卒中急性期病人中医综合康复护理效果观察

[目的]探讨中医综合康复护理对卒中急性期病人神经功能缺损及日常生活能力（ADL）的影响。[方法]选择2004年9月-2006年9月在3家协作医院住院的卒中急性期238例病人为研究对象，随机分为实验组和对照组，两组药物治疗基本相同。实验组按中医综合康复护理方案进行护理．对照组采用卒中护理常规进行护理。对入选的病人在入院第1周内和4周后进行神经功能缺损及ADL的评定。[结果]4周后实验组在临床神经功能缺损、ADL等方面明显优于对照组，差异有统计学意义（P〈0．01）。[结论]中医综合康复护理可促进肢体的功能恢复，提高病人的ADL。     

Evaluation of stroke rehabilitation by randomized controlled studies: a review

In all, 22 reports of 20 randomized, controlled rehabilitation studies were evaluated. In 18 of these, the design of the trial was parallel, with a cross-over format being employed in the remaining 2 instances. Seven studies related to intensive rehabilitation during the early post-acute period. In six others, specific techniques--sometimes associated with traditional physiotherapy procedures--were compared: biofeedback, perceptual retraining, and amphetamine treatment. Eight experiments evaluated speech therapy in aphasia. Frequently, methodological considerations limited the interpretation of the results. The review showed that: 1) as regards activities of daily life and motor function, differences as between rehabilitation in stroke units on the one hand and non-rehabilitation or rehabilitation in medical wards on the other, were detected in relatively few quality studies and remained particularly inconclusive insofar as life in the home environment was concerned; 2) rehabilitation for aphasia and perceptual dysfunction proved effective for at least several months after acute stroke; 3) in general, examination of the reports cited revealed no differences in the effects of biofeedback and perceptual retraining vs conventional physiotherapy; 4) rehabilitation, whether administered by specialists or amateur caregivers purpose-trained by specialists, proved equally effective for aphasia. These conclusions constitute a valuable basis for the development and evaluation of modern rehabilitation programs for stroke patients.     

Arm function after axillary dissection for breast cancer: a pilot study to provide parameter estimates.

Sixty-three women participated in a study in Calgary, Alberta to assess the rate of arm recovery and factors affecting it up to one year after axillary node dissection for breast cancer. Outcomes included objective measures of swelling, mobility, and strength, and subjective assessments of pain (at rest and with movement) and stiffness. Approximately 42% of women had residual impairment of at least one type one year after surgery, the most common problems being pain (16%) and reduced grip strength (16%). Except for lymphedema, measurements one year after surgery showed little change from measurements at 6 months, suggesting that the shorter follow-up may be appropriate for assessing the long term effects of axillary dissection. Lymphedema was the only sequela which increased over time. The results provide parameter estimates for designing studies to evaluate the role of physiotherapy after axillary dissection.     

58例脊髓损伤合并轻中度肾积水的临床分析

目的探讨脊髓损伤（SCI）肾积水的临床表现特点、发病机理和最佳治疗途径。方法对58例轻、中度脊髓损伤肾积水患者进行回顾性分析，观察肾积水缓解所需的治疗时间和复发情况。结果留置尿管、间歇导尿加药物、综合疗法3种治疗方法所需的治疗时间无差异；其中有效56例（96．55％）；3个月内复发28例（48．28％）；逼尿肌反射亢进合并括约肌痉挛（DSD）的复发率（57．14％）高于逼尿肌反射亢进者（28．57％）和低下者（14．29％）；肾积水复发与患者不能坚持治疗有关。结论SCI肾积水的病程隐匿且易复发；长期坚持间歇导尿和药物治疗能有效预防肾积水的复发。     

Users' subjective evaluation of electronic vision enhancement systems

The aims of this study were (1) to elicit the users' responses to four electronic head-mounted devices (Jordy, Flipperport, Maxport and NuVision) and (2) to correlate users' opinion with performance. Ten patients with early onset macular disease (EOMD) and 10 with age-related macular disease (AMD) used these electronic vision enhancement systems (EVESs) for a variety of visual tasks. A questionnaire designed in-house and a modified VF-14 were used to evaluate the responses. Following initial experience of the devices in the laboratory, every patient took home two of the four devices for 1 week each. Responses were re-evaluated after this period of home loan. No single EVES stood out as the strong preference for all aspects evaluated. In the laboratory-based appraisal, Flipperport typically received the best overall ratings and highest score for image quality and ability to magnify, but after home loan there was no significant difference between devices. Comfort of device, although important, was not predictive of rating once magnification had been taken into account. For actual performance, a threshold effect was seen whereby ratings increased as reading speed improved up to 60 words per minute. Newly diagnosed patients responded most positively to EVESs, but otherwise users' opinion could not be predicted by age, gender, diagnosis or previous CCTV experience. User feedback is essential in our quest to understand the benefits and shortcoming of EVESs. Such information should help guide both prescribing and future development of low vision devices.     

