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1.
目的:观察自制踝足矫形带对脑卒中偏瘫患者下肢运动功能的影响。方法:60例脑卒中偏瘫患者随机分为观察组和对照组各30例。2组患者常规治疗相同,对照组在此基础上进行步态训练;观察组在此基础上佩戴自制踝足矫形带同时进行步态训练。治疗后分别采用综合痉挛量表(CSS)评定踝关节痉挛,Berg平衡量表(BBS)评定平衡功能,Fugl-Meyer运动评分量表中下肢部分(FMA)评定下肢运动功能和步速。结果:治疗3周后,2组患者患侧CSS较治疗前显著降低(P<0.01),且观察组更低于对照组(P<0.01);2组患者BBS、FMA及步速均显著高于治疗前(P<0.01),且观察组更高于对照组(P<0.05,0.01)。结论:自制踝足矫形带联合康复训练能有效降低脑卒中偏瘫患者的踝关节痉挛,矫正足下垂内翻,改善平衡功能,增加步速和提高下肢运动功能。  相似文献   

2.
目的探讨经皮穴位电刺激结合任务导向训练对亚急性期脑卒中患者下肢运动功能和踝关节控制的影响。 方法将32例亚急性期脑卒中后偏瘫患者按随机数字表法分为治疗组和对照组,每组16例。所有患者均给予常规康复治疗,治疗组在此基础上增加30min的经皮穴位电刺激和60min任务导向训练,对照组则增加30min假经皮穴位电刺激和60min任务导向训练。于治疗前和治疗3周、6周后,采用改良Fugl-Meyer量表下肢部分(mFMA-LE)、综合痉挛量表(CSS)以及步行相关改良Barthel指数(wr-MBI)评定2组患者的运动功能、踝关节痉挛程度和日常生活活动(ADL)能力。 结果治疗3周和6周后,2组患者的mFMA-LE、CSS和wr-MBI评分与组内治疗前比较,差异有统计学意义(P<0.05)。治疗3周后,治疗组患者的mFMA-LE和wr-MBI评分分别为(14.12±3.36)分和(28.62±6.45)分,治疗6周后,其mFMA-LE、CSS和wr-MBI评分分别为(17.06±2.64)分、(9.06±1.48)分和(31.75±5.17)分,上述治疗组各项评分与对照组同时间点比较,差异均有统计学意义(P<0.05)。 结论经皮穴位电刺激结合任务导向训练可显著改善亚急性期脑卒中偏瘫患者下肢运动功能和步行能力,并增强其踝关节的控制能力。  相似文献   

3.
赵彬  唐强  王艳  朱路文  梁玉林  李超男 《中国康复》2019,34(10):529-531
目的:探讨悬吊运动疗法结合功能性电刺激对脑卒中后偏瘫患者下肢功能的影响。方法:90例脑卒中恢复期患者随机分为FES组、SET组和结合组各30例。 3组患者均进行常规康复训练,FES组和SET组在此基础上分别进行功能性电刺激训练和悬吊训练,结合组在常规康复训练基础上再配合功能性电刺激训练和悬吊训练。治疗前后采用Berg平衡量表(BBS)、Fugl Meyer下肢运动功能量表(FMA)、威斯康星步态量表(WGS)评分进行评定。结果:治疗8周后,3组患者BBS、FMA评分较治疗前均明显提高(均P<0.05),WGS评分较治疗前明显降低(均P<0.05);结合组的BBS、FMA评分均明显高于FES组和SET组(均P<0.05),WGS评分均明显低于FES组和SET组(均P<0.05);FES组和SET组治疗后各项评分比较差异无统计学意义。结论:悬吊运动疗法结合功能性电刺激对脑卒中偏瘫患者下肢运动功能、平衡功能和步行能力改善效果显著,并且较单独使用悬吊运动疗法或功能性电刺激治疗更有利于脑卒中偏瘫患者下肢功能的恢复。  相似文献   

