康复训练、溶栓和神经保护剂治疗对急性脑梗死患者运动功能的影响

目的　探讨康复训练、溶栓和神经保护剂联合治疗对急性脑梗死患者运动功能的影响。方法　对 12 0例急性脑梗死患者采用Seldinger法经股动脉插管、闭塞动脉内直接注入 5 0～ 10 0万u尿激酶并同时分别加用神经保护剂 (硫酸镁、GM1 和 2 1 -氨基酸类固醇 )和常规治疗 ,应用神经保护剂的各组均接受运动疗法、作业疗法及电疗等综合康复治疗方法。治疗前、后 3个月进行运动功能评价。结果　与对照组比较 ,综合康复治疗组患者Barthel指数 (BI)、运动功能Fugl -Meyer评分显著提高 (分别P <0 .0 1) ,且疗效高低顺次为GM1 组 >2 1 -氨基酸类固醇组 >硫酸镁组。结论　早期康复训练联合神经保护剂治疗能够显著降低急性脑梗死患者的功能障碍 ,提高溶栓治疗的临床疗效。     

Adding transcutaneous electrical nerve stimulation to visual scanning training does not enhance treatment effect on hemispatial neglect: a randomized,controlled, double-blind study

Background: Left-sided transcutaneous electrical nerve stimulation (TENS) increases right hemispheric activity, which may improve the rehabilitative outcome of hemispatial neglect.

Objective: To examine the behavioral effect of electrical stimulation of the nerve afferents of the left hand during early neuropsychological rehabilitation of post-stroke patients with hemispatial neglect.

Methods: This randomized, controlled, double-blind study included 29 patients (enrolled in the experimental or control group) with left hemispatial neglect after right hemispheric stroke. For 3 weeks, patients received 15 therapeutic sessions involving TENS (active or sham) with a mesh glove applied on the entire left hand during the first 30 minutes of a 45-minute conventional visual scanning training (VST). Signs of hemispatial neglect were assessed using a psychometric test before and after treatment.

Results: Univariate analysis of covariance revealed that differences between the control and experimental groups were not significant after treatment (F(1, 22)?=?0.294, P?=?0.593) when adjusted for pre-treatment scores and time since stroke onset. This suggested that electrical stimulation failed to mitigate the severity of hemispatial neglect symptoms.

Conclusion: Our study did not provide evidence of the effectiveness of TENS when added to VST during early rehabilitation for patients with post-stroke hemispatial neglect. Other techniques (applied alone or together) should be sought to improve recovery in this population.     

The feasibility and validity of care mapping in the clinical neurosciences

Dementia Care Mapping (DCM) is an observational tool and process that is widely used in dementia care in measuring and improving person-centred care (PCC). DCM was previously piloted on a neurorehabilitation ward, where it was found to be feasible and acceptable in this setting. Following this, a new modified tool and accompanying manual were developed: Care Mapping – Neurorehabilitation (DCM-NR). The current study aimed to assess the feasibility and validity of DCM-NR by piloting its use in a range of clinical neuroscience settings. A mixed-methods design was used employing both quantitative and qualitative techniques. The new DCM-NR was found to be feasible for use both in terms of the suitability of its coding system and the implementation process. DCM-NR was shown to have a moderate level of concurrent validity with participants' self-report of PCC. Participants' subjective reports on their experiences of care provided validation for the areas of psychological need observed in DCM-NR. The results of this study indicate that DCM-NR is feasible and valid for use in a range of clinical neuroscience settings. Further longitudinal research is required to evaluate the impact of DCM-NR on PCC practices over time.     

