程序康复对急性心肌梗死患者生活质量的影响

目的 :观察 2周程序康复能否改善急性心梗 (AMI)患者的生活质量 (QOL)。方法 :通过多种QOL问卷(QOLQ)对顺利完成早期康复计划的 2 1例AMI患者进行QOL评估。结果 :对完成程序康复的AMI患者 (平均住院时间为 15 .4 1± 3 .76天 )通过WHOQOL等量表进行QOLQ的测试 ,主观感受积分较对照组高 (P <0 .0 0 1) ,在生理、心理及环境领域的得分亦高于对照组 (P <0 .0 0 0 1)。结论 :AMI患者早期程序康复可改善患者的生活质量     

Participants’ perceptions of an aphasia-friendly occupational therapy home program

Background: Upper extremity impairments post-stroke impact participation in valued occupations. Home programs are used to extend the frequency and amount of upper extremity practice for people post-stroke, but novel ways of increasing adherence to these programs is needed to ensure intense repetitive practice.

Objectives: The purpose of this process evaluation, was to examine the perceptions of people with aphasia as it relates to modifications to home programs that could influence participation, specifically listening to music and aphasia-friendly adaptations of written materials.

Methods: Seven people with chronic aphasia completed an upper extremity home program that included the use of music and aphasia-friendly modified materials (ClinicalTrials.gov ID:2016/06/18). After the home program, participants completed semi-structured interviews to understand their perceptions of the program and the modifications.

Results: Five themes were identified including (1) music, (2) activities, (3) instructions, (4) logistics, and (5) progress. Most participants perceived music as helpful, but a few reported it being distracting. Participants found the variety of activities helpful as well as specific characteristics of the instructions such as photographs and images. Some participants expressed elements of the home program to be barriers to practice such as using the activity monitors and logbook, which required assistance at times. Finally, participants noted their own progress resulting from the program and liked that they could adjust the intensity of the program as they progressed.

Conclusions: Overall participants in this study with aphasia perceived the modifications to home programs including aphasia friendly written instructions and music to facilitate successful home practice.     

Role of Quantitative Electroencephalography,Neurotherapy, and Neuroplasticity in Recovery from Neurological and Psychiatric Disorders

Introduction. Until recently, patients with brain injuries had poor prognosis for recovery, but new insights into neuroplasticity and neurorehabilitation have significantly improved outcomes. Neurotherapy or neurofeedback is one of those promising techniques for neurorehabilitation.

Methods. Neurofeedback or EEG biofeedback, as it is also called, uses operant conditioning to reinforce desirable self-regulated changes in EEG rhythms, changes that are believed to correspond to reorganization in neural networks, particularly in thalamocortical and corticothalamic circuits. Sensorimotor rhythm reinforcement has been effective in facilitating recovery in patients with traumatic brain injury, stroke, seizures, and certain sleep disorders.

Results. We describe the case of a 19-year-old man with severe, partial secondarily generalized seizures that did not respond to extensive conventional treatments including all antiepilepsy drugs.

Conclusion. He underwent two 3-week sessions of daily neurotherapy, which produced remarkable EEG and behavioral normalization.     

上海市部分医院骨科护士康复护理行为现状及其影响因素

目的了解上海市部分医院骨科护士康复护理行为的现状及其影响因素，为提高骨科护士的康复护理水平提供依据。方法采用自行设计的骨科护士康复护理行为问卷，内容包括骨科护士一般资料及康复护理行为，对上海市15所医院的282名骨科护士进行调查，调查数据用SPSS11．0软件进行统计分析。结果在康复护理行为的6项内容中，只有健康教育得分较高，其他项目如康复护理评估、指导患者功能锻炼、日常生活活动能力训练、心理护理和出院指导及随访得分都较低。不同学历、职称的护士康复护理行为得分无显著性差异；不同工作年限的护士康复护理行为得分有显著性差异（P〈0．05）。结论亟须通过规范化继续教育提高骨科护士的康复护理水平，加强对低年资护士的培训，同时充分发挥高年资护士的业务专长。     

Modified Approach to Stroke Rehabilitation (MAStR): feasibility study of a method to apply procedural memory concepts to transfer training

Objective: Training and implementation for a multidisciplinary stroke rehabilitation method emphasizing procedural memory.

Background: Current practice in stroke rehabilitation relies on explicit memory, often compromised by stroke, failing to capitalize on better-preserved procedural memory skills. Recruitment of procedural memory requires consistency and practice, characteristics difficulty to promote on inpatient rehabilitation units. We designed a method Modified Approach to Stroke Rehabilitation (MAStR) to maximize consistency and practice for transfer training with stroke patients.

Design: Phase I, single-group study. MAStR has two innovations: (1) simplification of instructions to only three words, other direction provided non-verbally; (2) having all rehabilitation staff apply the same approach for transfers. Staff training in MAStR included review of written material describing the rationale for MAStR and demonstration of a transfer using MAStR. Enrolled patients completed each transfer with MAStR in addition to standard rehabilitation therapy.

Results: The MAStR method was taught to a large, multidisciplinary rehabilitation staff (n = 31). Training and certification required 15 min per staff member. Five stroke patients were enrolled. No transfers with MAStR resulted in injury, no negative feedback was received from staff or patients. Staff reported satisfaction with the brief MAStR training and reported transfers were easier to complete with the MAStR method.

Conclusions: Feasibility was demonstrated for an innovative application of procedural memory concepts to stroke rehabilitation. All rehabilitation disciplines were successfully trained. MAStR was well-tolerated and liked by rehabilitation staff and patients. These results support pursuit of a Phase II pilot study.     

