低频电刺激在改善脑卒中偏瘫患者上肢功能方面的应用

上肢功能障碍是脑卒中偏瘫患者最常见的后遗症之一,低频电刺激疗法是一种重要的治疗方法,其中常用的有神经肌肉电刺激(neuro-muscular electrical stimulation,NMES)、功能性电刺激(functional electrical stimulation,FES)以及经皮神经电刺激(transcuta-neous electricalnerve stimulation,TENS)。本文对NMES、FES和TENS在治疗脑卒中偏瘫上肢功能障碍方面做以综述。     

Effectiveness of Functional Electrical Stimulation - Cycling Treatment in Children with Cerebral Palsy

AimThe purpose of this study was to evaluate the effects of functional electrical stimulation (FES) bicycle therapy system on motor function, gait pattern, spasticity, daily living activities, and aerobic capacity in children with cerebral palsy (CP) and to compare the results with sham stimulation and standard treatment.MethodsPatients with cerebral palsy who received botulinum toxin type-A injections to lower extremities and those with Gross Motor Function Measure Classification System (GMFCS) levels I – III, were included in the study. Twenty-five patients were randomly assigned into three treatment groups for 4-weeks: Group 1, FES-cycling and standard treatment; Group 2, Sham stimulus FES-cycling and standard treatment; Group 3, Standard treatment. Clinical assessment tools included the Modified Ashworth Scale (MAS), Modified Tardieu Scale (MTS), Pediatric Functional Independence Measure (WeeFIM), GMFCS, Gross Motor Function Measure-88 (GMFM-88), selective motor control tests, 6-minute walk test, and Visual Gait Analysis (VGA).ResultsIn all groups, there were significant improvements in MAS, MTS, WeeFIM, GMFM-88, 6-minute walk test, and VGA scores. No changes in GMFCS levels were observed in any group. At the end of the study, there was no significant difference among the groups in terms of any clinical assessment parameter.ConclusionsAll groups showed statistically significant improvements in motor function, walking pattern, spasticity, daily living activities, and aerobic capacity in patients with CP following the rehabilitation period. Although FES-cycling demonstrated no superiority over the other approaches and provided no additional benefit to the results, FES appears to be safe and well-tolerated in children with CP, at least as much as standard exercise treatment.     

培土生金法对缓解慢性阻塞性肺疾病患者稳定期呼吸肌疲劳临床研究

目的：根据慢性阻塞性肺疾病（COPD）患者呼吸肌疲劳的发病机制,探讨培土生金法在缓解COPD患者稳定期呼吸肌疲劳的意义。方法：在中医理论的指导下,根据相关文献资料及临床、科研研究,检索近年来的有关文献资料并进行归纳和分析。结论：培土生金法在缓解COPD患者稳定期呼吸肌疲劳、提高生活质量和改善肺功能方面具有良好的疗效,值得临床推广和应用。     

A Clinical and Experimental Study on the Protective Effects of Jiangzhi Tongmai Fang on Endothelial Injury

31 cases of atherosclerosis (AS) were treated with Jiang Zhi Tong Mai Fang ([symbol: see text], formula of JZTMF), and its effect was compared with 30 cases treated with lovastatin in the control group. Clinically, the JZTMF formula showed an effect of regulating blood lipids, and therefore it was antiatherosclerotic. The mechanism is, probably, restoration of the function of endothelial cells (EC) by increasing the synthesis of 6-keto-PGF1 alpha and decreasing the release of endothelin (ET) as evidenced in the experimental study.     

Rehabilitation medicine: 3. Management of adult spasticity

SPASTICITY REFERS TO AN ABNORMAL, velocity-dependent (i.e., how fast the joint is moved through its range) increase in muscle tone resulting from interruption of the neural circuitry regulating the muscles and is a common complication of cerebral palsy, brain injuries, spinal cord injuries, multiple sclerosis and stroke. The muscle stretch reflex is thought to play an important role in spasticity generation. Spasticity can have a significant detrimental effect on daily functions, such as feeding, dressing, hygiene, bladder and bowel control, and mobility; patients' need for support can also influence the cost of care. Thus, managing these patients appropriately or referring them to those with expertise in this area is important. In this article, I review the pathophysiology of spasticity and the evaluation and management of adult patients with the condition. Two hypothetical cases are presented to illustrate the management of spasticity.     

Usefulness of radial extracorporeal shock wave therapy for the spasticity of the subscapularis in patients with stroke: a pilot study

