强化作业疗法对脑卒中偏瘫患者运动能力的影响

目的观察强化作业疗法对脑卒中偏瘫患者运动能力的影响。方法将80例脑卒中偏瘫患者分为治疗组（40例）和对照组（40例）,对照组采用综合康复治疗措施,治疗组在综合康复治疗措施基础上强化作业治疗,治疗3个月后对两组患者进行疗效观察。结果治疗组在提高偏瘫患者上肢及手、下肢运动能力和ADL能力方面,效果明显优于对照组,两组比较差异有统计学意义（P〈0.05）。结论强化作业疗法可明显促进脑卒中偏瘫患者运动能力的提高。     

基底节病变致儿童急性偏瘫12例临床分析

目的 探讨基底节病变致儿童急性偏瘫的临床特点。方法 回顾分析12例基底节病变所致的脑梗死的症状、体征、头颅MRI、MRA、CT、TCD、EEG检查的结果及治疗效果。结果 本组病例头颅MRI均异常,提示基底节区有缺血性梗死灶,病灶位于偏瘫对侧,与临床定位相符。临床表现均以急性偏瘫为首发症状,无伴意识障碍,无颅内高压症状,无言语异常。行CT检查的11例中,6例双侧基底节区有点状或片状钙化。MRA检查9例均无异常。EEG检查的9例中4例异常。TCD检查11例中6例异常,提示双侧大脑中动脉血流速度加快和/或病灶对侧大脑前动脉血流速度加快。经治后2-10天肌力有所恢复,6-40天肌力恢复至V-级或正常,肌力恢复均下肢早于上肢,中枢性面瘫最后恢复。结论 婴幼儿颅脑外伤程度轻,但有明显的脑梗死症状者,基底节梗死可能性大,基底节有钙化灶的婴幼儿在轻微外伤后易出现急性偏瘫。     

用Fugl-Meyer量表评价靳三针结合康复训练对脑梗死偏瘫的疗效

目的:采用Fugl-Meyer量表评价靳三针结合康复训练对脑梗死偏瘫患者肢体运动功能的影响,探讨靳三针结合康复训练对脑梗死偏瘫的临床价值。方法:将来源于7家医院的254例脑梗死后偏瘫患者随机分配为靳三针组83例、康复组84例、靳三针结合康复组(结合组)87例。在常规治疗的基础上,靳三针组采用靳三针疗法,取穴以颞三针为主,根据痉挛瘫和弛缓瘫不同结合辨证配以曲池、外关、合谷及伏兔、足三里、三阴交等穴,留针30 min;康复组根据痉挛瘫和弛缓瘫不同给予适宜的康复训练;结合组采用靳三针结合康复训练。3组疗程均为28 d,分别在治疗前和治疗14、28 d后用四肢简式Fugl-Meyer运动量表(FMA)、临床神经功能缺损程度评分(NDS)评价患者肢体运动功能的变化。结果:经过28 d治疗后,靳三针组和结合组患者的显效率优于康复组(P<0.05)。治疗14 d和28 d后,3组患者NDS评分显著降低(均P<0.05),结合组NDS评分较康复组下降明显(均P<0.05)。经28 d治疗后,结合组FMA评分高于其它两组(均P<0.05)。结论:靳三针结合康复训练能够明显改善脑梗死偏瘫患者肢体的运动功能,二者具有良好的协同作用。     

小针刀治疗中风后肩疼痛疗效分析

目的：本次随机对照临床实验是为了研究针刀治疗中风后痉挛肩疼痛的疗效。方法：40例病人被随即分为A组（针刀治疗配合曲安缩松肩关节腔注射）和B组（曲安缩松关节腔注射）,每组20人,于治疗前和治疗后1、2、4周测量患肩VAS疼痛评分、肩关节被动外展和外旋活动度和上肢MAS痉挛评分。结果：A组的疼痛评分和外旋动作在1周后就有改善,在治疗后2周和4周有明显改善,与基线比较有统计学差异,4周后的MAS评分与对照组相比有统计学意义,外展运动改善没有统计学意义。结论：肩胛下肌的痉挛与肩关节疼痛密切相关。针刀能明显改善肩胛下肌痉挛,缓解中风后肩痛。     

基于ICF理念下的家庭式手工训练对痉挛型偏瘫脑瘫患儿功能独立性的影响

目的　探索基于国际功能、残疾和健康分类（ICF）理念下的家庭式手工训练对痉挛型偏瘫脑瘫患儿功能独立性的影响。方法　选取2021年3月至9月广州市社会福利院康复医院康复科收治的50例6～12岁存在手运动功能障碍的痉挛型偏瘫脑瘫患儿作为研究对象,采用随机数字表法将其分为试验组与对照组,每组各25例。试验组男15例、女10例,年龄（8.2±1.0）岁;对照组男14例、女11例,年龄（8.6±0.6）岁。使用《国际功能、残疾和健康分类（儿童和青少年版）》（ICF-CY）核心分类组合简明通用版对两组患儿进行初评,与护理员（监护人角色）共同制定针对性的综合康复方案,并根据康复方案对护理员进行相应培训。试验组护理员对患儿每天进行40 min手工训练+常规康复治疗,对照组护理员对患儿每天进行常规康复治疗,持续干预3个月。比较两组患儿治疗前后的功能独立性。采用χ²检验、t检验。结果　两组患儿治疗前儿童功能独立性评定量表（WeeFIM）评分比较,差异无统计学意义（P>0.05）;治疗3个月后,试验组WeeFIM评分明显高于对照组［（75.76±5.07）分比（61.24±3.06）分］,且两组患儿治疗后WeeFIM评分均明显高于治疗前［（75.76±5.07）分比（49.84±3.95）分、（61.24±3.06）分比（49.84±3.46）分］,差异均有统计学意义（均P<0.05）;试验组治疗前后差值［（25.92±3.39）分］与对照组［（11.40±2.78）分］比较,差异有统计学意义（P<0.05）。结论　手工训练对痉挛型偏瘫脑瘫患儿功能独立性有较好改善,可适当将手工训练引入居家及社区康复治疗中。     

