早期康复护理对脑卒中偏瘫患者肢体功能作用的观察

目的 观察早期康复护理对脑卒中偏瘫患者肢体功能恢复的作用.方法 将60例脑卒中偏瘫患者随机分为康复组(30例)和对照组(30例),2组均给予常规药物治疗和常规护理,康复组在此基础上采用早期肢体功能康复锻炼,3个月后进行效果评价;疗效评价采用Fugl-Meyer积分评价肢体功能,Barthel 指数评价日常生活能力.结果 对照组和康复组患者治疗后的FMA值及BI值均显著高于治疗前(P<0.05),康复组的功能改善优于对照组(P<0.05).结论 早期康复护理对脑卒中偏瘫患者能有效促进其生活能力及运动功能恢复,提高患者的生活质量.     

脑卒中早期规范化康复治疗的临床观察

目的 观察早期规范化康复治疗对脑卒中偏瘫患者运动功能的影响.方法 86例脑梗死偏瘫患者随机分为治疗组和对照组,2组均常规进行神经内科的药物治疗和针灸治疗,治疗组加规范化的肢体运动康复疗法.结果 3个月后治疗组运动功能恢复优于对照组(P＜0.05).结论 早期规范化的肢体运动康复治疗可明显降低脑卒中患者的运动功能障碍,值得临床推广.     

急性脑卒中患者早期康复的临床研究

目的　对急性脑卒中患者进行规范化的康复治疗,探讨对偏瘫肢体运动功能和日常生活活动能力的影响。方法　60例急性脑卒中患者随机分组并对康复组采用规范化的康复治疗,于治疗前后用Fugl Meyer法Barthel指数评定两组患者偏瘫肢体运动功能和日常生活活动能力。结果　治疗前两组Fugl meyer值及Barthel指数积分相近,差异无显著性(P >0 .0 5 ) ;治疗后(1个月和6个月) ,康复组Fugl meyer值、Barthel指数积分均明显高于对照组,具有显著性差异(P <0 .0 1)。结论　急性脑卒中患者早期给予系统规范的康复治疗能促进神经功能恢复,降低残废率,提高生存质量。     

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.     

早期综合康复锻炼对急性脑卒中偏瘫患者肢体功能康复的影响

目的探讨早期综合康复锻炼在急性脑卒中偏瘫患者肢体功能恢复中的效果。方法选择急性脑卒中偏瘫患者96例,随机分为康复组48例和对照组48例。康复组在接受神经内科常规治疗基础上接受综合康复锻炼,而对照组只接受常规药物治疗和未经指导的自我锻炼。分别于治疗前1d和治疗后60d采用Barthel指数评定患者的日常生活活动能力,用运动功能积分法（FMA）测评患者的肢体运动功能。结果经过60d治疗,康复组无论是日常生活活动能力还是运动功能均显著优于对照组（P〈0.01）。结论急性脑卒中偏瘫患者早期进行综合康复锻炼能明显提高患者的肢体运动功能和日常生活能力,从而有效提高患者生活质量。     

早期康复治疗对急性脑卒中偏瘫患者肢体功能的影响

目的　探讨早期康复治疗对急性脑卒中偏瘫患者肢体功能及日常生活能力的影响。方法　 77例急性脑卒中偏瘫患者随机分成康复组 3 9例和对照组 3 8例。两组患者接受神经内科常规治疗方法相同 ,康复组按早期康复训练程序进行系统训练 ,对照组自行锻炼。结果　采用修订的Barthel指数 (MBI)和Fugl Meyery运动功能积分法对两组患者进行治疗前后评定显示 :治疗前两组评分差异均无显著性 (P >0 0 5 ) ;治疗后康复组评分明显优于对照组 (P <0 0 1)。结论　早期康复治疗对急性脑卒中偏瘫患者运动功能及日常生活能力恢复具有促进作用 ,对患者预后有良好的影响。     

