with a cerebrovascular accident volunteered to be subjects. METHODS: Participants engaged in one 30-minute static stretch and one 30-minute cyclic stretch of the calf muscle, using an isokinetic dynamometer that also collected torque and angle measurements. Before and after treatments, 10-m walking times were collected. Ankle joint stiffness was calculated from the slope of the torque and angle curves before and immediately after treatments, and torque relaxation was calculated as the percentage of decrease in peak passive torque over the 30-minute stretch durations. RESULTS: Ankle joint stiffness decreased by 35% and 30% after the static and cyclic stretches, respectively. Stiffness values and 10-m walk times were not different between conditions. The amount of torque relaxation was 53% greater for static stretching than for cyclic stretching. DISCUSSION AND CONCLUSION: These preliminary data from a very small sample of people with stroke indicate that ankle joint stiffness decreases after both prolonged static and cyclic stretches; however, neither technique appears to be better at reducing stiffness in people with stroke. Torque relaxation is greater after static stretching than after cyclic stretching, and walking speed does not appear to be influenced by the stretching treatments used in our study.     

Agility and perturbation training for a physically active individual with knee osteoarthritis

BACKGROUND AND PURPOSE: People with knee osteoarthritis (OA) sometimes report episodes of knee instability that limit their activities of daily living. The episodes of instability are similar to those reported by people with knee ligament injuries. The authors believe that modifications of interventions that are used to promote knee stability in individuals with knee ligament injuries can be used to enhance knee stability and function in people with knee OA. The purpose of this case report is to describe the development and implementation of an agility and perturbation training program that was used in conjunction with traditional rehabilitation activities for a patient with knee OA. CASE DESCRIPTION: The patient was a 73-year-old woman with a diagnosis of bilateral knee OA. Her chief complaints were knee pain and episodes of partial "giving way" at the knee during walking, stair climbing, and participation in tennis and golf. The patient participated in 12 treatment sessions at a frequency of 2 visits per week. The rehabilitation program consisted of lower-extremity stretching, strengthening and endurance exercises that were supplemented with a variety of walking-based agility training techniques, and perturbation training techniques. OUTCOME: At the completion of rehabilitation, the patient was able to walk on level surfaces and stairs and return to playing golf and tennis without episodes of instability and with reduced pain. DISCUSSION: Supplementing rehabilitation programs for people with knee OA with a modified agility and perturbation training program may assist them in returning to higher levels of physical activity with less pain and instability following rehabilitation. Further research is needed to determine the role of agility and perturbation training in people with knee OA.     

阶梯性康复训练联合持续静态牵伸技术对肘关节骨折患者术后关节功能恢复及预后的影响

目的:探讨阶梯性康复训练联合持续静态牵伸技术对肘关节骨折患者术后关节功能恢复及预后的影响。方法:选择160例肘关节骨折患者作为研究对象,随机分为对照组和观察组,各80例。2组患者均给予骨折切开复位内固定手术治疗,对照组患者术后给予持续静态牵伸技术训练,观察组患者在上述治疗的基础上外加阶梯性康复训练。比较2组患者治疗前、治疗3个月后肘关节功能、肘关节主动活动度及肿胀评分及日常生活能力评分变化,分析2组患者骨折愈合时间、并发症及治疗满意度差异。结果:与治疗前相比,2组患者治疗后日常生活、疼痛、运动功能及肘关节功能和日常生活能力评分总分均明显升高,肿胀评分明显降低,且观察组患者治疗后上述评分改善更为显著(P<0.05)。观察组患者的骨折愈合时间明显低于对照组(P<0.05),肘关节主动活动度康复效果明显高于对照组(P<0.05)。结论:阶梯性康复训练联合持续静态牵伸技术治疗肘关节骨折术后患者,可以明显改善其肘关节功能,降低骨折愈合时间,提高预后生活质量,具有一定的临床应用价值。     

兔屈趾肌腱机械牵伸的研究

测定兔屈趾肌腱的粘弹性,观察不同测试条件下肌腱组织塑性变形、绥弹性变形和急弹性变形的变化。结果表明:较大载荷下肌腱的塑性变形和急弹性变形明显增加;在恒定载荷下,随持续拉伸时间延长或温度升高,肌腱的塑性变形明显增加。本研究结果对于临床上有效地牵伸挛缩、粘连的胶原组织,提高关节活动度的康复治疗的疗效提供了参考依据。     

