运动姿态与肌电融合的脑卒中上肢运动功能评估系统的可行性研究

目的探讨基于运动姿态与表面肌电融合的上肢运动功能评估系统在脑卒中患者上肢运动功能评估中的可行性。方法 2018年1月至2019年3月,在南京同仁医院选取脑卒中患者10例,按照事先设计的康复评估动作,分别获取康复动作完成过程中患肢的运动姿态和表面肌电数据,运用运动姿态与肌电融合的上肢运动功能评估系统对患者上肢运动功能进行评估,并分别与单纯基于运动姿态或肌电的评估结果进行比较;同时分析系统评估效度。所有患者均接受Fugl-Meyer评定量表上肢部分(FMA-UE)的评估。结果运动姿态与肌电融合的上肢运动功能评估系统与FMA-UE评分之间呈正相关(r=0.891, P=0.001),优于单纯运动姿态(r=0.758, P=0.011)或肌电(r=0.697, P=0.025)评估结果。结论运动姿态与肌电融合的上肢运动功能评估系统能有效地对脑卒中患者上肢运动功能进行评估。     

微型传感器运动捕获系统结合同步表面肌电对脑卒中偏瘫患者上肢够物功能的定量评估

目的应用微型传感器运动捕获系统并结合同步表面肌电评估脑卒中偏瘫患者上肢够物动作的运动学及动力学特征。 方法选取16例脑卒中偏瘫患者［平均年龄（65.9±10.0）岁］及10例年龄相匹配的健康老年人作为研究对象。2组受试者坐在椅子上用患手（患者）或右手（健康人）够取放在肩前方距肩一臂长距离处的杯子,采用微型传感器运动捕获系统记录受试者躯干及上肢运动学数据,同时采集被测肢体斜方肌、三角肌前组、肱二头肌、肱三头肌表面肌电信号。共进行4次够取任务测试,选取最好的一组数据进行分析。将同步采集的运动学数据与表面肌电信号处理后得到肩、肘关节活动范围及达标时间、角度变化峰值及对应时间、每组肌群做功和肌群做功比值（如斜方肌/三角肌前组、肱二头肌/肱三头肌）等。本研究同时采用Fugl-Meyer运动功能量表（FMA）上肢部分对入选患者上肢运动功能进行评分。采用独立样本秩和检验比较脑卒中患者运动学参数及肌电参数与健康人间的差异,采用Spearman相关性分析探讨患者偏瘫侧上肢FMA评分与运动学特征及肌电特征间的相关性。 结果脑卒中偏瘫患者上肢够物功能的运动学参数及肌电参数与健康人间差异均具有统计学意义（P<0.05）。脑卒中患者偏瘫上肢FMA评分与肩关节活动峰速度具有相关性（P<0.05）,部分运动学参数与肌电参数具有相关性,如肩关节活动最大角度与斜方肌做功、肩关节活动速度达峰时间与肱二头肌/肱三头肌做功比值间具有相关性（P<0.05）。 结论微型传感器运动捕获系统结合同步表面肌电分析可定量评测脑卒中偏瘫患者在三维实际环境中够取物体时的多关节运动学及动力学特征,为临床优化康复治疗方案提供客观依据。     

