A型肉毒毒素矫正脑卒中后中枢性面瘫的疗效

目的观察肉毒毒素健侧面肌注射矫正脑卒中后患者患侧中枢性面瘫的效果。方法30例脑卒中后中枢性面瘫的患者分为治疗组和对照组。对照组给予面肌运动训练,治疗组在此基础上,依据病情选择健侧面肌进行A型肉毒毒素注射。注射前、注射后4周测定嘴角至门齿中缝的双侧距离差(D1)、眼骨性外眦到嘴角的双侧距离差(D2)。结果治疗后,治疗组静态、动态D1、D2均较治疗前减小(P<0.05),且较对照组减小(P<0.05)。结论 A型肉毒毒素注射能进一步矫正中枢性面瘫。     

肌内效贴治疗中枢性面瘫疗效研究

目的:观察肌内效贴治疗中枢性面瘫的临床疗效。方法:将60例中枢性面瘫患者随机分为对照组和观察组,每组30例。对照组采用低频脉冲电刺激结合面肌功能训练等常规治疗,观察组在对照组基础上联合肌内效贴扎治疗,治疗2周后采用House-Brackmann(H-B)面神经功能分级量表及面部残疾指数(FDI)评估2组的临床效果。结果:治疗后,观察组H-B分级、FDIp和FDIs与治疗前比较均明显改善(均P0.05);常规治疗组FDIp、FDIs与治疗前比较明显改善(均P0.05),2组治疗后比较,观察组H-B分级和FDIp、FDIs均优于对照组(均P0.05)。2组治疗后疗效比较,观察组总有效率明显高于对照组(P0.01)。结论:肌内效贴治疗中枢性面瘫有效,为中枢性面瘫治疗提供了一种新的治疗方法。     

牵正复瘫汤联合面肌训练、电针刺激治疗周围性面瘫的疗效

目的:分析牵正复瘫汤联合面肌训练、电针刺激治疗周围性面瘫的疗效。方法:选取2018年1月～2019年7月周围性面瘫患者78例为研究对象,依照随机数字表法分为参照组和实验组各39例,参照组予以面肌训练、电针刺激联合治疗,实验组予以面肌训练、电针刺激、牵正复瘫汤联合治疗。对比两组疗效、面神经功能分级评分、面部对称评分及面瘫症状评分。结果:实验组总有效率为97.44%,高于参照组的79.49%(P0.05);治疗后,实验组口眼、鼓腮、鼻唇沟、额纹评分高于参照组(P0.05);治疗后,实验组面部对称评分高于参照组,面神经功能分级评分低于参照组(P0.05)。结论:牵正复瘫汤、面肌训练、电针刺激联合治疗周围性面瘫疗效显著,可明显改善患者面瘫症状,减轻面部神经障碍,改善面部对称性。     

肌内效贴导向疗法对卒中后面瘫及流涎的作用

目的观察基于具身认知理论的肌内效贴导向疗法治疗脑卒中后面瘫及流涎的临床疗效。方法 2018年1月至7月,脑卒中后中枢性面瘫患者30例随机分成对照组和观察组,各15例。对照组采用冰棉块刷擦刺激、面部手法按摩、面肌功能训练和低频脉冲电刺激治疗;观察组在面部手法、面肌功能训练的同时,使用"Y"形或"O"形贴布交替进行肌内效贴导向治疗,并嘱患者尽量保持贴扎至第2天。治疗前和治疗4周后,采用教师流涎量表(TDS)、House-Brackmann (H-B)分级和面神经功能临床评定量表进行评估。结果治疗后,两组TDS分级、H-B分级和面神经功能临床评定量表评分均改善(Z 2.460, t 4.971, P 0.05),观察组明显优于对照组(Z 2.817, t 4.964, P 0.01)。结论肌内效贴导向疗法治疗脑卒中后中枢性面瘫和流涎有效。     