487例(685指)断指再植体会

目的 探讨断指再植手术的经验与技巧.方法 回顾性分析487例(685指)断指再植的临床资料.结果 685指成活622指,成活率达90.8%.411例(578指)获得1～5年随访:指间关节僵直21指,屈肌腱粘连17指,行松解术,另有13指肌腱粘连由于不影响功能未行松解术,4指指腹萎缩、感觉差;其余外观、功能和感觉均较理想,拇指关节自主活动度＞90°,手指关节自主活动度260°～170°,两点辨别觉为＜6 mm.按中华医学会手外科学会断指再植功能评定试用标准评定:优393指,良130指,差55指;优良率为90.5%.结论 具备丰富的手术经验和技巧才能完成复杂、高难度的再植手术,并适当拓宽断指再植的适应证,获得较高的成功率.     

Chronic fatigue syndrome: traditional and community-based approaches to rehabilitation

Chronic fatigue syndrome (CFS) is a controversial condition defined by 6 months or more of unexplained fatigue, and at least four out of eight cognitive and physical symptoms. Over the past 2 decades, CFS has been the subject of significant debate regarding its definition, cause and recommended treatment. Because a cure for the syndrome has not yet been located, efforts to improve functioning and overall quality of life through rehabilitation represent the most practised form of treatment to date. However, controversy remains as to which approach to rehabilitation is most effective for individuals with CFS. Interventions which take place within real‐world environments and utilise community‐based organizations such as centres for independent living offer a newly explored means of support and rehabilitation. The present paper reviews a variety of approaches to rehabilitation for individuals with CFS, describing their applications with different types of patients, and providing critical commentary on the research methodologies used to evaluate them. Innovative community‐based rehabilitation programmes and their outcomes are described as an alternative with some promise that may compliment more traditional approaches.     

Injuries in national karate competitions in Finland

The injuries sustained in 6 national karate competitions in Finland were studied by analyzing data from 450 bouts during the season 1991–1992. The analyzed data included a personal interview with each competitor and detailed information on the bouts and any injuries sustained. The overall probability of injury was 0.28 per bout. These injuries occurred to 16% of the 647 competitors. Occurrence of injury was greatest among adult men, which was pronounced in final bouts. Of all injuries diagnosed by the physicians for the competitions, more than 95% were localized to the head. The majority of these were minor injuries. Experienced competitors were more injury-prone than beginners. On the other hand, none of the background factors studied significantly affected the probability of injuring one's opponent. Most injuries and penalties, as well as full scores, were caused by direct punches to the head. From these findings it was concluded that a protective guard for the head together with modification of competition rules could significantly reduce injuries.     

26例糖尿病足内科与康复治疗分析

本文对26例糖尿病足以内科和康复方法治疗，强调控制血糖，使用强而广谱抗生素，加强伤口的处理，采用正负压治疗仪改善局部血液循环，水泥清洁创面等康复手段，取得良好效果。     

REHABILITATION OF LOWER LIMB AMPUTEES AND SOME IMPLICATIONS FOR SURGICAL MANAGEMENT

Aspects of peri-operative management, amputation level and rehabilitation of the lower limb amputee are reported in the context of a review of a rehabilitation service for amputees which includes an integrated prosthetic service. Two hundred admissions were reviewed and some complex cases described. It is concluded that: a very close liaison between the surgeon and the rehabilitation team (ideally with pre-operative consultation) is in the patient's best interests; any person previously walking (or a potential walker) should be considered for a trial of prosthetic walking; an integrated prosthetic service enhances the efficiency of the rehabilitation service; and that modification of the current Artificial Limb Scheme to allow manufacture of first definitive limbs in prosthetic rehabilitation units would further enhance service to patients.