手部外骨骼机器人辅助双侧对称性训练与镜像疗法对偏瘫患者手功能的康复效果比较

目的比较手部外骨骼机器人辅助双侧对称性训练与镜像疗法对脑卒中偏瘫患者手功能的康复效果。方法选取2018年6月至2019年7月在安徽医科大学第一附属医院康复医学科住院的脑卒中偏瘫患者36例,采用随机数字表法分为外骨骼组与镜像组,每组18例。外骨骼组患者利用手部外骨骼机器人进行双手同步对称性训练,镜像组给予镜像疗法。观察两组患者治疗前后手功能及日常生活活动能力的变化,比较两组患者治疗方法的疗效差异。结果治疗后,两组患者Fugl-meyer运动功能量表评分(FMA)及改良Barthel指数均较治疗前提高,差异有统计学意义(P<0.001)。治疗后,外骨骼组患者的FMA评分高于镜像组,差异有统计学意义(P=0.034)。治疗2周后,外骨骼组患者治疗有效率高于镜像组,差异有统计学意义(P=0.044),两组患者治疗显效率差异无统计学意义(P>0.05);治疗3、4周后,两组患者治疗有效率差异均无统计学意义(P>0.05),外骨骼组治疗显效率高于镜像组,差异均有统计学意义(P=0.035,P=0.022)。结论基于手部外骨骼机器人的双侧对称性训练能加速脑卒中患者手功能的恢复进程,对于手功能的改善程度优于镜像疗法。     

阶段式考核在《康复评定技术》实践技能考核中的应用

目的分析阶段式考核方式在《康复评定技术》实践技能考核中的效果。方法将174名学生以行政班级为单位随机分为两组,实验组87人,采取阶段式考核;对照组87人,采取传统考核方式。结果实验组学生对技能的掌握程度及学习技能的兴趣高于对照组。结论阶段式考核方式在《康复评定技术》实践技能考核中有一定优势。     

Oral rehabilitation of patients after maxillectomy. A systematic review

Patients who have maxillectomy can be rehabilitated with reconstructive surgery or obturator prostheses with or without osseointegratable implants. To identify studies on possible treatments in this group, we systematically searched the Scopus, Embase, PubMed/Medline, and Cochrane databases to collect data on patients’ characteristics, radiotherapy, and results related to speech, swallowing, mastication or diet, chewing, aesthetics, and quality of life. Of the 1376 papers found, six were included, and one other was included after an additional search of references. A total of 252 patients were included, and of them, 86 had reconstructive surgery, 91 were treated with obturator prostheses, 39 had reconstructive surgery or obturator prostheses associated with implants, and 36 had reconstruction plus an obturator prosthesis. Data on radiotherapy were incomplete. There is a lack of consensus about the indication for rehabilitation, as the treatment must be based on the individual characteristics of each patient.     

Experienced Health,Life Satisfaction,Sense of Coherence,and Coping Resources in Individuals Living with Heart Failure

The purpose of this study was to explore relationships between experienced health, sense of coherence, coping resources, and life satisfaction in individuals living with heart failure. Twenty-two patients--12 men and 10 women--were included in the study. All subjects were admitted to a eight-week programme of aerobic training. Four questionnaires were used: the Minnesota Living with Heart Failure Questionnaire (MHLF), the Sense of Coherence scale (SOC), the Coping Resources Inventory (CRI), and the Life Satisfaction Checklist of Fugl-Meyer et al. After the exercise programme the mean score of MLHF was significantly lower as compared with the start of the programme. The majority of the individuals reported that they were satisfied with life as a whole, family life, partnership relation contact with friends, and their psychological state of health. Only one-third were satisfied with their sexual life. A high sense of coherence and coping resources characterized the subjects. There was a slight tendency for those who reported satisfaction with life as whole to report a stronger sense of coherence, a higher degree of coping resources, and a lower degree of symptoms of heart failure. A conclusion was that clinicians should emphasize that patients can continue to remain active and enjoy a reasonable quality of life.     