早期康复治疗对脑卒中患者生活能力的影响

目的探讨早期康复治疗对脑卒中患者偏瘫肢体的恢复程度和日常生活能力(ADL)的影响。方法选择131例急性脑卒中患者,随机分为康复组(66例)和对照组(65例)进行研究,2组均进行药物常规治疗。康复组在此基础上应用Bobath技术进行早期运动康复锻炼1个月,对每例患者采用神经功能缺损程度(CSS)评定,改良Barthel指数(MBI)于初期和末期进行评定。结果治疗后治疗组临床神经功能缺损评分与对照组比较明显减少(P<0.01),MBI明显高于对照组(P<0.01)。结论早期康复治疗能明显提高患者患肢运动功能和日常生活能力。     

偏瘫早期康复基础训练疗效观察

目的 探讨偏瘫早期康复基础训练对急性脑卒中患者并发症发生率和患肢功能恢复程度的影响.方法 选择急性脑卒中偏瘫患者88例,随机分成2组,对照组进行常规药物治疗,康复组除药物治疗同时给予康复基础训练.结果 康复组在肢体痉挛、肩关节半脱位、肩关节痛、足下垂内翻、废用综合征的发生及患肢功能恢复程度与对照组存在明显差异.结论 早期对偏瘫患者实施基础康复训练有利于降低脑卒中患者并发症的发生,能够改善偏瘫肢体功能,降低致残率,提高生存质量.     

探讨早期康复治疗对脑卒中患者生活能力的影响

目的探讨早期康复治疗对脑卒中患者偏瘫肢体的恢复程度和日常生活能力(ADL)的影响。方法选择108例急性脑卒中患者,随机分为康复组(54例)和对照组(54例)进行对照研究,2组均进行常规神经内科药物治疗。康复组在此基础上应用Bobath技术进行早期肢体运动康复锻炼4周,对每例患者采用神经功能缺损程度(CSS)评定,改良Barthel指数(MBI)于初期和末期进行评定。结果治疗后康复组临床神经功能缺损评分与对照组比较明显减少(P0.01),MBI明显高于对照组(P0.01)。结论早期康复治疗能明显提高患者患肢运动功能和日常生活能力。     

脑卒中偏瘫患者运动功能康复的护理延伸

目的探讨家庭康复护理指导对脑卒中偏瘫患者运动功能恢复的效果。方法将114例脑卒中偏瘫患者进行回顾性分析,随机分为康复组64例,对照组50例。康复组出院前对患者及家属进行康复知识培训,出院时制定了统一的家庭康复护理计划,并定期去患者家中进行康复指导和评估,对照组未提供康复知识,3个月后观察康复效果。结果经过康复护理指导的患者,效果明显优于对照组(P<0.05)。结论家庭康复护理指导,能较大限度地恢复肢体功能,降低患者的致残率。     

Impairment and recovery of left motor function in patients with right hemiplegia.

OBJECTIVE: To assess the motor function of the left, supposedly unaffected, limbs of patients with an acute right vascular hemiplegia. METHODS: Fifteen patients with an acute vascular right hemiplegia and 16 matched healthy controls were studied. Motor function of the left limbs of each patient was evaluated on days 20 and 90 after their stroke using four validated tools (hand dynamometer, isokinetic dynamometer, finger tapping, and nine hole peg test). RESULTS: There was a significant impairment of motor function of the left limbs of patients at day 20 compared with controls. The impairment had recovered almost completely at day 90 after the stroke. CONCLUSION: These results show the bilateral cerebral representation of the human motor system and suggest the participation of ipsilateral motor pathways in recovery after a stroke.     

Dual extradural cortical stimulation in chronic stroke patients with large infarcts: technical case report

Abstract

Objective and importance: Recent works on extradural cortical stimulation have been successful in improving neurological recovery in chronic stroke patients. On the other hand, single perirolandic stimulations are often associated with disappointing results.

Clinical presentation: We report two cases of chronic stroke in which the magnitude of infarct was too large to be improved with single perirolandic stimulation. Patient 1 had severe hemiplegia associated with large cortical infarct in the right frontoparietal area. The patient could neither stand independently or walk. Patient 2 had hemiplegia and aphasia due to cortical infarct in the left middle cerebral artery territory. Both patients had intensive rehabilitative training for more than 6 months with no beneficial results.

Intervention: Two paddle electrodes covering frontal and parietal area were implanted, followed by dual cortical stimulation with concurrent rehabilitative training in patient 1. After 6 months of stimulation, the patient could walk with a good posture. Two paddle electrodes were implanted to cover pre-motor and motor cortex in patient 2. After similar treatment, the motor function was markedly improved.