A Randomized Trial Investigating the Influence of Strength Training on Quality of Life in Ischemic Stroke

Background: Strength training post stroke is widely acknowledged as an important part of a rehabilitation program. Muscle strength has been shown to be a significant contributor to physical disability after stroke, which in turn has an immense impact on the reintegration of patients into society, affecting their quality of life.

Objective: This was a randomized intervention trial to determine the effect of a resistance training program on the quality of life in patients with stroke.

Methods: An experimental group (EG), consisting of 11 subjects aged 51.7 ± 8.0 years, and a control group (CG), consisting of 13 subjects aged 52.5 ± 7.7 years, were studied before and after 12 weeks. EG underwent 12 weeks of strength training three times a week. The CG did not undergo strength training during the 12-week study period.

Results: There was a significant increase in quality of life from pre-test to post-test (Δ% = 21.47%; p = 0.021) in EG. There were significant differences in all indicators of quality of life between groups at 12 weeks. There were greater gains in strength in EG than in CG (p ≤ 0.05). There was a negative correlation between the strength gains as determined with the 1RM test and the quality of life, especially in lower limb exercises.

Conclusion: The results of this study indicate that there was an improvement in the measures of strength in EG, and that there was a correlation between improvements in strength and quality of life in these patients who had previously suffered a stroke at least one year prior to study.     

PDCA循环结合健康教育在脑卒中患者康复护理中的应用

目的探讨PDCA循环结合健康教育在脑卒中患者康复护理中的应用效果。方法 2013年1月至2015年1月,采用便利抽样法选择在长江航运总医院武汉脑科医院康复医学科住院进行康复治疗的脑卒中伴肢体活动障碍患者124例,按随机数字表法将其分为观察组与对照组各62例,观察组患者予以PDCA循环结合健康教育的护理方法,对照组予以常规护理方法,治疗8周后,评价并比较两组患者的神经功能缺损评分(national institute of health stroke scale,NIHSS)、日常生活活动能力评分(activities of daily living,ADL)及患者满意率。结果入院时,两组患者的NIHSS评分、ADL评分差异均无统计学意义(均P0.05);治疗8周后,两组患者的NIHSS评分、ADL评分均优于入院时,且观察组的NIHSS评分显著低于对照组、ADL评分显著高于对照组,差异均有统计学意义(均P0.05);观察组患者的满意率为100%,高于对照组的88.7%,差异有统计学意义(P0.05)。结论 PDCA循环结合健康教育的康复护理方法可以提高康复科护理质量,改善脑卒中患者的神经缺损功能及日常活动能力,提高科室护理满意率,值得在康复科推广应用。     

综合性肺康复治疗对稳定期慢性阻塞性肺疾病患者运动能力与生存质量影响

目的:探讨稳定期慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者门诊肺康复综合治疗的临床价值,分析肺康复综合治疗对稳定期COPD患者运动耐力及生存质量等方面的影响。方法:选取2012年11月—2013年10月医院收治的200例稳定期COPD患者为研究对象,随机分为对照组与观察组,对照组给予常规门诊康复训练:呼吸功能训练(缩唇呼吸、腹式呼吸)结合氧疗,观察组给予门诊综合康复训练(运动、呼吸肌、长期家庭氧疗、营养支持、健康教育、心理与行为干预),训练前测定COPD生存质量评分、6min步行距离、Borg评分及St George呼吸问卷(SGRQ)评分,1秒用力呼气容积(FEV1)与最大肺活量(FVC),计算FEV1/FVC,分别与训练2周、1个月、3个月、6个月、1年、2年复测上述指标,并进行比较。结果:观察组患者训练6个月、1年、2年后生存质量评分、SGRQ明显优于训练前(P0.05),观察组优于对照组(P0.05);观察组患者训练3个月、6个月、1年、2年后6min步行距离、Borg评分明显优于训练前(P0.05),观察组明显优于对照组(P0.05),两组训练6个月、1年、2年患者FEV1/FVC与训练前比较显著升高(P0.05)。结论:稳定期COPD患者行门诊综合康复治疗可显著改善运动能力,提高生存质量,呈现一定时间累积效应,长期训练效果更好。     

深度手烧伤的治疗及功能康复

目的 :探讨深度手烧伤早期创面修复及功能康复最好的治疗方法。方法 :应用中厚皮、异体去细胞真皮基质作支架加自体刃厚皮片移植 ,腹部真皮血管网皮片及超薄皮瓣移植等手术方式 ,进行深度手烧伤早期切削痂。结果 :2 94例 4 6 2只手功能良好者 138例 2 32只手 (5 0 % ) ,功能较好者 79例 134只手 (2 9% ) ,功能障碍者 77例 96只手 (2 1% )。结论 :应用早期切削痂植皮的方法可减少瘢痕增生和畸形 ,使深度手烧伤后获得满意的外形和功能     

Soleus H‐reflex operant conditioning changes the H‐reflex recruitment curve

Introduction: Operant conditioning can gradually change the human soleus H‐reflex. The protocol conditions the reflex near M‐wave threshold. In this study we examine its impact on the reflexes at other stimulus strengths. Methods: H‐reflex recruitment curves were obtained before and after a 24‐session exposure to an up‐conditioning (HRup) or a down‐conditioning (HRdown) protocol and were compared. Results: In both HRup and HRdown subjects, conditioning affected the entire H‐reflex recruitment curve. In 5 of 6 HRup and 3 of 6 HRdown subjects, conditioning elevated (HRup) or depressed (HRdown), respectively, the entire curve. In the other HRup subject or the other 3 HRdown subjects, the curve was shifted to the left or to the right, respectively. Conclusions: H‐reflex conditioning does not simply change the H‐reflex to a stimulus of particular strength; it also changes the H‐reflexes to stimuli of different strengths. Thus, it is likely to affect many actions in which this pathway participates. Muscle Nerve 47: [?show $1534v]–[?show $1535v], 2013