岛盖综合征患者临床特征与康复规律的研究

目的:探讨岛盖综合征的主要临床特征和恢复规律,优化岛盖综合征的临床诊断和康复干预方法。方法:收集13例门诊或住院的岛盖综合征患者,用口面失用量表、Frenchay构音障碍评定法等量表,在首次门诊或入院后第1天、出院前1天评定患者,根据入院后第1天康复评定的结果予以住院患者个体化的康复干预。结果:8例皮质型患者的皮质病损部位累及单侧或双侧岛盖;所有患者首诊或入院时口面失用量表评定均提示有显著的口、面、舌肌的自主运动障碍,住院患者经康复干预后口面失用量表评分显著性增高,9例入院时为鼻饲营养的住院患者经康复治疗后有6例患者改为经口进食,约占66.7%;所有患者首诊或入院时均表现为重度构音障碍,10例住院患者经20天以上的康复训练,仍为重度构音障碍。结论:口腔期吞咽障碍和重度构音障碍是岛盖综合征患者重要临床特征,大多数岛盖综合征患者经康复治疗能恢复经口进食,而构音障碍却很难恢复。     

视觉反馈联合躯干强化训练对脑卒中Pusher综合征的疗效观察

目的:探讨视觉反馈联合躯干强化训练对脑卒中Pusher综合征的疗效观察。方法:脑卒中Pusher综合征患者50例,将其随机分为观察组和对照组各25例,2组均给予常规的康复训练,观察组在此基础上加用视觉反馈联合躯干强化训练,训练前后采用Berg平衡量表(BBS)、Burke倾斜量表(BLS)以及Sheikh躯干控制积分进行疗效评定。结果:经过8周治疗,2组BBS及Sheikh评分均较治疗前明显提高(均P0.05),BLS评分明显降低(P0.05),且观察组3项评分改善幅度更高于对照组(均P0.05)。结论:视觉反馈联合躯干强化训练能有效地提高脑卒中Pusher综合征患者的平衡功能,值得临床应用。     

系统脱敏疗法对脑卒中Pusher综合征患者 平衡功能和日常生活能力的影响

目的:探讨系统脱敏疗法对脑卒中Pusher综合征患者平衡功能和日常生活能力的影响。方法:选取2014年6月至2016年6月期间成都市第二人民医院康复科住院脑卒中Pusher综合征患者40例。根据患者入院先后顺序随机将患者分为常规组和系统脱敏组各20例,常规组给予常规治疗,系统脱敏组在常规治疗基础上增加系统脱敏疗法,疗程为4周。在治疗前和治疗4周后行Berg平衡量表(BBS)和改良Barthel指数(MBI)评分并且比较2组患者的评分。结果:治疗4周后2组患者BBS评分、MBI评分均高于治疗前(P0.05),并且系统脱敏组评分均高于常规组(P0.05)。结论:系统脱敏疗法能改善脑卒中Pusher综合征患者的平衡功能和日常生活能力。     

经颅直流电刺激协同患侧下肢强制性负重训练对脑卒中Pusher综合征的效果

目的 探讨经颅直流电刺激(tDCS)协同患侧下肢强制性负重训练对脑卒中Pusher综合征的疗效。方法 选取2021年1月至12月在苏州大学附属第一医院康复科住院的脑卒中Pusher综合征患者60例,随机分为tDCS组、强制组和协同组,各20例。3组均给予常规康复训练,tDCS组加阳极tDCS,强制组加患侧下肢强制性负重训练,协同组加入tDCS协同患侧下肢强制性负重训练,共8周。训练前后采用Berg平衡量表(BBS)、Fugl-Meyer评定量表下肢部分(FMA-LE)、Burke倾斜量表(BLS)及Holden步行功能分级进行评定。结果 治疗后,3组BBS、FMA-LE、BLS以及Holden步行功能分级评分均改善(|t|> 1.452, P <0.05),协同组各项指标均最优(|F|> 1.827, P <0.05)。结论 tDCS协同患侧下肢强制性负重训练能有效改善脑卒中Pusher综合征患者下肢功能。     

强化平衡功能康复治疗对急性期脑卒中Pusher综合征的疗效研究

目的:探讨强化平衡功能康复治疗对Pusher综合征的疗效.方法:选择我院住院治疗的Pusher综合征患者62例,按入院时间分为常规组29例(给予常规康复治疗)及强化组33例(在常规康复治疗基础上,增加强化平衡功能康复治疗),疗程4周.于治疗前及治疗4周后,采用Fugl-Meyer运动功能评分法(FMA)、Berg平衡量...     

