The feasibility,acceptability and preliminary efficacy of a low-cost,virtual-reality based,upper-limb stroke rehabilitation device: a mixed methods study

Purpose: To establish feasibility, acceptability, and preliminary efficacy of an adapted version of a commercially available, virtual-reality gaming system (the Personalised Stroke Therapy system) for upper-limb rehabilitation with community dwelling stroke-survivors.

Method: Twelve stroke-survivors (nine females, mean age 58 years, [standard deviation 7.1], median stroke chronicity 42 months [interquartile range 34.7], Motricity index 14–25 for shoulder and elbow) were asked to complete nine, 40-min intervention sessions using two activities on the system over 3 weeks. Feasibility and acceptability were assessed through a semi-structured interview, recording of adverse effects, adherence, enjoyment (using an 11-point Likert scale), and perceived exertion (using the BORG scale). Assessments of impairment (Fugl–Meyer Assessment Upper extremity), activity (ABILHAND, Action Research Arm Test, Motor Activity Log-28), and participation (Subjective Index of Physical and Social Outcome) were completed at baseline, following intervention, and at 4-week follow-up. Data were analysed using Thematic Analysis of interview and intervention field-notes and Wilcoxon Signed Ranks. Side-by-side displays were used to integrate findings.

Results: Participants received between 175 and 336 min of intervention. Thirteen non-serious adverse effects were reported by five participants. Participants reported a high level of enjoyment (8.1 and 6.8 out of 10) and rated exertion between 11.6 and 12.9 out of 20. Themes of improvements in impairments and increased spontaneous use in functional activities were identified and supported by improvements in all outcome measures between baseline and post-intervention (p?<?0.05 for all measures).

Conclusions: Integrated findings suggested that the system is feasible and acceptable for use with a group of community-dwelling stroke-survivors including those with moderately-severe disability.

• Implications for rehabilitation

• To ensure feasibility of use and maintenance of an appropriate level of challenge, gaming technologies for use in upper-limb stroke rehabilitation should be personalised, dependent on individual need.

• Through the use of hands-free systems and personalisation, stroke survivors with moderate and moderately-severe levels of upper-limb impairment following stroke are able to use gaming technologies as a means of delivering upper-limb rehabilitation.

• Future studies should address issues of acceptability, feasibility, and efficacy of personalised gaming technologies for delivery of upper-limb stroke rehabilitation in the home environment.

• Findings from this study can be used to develop future games and activities suitable for use in stroke rehabilitation.

     

针刺疗法联合康复训练治疗中风偏瘫临床观察

目的分析针刺疗法联合康复训练治疗中风偏瘫的临床效果。方法本研究所选对象为2018年5月—2019年5月在南昌市洪都中医院治疗的70例中风偏瘫患者,按随机数字表法将其分为对照组与联合组,每组35例。对照组给予康复训练,联合组在此基础上联合针刺干预。比较2组下肢功能改善率、运动功能评分及生活能力评分。结果联合组下肢功能改善率高于对照组(P<0.05);2组干预前的运动功能评分、生活能力评分比较,差异无统计学意义(P>0.05);干预后,联合组的运动功能评分、生活能力评分高于对照组(P<0.05)。结论对中风偏瘫患者实施针刺及康复训练,能够改善患者下肢运动功能,并提高其生活自理能力。     

Hemiplegic migraine during pregnancy: unusual magnetic resonance appearance with SPECT scan correlation

OBJECTIVE: This article discusses the pathophysiology and implications for treatment of hemiplegic migraine within a case study presentation. BACKGROUND: We evaluated a 31-year-old white woman for hemiplegia in her 36th week of pregnancy. She initially presented with severe headache, dysarthria, lethargy, and left-sided numbness and weakness. Hemiplegic migraine remains a diagnosis made by exclusion; neurologic examination of these patients is localizing, but nonspecific. DESIGN: Magnetic resonance imaging and single photon emission computed tomography scanning were performed on this patient during an exacerbation of headache associated with dense hemiplegia. RESULTS: Magnetic resonance imaging showed a superficial cerebral hemispheric signal abnormality with enhancement. Single photon emission computed tomography scanning confirmed hyperperfusion of that hemisphere. CONCLUSIONS: We believe the imaging evidence in our patient suggests that hemiplegia was caused and sustained by hyperperfusion. This case lends supportive evidence to a primarily vasodilatory mechanism and hyperperfusion as an etiology of the paralysis in such headaches and perhaps migraine with aura.     