4.
目的 观察多通道功能性电刺激(FES)对脑卒中偏瘫患者下肢功能的影响。 方法 将30例脑卒中偏瘫患者按随机数字表法分为对照组、电刺激A组和电刺激B组,每组10例。3组患者均接受常规康复治疗和药物治疗,电刺激A组每日进行15 min常规康复治疗和15 min多通道FES治疗,共计30 min,每日1次;电刺激B组在电刺激A组基础上,增加FES治疗时间至30 min,每日1次。治疗前及治疗4周后(治疗后),采用Fugl-Meyer量表(FMA)下肢部分、起立-行走测试(TUGT)、10米最大步行速度测试(10 mMWS)、功能性步行分级(FAC)、Barthel指数(BI)进行评定。 结果 治疗前,3组患者TUGT、10 mMWS、FMA、FAC、BI比较,差异无统计学意义(P>0.05)。治疗后,3组患者TUGT、10 mMWS、FMA、FAC、BI均较组内治疗前改善(P<0.05)。与对照组治疗后比较,电刺激A组和电刺激B组TUGT、10 mMWS、FMA、FAC、BI较为优异(P<0.05),且电刺激B组TUGT[(18.01±6.16)s]、10 mMWS[(0.83±0.14)m/s]、FMA[(24.57±2.59)分]、FAC[(4.37±0.43)级]、BI[(71.50±9.14)分]优于电刺激A组(P<0.05)。 结论 增加多通道FES治疗时间可以明显改善脑卒中患者的下肢运动功能,提高生活质量。  相似文献   

5.
目的:探讨多通道功能性电刺激(FES)对脑卒中偏瘫患者早期下肢运动及平衡功能的影响及其脑可塑性机制。方法:将早期脑卒中患者18例随机分为FES组10例和对照组8例。2组均采用常规治疗,FES组加用基于人体正常行走模式设计的FES治疗仪治疗,对照组给予无电流输出的安慰电刺激。治疗前后采用Fugl—Meyer运动评定量表(FMA)中下肢部分评定下肢运动功能和Berg平衡量表(BBS)评定平衡功能,并给予核磁共振弥散张力成像(DTI)检查。结果:治疗3周后,2组FMA及BBS评分均较治疗前明显提高(P〈0.05),且FES组更高于对照组(均P〈0.05);DTI检查结果显示:治疗后,FES组病灶局部水肿较治疗前明显减少,双侧纤维束较治疗前明显增多增粗;对照组病灶局部水肿较治疗前减少,患侧纤维束较治疗前增加不明显。结论:FES治疗能提高脑卒中早期患者下肢运动功能,改善平衡功能,同时促进脑功能重组。  相似文献   

6.
目的观察功能性电刺激(FES)对老年脑卒中偏瘫患者早期疗效的影响。 方法40例老年脑卒中患者分为FES组和对照组,每组20例。2组患者均行常规药物治疗和基本的康复训练。FES组加用FES治疗,每天治疗1次,每次30 min,共3周(15次)。对照组在治疗期间不接受任何电刺激。2组患者在治疗前、治疗3周后分别采用Fugl-Meyer运动功能量表(FMA)、Berg平衡量表(BBS)及Barthel指数(BI)进行功能评定。 结果FES组患者上肢FMA评分治疗前、后比较,差异有统计学意义(P<0.01),治疗后FES组上肢FMA评分与对照组相比,差异有统计学意义(P<0.05)。2组患者下肢FMA治疗前、后比较,差异有统计学意义(P<0.05),治疗后FES组下肢FMA评分与对照组相比,差异有统计学意义(P<0.05)。2组患者BBS评分治疗前、后比较,差异有统计学意义(P<0.05),治疗后FES组BBS评分与对照组相比,差异有统计学意义(P<0.05)。 FES组患者BI评分治疗前、后比较,差异有统计学意义(P<0.01);治疗后FES组BI评分与对照组相比,差异有统计学意义(P<0.05)。 结论FES治疗能提高老年脑卒中早期患者偏瘫肢体运动功能,改善患者的平衡能力,进而提高患者日常生活活动能力。  相似文献   

