A Comparative Study on the Immediate Effects of Hand Orthoses on Reducation of Hypertonus

This paper compares the immediate effects of dorsal, volar and no splints in reducing hypertonicity in the wrist flexors of spastic hemiplegic subjects. The measures include: (i) passive range of motion; (ii) angle of point of stretch reflex; (iii) resistance to passive wrist extension; and (iv) force of spontaneous wrist flexion. Results of this study indicate a significant reduction in hypertonicity following both dorsal and volar splint application on the passive range of motion and resistance to passive extension measures (P < .05), and a significant reduction in hypertonicity as measured by spontaneous flexion following two hours of dorsal splint wearing (P < .05). No significant reductions in hypertonicity were noted on the angle of point of stretch reflex measure, and on the force of spontaneous flexion measure. Possible explanations for results and suggestions for further resarch are discussed.     

Acupoint electrogymnastics therapy in stroke hemiplegia

BACKGROUND： Electrogymnastics can offer a range of proprioceptive, motor, and cutaneous sensation impulses to the central nerve system. The center receives perception of the paralyzed muscle through the aid of these impulses. During this process, functional reorganization of connecting network between segment and intersegment takes place. OBJECTIVE： To observe the therapeutic efficacy of acupoint electrogymnastics and traditional electroacupuncture on stroke hemiplegia. DESIGN, TIME AND SETTING： A multicenter, randomized, controlled, blinded, clinical study was performed at the College of Acu-moxibustion and Massage in Shanghai University of Traditional Chinese Medicine from May 2004 to September 2006. PARTICIPANTS： A total of 153 patients suffering from stroke hemiplegia, comprising 83 males and 70 females, aged 63-70 years, were admitted to outpatient and inpatient at LongHua Hospital Affiliated Shanghai University of Traditional Chinese medicine, Putuo District Traditional Chinese Medicine Hospital and Changqiao Street Community Health Service Center of Shanghai. METHODS： The patients were randomly divided into treatment （n = 77） and control （n = 76） groups. They were treated with acupoint electrogymnastics and traditional electroacupuncture, respectively. In the treatment group, two pairs of positive and negative JD-2008 type electrodes from a hemiplegia treatment apparatus were directly pasted on the Shousanli （LI 10） and Waiguan （SJ5） acupoints of the upper limb, as well as the Zusanli （S36） and Yanglingquan （GB34） acupoints of the lower limb, respectively. In the control group, needles were consecutively inserted into the above acupoints. Using the method of lifting-inserting and twisting-rotating, the needle was manipulated with small amplitude of 5-7 mm and a fast frequency of 80-120 times/min when the needle was inserted to a suitable depth. When the sensation of needling was attained, the two pairs of positive and negative electrodes of type G6805-Ⅱelectro-acupunctur     

电针阳明经穴位对偏瘫患者运动功能康复的影响

目的探讨电针阳明经穴位对偏瘫患者运动功能康复的影响。方法54例早期脑卒中后偏瘫患者,分为A、B、C三组,A组行运动疗法,B组行运动疗法加电针阳明经穴,C组行运动疗法加平衡肌张力针法,2周和4周后,根据Ashworth痉挛评级和Fugl-Meyer评定(FMA)评定两组疗效。结果3组治疗后运动功能明显改善、肌张力提高,但B、C组评分高于A组(P<0.05)。治疗4周后B组较C组、A组下肢Ashworth分级评分均有显著性差异(P<0.05)。结论电针偏瘫患者阳明经穴位主要提高患者肌张力,对软瘫期运动功能康复可能有效,而不适用于痉挛期。     

脑卒中偏瘫患者药熨配合中医推拿的康复护理

2005年5月-2006年5月收治的66例脑卒中偏瘫患者在神经内科常规治疗的基础上，以药熨配合中医推拿进行康复治疗及护理。药熨法：取吴茱萸50g、莱菔子50g、白芥子50苦、菟丝子50g、苏子50g干燥成熟种子放入小布袋内充分摇匀，放入微波炉内（旁边放1小杯水）用高火加热2-3min，达70～80℃，将药袋放到患肢用力来回推熨；中医推拿：由专业治疗师为患者进行穴位推拿，护士协助其进行坐站走康复练习等。连续施护8周后瘫侧上肢运动功能2级以下7例，2～4级24例，～6级35例；瘫侧下肢运动功能2级以下8例，2～4级12例，～6级46例；治疗后步行能力1级6例，2级15例，3级21例，4级24例。认为在整个康复过程中，康复护理要做好：（1）非活动时瘫痪肢体需功能位摆放；（2）预防和治疗瘫痪肢体痉挛；（3）掌握患者残存机能的范围和程度，以便指导和训练患者进行日常生活活动。药熨时掌握药袋的适宜温度，不可在皮肤病变及破损处行药熨。     

腘绳肌练习对脑卒中后膝稳定性及日常生活活动能力的影响

目的:观察月国绳肌练习对改善脑卒中患者膝关节过伸及日常生活活动能力(ADL)的疗效。方法:38例患者随机分为治疗组(20例)和对照组(18例)。治疗组除了给予常规康复治疗(中级偏瘫医疗体操;神经肌肉促进技术;步态分解练习;ADL训练),还给予针对性月国绳肌练习(月国绳肌最大向心性等张-膝关节末端等长抗阻练习;月国绳肌肌电生物反馈治疗);对照组只给予常规康复治疗。治疗时间60d。比较治疗前后LKSS膝关节功能评定、上田敏12级评定、Barthel指数等各项指标的变化。结果:治疗组各项指数的改变均明显优于对照组(P<0.01)。结论:月国绳肌练习对脑卒中偏瘫患者的膝关节不稳有明显疗效,并能改善患者的日常生活活动能力。     

闭环肌电反馈电刺激在偏瘫早期康复训练中的应用

目的观察闭环肌电反馈电刺激在改善早期偏瘫患者肢体运动和促进功能恢复方面的效果。方法选发病 4周内的患者 12 0例 ,随机分为治疗组和对照组。两组患者均接受常规康复训练治疗 ,治疗组加用闭环肌电反馈电刺激治疗。使用该仪器测定的肌电值及简式Fugl Meyer功能评价表进行评定。 结果全部患者治疗前后的肌电值及功能评分值均有显著提高 ,治疗组与对照组相比有显著性差异 (P <0 .0 5 ) ,其康复效果与治疗次数正相关。结论闭环肌电反馈电刺激可促进早期偏瘫患者患肢运动功能恢复。     

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.