三期康复干预对偏瘫患者日常活动能力的影响

目的:探讨6个月内康复干预对脑卒中后偏瘫患者日常活动能力的影响。方法:80例发病3周内的脑卒中偏瘫患者随机分成对照组和康复组,对照组进行一般临床治疗,康复组早期介入康复训练,在入组前、发病1个月、3个月、6个月分别用改良Barthel指数评价日常活动能力。结果:在发病1个月时,康复组的修饰、用厕、穿衣三项能力与对照组比较差异有显著性意义(P<0.05),在发病3个月时,除上述能力进一步存在组间差异外,转移、行走、上下楼三项能力两组间比较差异有显著性意义(P<0.05),在发病6个月时,除大便控制两组间差异无显著性意义(P>0.05)外,其余各项两组间比较差异有显著性意义(P<0.05)。结论:康复的早期干预有利于大多数患者的ADL项目的改善。     

神经肌肉促进技术在偏瘫上肢康复训练中的临床应用

目的:探讨神经肌肉促进技术在偏瘫上肢康复训练中的临床应用方法,并观察其疗效。方法:36例脑血管意外后的偏瘫患者被随机分成神经肌肉促进技术组(治疗组)与一般康复治疗组(对照组),其中治疗组17例,对照组19例,两组均接受每日1次、每周5次的治疗10-40次。采用Fugl-Meyer评价法的上肢主动运动功能积分及Barthel指数作为评定指标。结果:两组患者的Fugl-Meyer上肢主动运动功能积分和Barthel指数积分经治疗后都有明显提高(P<0.001),但治疗组的改善情形明显优于对照组(P<0.001或<0.01)。结论:本文所介绍的神经肌肉促进技术在偏瘫上肢康复训练中的临床应用方法对改善偏瘫上肢运动功能及患者日常生活活动能力方面(尤其是偏瘫上肢运动功能方面)有一定的疗效。     

复方抗栓酶对脑卒中偏瘫患者康复疗效的影响

276例脑卒中偏瘫患者随机分为治疗组186例用复方抗检酶治疗，对照组90例用胞二磷胆碱治疗，2组同时配合肢体功能训练及物理疗法。治疗前后采用上田敏标准化的偏瘫功能12级法和Barthel指数等方法对患者偏瘫肢体功能评测。结果表明：脑卒中患者偏瘫肢体运动功能、手的功能、步行能力以及日常生活活动等方面，治疗组康复效果明显优于对照组，差异有非常显著性意义（P＜0．001）。     

社区脑血管病致偏瘫病人生活调查与护理干预

目的通过对社区中脑血管病致偏瘫60例病人生活调查,了解他们的生活、心理及社会状况、康复现状和生活自理能力等。制定针对性康复计划和指导,实施护理干预。方法以街道为单位,整群抽样东莞市石龙古城镇长住居民中因脑血管病致偏瘫的病人共60例,采取入户访谈、询问方式对研究对象进行问卷调查。结果护理干预后1个月病程基本痊愈11例,显效10例,有效6例,无效5例;3个月病程基本痊愈0例,显效2例,有效2例,无效4例。结论通过各种护理干预后病人肢体功能有所提高,最大限度地改善和提高了病人的生活质量,减少对社会、家庭的影响和负担有着重要的意义。     

基于数字视频和图像处理的步态分析系统信度研究

目的研究基于数字视频和图像处理的二维步态分析系统的可靠性、敏感性。方法由同一名评定者对20名正常人进行间隔1周的2次测试,检验评定者内部信度;另由2名评定者再分别重复测试2次,检验评定者间信度;比较偏瘫患者患侧和正常人的测试结果,检验系统敏感性。结果20名正常人2次测试结果各指标高度相关,偏瘫患者患侧和正常人的各项测试指标有显著性差异。结论本系统具有良好的可靠性和敏感性。     

头针治疗不同时期脑卒中偏瘫的康复测评

目的 :探讨脑卒中偏瘫后早期行头针治疗的临床意义。方法 :脑卒中偏瘫患者 5 7例分为早治组 32例和晚治组 2 5例 ,分别于偏瘫后第 3～ 14天和第 31～ 6 4天进行药物和头针治疗。采用Fugl Meyer运动功能积分评定法评测 2组治疗前后的疗效。结果 :治疗前 2组患者上下肢运动功能Fugl Meyer评分比较差异无显著性(P >0 .0 5 ) ;治疗后 2组评分与治疗前比较均明显升高 (P <0 .0 1) ,早治组与晚治组比较 ,上肢运动功能改善更显著(P <0 .0 5 )。结论 :脑卒中偏瘫后早期配合头针治疗可明显提高康复疗效。     

康复护理对提高偏瘫患者手功能障碍的影响

目的探讨康复护理对偏瘫患者手运动功能及日常生活活动能力的影响。方法采用运动疗法、ADL训练、作业疗法等对94例接受偏瘫康复的患者手的功能障碍进行1～6个月的康复护理,并用运动功能Fugl-Meyer评价法中腕关节与手的主动运动功能积分及Barther指数积分于治疗前、后对偏瘫侧手的运动功能、日常生活活动能力进行评估,比较治疗效果。结果治疗后94例患者手的运动功能、日常生活活动能力均有明显改善(P<0.005)。结论康复护理能显著提高偏瘫患者手运动功能及日常生活活动能力。