Conclusion: Dual cortex stimulation, which acts on more diffuse areas or functionally related areas, is beneficial to promote the motor recovery in chronic stroke patients with large infarcts.     

急性脑卒中的综合治疗及SPECT动态观察

目的探讨药物治疗合以早期康复为主要手段的综合性治疗措施对急性脑卒中治疗的优越性及脑SPECT在急性脑卒中患者脑血流灌注状态的动态变化。方法选择118例首次发病的急性脑卒中病人，随机分为康复组62例，56例为对照组，入选标准为经CT或MRI确诊发病48小时内的急性偏瘫，诊断符合第四届全国脑血病会议诊断标准。分别用Fulg—Meyer和Barthel指数评定患者的运动功能和ADL能力，比较两组主要临床指标及动态检查脑放射性核素显像SPECT，观察脑部病灶周围及时侧的脑血流灌注状态。结果康复组3个月内病死率为6．45％，对照组为10．71％（P〈0．01）；治疗后两组的Fulg—Meyer评分及Barthel指数均有改善，但康复组改善更明显，差异有显著性意义（P〈0．05）；康复组SPECT变化显示1个月后局部脑损伤灶周围及对侧脑组织的血供有明显改善。结论药物治疗合以早期康复为主要手段的综合性治疗模式下的急性脑卒中患者的预后，比单纯药物治疗的疗效更具有优越性，单纯追求药物在疾病转归中的价值可能是个误区。康复体疗可以促进局部脑损伤灶周围及对侧脑组织的血供．有利于瘫痪肢体的功能康复。     

早期康复治疗对急性脑卒中患者运动功能和生活能力的影响

目的探讨早期康复治疗对脑卒中患者运动功能和日常生活活动能力(ADL)的影响。方法将50例脑卒中偏瘫患者随机分成康复组(25例)和对照组(25例)进行临床对照研究,两组均进行常规神经内科药物治疗,康复组加以运动疗法,每例患者入组时、治疗第30d分别用Fugl-Meyer运动功能(FMA)量表测试运动功能和改良Barthel指数量表(MBI)测试ADL。结果MBI值:康复组治疗前、后分别为:20.68±8.98、72.36±17.39,对照组治疗前后分别为:21.24±12.59、51.29±18.52。FMA值:康复组治疗前、后分别为33.84±12.63、68.46±20.45,对照组治疗前、后分别为32.13±11.26、44.25±18.86。康复组和治疗组组间及组内比较差异具有显著统计学意义。结论康复治疗对偏瘫患者运动功能和日常生活活动能力具有良好的促进作用。可明显降低患者的依赖程度,提高其生活质量。     

Rehabilitative treatment for knee osteoarthritis in 28 hemiplegia patients after stroke

BACKGROUND: The pain of knee joint in the paralyzed leg of hemiplegic patients after stroke will affect the training of standing and walking, and delay the proceeding of rehabilitation. OBJECTIVE: To investigate the effective method for relieving pain of knee osteoarthritis and improving the function of lower limbs in hemiplegic patients after stroke. DESIGN: A randomized controlled study. SETTING: Department of Rehabilitation and Physical Medicine, Anhui Provincial Corps Hospital, Chinese People's Armed Police Forces. PARTICIPANTS: Twenty-eight hemiplegic patients after stroke with knee osteoarthritis were selected from the Department of Rehabilitation and Physical Medicine, Anhui Provincial Corps Hospital, Chinese People's Armed Police Forces from January 2003 to December 2006, including 11 males and 17 females, aged 47–77 years, they all conformed to the diagnostic criteria of stroke set by the Fourth National Academic Meeting for Cerebrovascular Disease in 1995, as well as the diagnostic standards of knee osteoarthritis. Informed consents were obtained from all the patients and their relatives. METHODS: The 28 patients were randomly divided into treatment group (n =14) and control group (n =14). All patients had received facilitative technique training, such as normal motor pattern exercising and knee joint control exercising after hospitalization, besides, the patients in the treatment group received an extra complex therapy of electro-acupuncture therapy, physical therapy and exercise therapy, once a day, and 10 days as a course. MAIN OUTCOME MEASURES： The evaluation and effectiveness of the visual analogue scale (VAS) and Fugl-Meyer Assessment (FMA) score of lower limbs function before and after therapy in the two groups. RESULTS: ① VAS results: The score of pain evaluation in the treatment group after therapy was significantly lower than that in the control group (P < 0.01), and the effectiveness of the treatment group was significantly higher than that of the control group (P < 0.01). ② FMA score of lower limbs motor function: There were no significant differences between the two groups before and after therapy (P > 0.05). CONCLUSION: The complex therapy of electro-acupuncture therapy, physical therapy, and exercise therapy based on facilitative technique training is effective in relieving pain of knee osteoarthritis in hemiplegic patients after stroke, but it is similar to the single rehabilitative training in improving the function of lower limbs.     