视觉反馈结合核心稳定训练对脑卒中Pusher综合征患者的影响

目的:视觉反馈结合核心稳定训练对脑卒中Pusher综合征患者的影响。方法:本试验采用双盲法,Pusher综合征患者25例,按入院顺序将其随机分为视觉反馈训练组8例(A组)、核心稳定训练组8例(B组)、视觉反馈结合核心稳定训练组9例(C组)。分别予三个试验组视觉反馈训练、核心稳定训练、视觉反馈结合核心稳定训练,各组在训练前后均进行临床倾倒量表(SCP)、Berg平衡量表(BBS)、日常生活活动能力Barthel指数(BI)评定。结果:治疗6周后,三个试验组BI及BBS评分均较治疗前提高(P0.05);核心稳定训练组SCP评分较训练前无明显变化(P0.05),视觉反馈组及视觉反馈结合核心稳定训练组SCP评分较治疗前明显下降(P0.05),但两组组间比较无明显差异。结论:视觉反馈训练能有效改善脑卒中Pusher综合征,可以使Pusher综合征患者尽早恢复直立位,加快康复进程。     

脑卒中Pusher综合征的临床研究

目的　研究一定区域内脑卒中偏瘫患者Pusher综合征的发生比例及其与脑损伤侧及神经心理学症状的相关性 ,探讨Pusher综合征的发生机制和相关对策。方法　实验组Pusher综合征 39例 ,对照组91例。检查脑损伤部位及相关神经心理学症状 ,每周施Barthel指数 (BI)评价及功能训练、ADL训练等。结果在本区域内 ,Pusher综合征占研究阶段所有入院康复脑卒中患者的 1 7% ,占入选患者的 30 %。右脑损伤Pusher综合征发生比例高于对照组 (P <0 .0 0 1 )。实验组单侧空间忽略和疾病失认的发生比例高于对照组(P <0 .0 0 1 )。实验组脑出血患者Pusher综合征的发生比例多于脑梗死 (P <0 .0 1 ) ,额、颞、顶叶及基底节及内囊后肢均受损的百分率 ,实验组明显高于对照组 (P <0 .0 1 )。两组治疗后的BI指数均明显高于治疗前(P <0 .0 0 0 1 )。两组间最后的ADL水平的百分率差异无显著性 (P >0 .0 5)。在获得同一水平最佳功能所需时间上 ,实验组比对照组多 9周 (P <0 .0 5)。结论　Pusher综合征在本研究阶段、一定区域内 ,占所有入院康复治疗脑卒中患者的 1 7% ,占偏瘫不能行走患者的 30 %。而且多在右脑损伤时出现 ,易伴有神经心理学症状。Pusher综合征不影响患者最后的功能恢复 ,但可能使康复治疗时间增加     

平衡训练对脑卒中Pusher综合征患者下肢运动能力的影响

目的：探讨平衡训练对脑卒中Pusher综合征患者下肢运动能力的影响。方法：Pusher综合征患者61例,将其随机分为观察组31例和对照组30例。2组均给予常规康复训练,观察组在此基础上加用Biodex平衡功能分析训练仪进行训练;训练前后进行功能性步行量表（FAC）、下肢运动功能评定量表（FMA）、日常生活活动能力Bar—thel指数（BI）及Berg平衡量表（BBS）评定。结果：治疗5周后,2组FAC、FMA、BI及BBS评分均较治疗前明显提高（P〈0．05）,且观察组更高于对照组（P〈0．05）。结论：平衡训练结合常规康复治疗对脑卒中Pusher综合征患者下肢运动能力的恢复较常规康复治疗效果更好。     