延续护理在舌癌术后患者康复中的应用与效果

目的探讨延续护理对舌癌术后患者舌部运动功能康复的影响。方法选择2010年1月至2013年2月在我科住院手术的舌癌患者26例,根据患者舌部活动度的恢复情况,通过延续护理服务,全面指导患者的舌部运动功能训练,制订切实可行的训练计划,促进患者舌的伸展性和活动度的恢复。结果 26例患者执行舌部活动度的训练计划后,伸舌受限度明显改善,术后1个月总有效率为23.08%,术后2个月总有效率为57.69%。结论延续护理可促进舌癌术后患者舌部运动功能的康复。     

Effects of home strength training and stretching versus stretching alone after lumbar disk surgery: a randomized study with a 1-year follow-up

OBJECTIVE: To assess the adherence to and effects of a 12-month combined strength and stretching home exercise regimen versus stretching alone, on patient outcome after lumbar disk surgery. DESIGN: Randomized controlled trial. SETTING: Departments of physical medicine and rehabilitation and orthopedics at a Finnish hospital. PARTICIPANTS: Patients (N=126) were randomized into either a combined strength training and stretching group (STG, n=65) or a control group (CG, n=61). INTERVENTION: The STG was instructed to perform strength training and both the STG and CG were instructed in the same stretching and stabilization exercises for 12 months. MAIN OUTCOME MEASURES: Pain on the visual analog scale (VAS), the Oswestry and the Million disability indexes, isometric and dynamic trunk muscle strength, mobility in the lumbar spine, and straight-leg raising were measured. RESULTS: The trial was completed by 71% and 77% of the patients from the STG and the CG, respectively. The mean strength training frequency decreased from 1.5 to 0.6 times a week in the STG during the intervention. The mean stretching frequency decreased from 3.7 to 1.6 times a week in both groups. Median back and leg pain varied between 17 and 23 mm (VAS), and the Million and Oswestry indices varied between 14 and 23 points 2 months postoperatively. No statistically significant changes took place in these outcome measures during the 12-month follow-up in both groups. The changes in isometric trunk extension favored the STG ( P =.016) during the first 2 months. However, during the whole 12-month training period, both dynamic and isometric back extension and flexion strength, as well as mobility of the spine and repetitive squat-test results, improved significantly in both groups, and no differences were found in any of the physical function parameters between the STG and CG. CONCLUSIONS: At the 12-month follow-up, no statistically significant changes were found in the physical function, pain, or disability measures between the groups. In the STG, training adherence with regard to training frequency and intensity remained too low to lead to specific training-induced adaptations in the neuromuscular system. Progressive loading, supervision of training, and psychosocial support is needed in long-term rehabilitation programs to maintain patient motivation.     

1例偏瘫患者康复训练前后视觉指令食指伸屈运动脑磁图分析

目的观察偏瘫患者恢复期康复训练前后双手食指伸屈运动过程中脑磁图（MEG）变化。方法对1例偏瘫患者应用MEG记录双手食指伸屈运动时的脑电磁波并与MRI叠加形成磁源性影像（MSI）,对比康复训练前后MEG变化。结果两次MEG检测右侧半球皮质均无运动诱发出脑磁反应,左侧半球均有运动诱发反应;第1次和第2次潜伏期分别为-34.2ms和-61.7ms,部位向内前下移位,MSI显示兴奋的皮质位于中央前回,第2次激活的脑皮质体积（9569.6m3）明显大于第1次（2309.7m3）;第1次食指运动未诱发右半球体感反应;第2次食指运动诱发了右半球的体感反应,潜伏期为91.1ms,MSI显示兴奋的皮质位于中央后回。结论脑卒中患者皮质感觉功能先于运动功能恢复,未损半球经康复训练后功能明显增强。     

Active muscular relaxation techniques. Part II: Clinical application

Both muscular and articular factors play a significant role in the functional pathology of the motor system. Concepts of muscle imbalance, altered movement patterns, and the relationship between joint and muscle dysfunction are explained. Chiropractic rehabilitation involves treatment of muscles, joints and the nervous system. The sequential timing of adjustments, muscle relaxation, stretching and strengthening techniques are discussed. The importance of re-educating abnormal sensory-motor pathways is also emphasized.     

