居家抗痉挛护理对脑卒中肢体痉挛患者的影响

目的探讨居家抗痉挛护理对脑卒中肢体痉挛患者功能康复的影响。方法选取2014年10月—2015年12月在上海市黄浦区打浦桥街道社区卫生服务中心就诊的早期脑卒中肢体痉挛患者50例。成立居家护理干预小组,由专业护士针对患者及其照顾者进行评估后,实施居家肢体抗痉挛护理。干预6个月后,采用改良Ashworth痉挛量表(modified Ashworth scale,MAS)评估患者肢体痉挛情况;采用简化Fugl-Meyer运动功能评定量表(Fugl-Meyer Assessment,FMA)评估患者肢体运动功能;采用Barthel指数(Barthel Index,BI)评估患者日常活动能力。结果干预6个月后,患者肢体痉挛情况改善,肢体运动功能改善,日常活动能力改善,干预前后比较差异均有统计学意义(P0.05)。结论居家抗痉挛护理有助于脑卒中肢体痉挛患者的功能康复,可有效提高患者的日常生活自理能力。     

A型肉毒毒素在脑卒中后肢体痉挛患者康复中的应用

目的:研究A型肉毒毒素(BTXA)在脑卒中后肢体痉挛患者康复中的应用价值。方法:选取脑卒中后肢体痉挛患者100例,随机分为实验组和对照组各50例。2组均按常规方法进行康复训练,实验组加用BTXA局部注射痉挛的肌肉,每次注射总剂量≤500 IU。在治疗前和治疗后2、6、12周分别采取改良Ashworth痉挛量表(MAS)、Fugl-Meyer运动功能量表(FMA)、改良Barthel指数(MBI)、足印分析法评估2组的肌痉挛状况、步行能力、日常生活活动能力及步态。结果:与治疗前比较,治疗后2周、6周2组的MAS评分显著下降,FMA及MBI评分均显著升高,步速及步长显著提高,并且实验组表现更优(P0.05)。治疗后12周,2组的MAS、FMA、MBI、步速、步长等指标显著优于治疗前,且实验组优于对照组,差异均有统计学意义(P0.05)。结论:BTXA联合康复训练可显著降低脑卒中后痉挛肢体的肌张力,提高运动功能及日常生活能力,并且不良反应较低。     

双侧肢体电刺激对缺血性脑卒中患者早期运动功能的影响

目的探讨双侧肢体同期电刺激对缺血性脑卒中患者运动功能的影响。方法颈内动脉系统缺血性脑卒中患者60例,抽签随机分为2组,双侧组:在神经系统症状不在进展后48h开始,应用北京爱生NMT-91神经肌肉治疗仪对偏瘫侧肢体和未受损侧肢体进行同期低频脉冲式电流刺激;单侧组对偏瘫侧肢体进行低频脉冲式电流刺激。观察指标:分别在康复开始时及4周后评估神经功能缺损评分量表(clinicalnervefunctionlimitationscores,CNS),改良Fugl-Meyer运动功能评定量表(FMA),改良巴氏指数(modifiedbarthelindex,MBI)。结果双侧组1例患者实验期间因脑卒中进展,不进行统计学处理。两组患者上述观察指标相比较差异均有统计学意义。结论双侧肢体电刺激可以显著提高缺血性脑卒中早期康复护理效果。     

中药湿热敷治疗脑卒中后肢体痉挛的疗效观察

目的观察中药湿热敷对脑卒中后肢体痉挛的疗效。方法将60例脑卒中后肢体痉挛患者用数字表法分为观察组和对照组各30例。两组均予神经内科常规处理及中医针灸、推拿等综合治疗,观察组在此基础上加用中药湿热敷。采用改良Ashworth量表对两组治疗前后肢体痉挛状态作评价。结果观察组治疗后上、下肢痉挛评分较治疗前有明显改善,与对照组比较有统计学意义。结论中药湿热敷能明显改善脑卒中患者的肢体痉挛状态,减轻卒中后遗症状。     

