上肢机器人对脑卒中患者上肢功能恢复的影响

目的 分析上肢机器人对脑卒中患者恢复期上肢及手功能恢复的影响.方法 对60例脑卒中上肢功能损伤的患者进行分组治疗,治疗组（n=30）和对照组（n=30）.治疗组进行常规作业疗法训练、上肢机器人训练.对照组进行常规作业疗法.2组患者训练时间均为2次/d,5 d/周,共2个月,同时2组均进行常规药物治疗、运动疗法训练和针灸治疗.治疗前后采用Brunnstrom偏瘫上肢功能评价法对2组患者进行上肢功能评定.结果 通过常规的作业疗法和运动疗法及传统针灸康复治疗,2组患者Brunnstrom分级都有所改善,但治疗组效果明显优于对照组,2组相比P＜0.05.结论 通过应用上肢康复机器人重复训练,使大脑发生神经结构可塑性的改变,脑卒中患者上肢及手部功能有所提高,结合复合运动训练,从而改善了上肢的功能障碍,加强上肢多关节肌的力量和肌间协作能力,能使患者最大限度地获得自立,最终回归家庭,重返社会.     

急性脑卒中患者肩-手综合征的康复治疗与护理

部分急性脑卒中患者在发病1周左右会出现患侧肩部疼痛,活动受限,手部肿胀,部分患者伴胀痛,皮温升高,严重影响肩、手功能恢复.发生疼痛及水肿原因,可能与偏瘫后患肢活动减少,经常向患侧卧位,使上肢受压、水肿,血液循环不良或不恰当的牵拉致肩关节周围软组织损伤及肩关节半脱位,植物神经功能紊乱等有关.肩、手功能在日常生活中具有重要作用,作者采用综合治疗方法,对10例肩-手综合征患者进行康复治疗与护理,肩、手功能恢复良好,现总结如下.     

早期康复治疗对脑卒中肩手综合征及上肢运动功能的影响

目的探讨早期康复治疗对预防脑卒中肩手综合征及改善上肢功能的临床效果。方法选取2013年5月~2014年5月来本院就诊的脑卒中患者97例,采用随机数字法分为观察组(Treat Group,TG)与对照组(Control Group,CG)2组。观察组运用早期综合康复治疗,比较2组患者肩手综合征发生率,并采用Fugl-Meyer(FMA)评分法评价治疗前后上肢的运动功能。结果观察组共发生肩手综合征4例(8.00%),对照组共发生肩手综合征12例(25.53%),观察组肩手综合征的发生率明显低于对照组,上肢Fugl-Meyer功能评分明显优于对照组(P0.05)。结论早期康复治疗可以在一定程度上预防肩手综合征的发生,并能改善上肢功能,提高患者生存及生活质量。     

三联疗法治疗脑卒中后肩-手综合征的临床疗效观察

肩-手综合征(shoulder-hand syndrome,SHS)又称为反射性交感神经营养不良(reflex sympathetic dystrophy,RSD)、Sudeck综合征、Steinbrocker综合征等,是脑卒中患者常见的并发症之一,主要表现为患手突然浮肿、疼痛及患侧肩疼痛,并使手的运动功能受限制[1],严重影响上肢和手功     

电子生物反馈联合康复机器人对脑卒中上肢功能恢复的作用观察

目的观察电子生物反馈疗法联合上肢康复机器人治疗对脑卒中后偏瘫上肢运动功能的临床效果。方法将60例脑卒中后上肢瘫痪患者采用随机对照的方法分为治疗组和试验组各30例,治疗组采用常规康复治疗措施(作业疗法和手功能训练),结合电子生物反馈疗法,2次/d,30 min/次,12次/周,共6周。试验组在常规康复治疗基础上应用上肢康复机器人进行治疗,同时联合电子生物反馈疗法,2次/d,20 min/次,12次/周,共6周。治疗前及治疗后2组采用Fugl-Mayer运动功能量表上肢部分评定(FMA-UE)、Carroll上肢功能评定(UEFT)以及改良Barthel指数(MBI)评价2组患者上肢功能及日常生活活动能力。结果治疗后2组FMA-UE、UEFT、MBI与治疗前比较差异均有统计学意义(P0.05)。试验组效果较治疗组更显著(P0.05)。结论电子生物反馈疗法联合上肢康复机器人对脑卒中上肢运动功能障碍的改善及日常生活活动能力的提高效果优于常规康复治疗。     