实时手部精细运动意图识别方法的研究

目的:利用脑卒中患者的自主运动意识进行主动神经康复是促进患者脑功能重塑、提高康复训练效果的重要工程学手段。针对脑卒中患者手部精细运动功能恢复速度慢、恢复程度有限等问题,本文提出了一种基于数据手套的模板匹配方法,用于识别患者的手部精细运动意图。方法:利用自主研发的虚拟现实康复训练平台,将基于数据手套模板匹配的运动意图识别方法嵌入其中,并与基于表面肌电模式识别方法进行对比研究。招募了6例健康受试者参与实验,对16个手部精细动作的离线识别性能和实时识别性能分别进行分析,并对离线性能指标与实时性能指标之间的关系进行相关性研究。结果:采用基于数据手套模板匹配方法取得的平均离线动作识别准确率为95.00%±3.66%,平均实时动作完成率为91.31%±1.17%,显著高于基于表面肌电模式识别方法的离线动作识别准确率(84.66%±4.66%,P0.01)与实时动作完成率(71.86%±10.04%,P0.01)。另外,基于数据手套模板匹配方法取得的离线动作识别准确率与实时动作完成率是线性相关的(P0.05),而基于表面肌电模式识别方法取得的离线与实时性能指标不存在线性关系(P=0.4005)。结论:与传统的肌电模式识别方法相比,基于数据手套模板匹配方法具有显著的比较性优势。因此,有望成为手部精细运动功能主动神经康复中的一种有效的运动意图识别方法。     

基于肌电和惯性传感器数据融合的脑卒中患者上肢够物运动定量评估

目的:探讨融合肌电和惯性传感数据的定量化脑卒中患者上肢运动评估方法的有效性.方法:实验联合使用微型惯性传感器和多通道肌电传感器,同步采集了20例脑卒中患者(患者组)和年龄匹配的10名老年人(健康组)的肌电及运动数据,融合这两种数据分别进行了分组统计学分析和典型个例分析.结果:患者组的运动学参数与健康组比较差异有显著性意义,并且运动学参数与肌电参数之间有着较高的相关性.运动参数所反映出的异常运动模式与肌电所反映出的情况相一致,肌电数据能用于解释异常运动模式的原因.结论:本定量化康复评估方法可以实时、定量和可视化地进行临床分析和诊断治疗.     

三维动态捕捉系统结合表面肌电在脑卒中偏瘫患者上肢运动功能评估中的应用

目的 应用三维动态捕捉系统结合表面肌电分析脑卒中患者和健康人上肢触碰试验的运动学和生理学特点,并探讨其对脑卒中患者上肢运动功能评定的价值。     

基于表面肌电信号的腕手功能评定与重建研究

目的通过表面肌电信号特征的提取和分析,建立基于表面肌电信号的脑卒中患者腕手运动功能评定新方法;并以此为基础,通过客观评价中枢神经损伤后上肢及腕手的运动功能,开展不同方案低频电刺激方法促进瘫痪腕手运动重建的疗效评价和相关研究。方法选择Fugl-Meyer上肢腕手评分≥7分的脑梗死、脑出血患者36例,随机分为3组。治疗组A(常规康复+低频电刺激伸肌),治疗组B(常规康复+低频电刺激屈伸肌)和对照组(常规康复),采集患者上肢肘和手腕部活动时主动肌、协同肌、拮抗肌的表面肌电信号(sEMG),提取特征值最大振幅(MAX)、所得肌电信号经整流滤波后单位时间内曲线下面积的总和(AE-MG)。结果治疗后两组患者的腕手功能均有恢复;对照组总有效率为52.47%但治疗组手腕部MAX、AE-MG、Fugl-Meyer运动功能分值、ADL值提高较明显(P<0.05),且治疗组B的疗效(总有效率72.54%)大于治疗组A(总有效率60.76%)。结论sEMG信号检测是一种客观、灵敏且精确的运动评定方法,低频电刺激对脑卒中患者恢复肢体运动功能具有一定促进作用。     