脑卒中肢体沉重感现状及其与卒中后疲劳、肌力的相关性

目的探讨脑卒中肢体沉重感情况,分析其与卒中后疲劳和肌力的相关性。方法选取2017年9月至2019年9月本院收治的脑卒中患者80例,将其中无肢体沉重感的48例患者设为对照组;有肢体沉重感32例患者设为试验组,采用改良Rankin量表、改良Barthel量表及疲劳严重度量表(FSS)评估患者沉重感现况,肌力、疲劳及功能现状;采用Pearson相关性分析法,分析肢体沉重感与卒中后疲劳和肌力的相关性。结果试验组患侧上肢肌力、患侧下肢肌力、改良Rankin与对照组比较差异无统计学意义(P 0. 05);试验组改良Barthel评分、FSS评分明显高于对照组(P 0. 05);脑卒中肢体沉重感与其卒中后疲劳呈正相关(P 0. 05),且与肌力无明显关系(P 0. 05)。结论肢体沉重在脑卒患者中具有较高的发生率,肌力与肢体沉重无相关性,但肢体沉重与卒中后疲劳呈正相关。     

电针刺头皮运动区及足运感区配合手法治疗治疗脑卒中后上肢痉挛性偏瘫

目的观察电针刺头皮运动区、足运感区配合手法治疗对脑卒中后上肢痉挛性偏瘫的临床疗效。方法将40例脑卒中后上肢痉挛性偏瘫患者,按随机数字表法分为观察组和对照组各20例。观察组行电针刺头皮运动区及足运感区配合手法治疗,对照组仅行手法治疗。2组患者在治疗前后分别应用改良Ashworth量表评定痉挛程度、Fugl-Meyer运动功能评定量表评定上肢运动功能。结果与治疗前比较,治疗6个疗程后2组上肢改良Ashworth痉挛量表评级明显降低,上肢的Fugl-Meyer运动功能评定量表评分明显提高(均P<0.05);与对照组比较,治疗6个疗程后观察组上肢改良Ashworth痉挛量表评级明显降低,上肢的Fugl-Meyer运动功能评定量表评分明显提高(均P<0.05)。结论电针刺头皮运动区及足运感区配合手法治疗可减轻脑卒中后偏瘫上肢痉挛程度,改善上肢运动功能。 更多还原     

A型肉毒毒素在治疗儿童脑外伤后肢体痉挛中的应用

目的：探讨A型肉毒毒素（BTX-A）配合康复训练治疗儿童脑外伤后肢体痉挛性运动障碍的疗效。方法采用前瞻性随机对照研究,选取脑外伤后肢体痉挛性运动障碍的患儿44例。随机分为两组。治疗组：注射A型肉毒毒素+康复训练组22例（其中上肢痉挛12例、下肢痉挛10例）。对照组：单纯康复训练组22例（其中上肢痉挛10例、下肢痉挛组12例）。分别观察治疗前、治疗后4周、8周、12周时用改良Ashworth量表、粗大运动功能评估量表（GMFM）进行评估。结果治疗组与对照组之间同期比较,其改良Ashworth量表、粗大运动功能评估量表评估均优于对照组,差异有统计学意义（P<0.05）。治疗组中上肢痉挛患儿改良Ashworth评估及粗大运动功能评估量表评估优于下肢痉挛患儿,差异有统计学意义（P<0.05）。结论 A型肉毒毒素注射治疗联合康复训练对儿童脑外伤后痉挛性运动障碍的改善有较好作用,且上肢痉挛者获益可能优于下肢痉挛者。     