早期作业治疗对脑卒中偏瘫患者上肢功能与ADL的影响

目的 探讨早期作业治疗对脑卒中偏瘫患者3个月后上肢功能与日常生活活动能力的影响.方法 选择初发型脑卒中偏瘫患者64例,随机分为康复组和对照组,2组患者在年龄、性别、疾病分型、偏瘫侧、病程和简化Fugl-Meyer运动量表及Barthel指数等方面差异均无统计学意义.2组均接受神经内科常规药物治疗,康复组在药物治疗的同时,于患者病情不再进展,生命体征稳定后即开始早期介入正规作业治疗;对照组在给于药物治疗的同时,较康复组晚的介入正规作业治疗.2组患者分别于治疗开始时(初评时)、治疗后3个月进行Fugl-Meyer运动量表上肢功能评分和日常生活能力的Barthel指数评分.结果 2组患者上肢功能及Barthel指数评分,初评时差异无显著性(P>0.05),经3个月治疗后差异有显著性(P<0.05,P<0.01).结论 早期介入正规作业治疗对脑卒中偏瘫患者上肢功能与日常生活能力的恢复具有很好的促进作用.     

肩周封闭结合康复训练治疗肩手综合征疗效观察

目的 探讨肩周封闭疗法配合康复训练治疗治疗脑卒中后肩-手综合征的疗效。方法 60例脑卒中后肩-手综合征患者随机分为两组，单纯治疗组采用康复训练疗法，复合治疗组在康复训练疗法的基础上加用肩周封闭治疗，于治疗后4周对患者肩关节疼痛程度（采用视觉模拟评分即VAS法）、肩关节活动度、上肢运动功能（简化Fugl-Meyer）进行评定。结果 复合治疗组的疼痛评分明显低于单纯治疗组（P〈0．05），肩关节活动度（外展、外展上举）明显〉单纯治疗组（均P〈0．05或0．01），Fugl-Meyer运动功能评分明显高于单纯治疗组（P〈0．05）。结论 肩周封闭配合康复训练治疗脑卒中后肩-手综合征疗效显著。     

作业治疗对脑卒中后偏瘫患者日常生活活动能力的影响

目的探讨作业治疗对脑卒中偏瘫患者日常生活活动能力的影响。方法选取40例脑卒中后上肢及手功能障碍患者,随机分为对照组(A组)和治疗组(B组)各20例。对照组接受基础康复训练,治疗组采取基础康复训练和日常生活能力训练,治疗时间均为6周。治疗前后采用改良Barthel指数(MBI)评定患者的日常生活活动能力。结果治疗6周后,2组患者的MBI评分较治疗前均明显提高(P0.05),且治疗组改善效果更显著(P0.01)。结论作业治疗能更有效提高脑卒中偏瘫患者的日常活动活动能力。     

脑卒中患者摄食-吞咽功能训练的风险管理

目的分析脑卒中患者摄食-吞咽功能训练的风险管理对患者的影响。方法以我院2009—2013年收治的158例脑卒中患者为研究对象,其中2009—2011年采用常规训练模式的79例患者为对照组,2012—2013年在常规训练模式基础上给予风险管理措施的79例患者为观察组,比较2组患者经摄食-吞咽功能训练后吞咽障碍程度和不良反应发生情况。结果2组患者治疗后摄食-吞咽障碍程度方面无明显差异(P0.05),观察组患者治疗过程中误咽、误吸、食管反流以及肺部感染明显少于对照组(P0.05)。结论对脑卒中患者摄食-吞咽功能训练过程中采取相应的风险管理措施,可有效减少患者出现误咽、误吸、食管反流以及肺部感染的发生率,值得临床推广使用。     

康复护理对脑卒中患者摄食-吞咽功能恢复的应用效果观察

目的探讨康复护理对脑卒中患者摄食-吞咽功能恢复的应用效果。方法选取我院收治的158例脑卒中患者作为研究对象,随机分为观察组和对照组各79例,对照组给予常规护理,观察组在对照组的基础上给予康复护理干预。比较2组经摄食-吞咽功能训练后吞咽障碍程度和不良反应发生情况。结果 2组治疗后在摄食-吞咽障碍程度方面并无明显差异(P0.05),而观察组治疗过程中出现误咽、误吸、食管反流以及肺部感染的人数明显少于对照组,差异有统计学意义(P0.05)。结论对脑卒中患者摄食-吞咽功能训练过程中采取相应的康复护理干预,可有效减少患者出现误咽、误吸、食管反流以及肺部感染的发生率,值得临床推广使用。     

A treatment for a chronic stroke patient with a plegic hand combining CI therapy with conventional rehabilitation procedures: case report