杏芎氯化钠注射液对脑梗死患者肢体运动功能的疗效研究

目的观察分析杏芎氯化钠注射液对脑梗死患者肢体运动功能恢复的疗效。 方法选取广州医科大学附属第五医院神经康复科自2018年2月至10月住院的200例脑梗死患者,随机分组,试验组103例,对照组97例。对照组予以标准脑梗死二级预防治疗及神经康复治疗,试验组则在对照组治疗的基础上加用杏芎氯化钠注射液治疗,采用Brunnstrom分期及简化Fugle-Meyer评分评定2组患者治疗前后的运动功能。 结果从Brunnstrom分期角度分析,试验组和对照组治疗14 d后手、上肢、下肢运动功能与治疗前比较均有改善,差异具有统计学意义（P<0.05）。从Fugle-Meyer评分角度分析,试验组Fugle-MeyerⅠ级、Ⅱ级患者65例,治疗后25例肢体功能评估为Ⅲ级;对照组Fugle-MeyerⅠ级、Ⅱ级患者62例,治疗后14例患者肢体功能评估为Ⅲ级;试验组疗效高于对照组,差异具有统计学意义（P=0.046）。 结论试验组、对照组的疗法对脑梗死患者肢体运动功能均有全面而明显的改善作用。在标准脑梗死二级预防及针对性肢体康复治疗基础上,结合杏芎氯化钠注射液治疗可以促使患者肢体功能从Fugle-MeyerⅠ、Ⅱ级向Ⅲ级好转。     

Clinical elements for the neuromuscular stimulation and functional electrical stimulation protocols in the practice of neurorehabilitation

The physicians and their multidisciplinary teams involved in the clinical practice of neurological rehabilitation have more and more opportunities to apply neuromuscular stimulation (NMS) and functional electrical stimulation (FES) of peripheral nerves as a part of their daily practice. In this article, we outline clinical protocols of NMS and FES in the following clinical conditions of upper motor neuron dysfunction: to prevent consequences of disuse of the neuromuscular system of the upper motor neuron, to facilitate recovery processes of impaired upper motor neuron functions due to acute and/or subacute neurological conditions, to maintain or enhance the trophic state of the muscle, to modify altered control of muscle tone, to modify altered patterns of automatic and volitional functional movements, to enhance functional movement of the single joint muscle group within intact functional multijoint movement, and to modify altered neurocontrol of posture, locomotion, and skillful movements. We emphasize the importance of understanding the motor control alteration while developing clinical protocols and defining the goals. It is very important to be aware that similar clinical findings and due to the same cause can have different features of residual motor control, and therefore potentials for recovery or modification can be very different.     

Is intensive gait training feasible and effective at old age? A retrospective case-control study on the use of Lokomat Free-D in patients with chronic stroke

BackgroundIn the last decade, the number of people over 60 has increased, leading to various healthcare problems. The aim of this retrospective study is to evaluate the effects of robotic rehabilitation in elderly patients as well as their perception of usability and adaptation to intensive robotic neurorehabilitation.MethodsThis is a retrospective case-control study. Eighty elderly stroke patients were included in the analysis using an electronic data retrieval system. The enrolled patients were divided into two groups: the experimental group (EG) underwent rehabilitation training with Lokomat FreeD, equipped with a VR screen, while the control group (CG) performed traditional rehabilitation training. The two groups matched for age, sex, education, brain injury, stroke interval. The rehabilitation protocol included a total of 40 training sessions.ResultsBoth types of rehabilitation led to an improvement in the perceived level of disability (FIM) and in the performance in gait and balance (TT), highlighting a significant improvement especially in the EG. However, only in the EG, Lokomat training had induced an increase in the distance covered in 10 min (10 m walk test), and a significant improvement in mood (HRS-D). Moreover, Lokomat-FreeD was well tolerated by patients with high levels of usability.ConclusionsOur results suggest that elderly patients may benefit from high-intensity robotic neurorehabilitation using the Lokomat-Pro FreeD.     

中西医结合神经康复方案治疗脑性瘫痪临床疗效分析

目的研究以针刺为主的中西医结合神经康复方案对脑性瘫痪（CP）患者临床疗效的影响。方法对30例CP患者给予针刺、神经促通手法、电磁物理因子刺激、躯干肢体易化训练以及神经营养药物,分析治疗前、治疗1.5个月后（中评）、治疗3个月后（末评）功能独立性评定（FIM）结果以及治疗效果的变化。结果治疗1.5个月时FIM结果变化不明显（P〉0.05）,而治疗3个月后FIM明显提高,其中生活自理能力、转移行进能力以及社交交流能力好转明显（P〈0.05）,而括约肌功能变化差异无统计学意义;末评的显效率、总有效率比中评时提高,差异有统计学意义（P〈0.05）;男、女性患者治疗的FIM结果比较,差异无统计学意义（P〉0.05）;治疗后3～9岁患者的FIM值提高较明显（P〈0.05）。结论以针刺为主的中西医神经康复方案能明显促进CP患者生活自理能力、行进转移能力以及社交交流能力的提高,而且以坚持治疗3个月以上者效果显著。