双侧肢体电刺激对缺血性脑卒中患者早期运动功能的影响

目的 探讨双侧肢体同期电刺激对缺血性脑卒中患者运动功能的影响。方法颈内动脉系统缺血性脑卒中患者60例，抽签随机分为2组，双侧组：在神经系统症状不在进展后48h开始，应用北京爱生NMT-91神经肌肉治疗仪对偏瘫侧肢体和未受损侧肢体进行同期低频脉冲式电流刺激；单侧组对偏瘫侧肢体进行低频脉冲式电流刺激。观察指标：分别在康复开始时及4周后评估神经功能缺损评分量表(clinical nenrve function limition scores，CNS)，改良Fugl-Meyer运动功能评定量表(FMA)，改良巴氏指数(modified barthel index，MBI)。结果 双侧组1例患者实验期间因脑卒中进展，不进行统计学处理。两组患者上述观察指标相比较差异均有统计学意义。结论 双侧肢体电刺激可以显著提高缺血性脑卒中早期康复护理效果。     

居家抗痉挛护理对脑卒中患者肢体功能康复的影响

[摘要] 目的 探讨抗痉挛护理对50例居家脑卒中肢体痉挛患者功能康复的影响。方法 选取2014年10月1日—2015年12月1日在黄浦区某街道社区卫生服务中心就诊的早期脑卒中肢体痉挛患者。成立居家护理干预小组,由专业护士针对患者及其照顾者进行评估后,实施居家肢体抗痉挛护理。居家干预6个月后评估其肢体痉挛情况和自理能力。痉挛评定采用改良Ashworth痉挛量表（modified Ashworth Scale,MAS）。结果 纳入52名研究对象,完成随访49例,上肢痉挛者28例,下肢痉挛者6例,上下肢均发生痉挛的有15例。统计分析发现,Fugl-Meyer运动功能评分由（45.40±16.710）分提高至（56.18±13.411）分,日常生活活动能力评分（Barthel Index,BI）得分由（26.00±19.151）分提高至（43.80±14.054）分,干预前后的比较具有统计学意义（P<0.05）。结论 采用抗痉挛护理有助于脑卒中肢体痉挛患者的功能康复,并可有效提高患者的日常生活自理能力。     

中药蜡疗治疗脑卒中肢体痉挛的疗效观察

[目的]探讨中药蜡疗治疗脑卒中后肢体痉挛的效果。[方法]将70例脑卒中肢体痉挛病人随机分为观察组和对照组各35例。对照组进行常规电针、低频脉冲治疗及康复科护理,观察组在常规治疗及护理基础上实施中药蜡疗。采用改良Ashworth痉挛分级量表(MAS)对两组病人在治疗前和治疗1个疗程后、2个疗程后进行效果评定。[结果]观察组治疗1个疗程后及2个疗程后较对照组MAS评分明显改善(P0.05)。[结论]中药蜡疗外敷治疗脑卒中后肢体痉挛具有很好的解痉作用。     

CORRELATION OF N30 SOMATOSENSORY EVOKED POTENTIALS WITH SPASTICITY AND NEUROLOGICAL FUNCTION AFTER STROKE: A CROSS-SECTIONAL STUDY

ObjectiveTo test whether the presence of N30 somatosensory evoked potentials, generated from the supplementary motor area and premotor cortex, correlate with post-stroke spasticity, motor deficits, or motor recovery stage.DesignA cross-sectional study.PatientsA total of 43 patients with stroke hospitalized at Maoming People’s Hospital, Maoming, China.MethodsForty-three stroke patients underwent neurofunctional tests, including Modified Ashworth Scale (MAS), Brunnstrom stage, manual muscle test and neurophysiological tests, including N30 somatosensory evoked potentials, N20 somatosensory evoked potentials, motor evoked potentials, H-reflex. The results were compared between groups. Correlation and regression analyses were performed as well. Results: Patients with absence of N30 somatosensory evoked potential exhibited stronger flexor carpi radialis muscle spasticity (r = –0.50, p < 0.05) and worse motor function (r = 0.57, p < 0.05) than patients with presence of N30 somatosensory evoked potential. The generalized linear model (GLM) including both N30 somatosensory evoked potentials and motor evoked potentials (Akaike Information Criterion (AIC) = 121.99) better reflected the recovery stage of the affected proximal upper limb than the models including N30 somatosensory evoked potentials (AIC = 125.06) or motor evoked potentials alone (AIC = 127.45).ConclusionN30 somatosensory evoked potential status correlates with the degrees of spasticity and motor function of stroke patients. The results showed that N30 somatosensory evoked potentials hold promise as a biomarker for the development of spasticity and the recovery of proximal limbs.LAY ABSTRACTImpair motor function and spasticity adversely affect the ability to conduct the activities of daily life. Somatosensory evoked potentials and motor evoked potentials are essential to differential evaluation of degree of post-stroke spasticity and stage of motor recovery. This is the first study of the correlations between somatosensory evoked potentials N30, components of somatosensory evoked potentials related to the supplementary motor area and dorsolateral premotor cortex combined with motor evoked potentials and motor function. The results indicate that the N30 somatosensory evoked potential status is correlated with the degrees of spasticity and motor function of stroke patients. The conclusion showed that N30 Somatosensory evoked potentials hold promise as a biomarker for the development of spasticity and the recovery of proximal limbsKey words: stroke, hemiparesis, spasticity, N30 somatosensory evoked potential, motor evoked potential, function recovery