Constraint-Induced Movement therapy (CI therapy) is a recognized rehabilitation approach for persons having stroke with mild to moderately severe motor upper extremity deficits. To date, no rehabilitation treatment protocol has been proven effective that addresses both motor performance and spontaneous upper extremity use in the life situation for chronic stroke participants having severe upper extremity impairment with no active finger extension or thumb abduction. This case report describes treatment of a chronic stroke participant with a plegic hand using a CI therapy protocol that combines CI therapy with selected occupational and physical therapy techniques. Treatment consisted of six sessions of adaptive equipment and upper extremity orthotics training followed by a three-week, six-hour daily intervention of CI therapy plus neurodevelopmental treatment. Outcome measures included the Motor Activity Log for very low functioning patients (Grade 5 MAL), upper extremity portion of the Fugl-Meyer Motor Assessment, Graded Wolf Motor Function Test - for very low functioning patients (gWMFT- Grade 5), and Modified Ashworth Scale. The participant showed improvement on each outcome measure with the largest improvement on the Grade 5 MAL. In follow-up, the participant had good retention of his gains in motor performance and use of his more affected arm for real world activities after 3 months; after a one-week brush-up at 3 months, and at one year post-treatment.     

基于镜像视觉反馈的作业疗法对偏瘫儿童运动功能及生活能力的影响

目的 探讨基于镜像视觉反馈的作业疗法对偏瘫儿童运动功能及生活能力的影响。方法 选取2016年1月-2018年1月本院收治的偏瘫患儿200例,依据随机数字表法分为镜业组和常业组,每组各100例,常业组给予常规作业疗法治疗,镜业组给予基于镜像视觉反馈的作业疗法治疗,比较干预前后2组运动功能、生活能力、康复效果。结果 镜业组和常业组干预3、6个月后Fugl-Meyer运动功能评分法(FMA)、日常生活能力量表(ADL)得分明显高于干预前,镜业组干预3、6个月后FMA、ADL得分明显高于常业组(P<0.05); 镜业组治疗有效率明显高于常业组(P<0.05)。结论 基于镜像视觉反馈的作业疗法可有效改善偏瘫患儿运动功能及生活能力,有利于提高康复效果。     

镜像训练对脑卒中患者上肢运动功能和心理状态的影响

目的 观察镜像训练对脑卒中患者上肢运动功能和心理状态的影响。方法 采用随机数字表将64例恢复期脑卒中偏瘫患者分为治疗组和对照组,每组各32例; 2组患者均给予相同常规康复治疗(偏瘫肢体功能综合训练、作业治疗、中低频电刺激治疗和气压泵治疗),对照组在此基础上增加2次/d,20min/次的镜像训练治疗; 以上治疗均5次/周,连续治疗4周; 2组患者均于治疗前和治疗4周后采用Fugl-Meyer量表上肢部分(FMA-UE)、Wolf运动功能测试量表(WMFT)、贝克抑郁量表(BDS)以及改良Barthel指数(MBI)进行评估。结果 治疗前2组FMA-UE评分、WMFT评分、BDS评分、MBI评分比较无明显差异(P>0.05); 治疗4周后除对照组BDS评分无明显变化,其余组别各评分均较治疗前有明显进步(P<0.05),且治疗组FMA-UE、WMFT、BDS、MBI评分与对照组比较有明显差异(P<0.05)。结论 镜像训练可明显提高脑卒中患者上肢运动功能,改善心理状态,提高生活质量。     

Absence of a proximal to distal gradient of motor deficits in the upper extremity early after stroke

OBJECTIVE: Our first purpose was to determine whether there was a proximal to distal gradient in motor deficits in nine segments of the affected upper extremity (shoulder, elbow, forearm, wrist, and five fingers) post-stroke. Our second purpose was to determine which upper extremity segments made the greatest contributions to hand function. METHODS: Thirty-three subjects were tested on average 18.6 (+/-5.6) days after stroke. The ability to move each segment was measured by active range of motion (AROM). Hand function was measured by a battery of standardized clinical tests which were synthesized into a single, sensitive score for hand function using principal component analysis. RESULTS: AROM at all nine segments of the upper extremity was reduced and there was no evidence of a proximal to distal gradient in AROM values. Strength of each segment was reduced and there was also no evidence of a gradient in strength values. AROM at each segment was strongly correlated with hand function scores (range 0.76-0.94). General multiple regression analysis showed that AROM explained 82% of the variance in hand function, with most of the variance shared across proximal, middle, and distal segments. Hierarchical regression analysis showed that shoulder AROM alone could explain 88% of the variance in hand function. CONCLUSIONS: Early after stroke a proximal to distal gradient of motor deficits was not present, and loss of hand function was due to a loss of ability to move many segments of the upper extremity and not just the distal ones. SIGNIFICANCE: These results suggest that a change in the clinical perception of motor deficits post-stroke is needed. Our finding that shoulder AROM predicted almost all the variance in hand function opens up the possibility that this quick, simple measure may be predictive of future hand function. This would be of high economic and clinical utility compared to other ongoing efforts attempting to predict outcomes post-stroke (e.g. fMRI, MEG).     