镜像疗法结合肌电生物反馈疗法促进脑卒中偏瘫患者上肢功能重建的临床观察

目的探讨镜像疗法结合肌电生物反馈疗法对脑卒中偏瘫患者上肢功能的影响。 方法选取45例脑卒中偏瘫患者,采用随机数字表法分为常规组、肌电组和联合组,每组15例。所有患者均根据自身肢体功能障碍情况接受相应的常规康复治疗,肌电组在此基础上增加肌电生物反馈疗法治疗,联合组则在常规康复治疗的基础上增加镜像疗法结合肌电生物反馈治疗。分别于治疗前和治疗4周后（治疗后）,采用Fugl-Meyer运动功能评定量表上肢部分、偏瘫Brunnstrom分期评定量表（上肢及手部分）、功能独立性评定量表运动功能部分、患侧腕关节背伸主动关节活动度、患侧前臂伸肌集群相关肌电积分对各组患者的上肢功能进行评定。 结果①组内比较：治疗后,3组患者中除常规组偏瘫Brunnstrom分期上肢部分外,其它各项指标包括Fugl-Meyer运动功能评分［（49.73±8.26）分］、功能独立性评分［（66.13±8.47）分］、患侧腕关节背伸主动关节活动度［（48.93±12.79）°］、患侧前臂伸肌集群相关肌电积分［（84.11±26.86）μV］分别较组内治疗前［（22.67±10.95）分、（34.53±7.82）分、（17.07±7.52）°、（28.03±10.26）μV］有明显改善,差异均有统计学意义(P<0.05)。②组间比较：治疗后,肌电组各项指标与常规组相比,差异均有统计学意义(P<0.05);联合组各项指标与其它两组比较,差异有统计学意义(P<0.05)。 结论镜像疗法结合肌电生物反馈疗法可以更有效地改善脑卒中偏瘫患者的上肢功能。     

多通道功能性电刺激对脑卒中上肢运动功能的疗效及表面肌电特征研究

目的:探讨多通道功能性电刺激对脑卒中患者上肢运动功能及表面肌电信号的影响。方法:选取2019年1月至2019年6月在无锡市同仁康复医院康复医学科住院的脑卒中患者44例,随机分为观察组(21例)和对照组(23例),两组患者均给予常规临床、护理及康复治疗,在此基础上,对照组患者接受手摇车训练,而观察组患者在进行手摇车训练的同时辅以多通道功能性电刺激治疗,均每日治疗1次,每周5次,共治疗4周。分别在治疗前和治疗4周后对患者患侧上肢肱二头肌、肱三头肌进行表面肌电图测试,并采用Fugl-Meyer评定量表上肢部分(FMA-UE)和改良的Barthel指数(modified Barthelindex,MBI)对所有患者进行上肢运动功能及日常生活活动能力评定。结果:治疗前两组患者上肢肱二、三头肌表面肌电均方根值(root mean square,RMS)、协同收缩率(co-contractionratio,CR)以及FMA-UE、MBI评分均无显著性差异(P0.05)。治疗4周后,两组患者上肢肱二、三头肌RMS值、CR值较治疗前均有所降低(P0.05),FMA-UE和MBI评分较治疗前均有所提高(P0.05),差异具有显著性意义。4周后观察组各评分值改善程度优于对照组(P0.05)。结论:多通道FES可以有效提高脑卒中患者上肢运动功能和日常生活自理能力,同时能有效降低脑卒中患者上肢的肌张力,值得临床推广应用。     

肌电生物反馈刺激改善缺血性卒中患者急性期上肢功能的疗效观察

目的探讨肌电生物反馈治疗技术观察缺血性脑卒中患者急性期上肢功能的改善效果。方法选取2010年12月至2013年12月该院84例脑卒中患者,采用随机对照方法分为2组,试验组在对照组的基础上使用肌电生物反馈治疗,分析2组患者治疗前、治疗后2周对改良Barthel指数(MBI)、Fugl-Meyer运动功能评定量表(FMA)进行上肢部分评定。结果治疗后2组患者的上肢运动能力(FMA)及改良BI指数(MBI)比较,差异有统计学意义(P0.05);2组治疗前后上肢运动能力(FMA)及改良BI指数(MBI)的评定差值比较,差异有统计学意义(P0.05)。结论肌电生物反馈治疗对急性缺血性卒中患者患侧上肢功能恢复具有促进作用。     

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。     

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.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

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.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.