医学训练式治疗对恢复期脑卒中患者步行能力的影响

正脑卒中后恢复较好的步行能力不仅是患者本人和家属的迫切期望,更是物理治疗师工作的重要目标。影响脑卒中患者步行能力的因素包括患侧下肢的肌肉力量、肌肉耐力、肌肉张力、站立平衡功能、姿势控制等[1—2]。近年来,通过患侧下肢力量训练提高脑卒中患者步行能力的方法受到大家的重视。中国脑卒中康复指南也明确指出下肢肌力减弱与步行速度等步行能力下降直接相关,并推荐通过肌力强化训     

膝关节本体感觉训练对偏瘫患者平衡功能的影响

摘要 目的：探讨对脑卒中偏瘫患者施行膝关节本体感觉训练后其平衡功能恢复的影响。 方法：符合要求的20例受试者依年龄、性别、功能障碍程度、偏瘫侧等条件以一一配对的方式分成观察组和对照组,对照组接受常规康复治疗,观察组在常规康复治疗的基础上加强膝关节本体感觉训练。两组患者在治疗前和治疗后分别采用角度重建法测量膝关节位置觉和使用Berg平衡量表（BBS）测量平衡功能。 结果：观察组患侧膝关节位置重现的平均偏差变小（P<0.01）,屈膝30°、45°的测试中,试验后膝关节位置偏差与训练前测量值对比有显著性意义（P<0.05）。试验后,观察组与对照组患侧膝关节位置重现平均偏差比较有显著性意义（P<0.01）。试验后的BBS评分值,两组对比有显著性意义（P<0.05）。 结论：膝关节本体感觉训练对脑卒中患者的平衡功能恢复有积极的作用,对脑卒中偏瘫患者进行膝关节本体感觉训练很有必要的。     

Cardiovascular responses induced by whole-body vibration training in patients with subacute stroke

Background Whole-body vibration(WBV) therapy has become a common treatment in rehabilitation of various patient populations. While it has been shown in healthy young adults that the oxygen consumption rate(VO_2)and heat rate(HR) are significantly increased when WBV is added to exercise. However, the cardiovascular response to WBV in patients with subacute stroke is unknown. The objective of this study was to determine the acute cardiovascular responses to WBV during the various exercises in different WBV conditions in patients with subacute stroke(onset less than 3 months). Methods A total of 54 subjects with subacute stroke performed six exercises while being exposed to 3 WBV conditions:(1) no WBV,(2) low WBV intensity [amplitude: 0.6 mm,frequency: 20 Hz, peak acceleration: 0.96 gravitational constant(G)], and(3) high WBV intensity(amplitude:0.44 mm, frequency: 30 Hz, peak acceleration: 1.61 G). The cardiovascular responses(HR and VO_2) were measured by a FitMateTMPro metabolic system during the 6 exercises. Two-way repeated measures ANOVA was used to compare the VO_2, and HR data across the different conditions. In addition, we calculated the rate pressure product(RPP) =(HR × systolic blood pressure)/100, for measuring the myocardial oxygen demand. Two-way ANOVA with repeated measures was used to compare the RPP data across the different test conditions. Results Exposure to WBV(high-and low-intensity protocols) significantly induced higher VO_2 by 0.35-1.07 mL·kg-1·min-1(P0.001) and HR by 0.8-6.0 beats per minute(P0.001) compared with the no WBV condition, regardless of the exercise performed. No significant difference in VO_2 and HR was found between the low-and high-intensity WBV protocols(P0.05). For RPP, there was an overall significant effect between pre-and post-WBV(P0.001). The main effect of WBV intensity(P=0.572), and intensity × time interaction effect(P=0.756), however,were not significant. Conclusions HR and VO_2 are increased significantly with addition of WBV training. The added low-and high-intensity WBV induce a similar increase in VO_2 and HR. RPP is similarly increased after exercise, regardless WBV is added or not[.S Chin J Cardiol 2019;20(1):15-24]