护理干预结合微波湿热敷对中风后肢体痉挛的作用观察

观察护理干预结合微波湿热敷对中风后肢体痉挛的影响。方法:将65例中风患者随机分为观察组33例和对照组32例.观察时间为3周,对观察组患者制定个体化康复护理方案早期干预,对照组则给予康复科常规护理。均采用改良Ashworth量表、ADL-Barthel指数积分分级评分对2组患者入院后及出院前的情绪状态、日常生活能力及运动功能进行评价。结果:出院前末次评价2组患者的Ashworth量表、ADL评分较治疗前明显降低(P0.050.01),Ashworth量表、ADL评分较入院时初次评价时观察组改变幅度优于对照组,2组间统计学差异有显著性(P0.050.01)。结论:对中风偏瘫肢体痉挛患者实施康复护理干预能改善患者的肢体功能和日常生活能力。     

基于交互式视觉反馈的姿势控制训练对脑梗死Pusher综合征患者平衡功能的影响

目的:探讨基于交互式视觉反馈的姿势控制训练对脑梗死Pusher综合征患者静、动态平衡功能的影响。方法:36例Pusher综合征患者根据随机数字表分配为试验组和对照组,各18例。对照组采用常规姿势镜反馈下的平衡训练;试验组采用基于交互式视觉反馈的姿势控制训练。治疗前后采用Burke倾斜量表(BLS)、Berg平衡量表(BBS)及Biodex平衡仪中的姿势稳定测试(PST)进行评定。结果:治疗6周后,(1)倾斜程度:两组BLS评分均较治疗前明显降低(P0.05),且试验组较对照组明显降低(P0.05),差异有显著性意义(P0.05);(2)静态平衡:两组睁、闭眼下PST中总稳定值(OSI)、前后值(API)及左右值(MLI)均较治疗前明显降低(P0.05),且试验组较对照组明显降低(P0.05),差异有显著性意义(P0.05);(3)动态平衡:两组BBS评分均较治疗前明显提高(P0.05),且试验组优于对照组(P0.05),差异有显著性意义(P0.05)。结论:基于交互式视觉反馈的姿势控制训练可明显提高脑梗死Pusher综合征患者静、动态平衡功能,且效果优于常规姿势镜反馈下平衡训练。     

Responsiveness of 2 scales to evaluate lateropulsion or pusher syndrome recovery after stroke

Clark E, Hill KD, Punt TD. Responsiveness of 2 scales to evaluate lateropulsion or pusher syndrome recovery after stroke.ObjectivesTo analyze responsiveness to change of 2 outcome measures in the lateropulsion population after stroke. Lateropulsion describes an atypical balance problem after stroke where patients actively push themselves toward their paretic side. Secondary aims were to measure the incidence of lateropulsion and evaluate the site of the brain most commonly involved in lateropulsion.DesignStroke patients were screened for lateropulsion on admission to rehabilitation. Those demonstrating lateropulsion were assessed every 2 weeks using 2 scales to measure progress. Analysis of variance and the standardized response mean (SRM) were used to analyze change for each scale.SettingRehabilitation and geriatric units.ParticipantsProspective purposive sample of stroke patients (N=43) demonstrating lateropulsion on admission from a consecutive admission sample of 160. To allow comparison, data from 43 stroke patients who did not display lateropulsion were collected retrospectively, matched on age (±5y) and sex.InterventionsNot applicable.Main Outcome MeasuresIncidence of lateropulsion was calculated as a percentage of stroke patients admitted. Responsiveness to change was measured by using the Burke Lateropulsion Scale (BLS), to quantify severity of lateropulsion, and the Postural Assessment Scale for Stroke (PASS), which measures postural abilities.ResultsOf 160 stroke patients, 26.9% displayed lateropulsion (mean age, 72y; 51% men). The BLS and PASS had high levels of measurement responsiveness (BLS SRM =1.48 and 2.24; PASS SRM =1.76 and 1.87) at 4 and 8 weeks, respectively.ConclusionsThe BLS and PASS are responsive scales to monitor progress and recovery during rehabilitation. As more than 25% of stroke patients admitted to rehabilitation may exhibit lateropulsion, these 2 scales could be valuable in monitoring progress and designing future intervention studies.     