Osteoarthritis of the sacroiliac joint complicating resection of the pubic symphysis. Interest of a rehabilitation programme

Sacroiliac joint (SIJ) is an uncommon localisation of osteoarthritis. Instability of this joint is one of rare aetiologies. It can occur after resection of the pubic symphysis for whatever the reason. The biomechanical consequences on the SIJ are increasing shear forces and vertical restrain. This leads to secondary progressive SIJ osteoarthritis. There is no specific rehabilitation programme for this pathology. Here, we report the case of a patient who presents SIJ osteoarthritis 20 years after surgical resection of the pubic symphysis for osteochondroma. We proposed a rehabilitation programme based on the pelvic biomechanical characteristics. It included specific exercises of muscular strengthening (the transversely oriented abdominal muscles and pelvic floor muscles) and muscular stretching (the psoas major muscle). We obtained an improvement of pain and functional capacity in our patient.     

Repeated passive stretching: acute effect on the passive muscle moment and extensibility of short hamstrings

OBJECTIVE: To examine the response of short hamstring muscles to repeated passive stretching. DESIGN: A repeated measures design. SETTING: A university laboratory for human movement analysis in a department of rehabilitation. SUBJECTS: Students (7 men, 10 women) from the Department of Human Movement Sciences. MAIN OUTCOME MEASURES: The lift force, range of motion, pelvic-femoral angle, first sensation of pain, and electromyogram of the hamstrings were measured. RESULTS: Comparison of the data of the test group (n = 17) after five successive passive stretch tests by means of an instrumental straight-leg raising test showed no significant change of the variables passive muscle stiffness and extensibility (p>.05). CONCLUSION: The acute effect of repeated passive stretching of short hamstring muscles is negligible. With an instrumental straight-leg raising test, the relevant muscle variables can be examined noninvasively.     

脊髓损伤后居家康复的研究进展

居家康复可以有效减少脊髓损伤患者的临床并发症,加快患者的神经功能恢复,减轻医疗保健系统的负担。居家康复在多个研究中表现出有效性,应用神经反馈可使40%脊髓损伤居家患者的神经病理性疼痛得到缓解;应用可穿戴技术可监测手功能恢复情况并促进手运动功能的恢复;家用便携式刺激器和表面电极可抑制不必要的膀胱活动,改善尿失禁;在家进行加强伸展训练可以减轻慢性脊髓损伤患者的肩部疼痛;家中使用功能性电刺激可以改善脊髓损伤患者因失去神经营养而萎缩的肌肉功能。居家康复还存在一定局限性,如设备操作复杂、费用昂贵、不易携带,还有待进一步发展。     

Non-pharmacological interventions for spasticity in adults: An overview of systematic reviews

ObjectivesSpasticity causes significant long-term disability-burden, requiring comprehensive management. This review evaluates evidence from published systematic reviews of clinical trials for effectiveness of non-pharmacological interventions for improved spasticity outcomes.MethodsData sources: a literature search was conducted using medical and health science electronic (MEDLINE, EMBASE, CINAHL, PubMed, and the Cochrane Library) databases for published systematic reviews up to 15th June 2017. Data extraction and synthesis: two reviewers applied inclusion criteria to select potential systematic reviews, independently extracted data for methodological quality using Assessment of Multiple Systematic Reviews (AMSTAR). Quality of evidence was critically appraised with Grades of Recommendation, Assessment, Development and Evaluation (GRADE).ResultsOverall 18 systematic reviews were evaluated for evidence for a range of non-pharmacological interventions currently used in managing spasticity in various neurological conditions. There is “moderate” evidence for electro-neuromuscular stimulation and acupuncture as an adjunct therapy to conventional routine care (pharmacological and rehabilitation) in persons following stroke. “Low” quality evidence for rehabilitation programs targeting spasticity (such as induced movement therapy, stretching, dynamic elbow-splinting, occupational therapy) in stroke and other neurological conditions; extracorporeal shock-wave therapy in brain injury; transcranial direct current stimulation in stroke; transcranial magnetic stimulation and transcutaneous electrical nerve stimulation for other neurological conditions; physical activity programs and repetitive magnetic stimulation in persons with MS, vibration therapy for SCI and stretching for other neurological condition. For other interventions, evidence was inconclusive.ConclusionsDespite the available range of non-pharmacological interventions for spasticity, there is lack of high-quality evidence for many modalities. Further research is needed to judge the effect with appropriate study designs, timing and intensity of modalities, and associate costs of these interventions.