微信打卡督导管理模式在产妇产后盆底康复训练中的应用

目的探讨微信打卡督导管理模式对产妇产后盆底康复训练依从性及治疗效果的影响。方法选择2018年3月1日至2018年12月31日在浙江中医药大学附属杭州市西溪医院妇产科住院分娩,并于产后在门诊进行盆底康复训练的100例产妇作为研究对象,将其随机分为观察组和对照组,每组50例产妇。观察组产妇在对照组管理的基础上,采用微信打卡督导的方式将每次盆底肌训练的情况汇报并记录;对照组产妇进行常规微信管理与随访。两组产妇随访6个月后进行康复训练依从性、尿失禁、盆腔脏器脱垂和盆腔脏器脱垂/尿失禁性生活质量问卷调查,同时在治疗前后采用盆底治疗仪对I、Ⅱ类肌纤维肌力进行检测。通过分析上述相关指标,评价2种管理方式对产妇产后盆底康复训练依从性及治疗效果的差异。结果观察组产妇盆底康复训练依从性良好率(80.0%)显著优于对照组产妇(56.0%),依从性差占比(8%)低于对照组产妇(54%),其差异均具有统计学意义(均P<0.05)。观察组产妇训练后I、Ⅱ类肌纤维肌力(4.34±0.22,3.82±0.34)均高于对照组产妇(2.62±0.42,2.32±0.42),尿失禁(6%)和盆腔脏器脱垂(8%)发生率均明显低于对照组产妇(22%,24%),产后PISQ-12评分[(35.35±4.43)分]高于对照组产妇[(32.24±3.62)分],其差异均具有统计学意义(均P<0.05)。结论微信打卡督导管理模式可以提高产妇产后盆底康复训练的依从性,增强康复训练的效果。     

Correction of Dyssynergic Defecation,but Not Fiber Supplementation,Reduces Symptoms of Functional Dyspepsia in Patients With Constipation in a Randomized Trial

1. Download : Download high-res image (110KB)
2. Download : Download full-size image

     

Motor slacking during resisted treadmill walking: Can visual feedback of kinematics reduce this behavior?

BackgroundFunctional resistance training is frequently applied to rehabilitate individuals with neuromusculoskeletal injuries. It is performed by applying resistance in conjunction with a task-specific training, such as walking. However, the benefits of this training may be limited by motor slacking, a phenomenon in which the human body attempts to reduce muscle activation levels or movement excursions to minimize metabolic- or movement-related costs. While kinematic feedback could reduce one's tendency to minimize effort during training, this has not been verified experimentally.Research QuestionDoes functional resistance training during walking lead to motor slacking, and can techniques such as visual feedback be used to reduce these effects?MethodsFourteen able-bodied individuals participated in this experiment. Participants were trained by walking on a treadmill while a bidirectional resistance was applied to the knee using a robotic knee exoskeleton. During training, participants were either instructed to walk in a manner that felt natural or were provided real-time visual feedback of their kinematics. Electromyography and knee kinematics were measured to determine if adding resistance to the limb induced slacking and if feedback could reduce slacking behavior. Kinematic aftereffects were measured after training bouts to gauge adaptation.ResultsFunctional resistance training without feedback significantly reduced knee flexion when compared to baseline walking, indicating that participants were slacking. This reduction in knee flexion did not improve with continued training. Providing visual feedback of knee joint kinematics during training significantly increased knee muscle activation and kinematic aftereffects.SignificanceThe findings indicate that individuals are susceptible to motor slacking during functional resistance training, which could affect outcomes of this training. However, motor slacking can be reduced if training is provided in conjunction with a feedback paradigm. This finding underscores the importance of using additional methods that externally motivate motor adaptation when the body is not intrinsically motivated to do so.     

应用生物反馈技术增强氨氯地平的作用

氨氯地平是新型二氢吡啶类钙通道阻滞剂。本文报道应用氨氯地平治疗６０例冠心病高血压患者的结果。第１组单纯口服氨氯地平，第２组口服氨氯地平加上生物反馈治疗，疗程均为８周。治疗结果表明，第１与第２组患者１４种症状的有效率分别为８４．１２％与９４．５％。１４种日常生活能力以及卡氏心功能测定均有明显的改善，但第２组的效果更好（Ｐ＜０．０５）。氨氯地平的降压作用明显，舒张压的下降略逊于收缩压，加用生物反馈治疗后，有效率从８６．６２％增至９３．３４％。在第１与第２组中，心绞痛的发作分别减少了５２．６４％与７０％。     

Auditory biofeedback in spastic diplegia

Using a simple auditory feedback device that produces a continuous buzzing signal on heel contact, we studied the effects of augmented auditory biofeedback on the gait of four spastic diplegic children. The purpose of the biofeedback was to attempt to increase dorsiflexion at heel strike without causing other compensatory changes at the knee and hip, which might lead to crouch gait. We measured velocity, stride length, and thigh, knee, and ankle angles at the heel strike, midswing, and toe-off phases of gait. Four subjects, aged 5-8 years, were given a standard gait training program, supplemented with biofeedback two times per week in a clinical setting and 1 h daily in a home program over an 8-week period. Three computer video gait analyses of the sagittal plane were conducted without biofeedback in the pre- and posttraining conditions and twice with biofeedback over the course of treatment. We performed linear regression analysis of joint angles at heel strike, midswing, and toe-off as a function of days into the study for each patient. Angle-angle diagrams for a test subject before, during, and after treatment indicate changes toward a normal gait pattern with biofeedback. The linear regression analysis showed a statistically significant (p less than 0.01) shift toward dorsiflexion at heel strike with repeated exposure to biofeedback. A compensatory crouch gait was not induced. The linear regression analyses for hip and knee angles were not statistically significant (p greater than 0.25), indicating a disassociation of movement among hip, knee, and ankle.     