Concerning the mechanism of recovery in stroke hemiplegia.

Two patients with pure motor hemiplegia were regaining strength in the affected limbs when a pure motor stroke developed on the opposite side. At the same time as the new hemiplegia appeared, the recovering side became re-paralyzed, suggesting that activity in the contralateral corticospinal tract had participated in the recovery process. Pathological studies were confirmatory. The literature pertaining to contralateral motor compensation is reviewed.     

Changes in motor function in the unaffected hand of stroke patients should not be ignored

Motor function changes in the unaffected hand of stroke patients with hemiplegia. These changes are often ignored by clinicians owing to the extent of motor disability of the affected hand. Finger tapping frequency and Lind-mark hand function score showed that the motor function of unaffected hands in stroke patients was poorer than that of a healthy control hand. After 2 weeks of rehabilitation treatment, motor function of the unaffected hand of stroke patients was obviously improved. Therefore, attention should also be paid to motor function in the unaffected hand of stroke patients with hemiplegia during rehabilitation.     

Changes in motor function in the unaffected hand ol stroke patients should not be ignored

Motor function changes in the unaffected hand of stroke patients with hemiplegia. These changes are often ignored by clinicians owing to the extent of motor disability of the affected hand. Finger tapping frequency and Lind-mark hand function score showed that the motor function of unaffected hands in stroke patients was poorer than that of a healthy control hand. After 2 weeks of rehabilitation treatment, motor function of the unaffected hand of stroke patients was obviously improved. Therefore, attention should also be paid to motor function in the unaffected hand of stroke patients with hemiplegia during rehabilitation.     

运动再学习训练对脑卒中急性期偏瘫患者运动功能的康复作用

目的探讨运动再学习训练对脑卒中急性期偏瘫患者运动功能的康复作用。方法共64例脑卒中急性期(病程≤14 d)偏瘫患者随机接受脑卒中常规药物治疗和常规康复训练(对照组,32例)以及在此基础上联合运动再学习训练(观察组,32例),采用Fugl-Meyer平衡功能评价量表(FMA-Balance)、改良Rivermead移动指数(MRMI)和改良Barthel指数(m BI)评价训练前后运动功能。结果 64例患者均顺利完成康复训练,无一例发生严重不良事件,仅少数患者训练后偶有轻度疲劳感,休息后缓解。与训练前相比,训练后两组患者FMA-Balance评分(P=0.000)、MRMI评分(P=0.000)和m BI评分(P=0.000)增加;与对照组相比,训练后观察组患者FMA-Balance评分(P=0.031)、MRMI评分(P=0.013)和m BI评分(P=0.049)亦增加。结论脑卒中患者早期进行运动再学习训练有助于运动功能的康复。     

系统化康复治疗对脑卒中偏瘫患者功能恢复的影响

目的探讨系统化康复治疗对脑卒中偏瘫患者肢体运动功能和日常生活活动(ADL)能力的影响。方法 84例脑卒中患者随机分为康复组和对照组,分别于治疗前及治疗后60 d对两组患者采用简化Fugl-Meyer量表(FMA)和Barthel指数(BI)来评定患者运动功能及ADL能力。结果治疗前,两组患者的FMA评分和BI评分差异均无显著统计学意义(P>0.05);治疗后,两组患者的FMA评分和BI评分与治疗前比较,均有明显改善(P<0.05)。结论系统化康复治疗对脑卒中偏瘫患者的肢体运动功能和ADL能力的恢复具有显著促进作用。