7.
目的:探讨神经松动术联合康复训练对脑卒中恢复期偏瘫患者下肢功能的影响。方法:将脑卒中恢复期偏瘫患者49例分为观察组25例和对照组24例。2组均采用常规治疗,观察组同时加用神经松动术治疗。治疗前后分别采用综合痉挛量表(CSS)评定踝关节痉挛,Fugl—Meyer运动评分量表(FMA)中下肢部分评定下肢运动功能,Berg平衡量表(BBS)评定平衡功能和改良Barthel指数(MBI)评定日常生活活动(ADL)能力。结果:治疗4周后,2组患者患侧CSS均较治疗前显著降低(均P〈0.01),且观察组更低于对照组(均P〈0.01);2组患者FMA、BBS及ADL能力均较治疗前显著提高(均P〈0.01),且观察组更高于对照组(P〈0.05,0.01)。结论:神经松动术联合康复训练能有效降低脑卒中恢复期偏瘫患者的踝关节痉挛,提高下肢运动功能、平衡功能及日常生活活动能力。  相似文献   

8.
目的观察早期肉毒毒素干预对脑卒中患者步态及其生活质量的影响。 方法选取早期脑卒中后下肢轻度痉挛的患者23例,根据随机数字表法分为治疗组(11例)和对照组(12例)。2组患者均接受8周的常规康复治疗,治疗组在常规康复治疗的基础上增加电刺激引导下的A型肉毒毒素注射治疗,对照组仅注射相同剂量的生理盐水。2组患者均于治疗前和注射治疗后第8周(治疗后)采用简式Fugl-Meyer运动功能评定量表(FMA)、改良的Ashworth痉挛量表(MAS)和MBI评分分别评定其下肢运动功能、肌张力和日常生活活动能力;且与治疗后采用Gaitwatch步态分析(步长、步频、步速)和6min步行距离(6MWD)进行评定。 结果治疗后,2组患者的FMA评分、MBI评分、Gaitwatch步态分析以及6MWD与组内治疗前比较,差异均有统计学意义(P<0.05);且治疗组治疗后FMA评分、MBI评分、步长、步频、步速以及6MWD分别为(29.0±3.3)分、(65.5±9.5)分、(103.8±9.8)cm、每分钟(82.6±8.1)步、(112.5±11.5)cm/s和(398.9±22.7)m,分别与对照组治疗后比较,差异均有统计学意义(P<0.05)。治疗后,治疗组肌张力MAS评级与对照组比较,差异有统计学意义(P<0.05)。 结论早期A型肉毒毒素注射治疗可显著降低脑卒中后患者痉挛下肢的肌张力,提高其步行能力和生活质量。  相似文献   

9.
目的探讨低频电刺激(LES)对脑卒中偏瘫患者日常生活活动(ADL)能力的影响。 方法37例早期脑卒中患者经minimize软件分层后随机分为电刺激组19例和对照组18例。2组常规治疗相同,对照组不行电刺激治疗,电刺激组采用LES治疗,电极置于偏瘫侧胫前肌及腓骨长、短肌的运动点上,刺激参数为频率30 Hz,脉宽200 μs,通电/断电比5 s/5 s,波升/波降为1 s/1 s,电流以患者最大耐受强度为限。每天治疗1次,每次30 min,共3周(15次)。用Fugl-Meyer运动功能评定量表(FMA)中下肢部分评定下肢运动功能,用改良Barthel指数(MBI)评定ADL能力。 结果2组患者一般资料及治疗前各项评定结果差异无统计学意义(P&rt;0.05)。治疗2周和3周后,电刺激组与对照组的FMA评分及MBI总分比较,差异均有统计学意义(P<0.05),电刺激组与对照组在MBI各项中的床椅转移、平地行走及上下楼梯等评分比较,差异有统计学意义(P<0.05)。 结论LES能提高早期脑卒中偏瘫患者下肢运动能力及ADL能力。  相似文献   