针灸联合刺络放血治疗顽固性面瘫的临床研究

目的探讨针灸联合刺络放血治疗顽固性面瘫的应用价值。方法采用前瞻性随机试验方法,选取商城县中医院2018年2月至2020年2月收治的98例顽固性面瘫患者作为研究对象,根据随机数字表分为观察组与对照组,各49例。对照组采取针灸治疗,观察组在此基础上加用刺络放血。两组持续治疗4周后,比较两组疗效、中医证候积分、面神经功能(Sunnybrook面神经评定量表)及面部残疾指数(FDI)。结果观察组总有效率高于对照组,差异有统计学意义(P0.05);治疗后,观察组口歪眼斜(0.87±0.09)分、眼闭不实(0.61±0.07)分、面肌无力(0.52±0.08)分、胀感明显(0.42±0.05)分的积分均低于对照组(1.06±0.13)分、(0.92±0.12)分、(0.89±0.11)分、(0.67±0.10)分,差异有统计学意义(P0.05);治疗后,观察组Sunnybrook(79.08±8.61)分、社会功能(32.49±3.72)分、躯体功能评分(29.35±3.48)分均高于对照组(71.28±9.37)分、(27.14±3.53)分、(25.11±3.26)分,差异有统计学意义(P0.05)。结论针灸联合刺络放血治疗顽固性面瘫疗效更为确切,可有效改善患者中医证候,改善面神经功能,促进面瘫恢复。     

双侧高频重复性经颅磁刺激治疗脑卒中后吞咽障碍的疗效观察

目的 观察高频重复性经颅磁刺激（rTMS）作用双侧大脑半球下颌舌骨肌皮质代表区对脑卒中后吞咽障碍的影响。 方法 采用随机数字表法将60例脑卒中患者分为双侧刺激组、单侧刺激组及对照组,每组20例。3组患者均给予常规吞咽功能训练,双侧刺激组在吞咽训练基础上对双侧大脑半球下颌舌骨肌皮质代表区进行高频（10 Hz）rTMS刺激;单侧刺激组则对患侧大脑半球下颌舌骨肌皮质代表区进行高频（10 Hz）rTMS刺激,健侧相同刺激点给予安慰性磁刺激;对照组则在双侧大脑半球相同位置给予安慰性磁刺激。于治疗前、治疗2周后分别采用标准吞咽量表（SSA）、吞咽障碍结局和严重度量表（DOSS）及渗透-误吸量表（PAS）评定3组患者吞咽功能改善情况。 结果 治疗前3组患者SSA评分、PAS及DOSS分级组间差异均无统计学意义（P>0.05）; 治疗2周后发现3组患者SSA评分、PAS及DOSS分级均较治疗前明显改善（P<0.05）;并且双侧刺激组、单侧刺激组SSA评分［分别为(30.55±2.79)分和(34.14±3.48)分］、PAS分级及DOSS分级均显著优于对照组水平（P<0.05）,并且双侧刺激组上述疗效指标亦显著优于单侧刺激组（P<0.05）。 结论 双侧高频rTMS刺激能有效改善脑卒中患者吞咽功能,其疗效优于单侧磁刺激。     

透刺经筋法联合甲钴胺穴位注射对周围性面瘫患者面神经功能的影响

目的:探究透刺经筋法联合甲钴胺穴位注射对周围性面瘫患者面神经功能的影响。方法:选取周围性面瘫患者102例,根据治疗方案不同分组,各51例。对照组给予常规治疗(改善循环、营养神经、抗病毒等),观察组于对照组基础上加用透刺经筋法、甲钴胺穴位注射,2组均持续治疗1个月。对比2组治疗前后神经功能分级(H-B)评分、面瘫Portmann评分、面部残疾指数(FDI)、面部生物电信号差(提唇上肌、咬肌)、血清Th17细胞表达。结果:治疗后观察组H-B评分较对照组低,Portmann评分较对照组高;治疗后观察组FDIS较对照低,FDIP较对照组高;治疗后观察组提唇上肌、咬肌生物电信号差较对照组低;治疗后观察组血清Th17细胞表达较对照组低,差异均有统计学意义。结论:透刺经筋法、甲钴胺穴位注射联合治疗周围性面瘫患者,可有效改善面神经功能、残疾指数、生物电信号差距,其作用机理可能与降低血清Th17细胞表达有关。     