Stroke is the leading cause of disability worldwide (1). Most patients with stroke experience motor deficits, which impair motor function and adversely affect their ability to perform activities of daily living (ADL). Spasticity, one of the motor deficits that appears after stroke, is accompanied by an increased risk of falling and resulting fractures, and is associated with increased morbidity and mortality (2). Both post-stroke recovery and the development of spasticity are associated with neural plasticity of different anatomical regions, such as the reticulospinal tracts, supplementary motor area (SMA) and dorsolateral premotor cortex (PMC) (3–5).Precise biomarkers of motor function are critical for early intervention. The identification of somatosensory evoked potentials (SEPs) is essential for the accurate diagnosis of patients with focal brain disorders, and SEP components reflect the activities of different neural structures (6). N30 SEPs are somatosensory evoked potential components. Anatomically, N30 SEPs are generated from the SMA and PMC (7), from which the corticoreticular tracts radiate (8–10). Pathophysiologically, N30 SEPs present apparent inhibition in individuals with other myotonic disorders (11). Continuous theta burst stimulation of the SMA reduces the amplitude of the N30 (12). Moreover, SMA impairment leads to myodystonia and is closely associated with motor outcomes (13, 14).Thus, it was hypothesized that the presence of N30 SEPs is related to the degree of spasticity and functional status in people with stroke. The aims of the study were to test: (i) whether the presence of N30 SEPs correlates with post-stroke spasticity (PSS), motor deficits and stage of motor recovery; and (ii) whether the combination of N30 SEPs and motor evoked potentials (MEPs) can be used for the differential evaluation of degree of PSS and stage of motor recovery.     

Inter- and intrarater reliability of the Modified Modified Ashworth Scale in patients with knee extensor poststroke spasticity

Muscle spasticity is a common motor disorder following upper motor neuron syndrome. A reliable and valid clinical tool is essential to document the effect of therapeutic interventions aimed to improve function by reducing spasticity. The Modified Ashworth Scale (MAS) is the most widely used and accepted clinical scale of spasticity. The MAS has been recently modified. The aim of this investigation was to determine the interrater and intrarater reliability of clinical test of knee extensor post-stroke spasticity graded on a Modified Modified Ashworth Scale (MMAS). Two raters scored the muscle spasticity of 15 patients with ischaemic stroke. For the inter- and intrarater reliability, two raters agreed on 80.1% and 86.6%, respectively. The Kappa values were good (kappa=0.72, SE=0.14, p<0.001) between raters and very good (kappa=0.82, SE=0.12, p<0.001) within one rater. The values of Kendall tau-b correlation were acceptable for clinical use with 0.87 (SE=0.06, p<0.001) between raters and 0.92 (SE=0.05, p<0.001) within one rater. The MMAS demonstrated reliable measurements for a single rater and between raters for measuring knee extensor post-stroke spasticity. The results encourage further study on the reliability and the validity of the scale.     