上海市COVID-19患者康复前后淋巴细胞绝对数分析

目的评估淋巴细胞绝对数(LYMPH#)检测在新型冠状病毒肺炎(COVID-19)患者临床预后判断中的价值。方法选取123例严重急性呼吸综合征冠状病毒2(SARS-CoV-2)感染患者作为研究对象,其中轻型及普通型112例(轻型及普通型组),重型及危重型11例(重型及危重型组)。回顾性收集所有患者外周血LYMPH#的初诊检测结果、出院前检测结果和初次随访检测结果;收集所有患者的临床资料。结果重症患者的年龄比轻症患者大。轻型及普通型组50.89%(57/112)的患者LYMPH#初诊检测结果低于正常值,重型及危重型组72.73%(8/11)的患者LYMPH#初诊检测结果低于正常值。轻型及普通型组和重型及危重型组LYMPH#初诊检测结果比较,无显著性差异(P=0.789)。轻型及普通型组和重型及危重型组之间LYMPH#恢复数值[(初次随访检测结果–初诊检测结果)/初次随访检测结果]和LYMPH#差值(初次随访检测结果–出院前检测结果)均有显著性差异(P=0.014和P=0.038)。结论SARS-CoV-2感染患者的细胞免疫功能普遍低下,康复出院的重症患者免疫功能需要进行持续监测,LYMPH#可作为临床监测COVID-19患者免疫功能和评估预后的指标。     

Critically ill patients with severe immune checkpoint inhibitor related neurotoxicity: A multi-center case series

PurposeSerious immune checkpoint inhibitor (ICI)-related neurotoxicity is rare. There is limited data on the specifics of care and outcomes of patients with severe neurological immune related adverse events (NirAEs) admitted to the Intensive Care Unit (ICU).Materials and methodsRetrospective study of patients with severe NirAEs admitted to the ICU at 3 academic centers between January 2016 and December 2018. Clinical data collected included ICI exposure, type of NirAE (central [CNS] or peripheral nervous system [PNS) disorders), and patient outcomes including neurological recovery and mortality.ResultsSeventeen patients developed severe NirAEs. Eight patients presented with PNS disorders; 6 with myasthenia gravis (MG), 1 had a combination of MG and polyneuropathy and 1 had Guillain-Barre syndrome. Nine patients had CNS disorders (6 seizures and 5 had concomitant encephalopathy. During ICU admission, 65% of patients required mechanical ventilation, 35% vasopressors, and 18% renal replacement therapy. The median ICU and hospital length of stay were 7 (2–36) and 18 (4–80) days, respectively. Hospital mortality was 29%. At hospital discharge, 18% of patients made a full neurologic recovery, 41% partial recovery, and 12% did not recover.ConclusionSevere NirAEs while uncommon, can be serious or even life-threatening if not diagnosed and treated early.     

功能独立性评价量表作为康复治疗前后和随访的功能评价指标

目的　应用功能独立性评价 (FIM )量表评定美国某医疗单位康复医学科 1年中住院患者康复治疗的疗效 ,以及随访情况 ;同时与美国康复医学统一数据系统 (UDSMR) 1995年和 1996年资料相比较。方法　统计 1999年 7月 1日至 2 0 0 0年 6月 30日美国华盛顿大学附属HarborviewMedicalCenter(HMC)康复医学科 2 87例患者的资料 ,包括 :患者入院、出院和随访 (出院 3个月 )FIM的评分 ,FIM效率(每天进步的分数 )及FIM进步程度等。结果　HMC康复医学科患者住院期间FIM进步程度为 37.7% ,UDSMR为 31.6 % ( 1995 )和 32 % ( 1996 ) ;HMC随访期间进步 7.8% ,UDSMR为 10 .5 % ( 1995 )和 10 .1%( 1996 ) ;HMC的FIM效率为 1.6 ,UDSMR为 1.7( 1995 )和 1.8( 1996 )。结论　各种功能障碍患者经过康复治疗 ,功能情况都有较大提高 ,出院后功能情况仍有一定程度进步。FIM量表作为康复治疗患者住院期间和随访期间功能评价指标 ,是一种较理想的评价指...     