本体感觉神经肌肉促进技术结合针刺治疗周围性面瘫的疗效观察

面瘫,即面神经麻痹,是以面部表情肌群运动功能障碍为主要特征的一种常见病,它是由病毒感染所致的周围性面神经麻痹[1].此病可见于任何年龄,起病急骤,多于晨起洗漱或进食中突然发现或被人发现一侧额纹消失,闭眼、皱眉不能,鼻唇沟变浅,口角下垂,嘴歪向健侧,鼓气时患侧嘴角漏气,食物常易滞留于患侧颊龈沟内[2].我科采取本体感觉神经肌肉促进疗法(proprioceptive neuromuscular facilitation,PNF)结合针刺治疗周围性面瘫患者30例,取得了较好效果,现报道如下.     

基于肌力分级法构建个性化周围性面神经炎治疗模式

目的：观察基于肌力分级法构建个性化治疗模式对周围性面神经炎运动功能的治疗效果。方法：选取周围性面神经炎患者90例,采用随机数字表法分为2组各45例。2组均接受相同的对症治疗和物理疗法。对照组接受面操训练,观察组接受基于肌力分级法的个性化康复治疗。分别于治疗前和治疗后第1、2、3、4周采用House-Brackmann面神经分级标准（H-B分级量表）和Sunnybrook评分量表评估治疗效果。治疗4周后评价2组的治愈率,6个月随访时评价2组的联带运动发生率。结果：与治疗前比较,2组均从第3周开始H-B分级量表评分明显下降（P＜0.01）;与对照组比较,观察组第3周和第4周的H-B分级量表评分明显下降（P＜0.05）;2组均从第2周开始Sunnybrook面神经评定量表评分明显升高（P＜0.01）;与对照组比较,观察组第3周和第4周的Sunnybrook面神经评定量表评分明显升高（P＜0.05）;治疗4周后,观察组治愈率明显高于对照组（60.0%、26.7%,χ2=10.181,P=0.003）;6个月后随访观察组的联带运动发生率显著低于对照组（4.4%、17.8%,χ2=4.050,P=0.044）。结论：基于肌力分级法构建的个性化治疗模式可以精准描述面部肌肉损伤情况,制定精确的治疗方案,提高治愈率,降低联带运动发生率,值得在临床中广泛应用与推广。     

面部运动疗法结合穴位按压治疗贝尔面瘫的临床观察

目的探讨运用面部运动疗法结合穴位按压治疗贝尔面瘫的有效性。方法58 例贝尔面瘫患者随机分为对照组(n=29)和观察组(n=29)。对照组进行常规治疗;观察组除常规治疗外,增加面部肌肉运动疗法和穴位按压治疗。治疗前、治疗2 周和治疗4 周时两组分别进行面神经功能评分和疗效评估。结果对照组平均治疗时间为(29.62±12.15) d,观察组为(25.63±11.56) d,两组相比无显著性差异(P>0.05)。两组总有效率为100%。对照组完全恢复率58.6%,观察组72.4%,但无显著性差异(P>0.05)。随着治疗时间的延长,两组面神经功能评分显著降低(F=176.578, P<0.001)。两组相比,仅治疗2 周时观察组面神经功能评分低于对照组(P<0.05)。但观察组的面神经功能评分始终存在低于对照组的趋势。结论面部运动疗法结合穴位按压治疗有促进贝尔面瘫恢复的趋势。     