Inter- and intrarater reliability of the Modified Modified Ashworth Scale in patients with knee extensor poststroke spasticity

Muscle spasticity is a common motor disorder following upper motor neuron syndrome. A reliable and valid clinical tool is essential to document the effect of therapeutic interventions aimed to improve function by reducing spasticity. The Modified Ashworth Scale (MAS) is the most widely used and accepted clinical scale of spasticity. The MAS has been recently modified. The aim of this investigation was to determine the interrater and intrarater reliability of clinical test of knee extensor post-stroke spasticity graded on a Modified Modified Ashworth Scale (MMAS). Two raters scored the muscle spasticity of 15 patients with ischaemic stroke. For the inter- and intrarater reliability, two raters agreed on 80.1% and 86.6%, respectively. The Kappa values were good (κ=0.72, SE=0.14, p<0.001) between raters and very good (κ=0.82, SE=0.12, p<0.001) within one rater. The values of Kendall tau-b correlation were acceptable for clinical use with 0.87 (SE=0.06, p<0.001) between raters and 0.92 (SE=0.05, p<0.001) within one rater. The MMAS demonstrated reliable measurements for a single rater and between raters for measuring knee extensor post-stroke spasticity. The results encourage further study on the reliability and the validity of the scale.     

高频与低频重复经颅磁刺激对脑卒中后肌痉挛的改善效果比较

目的 探讨高频和低频重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)治疗脑卒中后肌痉挛的临床效果。方法 54例诊断为脑卒中后肌痉挛患者随机分成3组(每组18例):高频组、低频组和对照组。所有患者均常规给予脑卒中后二级预防用药结合康复训练治疗4周,其中高频组给予患侧高频rTMS治疗,低频组给予健侧低频rTMS治疗,对照组不接受rTMS。分别于治疗前后进行评定,通过比较患侧屈腕肌的运动诱发电位(MEP)潜伏期、中枢运动传导时间(CMCT)、上肢Fugl-Meyer运动功能量表(FMA)评分及改良Ashworth痉挛量表(MAS)评分、临床痉挛指数(CSI)、改良Barthel指数(MBI)判定治疗效果。结果 3组治疗前相关指标检测差异无统计学意义(P>0.05)。治疗后,3组上肢FMA评分、MBI评分显著升高,而屈腕MAS、CSI指数、MEP潜伏期和CMCT时间显著降低,差异有统计学意义(P<0.05)。高频组和低频组FMA评分、MBI评分均高于对照组,屈腕MAS、CSI指数、MEP潜伏期和CMCT时间均低于对照组,以高频组更为明显,差异均具有统计学意义(P<0.05) 。结论 患侧高频和健侧低频rTMS均可安全、有效治疗脑卒中后肌痉挛,改善上肢运动功能,且患侧高频rTMS治疗效果优于健侧低频rTMS。     

卒中后偏瘫痉挛状态的评价方法现状

作为脑卒中最常见的并发症之一,偏瘫痉挛状态对患者的基本活动和日常生活造成极大影响,因此评定卒中患者的痉挛状态恢复程度是临床医生的重要任务.但现阶段临床研究中对于选择卒中后偏瘫痉挛状态的评价方法选择存在大量问题.本研究筛选出近十年临床研究中常用的卒中后偏瘫痉挛状态评价方法[痉挛状态及肌张力评价(ASS、MAS、CSI、M...     

Evaluation of the disabilities of hemiplegic patients]

OBJECTIVES: To identify and describe the most useful functional disability scales for assessing post-stroke hemiplegic patients and those used largely in clinical trials. METHODS: A literature review of Medline about the functional parameters for balance, gait and mobility, upper extremity functional abilities, and activities of daily living. The metrologic properties of the scales were specified as were their clinical use. RESULTS: Thirty-three scales were evaluated and classified into five categories: balance (6 scales), gait and mobility (4), upper limb function (11), global motricity scales (5) and independence in activities of daily living (7). DISCUSSION AND CONCLUSION: Many functional scales are useful for assessing post-stroke hemiplegic patients. To assess balance, the Postural Assessment Stroke Scale and Berg Balance Scale are the most interesting. The Functional Ambulation Classification and the Timed Up and Go Test are the most relevant to assess gait and mobility. The Action Research Arm Test is largely used to assess upper limb functional abilities. The Functional Independence Measure and the Barthel Index are largely used to assess independence in activities of daily living.     