卒中后膈肌功能及相关因素分析

目的 分析卒中后偏瘫患者的膈肌功能,并探讨其与卒中病程以及吞咽、呼吸、运动、平衡功能和日常生活能力的相关性。 方法 本研究为前瞻性研究,连续纳入首次卒中后单侧偏瘫的患者,记录患者的一般资料,洼田饮水试验、主观呼吸功能障碍程度量表、Fugl-Meyer运动功能评定量表（Fugl-Meyer motor function assessment scale,FMA）、Berg平衡量表（Berg balance scale,BBS）、改良Barthel指数（modified Barthel index,mBI）。采用超声测定膈肌功能,包括平静呼吸时的膈肌活动度以及用力呼吸状态下的膈肌活动度和膈肌增厚率。比较整体和不同瘫痪侧患者偏瘫侧和健侧的膈肌功能,分别比较左侧偏瘫和右侧偏瘫患侧的膈肌功能和健侧的膈肌功能。分析瘫痪侧的膈肌功能与病程、洼田饮水试验、主呼吸功能障碍程度量表、FMA、BBS、mBI等指标的相关性 结果 研究共纳入45例卒中患者,其中左侧偏瘫27例（60.00%）,右侧偏瘫18例（40.00%）。在整体患者中,用力呼吸状态下,偏瘫侧膈肌活动度（31.69±15.18 mm vs. 40.24±14.66 mm,P＜0.001）及膈肌增厚率（34.99%±23.70% vs. 48.13%±21.98%,P＜0.001）低于健侧。用力呼吸状态下,左侧偏瘫患者的偏瘫侧膈肌活动度（30.13±12.64 mm vs. 44.10±12.95 mm,P＜0.001）和膈肌增厚率（41.20%±23.42% vs. 54.63%±21.08%,P =0.004）较健侧低;右侧偏瘫患者的偏瘫侧膈肌增厚率（25.67%±21.47% vs. 38.37%±20.07%,P =0.005）较健侧低。用力呼吸状态下,右侧偏瘫患者的偏瘫侧膈肌增厚率低于左侧偏瘫患者（P =0.029）。右侧偏瘫患者的健侧膈肌活动度（P =0.028）及膈肌增厚率低于左侧偏瘫患者（P =0.012）。卒中患者平静呼吸状态下,偏瘫侧膈肌活动度与FMA（r =0.362,P =0.015）呈正相关;用力呼吸状态下,偏瘫侧膈肌活动度与洼田饮水试验（r =0.298,P =0.047）、主观呼吸功能障碍程度量表（r =0.437,P =0.003）、FMA（r =0.330,P =0.027）、BBS（r =0.370,P =0.012）、mBI（r =0.321,P =0.031）呈正相关,偏瘫侧膈肌增厚率与病程（r =-0.298,P =0.047）呈负相关。 结论 卒中后偏瘫侧膈肌功能较健侧下降,右侧偏瘫患者双侧膈肌功能较左侧偏瘫患者更差。卒中患者膈肌功能与病程呈负相关,与吞咽功能、呼吸功能、肢体运动功能、平衡能力及日常生活能力呈正相关。     

Upper extremity function and its relation with hand sensation and upper extremity strength in patients with multiple sclerosis

The purpose of this study was to investigate the relationships between the upper extremity functions, upper extremity strength and hand sensation in patients with Multiple Sclerosis (MS). Twenty-two patients with MS (mean age: 38.5 ± 8.31 years, median Expanded Disability Status Scale (EDSS): 2) and 10 healthy subjects were included. Upper extremity function was measured with the Nine-hole peg test, upper extremity strength (shoulder flexion-abduction, elbow flexion, pinch and grip) with hand-held dynamometer, hand grip dynamometer and manual pinch meter, threshold of light touch-pressure with Semmes-Weinstein monofilament, duration of vibration with 128-Hz frequency tuning fork, and distance of two-point discrimination with an aesthesiometer. Strength and functional level of the upper extremity, light touch-pressure, two-point discrimination, vibration sensations of the hand were lower in patients with MS compared with healthy controls (p < 0.05). Light touch-pressure sensation of thumb and index fingers, two-point discrimination of index finger and elbow flexion strength were found to be related with upper extremity function in patients with MS (p< 0.05). These results indicate that the hand sensation, upper extremity strength and function were affected in MS patients. Additionally upper extremity functions seem to be related with light touch-pressure and two-point discrimination sensations of the hand and elbow flexion strength. Upper extremity strengthening and sensorial training of the hand may contribute to the upper extremity function in patients with MS.     