10.
持续等速被动运动对脑卒中患者下肢表面肌电的影响   总被引:2,自引:1,他引:1  
目的:研究持续踝关节等速被动运动对脑卒中患者下肢表面肌电及肌痉挛的影响。方法:15例脑卒中患者(观察组)均有瘫痪侧痉挛性足下垂,将观察组患者患侧与15例正常人(对照组)对应侧踝关节进行持续等速被动运动,时间分别为5、10min,角速度为5&#176;/s,于运动前后测定双下肢在直腿坐位、踝关节被动90&#176;时的腓肠肌表面肌电均方根值(RMS)和综合痉挛量表评分(CSS);并进行分析与比较。结果:持续等速被动运动前,观察组运动5、10min时腓肠肌RMS值明显高于对照组(3.0&#177;1.4,3.4&#177;1.8与1.8&#177;0.9,1.7&#177;0.8,P〈0.01),运动后均明显低于治疗前(1.8&#177;0.8、1.9&#177;1.0,P〈0.01)。观察组运动5、10min时CSS评分与治疗前比较明显下降(12.1&#177;3.3、12.2&#177;2.0与14.5&#177;1.7,P〈0.01,0.05)。观察组运动5与10minRMS值及CSS评分均差异无显著性意义。结论:持续等速被动运动能有效缓解脑卒中患者腓肠肌肌痉挛,改善踝关节运动功能,表面肌电可作为评定肌痉挛状况的量化指标,具有临床使用价值。  相似文献   

11.
One important goal of cognitive neuroscience is to discover and explain properties common to all human brains. The traditional solution for comparing functional activations across brains in fMRI is to align each individual brain to a template brain in a Cartesian coordinate system (e.g., the Montreal Neurological Institute template). However, inter-individual anatomical variability leads to decreases in sensitivity (ability to detect a significant activation when it is present) and functional resolution (ability to discriminate spatially adjacent but functionally different neural responses) in group analyses. Subject-specific functional localizers have been previously argued to increase the sensitivity and functional resolution of fMRI analyses in the presence of inter-subject variability in the locations of functional activations (e.g., Brett et al., 2002; Fedorenko and Kanwisher, 2009, 2011; Fedorenko et al., 2010; Kanwisher et al., 1997; Saxe et al., 2006). In the current paper we quantify this dependence of sensitivity and functional resolution on functional variability across subjects in order to illustrate the highly detrimental effects of this variability on traditional group analyses. We show that analyses that use subject-specific functional localizers usually outperform traditional group-based methods in both sensitivity and functional resolution, even when the same total amount of data is used for each analysis. We further discuss how the subject-specific functional localization approach, which has traditionally only been considered in the context of ROI-based analyses, can be extended to whole-brain voxel-based analyses. We conclude that subject-specific functional localizers are particularly well suited for investigating questions of functional specialization in the brain. An SPM toolbox that can perform all of the analyses described in this paper is publicly available, and the analyses can be applied retroactively to any dataset, provided that multiple runs were acquired per subject, even if no explicit "localizer" task was included.  相似文献   

12.
OBJECTIVE: To determine whether the admission functional score influences the functional change after stroke rehabilitation. DESIGN: Two hundred forty-three patients who had received the Functional Independence Measure (FIM) assessment at admission and at discharge were enrolled in the study. The patients were stratified into three groups according to their FIM total scores at admission, i.e., < or =36, 37 to 72, and > or =73. RESULTS: The Scheffé's multiple comparison test showed that patients with FIM total scores of > or =73 at admission were significantly younger (58 +/- 11 [SD] yr) than those who had scores of 37 to 72 (64 +/- 11 yr) or < or =36 (66 +/- 12 yr). Patients with FIM total scores of 37 to 72 at admission showed significantly higher FIM gain (37 +/- 15) compared with those patients who had scores of > or =73 (20 +/- 10) or < or =36 (29 +/- 23). CONCLUSION: The functional levels of affected patients at admission stratified by the FIM scale roughly predict the degree of functional gain after rehabilitation in survivors with a first episode of ischemic stroke. Moderately affected patients will benefit from intensive rehabilitation. These findings may be useful for rehabilitation triage.  相似文献   

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Introduction

Chronic tension headache is a common medical problem. Many patients present to manual medicine specialists. Scientific data regarding the relevance of somatic dysfunction for the pathogenesis of chronic tension headache are inconsistent. In order to address this issue, a study protocol was developed. In the present study, the first two steps of the protocol were undertaken.

