肌电触发神经肌肉刺激对改善脑卒中早期患者腕背伸功能的疗效观察

目的:探讨肌电触发神经肌肉刺激在改善脑卒中早期患者的腕背伸功能中的作用。方法:将60例脑卒中早期患者随机分为早期肌电触发神经肌肉刺激训练组(治疗组)和对照组各30例,对照组给予常规康复训练,治疗组在常规训练的基础上,应用AM800型神经功能重建仪对患侧上肢腕背伸肌群进行20min/d肌电触发的神经肌肉电刺激。在入院24h内和治疗后12周分别对两组的最大肌电幅度、腕背伸活动度、上肢运动功能Fugl-Meyer(FMA)评定法及改良Barthel(MBI)评分进行评定。结果:治疗后,治疗组患者的患侧上肢运动功能、手部功能及腕背伸活动度、日常生活活动能力较对照组明显提高(P<0.01)。结论:肌电触发神经肌肉刺激的早期介入可明显提高脑卒中偏瘫患者的上肢运动功能和日常生活活动能力。     

功能强化训练结合肌电生物反馈对急性脑卒中患者上肢功能的影响

目的:观察肌电生物反馈电刺激联合上肢功能强化训练对急性脑卒中患者上肢功能障碍的疗效。方法:将60例脑卒中偏瘫患者随机分为观察组和对照组各30例。2组均给予常规康复治疗和上肢功能强化训练,观察组在此基础上给予肌电生物反馈电刺激治疗。2组患者于治疗前和治疗4周后进行Brunnstrom分级上肢评定、简化Fugl-Meyer上肢功能评定(FMA)、功能独立性评定(FIM)、肩外展及腕背伸主动活动范围(AROM)测定、主动肩外展和腕背伸时三角肌和桡侧腕长伸肌等长收缩的肌电积分值(IEMG)测定。结果:经治疗后,2组患者Brunnstrom分级、FMA评分、FIM评分,肩外展AROM、腕背伸AROM、IEMG值均高于组内治疗前(P<0.05),其中观察组各项评分均更高于对照组(P<0.01)。结论:肌电生物反馈电刺激结合功能强化训练能有效改善急性脑卒中偏瘫患者上肢运动功能,降低患者神经缺损程度,提高日常生活活动能力。     

肌电触发神经肌肉刺激对偏瘫患者腕指背伸功能的影响

目的探讨肌电触发神经肌肉刺激对脑卒中偏瘫患者腕指背伸功能的影响。方法对20例脑卒中偏瘫患者进行常规运动疗法、作业疗法和肌电触发神经肌肉刺激治疗,在治疗前、后分别测量患者腕指背伸时的肌电均值、腕背伸的主动活动度(ac-tiverange of motion,AROM)、上肢Fugl-Meyer评分(FMA)等指标。结果与治疗前相比,治疗后腕指背伸时的肌电均值、腕背伸AROM与FMA评分均增加(P0.05)。结论肌电触发神经肌肉刺激治疗有助于偏瘫上肢功能的恢复。     

对侧控制型神经肌肉电刺激对早期脑卒中患者功能恢复的影响

目的探讨对侧控制型电刺激（CCNMES）对早期脑卒中患者功能恢复的影响。 方法选取40例初次发病的脑卒中患者,按照随机数字表法将其分为对侧控制组和对照组,每组20例。所有患者均接受内科治疗与常规康复训练,包括良肢位摆放、直立床训练、关节活动训练、神经肌肉促进技术等。对侧控制组在患侧腕背伸肌、患侧胫前肌给予CCNMES。对照组接受患侧腕背伸肌群、患侧胫前肌常规神经肌肉电刺激（NMES）。治疗前、治疗4周后,采用美国国立卫生研究院卒中量表(NIHSS)、Fugl-Meyer运动功能评估量表（FMA）、运动力指数（MI）、患侧腕部背伸主动活动度（AROM）、患侧踝部背伸AROM对患者的功能情况进行评定。 结果2组患者治疗前各项功能评分之间比较,差异无统计学意义（P&rt;0.05）。治疗后,对侧控制组患者NIHSS［（11.24±6.36）分］、FMA［（41.14±13.45）分］、MI［（32.14±9.36）分］、患侧腕部背伸AROM［（15.68±4.51）°］、患侧踝部背伸AROM［（11.57±5.61）°］较组内治疗前均有显著提高（P<0.05）;对照组NIHSS［（13.34±4.43）分］、FMA［（37.84±14.13）分］、MI［（27.76±11.63）分］较组内治疗前显著提高（P<0.05）。治疗后,对侧控制组患侧腕部及踝部的背伸AROM均显著优于对照组（P<0.05）。 结论CCNMES能有效促进脑卒中患者的功能恢复,在腕部及踝部AROM方面的治疗效果优于NMES。     