通络法在老年中风后痉挛性偏瘫的辨证应用

临床上有多种治疗方法应用于中风后痉挛性偏瘫，通络法是针对络脉不畅引起病变的治疗大法。笔者结合老年人的生理特点论述运用通络法治疗不同证型的中风后痉挛性偏瘫。     

57例老年人无肢体瘫痪脑梗塞临床与CT分析

目的：探讨老年人无肢体瘫痪脑梗塞临床与CT的关系。方法：对57例老年人无肢体瘫痪脑梗塞的发病诱因，临床表现及CT进行回顾性分析，结果：高血压，TIA，高血脂，冠心病仍为无肢体瘫痪脑梗塞的重要危险因素，结论：肢体瘫痪的发生与否是和传导通路，梗塞部位和病灶大小有头，而与梗塞数目无关，在无MRI条件时，早期头颅CT扫描是诊断的唯一依据。     

Adverse relationships of adiposity and gait parameters: A survey of stroke patients undergoing rehabilitation

Poor adiposities are risk factors for major morbidities, but reports on how these relate with gait function of stroke patients undergoing rehabilitation is sparse and need further investigation. A convenience sample of 94 ambulatory stroke survivors and 94 matched apparently healthy individuals were assessed for adiposity markers (body mass index, waist circumference, thigh girth, waist-hip ratio, and percent body fat) and gait parameters (cadence, step length, stride length, stride width, gait velocity, and cycle). Mean age of the stroke and apparently healthy participants were 57 ± 5.2 years and 56.9 ± 4.8 years, respectively. We found significant (p < 0.05) relationships between waist circumference and each of gait cycle (r = 0.67) namely, cadence (r = −0.68), stride length (−0.62), step length (−0.61), and gait velocity (−0.75). Fairly similar correlations existed between body mass index, waist-hip ratio, percent body fat, thigh girth, and each of gait parameters, with only the thigh girth significantly correlating with stride width (r = 0.79). Obesity more than triples the odds of low gait velocities (odds ratio: 3.28; 95% confidence interval: 1.60–6.74). Findings provide clinicians with likely influence of adiposities on gait parameters of stroke patients. This may inform treatment decision and help to prioritize interventions through adiposity management for stroke patients undergoing rehabilitation.     

Reliability of the measures of weight-bearing distribution obtained during quiet stance by digital scales in subjects with and without hemiparesis

Abstract

Described as an alternative way of assessing weight-bearing asymmetries, the measures obtained from digital scales have been used as an index to classify weight-bearing distribution. This study aimed to describe the intra-test and the test/retest reliability of measures in subjects with and without hemiparesis during quiet stance. The percentage of body weight borne by one limb was calculated for a sample of subjects with hemiparesis and for a control group that was matched by gender and age. A two-way analysis of variance was used to verify the intra-test reliability. This analysis was calculated using the differences between the averages of the measures obtained during single, double or triple trials. The intra-class correlation coefficient (ICC) was utilized and data plotted using the Bland–Altman method. The intra-test analysis showed significant differences, only observed in the hemiparesis group, between the measures obtained by single and triple trials. Excellent and moderate ICC values (0.69–0.84) between test and retest were observed in the hemiparesis group, while for control groups ICC values (0.41–0.74) were classified as moderate, progressing from almost poor for measures obtained by a single trial to almost excellent for those obtained by triple trials. In conclusion, good reliability ranging from moderate to excellent classifications was found for participants with and without hemiparesis. Moreover, an improvement of the repeatability was observed with fewer trials for participants with hemiparesis, and with more trials for participants without hemiparesis.     

Neurological complications of herpes zoster

We report 31 cases of herpes zoster (HZ) with neurological complications: 14 with cranial nerve deficits, 1 with cranial nerve deficit associated with segmental motor disorder, 3 with segmental motor, deficits, 2 with meningoencephalitis, 2 with meningoencephalitis associated with cranial neuropaty or myelitis, 2 with meningitis, 2 with hemiplegia contralateral to the ophthalmic HZ, 1 with hemiplegia and motor deficit and finally 1 with hemiplegia and a cranial neuropathy. Smoking was the putative risk factor in 53% of our patients together with diabetes, which has already been mentioned in the literature. We frequently observed more than one complication in succession (19.3%) that could not easily be related to the cutaneous distribution. Acyclovir had no demonstrable positive effects on neurological complication in our patients.

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Sommario Riportiamo 31 casi di HZ complicato: 14 casi di deficit di nervi cranici, 1 caso con deficit di un nervo cranico più deficit di moto segmentario, 3 deficit di moto, 2 meningo-encefaliti, 1 meningo-encefalite con deficit di un nervo cranico ed 1 complicata da mielite, 2 meningiti, 2 mieliti, 2 emiplegie controlaterali a HZ oftalmico, 1 emiplegia controlaterale più deficit motorio ed 1 con deficit di nervo cranico. Come possibile fattore favorente le complicazioni proponiamo il fumo di sigaretta (presente come unico elemento nel 53% dei pazienti), oltre al diabete già menzionato in numerose casistiche. Molto frequenti nella nostra casistica le associazioni di più complicazioni diverse in successione temporale (19,3%) anche non facilmente spiegabili in senso topografico. Non dimostrabile nei nostri pazienti l’influenza positiva della terapia con acyclovir.