康复治疗结合面肌运动训练治疗特发性面神经麻痹

目的:观察康复治疗结合面肌运动训练治疗特发性面神经麻痹的疗效。方法:73例特发性面神经麻痹患者分为A组35例和B组38例,均给以常规药物、理疗和针刺治疗。A组同时结合面肌运动训练。结果:治疗21d后,Sunnybrook神经功能评分2组均较治疗前明显提高(P0.01);2组间比较,A组提高幅度高于B组(P0.05)。临床疗效比较,A组痊愈显效率明显高于B组(65.8%与51.4%,P0.05)。结论:康复结合面肌运动训练对特发性面神经麻痹患者面肌运动功能的提高有显著促进作用。     

Corrigendum to “Effects of laser acupuncture in a patient with a 12-year history of facial paralysis: A case report” [Complement. Ther. Med. 43 (April) (2019) 306–310]

BackgroundTraumatic facial palsy, whether accidental or iatrogenic, is a common cause of facial paralysis. Laser acupuncture therapy (LAT) is a non-invasive, pain-free method to stimulate traditional acupuncture points with non-thermal laser irradiation. Low-level laser therapy has proven beneficial in the regeneration of peripheral nerves. This case report describes the feasibility of this innovative treatment in a patient with a 12-year history of traumatic facial palsy and severe sequelae.Case summaryA52-year-old male presented with a severe left-sided facial paralysis that had lasted for 12 years. At initial presentation, the man could not fully close his left eye and had difficulty eating solid foods. The paralysis of his left-sided facial muscles had resulted in dysarthria. He was administered 30 LAT sessions in the Acupuncture Department of China Medical University Hospital, Taichung, Taiwan, over a 4-month period. His recovery was monitored by scores on the Facial Disability Index, the Sunnybrook Facial Nerve Grading System and measurements of the vertical palpebral distance in his left eye. Photographs were taken after every treatment. On the 10^th treatment, a change in closure of the left eye was noticed and facial muscle strength was improved. After 22 treatments, the patient could fully close his left eye.ConclusionLAT significantly improved the sequelae of long-term facial paralysis in this patient. Large-scale prospective studies are needed to confirm this observation.     

Effect of facial neuromuscular re-education on facial symmetry in patients with Bell's palsy: a randomized controlled trial

OBJECTIVE: To determine the effect of facial neuromuscular re-education over conventional therapeutic measures in improving facial symmetry in patients with Bell's palsy. DESIGN: Randomized controlled trial. SETTING: Neurorehabilitation unit. SUBJECTS: Fifty-nine patients diagnosed with Bell's palsy were included in the study after they met the inclusion criteria. Patients were randomly divided into two groups: control (n = 30) and experimental (n = 29). INTERVENTIONS: Control group patients received conventional therapeutic measures while the facial neuromuscular re-education group patients received techniques that were tailored to each patient in three sessions per day for six days per week for a period of two weeks. MAIN MEASURES: All the patients were evaluated using a Facial Grading Scale before treatment and after three months. RESULTS: The Facial Grading Scale scores showed significant improvement in both control (mean 32 (range 9.7-54) to 54.5 (42.2-71.7)) and the experimental (33 (18-43.5) to 66 (54-76.7)) group. Facial Grading Scale change scores showed that experimental group (27.5 (20-43.77)) improved significantly more than the control group (16.5 (12.2-24.7)). Analysis of Facial Grading Scale subcomponents did not show statistical significance, except in the movement score (12 (8-16) to 24 (12-18)). CONCLUSION: Individualized facial neuromuscular re-education is more effective in improving facial symmetry in patients with Bell's palsy than conventional therapeutic measures.     

Evaluation and treatment of synkinesis with botulinum toxin following facial nerve palsy

Purpose.?To assess the effect and efficacy of botulinum toxin type A (BTX-A) in reducing synkinesis in aberrant facial nerve regeneration (following facial paralysis).