针刺四神聪四关穴对脑卒中后抑郁患者P300的影响

目的观察脑卒中后抑郁患者针刺治疗前后P300电位的变化。方法将94例脑卒中患者根据汉密尔顿抑郁量表(HRS-D)评分分为抑郁组(63例)和非抑郁组(31例),抑郁组患者应用双四穴组针刺治疗;于HRS-D测评分组后,以及抑郁组患者针刺治疗1个疗程后,对两组患者进行P300电位测定。结果治疗前,与非抑郁组患者比较,抑郁组患者P300电位中的P3波潜伏期延长,波幅降低;经针刺治疗后,抑郁组患者的P3波潜伏期明显缩短(P<0.01),波幅增高(P<0.05)。结论P300电位测定有助于早期发现脑卒中后抑郁患者的认知障碍,及时进行针刺治疗可减轻或消除患者的抑郁情绪。     

Clinical scales for the assessment of spasticity, associated phenomena, and function: a systematic review of the literature

Purpose: To characterise clinical assessment methods for spasticity and/or its functional consequences in clinical patient populations at risk to suffer from spasticity. Method: Systematic literature search and manual-based two-step review process of psychometric properties of clinical assessment scales for spasticity and associated phenomena, as well as of functional scales with an association with spasticity. Reviewed psychometric properties included internal consistency, interrater, intrarater as well as retest reliability, construct validity, ecological validity, and responsiveness. Results: Until May 2003 electronic database searches established a reference pool of 4151 references of which 90 references contributed to the review objectives. An additional 20 references were identified by an informal reference search. Twenty-four clinical scales that assess spasticity and/or related phenomena as well as 10 scales for 'active function' and three scales for 'passive function' with an association with spasticity could be identified. Some evidence signals that a high interrater reliability of the Ashworth and modified Ashworth scales can be achieved, however not in all circumstances. For many scales, reliability data is, however, missing. This is especially true for test retest reliability. Information about construct validity can promote our understanding of what individual scales are likely to assess. Many scales have been able to document changes after therapeutic intervention. Conclusions: The collated evidence can guide our clinical decision about when to use which scale and can promote evidence-based assessment of spasticity and related clinical phenomena.     

Clinical scales for the assessment of spasticity, associated phenomena, and function: a systematic review of the literature

PURPOSE: To characterise clinical assessment methods for spasticity and/or its functional consequences in clinical patient populations at risk to suffer from spasticity. METHOD: Systematic literature search and manual-based two-step review process of psychometric properties of clinical assessment scales for spasticity and associated phenomena, as well as of functional scales with an association with spasticity. Reviewed psychometric properties included internal consistency, interrater, intrarater as well as retest reliability, construct validity, ecological validity, and responsiveness. RESULTS: Until May 2003 electronic database searches established a reference pool of 4151 references of which 90 references contributed to the review objectives. An additional 20 references were identified by an informal reference search. Twenty-four clinical scales that assess spasticity and/or related phenomena as well as 10 scales for 'active function' and three scales for 'passive function' with an association with spasticity could be identified. Some evidence signals that a high interrater reliability of the Ashworth and modified Ashworth scales can be achieved, however not in all circumstances. For many scales, reliability data is, however, missing. This is especially true for test retest reliability. Information about construct validity can promote our understanding of what individual scales are likely to assess. Many scales have been able to document changes after therapeutic intervention. CONCLUSIONS: The collated evidence can guide our clinical decision about when to use which scale and can promote evidence-based assessment of spasticity and related clinical phenomena.