Factors predicting stroke disability at discharge: a study of 793 Chinese

OBJECTIVE: To identify factors predicting stroke disability at discharge in a Chinese population. DESIGN: Retrospective analysis of data collected from stroke patients. SETTING: A 25-bed stroke rehabilitation unit in Hong Kong. PARTICIPANTS: A total of 793 Chinese patients with acute stroke consecutively admitted for inpatient rehabilitation. INTERVENTIONS: All patients received traditional rehabilitation therapies including physical, occupational, and speech therapies when appropriate. MAIN OUTCOME MEASURES: Disability was measured with the Barthel index (BI), and mild disability at discharge was defined as a BI score of > or =15. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed. RESULTS: Logistic regression analysis revealed that a BI score of > or = 15 points at admission strongly predicted that the patient's BI at discharge would be > or =15. For those whose BI score at admission was less than 15, these factors correlated negatively with a discharge BI of 15: BI at admission of <5 (OR .08, CI .04-.17); National Institutes of Health stroke scale at admission of >7 (OR .23, CI .12-.43); urinary incontinence at admission (OR .35, CI .21-.60); age > or =65 years (OR .44, CI .25-.77); and abbreviated mental test at admission of <7 (OR .56, CI .33-.94). CONCLUSIONS: For Chinese stroke patients, the disability at admission is the most important predictor for disability at discharge. Patients with very severe disability, severe neurologic impairment, urinary incontinence, old age, and impaired cognition at admission are less likely to recover to mild disability at discharge. Although hemorrhagic stroke is more common among Chinese populations, it is not an independent predictor for disability at discharge.     

Disorders of glucose metabolism in acute stroke patients: an underrecognized problem

OBJECTIVE: To determine the prevalence of disturbances in glucose metabolism in patients with acute stroke. RESEARCH DESIGN AND METHODS: Consecutively admitted acute stroke patients (n = 286) were screened for glucose tolerance according to the standardized World Health Organization protocol in the 1st and 2nd week after the stroke event. In addition, we repeatedly measured fasting capillary blood glucose during the first 10 days. RESULTS: Measurements were not performed or cancelled if patients were not fully conscious or had severe dysphagia or early complications that made transfers to other hospitals necessary (n = 48). Of the remaining 238 patients, 20.2% had previously known diabetes; 16.4% were classified as having newly diagnosed diabetes, 23.1% as having impaired glucose tolerance (IGT), and 0.8% as having impaired fasting glucose; and only 19.7% showed normal glucose levels. Another 47 patients (19.7%) had hyperglycemic values only in the 1st week (transient hyperglycemia) or could not be fully classified due to missing data in the oral glucose tolerance test. Patients with diabetes compared with nondiabetic subjects had more severe strokes (National Institutes of Health Stroke Scale [NIHSS] on admission: 7.2 +/- 6.6 vs. 4.6 +/- 3.1, 4.2 +/- 4.4, and 3.7 +/- 3.6 for IGT, transient hyperglycemia, and normoglycemia, respectively; P < 0.001), a worse outcome (modified Rankin scale 0-1 at discharge: 40.2 vs. 54.4, 63.8, and 72.3% for IGT, transient hyperglycemia, and normoglycemia, respectively; P < 0.001), and a higher rate of infectious complications (35.6 vs. 12.3, 21.2, and 4.2% for IGT, transient hyperglycemia, and normoglycemia, respectively; P < 0.001). In the multivariate analysis, NIHSS on admission, female sex, and the occurrence of urinary tract infection were independently associated with newly diagnosed diabetes. CONCLUSIONS: The majority of acute stroke patients have disorders of glucose metabolism, and in most cases this fact has been unrecognized. Diabetes worsens the outcome of acute stroke. Therefore, in the post-acute phase, an oral glucose tolerance test should be recommended in all stroke patients with no prior history of diabetes.     

FIM量表在外伤性颅脑损伤患者康复疗效评价中的应用

目的 :运用功能独立性评价量表 (FIM )评价外伤性颅脑损伤 (TBI)患者的康复治疗疗效 ,比较闭合性颅脑损伤 (CBI)和开放性颅脑损伤 (OBI)患者的临床特点和康复治疗的效果。方法 :79例TBI患者中 ,5 7例为CBI、2 2例为OBI。运用FIM量表评价两组患者康复治疗前后的功能情况 ,统计患者的入院天数 ,计算FIM效率。结果 :CBI和OBI患者入院时的FIM总评分分别为 81.5 1和 73.0 9;出院时FIM总评分分别为 115 .0 4和 117.77,两组平均增加 4 1%和 5 3%。两组患者康复治疗前后FIM各项评分自身相比有非常显著差异 (P <0 .0 0 1) ,但两组之间相比无显著差异。两组患者的FIM效率分别为 1.99分 /天和 1.71分 /天。结论 :康复治疗可有效改善TBI(无论是CBI还是OBI)患者的功能情况。康复治疗应强调早期和综合性治疗