肌电生物反馈治疗对脑卒中偏瘫患者上肢功能的影响

目的探讨肌电生物反馈治疗对脑卒中偏瘫患肢上肢功能的影响。方法将79例脑卒中偏瘫患者随机分成治疗组40例和对照组39例，两组均常规进行神经内科药物治疗和运动疗法，治疗组加以电生物反馈治疗。对每例患者在入组时和病程3个月分别测定腕背伸时主动关节活动范围(AROM)、腕背伸时肌肉最大收缩时肌电(EMG)幅值和用Fugl-Meyer评估表(FMA)对息侧上肢功能进行评定。结果两组治疗前后比较和组间比较均有显著性差异(P＜O．05)；两组的变化均数比较，治疗组3个月后ARoM、EMG幅值和FMA积分恢复优于对照绢(P＜O．01)。结论肌电生物反馈治疗有助于改善偏瘫患者上肢功能。     

肌电生物反馈疗法对脑卒中偏瘫患者腕背伸功能影响的临床研究

目的探讨肌电生物反馈治疗对脑卒中偏瘫患肢上肢腕背伸功能的影响。方法将36例脑卒中偏瘫患者随机分为治疗组和对照组,每组18例。两组药物治疗相同,对照组进行常规康复治疗,治疗组在常规康复治疗基础上加肌电生物反馈技术进行治疗。观察两组治疗前后腕背伸时主动关节活动范围（AROM）,腕背伸时肌肉最大收缩时肌电（EMG）阈值。结果 3个疗程后治疗组患者腕关节的AROM、EMG阈值均优于对照组（P〈0.001）。结论肌电生物反馈治疗有助于明显改善偏瘫患者腕背伸功能。     

肌电生物反馈训练对脑卒中偏瘫患者上肢运动功能的影响

目的观察肌电生物反馈训练对脑卒中偏瘫患者上肢运动功能的影响。 方法将60例脑卒中偏瘫患者分为对照组（30例）和治疗组（30例）。对照组给予常规治疗,治疗组在常规治疗的基础上辅以肌电生物反馈训练。2组患者分别于治疗前及治疗60 d后,测定偏瘫侧腕关节的主动背伸活动范围（AROM）,检测腕背伸肌最大收缩时EMG波幅,采用Fugl-Meyer运动功能量表（FMA）评估上肢运动功能。 结果2组患者经治疗后,偏瘫侧腕关节的AROM、腕背伸肌最大收缩时EMG波幅、FMA评分均明显改善（P<0.01）,且治疗组的功能改善优于对照组（P<0.05）。 结论肌电生物反馈训练能显著促进脑卒中偏瘫患者上肢运动功能的恢复。     

对侧功能性电刺激对偏瘫患者的疗效

正数据显示针对偏瘫侧腕及手部伸肌给予周期性神经肌肉电刺激(cNMES)可以提高亚急性及慢性脑卒中患者上肢末端的肢体功能。对侧功能性电刺激(CCFES)是一种新的物理疗法,其可以使患者灵活地张开偏瘫的手指。病人通过张开或者闭合健侧手指实时地控制刺激参数。本研究的目的是比较周期性神经肌肉电刺激与对侧功能性电刺激对偏瘫患者的疗效差异。这个平行对照研究纳入了发生脑出血或者缺血患者,其病程大于半年,且这些患者均具有单侧手指伸肌瘫痪。对于对侧功能性电刺激组的患     