Method.?A total of 55 sessions of BTX-A (Botox®) infiltration were performed on 30 patients (23 female) with synkinesis after facial palsy. Each subject was injected with 2.5 units of BTX-A in each injection site (the sites were chosen on a case-by-case basis). The synkinetic muscles targeted include: orbicularis oculi, zygomaticus major, depressor labii inferioris, platysma, healthy frontalis and healthy corrugator supercilii. The patients were examined using the Sunnybrook Facial Grading System, both before the BTX-A treatment and after an average of 35 days.

Results.?All 30 patients experienced improvement to the synkinesis after treatment. Total scores: median pre-BTX-A: 40; post 53 p?=?0.004. Resting symmetry scores: mean pre-BTX-A ?7.1; post: ?3.5; median pre ?5 [interquartile range (IQR) ?10 to ?5]; post: ?5 (IQR ?5 to 0); p?=?0.0001. Symmetry of voluntary movement median pre-BTX-A: 56 post 60 p?=?0.10. Synkinesis scores: median pre-BTX-A: ?9 post ?3 p?<?0.0001. Mean duration of improvement was 4 months.

Conclusions.?BTX-A injection treatment was effective in reducing facial synkinesis, thus improving facial expression symmetry both at rest and in voluntary movements.     

急性期介入低频重复经颅磁刺激对缺血性脑卒中患者上肢运动功能的影响

目的 探讨急性期介入低频重复经颅磁刺激(rTMS)对缺血性脑卒中患者上肢运动功能的影响。 方法 选取急性期缺血性脑卒中患者82例,按照随机数字表法将其分为对照组和试验组,每组41例,研究过程中每组均脱落1例,最终对照组和试验组各纳入40例。2组患者均给予常规康复治疗,试验组予以低频rTMS治疗,对照组予以rTMS假刺激治疗。治疗前、治疗4周后,采用Fugl-Meyer量表（FMA）上肢部分、Wolf运动功能评价量表（WMFT）、改良Barthel指数（MBI）、运动诱发电位(MEP)潜伏期和波幅评价2组患者的上肢运动功能。 结果 治疗前,2组患者FMA评分、WMFT评分、MBI评分、MEP波幅和潜伏期比较,差异均无统计学意义（P＞0.05）。治疗4周后,2组患者的FMA、WMFT、MBI评分和MEP波幅均较组内治疗前明显改善（P＜0.05）,且试验组治疗4周后的FMA［(39.20±7.36)分］、WMFT［(54.43±9.28)分］、MBI［(62.18±9.53)分］、MEP波幅［（0.74±0.08）mV］改善较对照组显著（P＜0.05）。 结论 急性期介入低频rTMS可改善缺血性脑卒中患者的上肢运动功能,提高日常生活活动能力。     

不同时序rTMS联合常规吞咽治疗对缺血性脑卒中吞咽障碍的临床研究

目的：观察不同时序rTMS刺激联合常规吞咽治疗对缺血性脑卒中患者吞咽障碍疗效的影响。方法：选取2020年10月～2021年10月在徐州医科大学第二附属医院神经内科住院的缺血性脑卒中患者60例,用随机数字表法分为常规组、rTMS-常规组、常规-rTMS组,每组20例。分别给予常规康复治疗、rTMS-常规顺序治疗以及常规-rTMS顺序治疗。rTMS刺激患侧运动皮质代表区,采用频率10Hz,治疗强度为80%的静息运动阈值,每次治疗2s,间隔10s,时间20min。3组患者均每日治疗1次,每周5d,连续治疗4周,治疗干预前后分别进行洼田饮水试验、标准吞咽功能评价量表（SSA）以及表面肌电图检查（sEMG）。结果：治疗4周后,3组洼田饮水试验评级较治疗前明显降低（P＜0.05）,rTMS-常规时序组和常规-rTMS时序组相比常规组洼田饮水试验评级明显降低（P＜0.05）,与常规-rTMS时序组相比rTMS-常规时序组洼田饮水试验评分明显降低（P＜0.05）;3组的SSA评分数值较治疗前降低（P＜0.05）,RMS值较治疗前提高（P＜0.05）,rTMS-常规组和常规-rTMS组相比常规组,SSA评分明显降低（P＜0.05）,RMS值明显提高（P＜0.05）,rTMS-常规治疗时序和常规-rTMS时序相比,RMS数值提高更明显（P＜0.05）,但是SSA评分差异无统计学意义。结论：rTMS刺激联合常规治疗比单纯常规治疗对于改善脑卒中后的吞咽障碍的效果更好,其中rTMS-常规时序的治疗方案最佳。     