生物反馈治疗高血压临床疗效剖析

对８９例Ⅰ／Ⅱ期高血压病人经一年的生物反馈治疗，发现疗效受多种生物心理社会因素的影响，其中收缩压销低，高神经质（情绪不稳定）、愤怒分值和焦虑分值较高，以及社会支持程度较高的病人其治疗效果较好。     

生物反馈治疗神经症病人的临床疗效观察

目的 :为了研究在常规药物治疗的基础上施行生物反馈治疗神经症患者疗效的影响。方法 :2 0 0 3年 6月～ 10月选择在本院门诊及住院病人 5 6例 ,均符合入组标准 :①符合中华医学会精神疾病CCMD - 3神经症的诊断标准 ;②排除既往有精神疾病史。随机分为研究组与对照组各 2 8例。二组在性别、年龄、心理状态无显著性差异。研究组与对照组均接受内科常规药物治疗 (抗抑郁、抗焦虑及对症等治疗 ) ,研究组患者同时给予生物反馈治疗 :每日 1次 ,每次 30min ,15d为 1个疗程 ,连续做 2个疗程。二组分别于入组时及治疗 1个月后进行焦虑自评量表 (SAS)、抑郁自评量表 (SDS)评定。统计学方法采用SPSS10 .0处理。结果 :研究组生物反馈治疗后 ,SAS、SDS减分率明显高于对照组P <0 0 1,临床症状改善程度研究组与对照组差异显著P <0 .0 1。结论 :神经症患者在常规内科药物治疗的基础上 ,配合生物反馈治疗是很有必要的 ,可以较彻底的缓解患者的焦虑、抑郁等负性情绪 ,并能提高疾病的整体疗效 ,改善预后。生物反馈治疗用于神经症患者的治疗显效 ,值得推广。     

Validation of surface EMG as a measure of intravaginal and intra-abdominal activity: Implications for biofeedback-assisted Kegel exercises

This study validates surface EMG as a measure of pelvic muscle and abdominal activity by showing its high correlation to internal pressure data. Using standardized scores, between-subjects correlation of perineal EMG and intravaginal pressure was r= .75, and the correlation of abdominal EMG and intra-abdominal pressure was r= .72. Discriminant validity was also demonstrated by showing low correlation between standardized abdominal and perineal EMG measurements (r= .10). A repeated measures multivariate analysis of variance demonstrated that visual and auditory biofeedback of EMG during pelvic floor contractions increases intravaginal pressure when compared with trials without biofeedback. Potential benefits of fabric electrodes include reduced invasiveness and risk and the ease with which patients can utilize this technology for home practice.     

青春期慢性前列腺炎及其盆底肌生物反馈治疗

目的探讨青春期慢性前列腺炎(CPP)的临床特点及盆底肌生物反馈治疗疗效。方法CPP患者25例,平均年龄16岁。下尿路相对正常研究对象15例作为对照组,平均年龄16岁。CPP患者组行慢性前列腺炎症状(NIH-CPSI)评分,前列腺按摩液(EPS)常规检查、细菌培养,行NIH分型。40例均行尿动力学检查,分析尿流曲线,记录最大尿流率(Q_(max))、剩余尿量(PVR)、逼尿肌括约肌协同失调(DSD)、最大逼尿肌排尿压(P_(det.max))、最大尿道闭合压(MUCP)等参数。CPP患者行生物反馈治疗,10周后评估疗效。结果CPP组中Ⅱ、ⅢA和ⅢB型分别为1、3和21例。治疗前CPP组和对照组Staccato排尿(20例vs．1例)和DSD (22例vs．1例)、Q_(max)(10．7±3．7 ml/s vs．15．0±4．3ml/s)、PVR(7．7±4．1 ml vs．3．2±2．6 ml)、P_(det.max)(115．1±33．6 cm H_2O vs．76．8±16．6 cm H_2O)和MUCP(176．5±45．7 cm H_2O vs．86．2±28．5 cm H_2O)比较差异有统计学意义(P＜0．05)。CPP组患者生物反馈治疗前后NIH-CPSI疼痛评分(4．6±2．2 vs．2．1±1．6)、排尿评分(7．9±2．0 vs．2．2±1．7)、生活影响评分(9．4±2．2 vs．2．6±2．1)、总分(22．0±5．2 vs．7．0±4．2)和Q_(max)(10．7±3．7 vs．14．9±5．6)差异有统计学意义(P＜0．05)。结论CPP以ⅢB型多见,临床主要表现为排尿异常,患者精神压力较大,有盆底肌功能障碍和尿动力学异常表现,盆底肌生物反馈治疗的近期疗效满意。     

Strengthening the pelvic floor with Kegel exercises

Pelvic floor exercises (PFE) have become a standard nursing intervention, both to prevent as well as to treat incontinence. A review of the literature shows great variety in the protocols for performing PFE, and inconsistent use of perineometers, palpation tests, or other biofeedback devices. Results are difficult to compare because of methodological inconsistencies. Suggestions for further research are included.