Ecological Momentary Assessment of Social Interactions: Associations With Depression,Anxiety, Pain,and Fatigue in Individuals With Mild Stroke

ObjectivesTo examine real-time relationships between social interactions and poststroke mood and somatic symptoms in participants’ daily environments.DesignProspective observational study using smartphone-based ecological momentary assessment (EMA) surveys 5 times a day for 2 weeks. Multilevel models were used to analyze data for concurrent and lagged associations.SettingCommunity.ParticipantsAdults (N=48) with mild stroke.InterventionsNot applicable.Main Outcome MeasuresEMA measures of self-appraisal of social interactions (confidence, satisfaction, and success), as well as mood (depression and anxiety) and somatic (pain and fatigue) symptoms.ResultsIn concurrent associations, increased depressed mood was associated with reduced ratings of all aspects of social interactions. Fatigue was associated with reduced ratings of social satisfaction and success. In lagged associations, increased anxious mood preceded increased subsequent social confidence. Higher average social satisfaction, confidence, and success were related to lower momentary fatigue, anxious mood, and depressed mood at the next time point. Regarding clinicodemographic factors, being employed was concurrently related to increased social interactions. An increased number of comorbidities predicted higher somatic, but not mood, symptoms at the next time point.ConclusionsThis study provides preliminary evidence of dynamic relationships between social interactions and somatic and mood symptoms in individuals with mild stroke. Interventions to not only address the sequelae of symptoms, but also to promote participation in social activities in poststroke life should be explored.     

Immediate weight bearing after plate fixation of fractures of the tibial plateau

BackgroundProximal articular fractures of the tibia are commonly stabilised with internal fixation using plates and screws. There is a lack of evidence and conflicting guidelines as to the most suitable post-operative rehabilitation regime including weight bearing status. There are numerous physiological and socioeconomic benefits of early weight bearing after orthopaedic surgery, but concerns remain around loss of fracture reduction. Therefore, the aim of this study is to investigate whether the weight bearing status after tibial plateau plate fixation is associated with any loss of reduction or articular collapse.MethodsWe retrospectively analysed data from our prospectively collected major trauma centre database. All tibial plateau fractures that required open reduction and internal fixation with plate and screws were included. The immediate post-operative weight bearing status of these patients was recorded. Group I consisted of those patients that were either non-weight bearing or touch weight bearing for the first six post-operative weeks. Group II consisted of patients who were instructed to weight bear fully (as tolerated) immediately after the operation. Radiographs were taken on day one post-operation, at six weeks and at three months and analysed for fracture displacement and joint depression or loss of fixation.ResultsA total of 90 patients were included in the study. Group I (non-weight bearing or touch weight bearing) consisted of 60 patients (67%). Group II (full weight bearing as tolerated) consisted of 30 patients (33%). The follow up radiographs demonstrated no failure of fixation in either study group. One patient from the weight bearing group had >1 mm joint depression (4 mm) identified at the first follow up, which did not progress.ConclusionsThis study shows immediate post-operative full weight bearing does not affect the fixation or cause articular collapse up to three months after surgery and thus we propose that patients should be allowed to weight bear immediately after surgical stabilisation of tibial plateau fractures. This will enable patients to benefit from the positive effects on fracture healing of early weight bearing post-surgery and avoid the complications of non-weight bearing without loss of fixation or articular collapse.     

丹红注射液联合西药及早期心理干预与康复训练治疗脑卒中后抑郁随机平行对照研究

[目的]观察丹红注射液联合西药及早期心理干预与康复训练治疗脑卒中后抑郁疗效。[方法]使用随机平行对照方法,将80例门诊及住院患者按随机数字表法分为两组。对照组40例脱水、脑保护及对症治疗,生命体征稳定48h后,心理干预,康复训练(运动治疗及作业治疗)。治疗组40例丹红注射液30mL+5%葡萄糖250mL,1次/d,静滴;糖尿病:生理盐水250mL。西医治疗同对照组。连续治疗14d为1疗程。观测HAMD评分、ADL评分、不良反应。连续治疗2疗程,判定疗效。[结果]HAMD及ADL评分两组均有改善(P0.05),治疗组改善优于对照组(P0.05)。[结论]丹红注射液联合西药及早期心理干预与康复训练治疗脑卒中后抑郁效果显著,值得推广。