脑卒中后感觉功能、反射和平衡功能评估

本文探讨脑卒中的感觉、反射和平衡功能的评定。(1)感觉功能评估除按缺失、减弱、过敏、倒错和正常5个指标评定外,简化的感觉指数评分法(SIS)简单、易行,适用于临床。对自发痛的评估可用目测类比评分法(VAS),但比较客观的感觉检测方法是体感诱发电位(SEP)。(2)反射功能评估临床常用者包括腱反射、皮肤反射和病理反射。(3)平衡功能评价常用修订的Semans标准、Fugl-Meyer平衡功能评定和平衡试验法。这些方法可用于脑卒中偏瘫的平衡障碍和躯干、下肢的协调性障碍的评价。     

再植术与足趾移植再造术后的感觉功能恢复比较

[目的]研究和比较再植与足趾移植再造术后的感觉功能恢复。[方法]对28例手指离断的患者进行再植或足趾移植再造术。其中,再植组14例,再造组14例,两组平均年龄分别为32.3和29.6岁。手术距损伤时间：再植组平均5.5 h,再造组平均42 d。再造组行健侧趾尖感觉功能测量,再植组行健侧指尖感觉功能测量。测量结果与术后指尖感觉功能测量的结果相比较。[结果]温度觉恢复最好可达90%,痛觉其次,之后为触觉和振动觉,可达到正常的70%。两点分辨觉恢复最差,结果为：健侧指尖（3.0±1.0）mm,健侧趾尖（6.5±2.5）mm,再植术后指尖（7.0±3.0）mm,再造术后指尖（9.0±5.0）mm。[结论]再植与再造术后感觉功能恢复,前者好于后者。再造手指感觉功能恢复总体满意,但不完全并有选择性。再造手指的感觉功能更接近足趾而非手指。     

PNF技术在桡神经损伤修复术后功能恢复的应用

目的：观察PNF技术治疗桡神经损伤修复术后对腕关节活动度、运动和感觉功能的影响。方法：选取桡神经损伤显微外科修复术后患者34例,随机分为对照组和PNF组各17例。2组均于术后患者病情稳定后,进行常规肌力、关节活动度和感觉刺激训练等康复治疗。PNF组增加等张,拮抗肌反转,关节活动度牵拉等PNF技术训练。结果：治疗4个月后,2组腕关节感觉和运动功能评分及ROM均较治疗前明显提高（P〈0.01）,且PNF组显著高于对照组（P〈0.01,0.05）。2组治疗后临床疗效比较,PNF组达优率及优良率均明显高于对照组（P〈0.05）。结论：PNF对桡神经损伤修复术后功能恢复有促进作用,值得临床推广应用。     

The validity of using an electrocutaneous device for pain assessment in patients with cervical radiculopathy

Abstract

The purpose of this study was to evaluate the validity and preference for assessing pain magnitude with electrocutaneous testing (ECT) compared to the visual analogue scale (VAS) and Borg CR10 scale in men and women with cervical radiculopathy of varying sensory phenotypes. An additional purpose was to investigate ECT sensory and pain thresholds in men and women with cervical radiculopathy of varying sensory phenotypes. This is a cross-sectional study of 34 patients with cervical radiculopathy. Scatterplots and linear regression were used to investigate bivariate relationships between ECT, VAS and Borg CR10 methods of pain magnitude measurement as well as ECT sensory and pain thresholds. The use of the ECT pain magnitude matching paradigm for patients with cervical radiculopathy with normal sensory phenotype shows good linear association with arm pain VAS (R² = 0.39), neck pain VAS (R² = 0.38), arm pain Borg CR10 scale (R² = 0.50) and neck pain Borg CR10 scale (R² = 0.49) suggesting acceptable validity of the procedure. For patients with hypoesthesia and hyperesthesia sensory phenotypes, the ECT pain magnitude matching paradigm does not show adequate linear association with rating scale methods rendering the validity of the procedure as doubtful. ECT for sensory and pain threshold investigation, however, provides a method to objectively assess global sensory function in conjunction with sensory receptor specific bedside examination measures.     

Contribution of tactile dysfunction to manual motor dysfunction in type II diabetes

Introduction: Changes in sensory and motor functions of the hand in type II diabetes (T2D) patients have been reported; there is speculation that these changes are driven by tactile dysfunction. The purpose of this study was to evaluate the effects of tactile feedback on manual function in T2D patients. Methods: T2D patients and healthy controls underwent median nerve blocks at the wrist and elbow. All participants underwent traditional timed motor evaluations, force dynamometry, laboratory‐based kinetic evaluations, and sensory evaluation. Results: Tactile sensation in the T2D group at baseline was found to be equivalent to tactile function of the control group after median nerve block. Traditional timed evaluation results were negatively impacted by anesthesia, but more sensitive kinetic measures were not impacted. Conclusions: These data suggest that mechanisms outside of tactile dysfunction play a significant role in motor dysfunction in T2D. Muscle Nerve 54 : 895–902, 2016     

Recovery of sensation and somatosensory evoked potentials following toe-to-digit transplantation in man

Recovery of digital nerve function in 21 patients with toe-to-digit transplantation was evaluated by clinical sensory tests and somatosensory evoked potentials (SEPs) to median and digital nerve stimulation. The mean interval between injury and surgery was 7 months, and that between surgery and study was 31 months. The transplanted toes achieved a satisfactory but incomplete recovery in temperature (warm and cold), pinprick, touch, vibration, and two-point discrimination in that order. The overall sensory status of the transplanted toes appeared to be closer to normal toes than to normal fingers. In SEPs from the transplanted side, median N9, N13, and N20 components had normal latency but reduced amplitude, whereas digital N9 component was usually absent, but N13 and N20 components had prolonged latency and reduced amplitude. Transplantation performed within 1 month after injury prevented amplitude reduction in median SEPs and latency prolongation in digital SEPs. The SEP data suggest that timing of surgery was critical in preventing retrograde effect on the median nerve, and that recovery of digital nerve function was incomplete correlating with clinical sensory findings. © 1995 John Wiley & Sons, Inc.     

Application of peripheral nerve conduits in clinical practice: A literature review

Understanding the pathomechanisms behind peripheral nerve damage and learning the course of regeneration seem to be crucial for selecting the appropriate methods of treatment. Autografts are currently the gold standard procedure in nerve reconstruction. However, due to the frequency of complications resulting from autografting and a desire to create a better environment for the regeneration of the damaged nerve, artificial conduits have become an approved alternative treatment method. The aim of this mini-review is to present the nerve scaffolds that have been applied in clinical practice to date, and the potential directions of developments in nerve conduit bioengineering.Articles regarding construction and characterization of nerve conduits were used as the theoretical background. All papers, available in PubMed database since 2000, presenting results of application of artificial nerve conduits in clinical trials were included into this mini-review.Fourteen studies including ≤10 patients and 10 trials conducted on >10 patients were analyzed as well as 24 papers focused on artificial nerve conduits per se. Taking into consideration the experiences of the authors investigating nerve conduits in clinical trials, it is essential to point out the emergence of bioresorbable scaffolds, which in the future may significantly change the treatment of peripheral nerve injuries. Also worth mentioning among the advanced conduits are hybrid conduits, which combine several modifications of a synthetic material to provide the optimal regeneration of a damaged nerve.