两种对侧控制型功能性电刺激方案对脑卒中患者上肢功能影响的研究

目的：探讨两种对侧控制型功能性电刺激（CCFES）方案对脑卒中患者的患侧上肢整体运动功能、抓握能力、肱三头肌和伸腕肌群表面肌电信号的影响。方法：选取2021年1月至2021年11月期间在浙江省人民医院康复医学科住院治疗的脑卒中患者60例,随机分为观察组（n=30）和对照组（n=30）,两组患者均给予常规康复治疗,对照组给予伸腕肌群CCFES,而观察组在对照组的基础上增加肱三头肌CCFES,每日1次,每次20min,连续治疗3个月。分别在治疗前后用上肢Fugl-Meyer评分法（FMA-UE）和盒子积木测试（BBT）评定上肢的整体运动功能和抓握能力,并获取上肢肱三头肌和伸腕肌群的RMS比值。结果：治疗前两组患者各评定指标均无显著性差异（P>0.05）,具有可比性。治疗3个月后,两组患者的FMA-UE评分、BBT评分、肱三头肌RMS比值和伸腕肌群RMS比值均较治疗前有所提高（P<0.05）;观察组的FMA-UE评分、肱三头肌的RMS比值和伸腕肌群的RMS比值优于对照组（P<0.05）,两组患者间的BBT评分没有显著性差异（P>0.05）。结论：在伸腕肌群CCFES的...     

肌电生物反馈疗法治疗脑卒中早期患者上肢功能障碍

目的 探讨肌电生物反馈疗法治疗脑卒中早期患者上肢功能障碍的有效性.方法 将发病＜3个月的脑卒中患者23例分为肌电生物反馈组13例和常规组10例,2组均给予常规康复治疗,肌电生物反馈组在此基础上增加肌电生物反馈疗法.治疗前及治疗1个月后评估2组患者偏瘫侧腕背伸肌肌力、腕关节主动活动度(AROM)、腕背伸平均肌电值(AE...     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.     

Advance Care Planning

Predictors of patient wishes and influence of family and clinicians are discussed. Research findings on patient decision-making relating to preferences in end-of-life care are described. Advance directives and durable powers of attorney are defined and differentiated. Most patients have not participated in advance care planning and the need for more effective planning is documented. Appropriate times for discussions of such planning are described. Scenarios discussed include terminal cancer, chronic obstructive pulmonary disease, AIDS, stroke, and dementia. Patient satisfaction is discussed, as is a structured process for discussions about patient preferences. Results of patient responses to hypothetical scenarios are described. Invasiveness of interventions, prognosis and other factors that favor or discourage patient preferences for treatment are discussed. Findings resulting from research funded by the Agency for Healthcare Research and Quality (AHRQ) are discussed. This research can help providers offer end-of-life care based on preferences held by the majority of patients under similar circumstances.     

Spiritual Dimensions of Nursing Practice. edited by V. B. Carson

The Cochrane Library of Systematic Reviewsis published quarterly. Issue one for 2004 of the library was published in February 2004. This issue contains 3,329 reviews and protocols of which 1,921 are fully published reviews. The trials database now stands at over 400,000 records with an additional 4,427 one-page summaries of non-Cochrane reviews in the NHS database of reviews of effectiveness (DARE). This version of the library contains the results of an extensive search for RCTs on EMBASE. The latest library contains 84 new reviews, seven are considered relevant to practitioners in pain and palliative care. References are published in the same format as the citation for Cochrane reviews.     

Évaluation,par l’imagerie ultrasonore,du recrutement musculaire,de la force motrice et de la détente verticale du quadriceps après électromyostimulation (cas de 15 étudiants de l’INJS)

The increase of strength seems to be an element of performance in some sports.