Upper extremity function in spina bifida

Poor upper extremity function is often recorded in meningomyelocele patients. Only 2 of the 25 patients we assessed, 5 to 19 years old, showed normal upper extremity function in the clinical neurological examination and a timed hand function test simulating daily activities. Slow performance with unsystematic variability was typical. Poor hand function correlated strongly with hydrocephalus. A trend towards better performance with increasing age may indicate that the difficulties are overcome in some patients. While patients without hydrocephalus showed a near-normal distribution in the seven subtests, patients with hydrocephalus needed more time than normal children. Patients with shunt-treated hydrocephalus did not cope as well as patients without a shunt. Mean age in the three groups differed and may partly explain the differences.     

Outcome following nonoperative treatment of brachial plexus birth injuries

Ninety-one infants who sustained a brachial plexus birth injury were treated with only physical and occupational therapy. The children were evaluated at 3-month intervals and followed for a minimum of 2 years. Sixty-three children with an upper or upper-middle plexus injury recovered good to excellent shoulder and hand function. In all of these children, critical marker muscles recovered M4 by 6 months of age. Twelve infants sustained a global palsy, with critical marker muscles remaining at M0-M1 at 6 months, resulting in a useless extremity. Sixteen infants with upper and upper-middle plexus injuries failed to recover greater than M1-M2 deltoid and biceps by 6 months, resulting in a very poor final outcome. These data provide useful guidelines for selection of infants for surgical reconstruction to improve ultimate outcome.     

Combination of Exoskeletal Upper Limb Robot and Occupational Therapy Improve Activities of Daily Living Function in Acute Stroke Patients

Purpose: Previous studies have suggested that upper limb rehabilitation using therapeutic robots improves motor function of stroke patients. However, the effect of upper limb robotic rehabilitation on improving functioning in activities of daily living (ADL) remains unclear. The present study aimed to determine whether upper limb rehabilitation using single joint Hybrid Assistive Limb (HAL-SJ) affects ADL function and the use of a hemiparetic arm in ADLs of acute stroke patients. Materials and Methods: Twelve acute stroke patients participated in the study and were randomly divided into group A or group B. The patients in group A followed an A-B-A-B design and those in group B followed a B-A-B-A design. The patients received combination HAL-SJ and occupational therapy during A and conventional occupational therapy during B. Results: Upper limb motor function and ADLs, in particular, dressing the upper body, were improved during combination HAL-SJ and occupational therapy. Interestingly, the use of a hemiparetic arm in daily life evaluated using the motor activity log was also significantly improved during A in group A. Conclusions: Combination HAL-SJ and occupational therapy affects ADL function and real use of a hemiparetic arm in the daily life of acute stroke patients.     

The Effect of Occupation-Based Bilateral Upper Extremity Training in a Medical Setting for Stroke Patients: A Single-Blinded,Pilot Randomized Controlled Trial

Background: Occupation used in occupation-based intervention requires the use of 2 naturally coordinated hands. Objective: To investigate by implementing occupation-based bilateral upper extremity training in medical setting to stroke patients and determine its effect in patients’ bilateral upper extremity function recovery. Methods: A total of 20 patients were randomly assigned to the experimental group (occupation-based bilateral upper extremity training) or control group (task-based bilateral upper extremity training). The intervention of the 2 groups was conducted 30 minutes a day, 5 times a week, and 4 weeks long. The outcome was assessed using the Canadian Occupational Performance Measure, Stroke Impact Scale, Action Research Arm Test, the Yonsei-Bilateral Activity Test, Accelerometer, and participants were assessed at baseline and after 4 weeks. Results: There was a significant change in the satisfaction and performance status of occupational performance, strength, Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL), emotion, participant recovery in stroke recovery, gross movement in the function of the affected side, satisfaction in perform bilateral upper extremity in the experimental group compared to the control group. Conclusions: The clinical significance of this study is that this study demonstrated the effectiveness and usefulness of the training in the actual medical setting in improving upper extremity function and psychosocial factors.