Material and methods

In order to identify valuable functional findings and tests, the first step of the study was a Delphi process. The second step consisted of testing the inter-rater reliability of the suggested tests.

Results

In total, 38 different clinical tests were identified to be relevant for chronic tension headache. Inter-rater reliability was reasonable for somatic dysfunction of the cervical spine, as was the test for muscular tension of the trapezius muscle. None of the other tests were found to be sufficiently reliable.

Conclusion

We could show that a subset of tests assumed to be relevant for chronic tension headache are reliable. The other tests have to be refined or the study protocol has to adapted to obtain an even distribution of positive/negative findings.
  相似文献   

16.
Neurophysiology of functional imaging   总被引:1,自引:0,他引:1  
The successes of PET and fMRI in non-invasively localizing sensory functions had encouraged efforts to transform the subjective concepts of cognitive psychology into objective physical measures. The assumption was that mental functions could be decomposed into non-overlapping, context-independent modules that are operated on by separable areas of a computer-like brain. The failures of cognitive modularity and of a very localized phrenology are generally, but not universally, accepted; but in their place, and usually not distinguished from the original revolutionary hopes of clarification, experimental results are being interpreted in terms of rather flexible definitions of both cognitive concepts and the degree of localization. In an alternative approach, we have connected fMRI, (13)C MRS, and electrophysiology measurements of brain energy to connect with observable properties of mental life (i.e., awareness). We illustrate this approach with a sensory stimulation experiment; the degree of localization found in BOLD signals was related to the global energy of the brain which, when manipulated by anesthetics, affected the degree of awareness. The influence of brain energy upon functional imaging maps is changing the interpretations of neuroimaging experiments, from psychological concepts generating computer-like responses to empirical responses dominated by the high brain energy and signaling at rest. In our view "baseline" is an operational term, an adjective that defines a property of a state of the system before it is perturbed by a stimulus. Given the dependence of observable psychological properties upon the "baseline" energy, we believe that it is unnecessarily limiting to define a particular state as the baseline.  相似文献   

17.
The brain is a complex network with time-varying functional connectivity (FC) and network organization. However, it remains largely unknown whether resting-state fNIRS measurements can be used to characterize dynamic characteristics of intrinsic brain organization. In this study, for the first time, we used the whole-cortical fNIRS time series and a sliding-window correlation approach to demonstrate that fNIRS measurement can be ultimately used to quantify the dynamic characteristics of resting-state brain connectivity. Our results reveal that the fNIRS-derived FC is time-varying, and the variability strength (Q) is correlated negatively with the time-averaged, static FC. Furthermore, the Q values also show significant differences in connectivity between different spatial locations (e.g., intrahemispheric and homotopic connections). The findings are reproducible across both sliding-window lengths and different brain scanning sessions, suggesting that the dynamic characteristics in fNIRS-derived cerebral functional correlation results from true cerebral fluctuation.OCIS codes: (170.2655) Functional monitoring and imaging, (170.5380) Physiology, (170.3880) Medical and biological imaging  相似文献   