Pain expression in patients with shoulder pathology: validity, properties and relationship to sickness impact

This study dealt with the validity and correlates of facial expressions of pain. Twenty-four patients seeking treatment for gleno-humeral joint pain and 12 controls underwent a standardized physiotherapy assessment protocol involving active and passive arm movements, and experimental pain induced by pressure. Subjects rated pain intensity on each trial using categorical, sensory and affective scales. Independent of testing, they completed a questionnaire measure of sickness impact. Facial behavior was measured by an abbreviated version of the Facial Action Coding System. Facial actions that related to pain indices included eyebrow lowering, narrowing and closing of the eyes, lip pulling, nose wrinkling and mouth opening. Facial actions during clinical tests showed consistent relationships with sensory and affective pain scales. Greater physical disability was associated with more intense pain actions on active, but not passive, tests. The results support the validity and generality of facial measures of pain, show that they yield graded sensitive information and suggest that they encode information about the psychosocial context of pain problems. Theoretical implications of these findings are discussed.     

运动观察疗法对恢复后期脑卒中患者手功能障碍的疗效研究

目的:探讨运动观察疗法(AOT)和重复经颅磁刺激(rTMS)分别结合作业治疗对恢复后期脑卒中患者手功能恢复的临床疗效差异。方法:将52例住院脑卒中患者随机分为对照组16例、AOT组19例和rTMS组17例。对照组接受常规的作业治疗,运动观察疗法组在此基础上增加AOT治疗,rTMS组在此基础上增加rTMS治疗,在治疗前及治疗2个疗程后采用中文版运动功能状态量表(MSS)、Carroll双上肢功能评定及改良Barthel指数量表(MBI)对患者手功能进行评定。结果:经过2个疗程的治疗,3组的MSS、Carroll及MBI评分较治疗前均有显著提高(均P<0.05),AOT组与rTMS组各项评分均高于对照组(均P<0.05),AOT组与rTMS组评分差异无统计学意义。结论:作业治疗结合AOT或rTMS均可提高恢复后期脑卒中患者手功能,2组治疗方法对手功能能力的提高并无显著差异。     

Physical therapy for facial paralysis: a tailored treatment approach

BACKGROUND AND PURPOSE: Bell palsy is an acute facial paralysis of unknown etiology. Although recovery from Bell palsy is expected without intervention, clinical experience suggests that recovery is often incomplete. This case report describes a classification system used to guide treatment and to monitor recovery of an individual with facial paralysis. CASE DESCRIPTION: The patient was a 71-year-old woman with complete left facial paralysis secondary to Bell palsy. Signs and symptoms were assessed using a standardized measure of facial impairment (Facial Grading System [FGS]) and questions regarding functional limitations. A treatment-based category was assigned based on signs and symptoms. Rehabilitation involved muscle re-education exercises tailored to the treatment-based category. OUTCOMES: In 14 physical therapy sessions over 13 months, the patient had improved facial impairments (initial FGS score= 17/100, final FGS score= 68/100) and no reported functional limitations. DISCUSSION: Recovery from Bell palsy can be a complicated and lengthy process. The use of a classification system may help simplify the rehabilitation process.