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目的分析静息状态下失眠患者杏仁核与其他脑功能连接的改变。方法失眠患者39例为失眠组,体检健康者23例为对照组,2组均进行临床匹兹堡睡眠质量指数量表(Pittsburgh Sleep Quality Index, PSQI)、汉密尔顿抑郁量表(Hamilton Depression Scale, HAMD)、汉密尔顿焦虑量表(Hamilton Anxiety Scale, HAMA)、世界卫生组织-加利福尼亚听觉词语学习测验(World Health Organization University of California Los Angeles Auditory Verbal Learning Test, WHO-UCLA AVLT)评估睡眠、认知、情绪情况,2组均行磁共振常规扫描和静息态功能MRI扫描(resting-state functional MRI, rs-fMRI),以双侧杏仁核为种子点,比较2组脑功能连接的差异;采用Pearson相关分析失眠组长时记忆评分与左侧杏仁核-左侧海马旁回、左侧杏仁核-右侧海马旁回的功能连接强度的相关性。结果失眠组PSQI[(13.46±2.74)分]、HAMA[(10.10±3.97)分]、HAMD[(9.56±3.48)分]评分及认知障碍评分[(1.23±0.67)分]明显高于对照组[(2.52±1.75)、(1.57±1.90)、(0.78±1.24)、(0.08±0.07)分](P<0.05),WHO-UCLA学习记忆量表中长时记忆[(10.67±2.35)分]和再认记忆[(12.36±2.40)分]评分低于对照组[(11.96±1.85)、(13.39±1.31)分](P<0.05);与对照组比较,失眠组左侧杏仁核与后扣带回、双侧海马旁回、双侧海马、颞叶、舌回和枕叶的功能连接增强(P<0.05),右侧杏仁核与边缘叶、右侧海马旁回、舌回、枕叶、右侧距状皮层、后扣带回、前额叶功能连接增强(P<0.05);失眠组长时记忆评分与左侧杏仁核-左侧海马旁回、左侧杏仁核-右侧海马旁回的功能连接强度呈正相关(r=0.556,P<0.001;r=0.150,P=0.032)。结论失眠患者双侧杏仁核与多个脑区的功能连接出现异常,可能是失眠患者出现情绪调节障碍、认知障碍等的机制之一。  相似文献   

20.
OBJECTIVE: To provide a multidimensional assessment of the extent of functional impairment during an acute migraine attack, and of the improvement in functioning in response to treatment, using 4 concurrently administered scales: the 7-item work productivity questionnaire (PQ-7), the functional assessment in migraine (FAIM) activities and participation (FAIM-A&P) subscale, the FAIM-impact of migraine on mental functioning (FAIM-IMMF) subscale, and the traditional 4-point global functional impairment scale (FIS). METHODS: Outpatients with an International Classification of Headache Disorders diagnosis of migraine were randomized to double-blind treatment of a single attack with either oral eletriptan 20 mg (n = 192) once-daily, eletriptan 40 mg (N = 213) once-daily, or placebo (n = 208). Patients were encouraged to take study medication as soon as they were sure they were experiencing a typical migraine headache, after the aura phase (if present) had ended. Patients with moderate-to-severe functional impairment were identified on each of the 4 disability scales, and 2-hour functional response was compared between treatments. RESULTS: At baseline, the PQ-7 and FAIM-IMMF items that assessed ability to perform tasks requiring concentration, sustained work or attention, and ability to think quickly or spontaneously, were especially sensitive to the effects of mild headache pain, with 27% to 48% of patients (n = 92-112) reporting moderate-to-severe impairment. Only 11.3% of patients (n = 112) reported this level of impairment due to mild pain on the FIS. Functional response at 2 hours was significantly higher on eletriptan 40 mg versus placebo on the FAIM-A&P (63% vs 36%; n = 218; P < .0001); on the PQ-7 (56% vs 34%; n = 116; P= .0052); and on the FAIM-IMMF (50% vs 34%; n = 215; P= .017). These rates were all lower than the functional response rates on the FIS for eletriptan 40 mg (75%) and eletriptan 20 mg (70%) versus placebo (45%; P < .001). Conclusions.-In this exploratory analysis, use of multidimensional scales was found to provide a sensitive measure of headache-related functional impairment, especially for detecting clinically meaningful cognitive effects, and for detecting drug versus placebo differences.  相似文献   

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