Background There are not many studies about treatment of shoulder spasticity. Although botulinum toxin injection has been reported to be effective for shoulder spasticity, the effectiveness was judged by pain and limited motion change, but not the spasticity itself. Shoulder spasticity is considered to play an important role in hemiplegic frozen shoulder. However, the subscapularis muscle, unlike the pectoralis major muscle, is located deep beneath scapula, where conventional injection is difficult to perform. As extracorporeal shock wave therapy （ESWT） has been reported to be effective for spasticity relief, and we thought spasticity of subscapularis muscle located deep beneath the scapula would be a good candidate for ESWT treatment. This study was to evaluate the beneficial effects of radial ESWT （rESWT） on spastic subscapularis muscle in stroke patients. Methods This is an uncontrolled, prospective, unicenter, clinical pilot study. Stroke patients （n=57; mean age 55.4 years） with spastic shoulders were recruited between June 2011 and February 2012 at the University Rehabilitation Hospital. rESWT was administered to each patient every two or three days for two weeks （five total treatments）. Evaluation consisted of 11 measurements for each patient; at the start of each of the five treatments and once per week during the following six weeks. Spasticity was measured at external rotator muscles of the shoulder using the modified Ashworth scale （MAS）, and passive range of motion （ROM） of the shoulder in external rotation was recorded. Pain was measured using a visual analogue scale （VAS） during passive ROM of the shoulder in external rotation, and was additionally recorded for patients who preserved cognitive and communicative ability （Pain group）. Results Reduction in MAS and VAS and improvement of ROM during and after rESWT treatments were prominent compared to baseline. The reduction in MAS and VAS and improvement of ROM continued four weeks after the last treatment and the effects of the treatment decreased afterward. Conclusion rESWT will be able to provide stroke patients with an effective and safe procedure for the reduction of spasticity and pain as well as for the improvement of ROM of spastic shoulders.     

Muscle Fatigue Detection in EMG Using Time–Frequency Methods, ICA and Neural Networks

The electromyography (EMG) signals give information about different features of muscle function. Real-time measurements of EMG have been used to observe the dissociation between the electrical and mechanical measures that occurs with fatigue. The purpose of this study was to detect fatigue of biceps brachia muscle using time–frequency methods and independent component analysis (ICA). In order to realize this aim, EMG activity obtained from activated muscle during a phasic voluntary movement was recorded for 14 healthy young persons and EMG signals were observed in time–frequency domain for determination of fatigue. Time–frequency methods are used for the processing of signals that are non-stationary and time varying. The EMG contains transient signals related to muscle activity. The proposed method for the detection of muscle fatigue is automated by using artificial neural networks (ANN). The results show that ANN with ICA separates EMG signals from fresh and fatigued muscles, hence providing a visualization of the onset of fatigue over time. The system is adaptable to different subjects and conditions since the techniques used are not subject or workload regime specific.     

芍药甘草汤治疗中风后肢体痉挛症

目的:观察运用张仲景"芍药甘草汤"治疗中风后的肢体痉挛症,达到抑制和缓解肢体痉挛状态,从而利于肢体康复的治疗。方法:选择中风后肢体痉挛患者45例,均以"芍药甘草汤"为主方加减治疗2周后,评估肌紧张、肌痉挛的治疗效果。结果:显效18例,占40%;有效24例占53.3%;无效3例,占6.7%。总有效率93.3%。结论:经观察证明,应用"芍药甘草汤"治疗中风后肢体痉挛有很好的疗效,对于肢体运动功能的康复治疗有积极的作用。     

表面肌电图对卒中病人患侧下肢肌张力评价的研究

目的:运用表面肌电图定量分析卒中病人患侧下肢肌张力,探讨卒中病人痉挛发生的神经肌肉生理机制。方法:记录17例卒中病人偏瘫侧下肢股直肌的13种表面肌电信号参数值,并比较MMT(徒手肌力检查等级)、AS(Ashworth指数)和它们的相关性。结果:AS和股直肌静息状态下的RMS Mean呈正相关(P=0.008,Pearson指数=0.619)。结论:卒中病人的痉挛发生与外周肌肉状态有一定的关联,可用表面肌电图定量分析卒中病人痉挛的程度。     

自拟解痉止痛方熏洗治疗脑卒中后肢体痉挛伴疼痛的临床观察

目的观察自拟解痉止痛方熏洗治疗脑卒中后肢体痉挛伴疼痛的临床疗效。方法 86例脑卒中后肢体痉挛伴疼痛患者,随机分为治疗组44例和对照组42例。治疗组采用中药熏洗结合运动疗法;对照组常规运动疗法。4周1疗程,分别观察肌痉挛情况、运动功能及日常生活活动(ADL)变化。结果与治疗前比较,2组患肢痉挛评分、Fugl-Meyer运动功能评分和ADL评分均显著改善,且治疗组优于对照组(P<0.05)。治疗组肢体痉挛缓解总有效率(90.91%)优于对照组(80.95%),疼痛缓解总有效率(88.64%)亦优于对照组(73.81%),差异均有统计学意义(P<0.05)。结论解痉止痛方熏洗有助于改善脑卒中后肢体痉挛伴疼痛情况。     

选择性臂丛神经根切断术治疗上肢痉挛性脑瘫的初步报告

目的：研究治疗上肢痉挛性脑瘫新的手术方法。方法：利用臂丛神经根相互代偿的原理设计了选择性壁丛神经根切断术治疗上肢痉挛性脑瘫的方法，并选择２例病例进行治疗。结果：术后２例２手部痉挛明显减轻，功能得到显著改善。结论：选择性臂丛神经根切断术对减轻上肢痉挛性脑瘫疗效显著。     

功能性电刺激改善急性脑卒中患者肢体功能的随机对照研究

目的研究功能性电刺激(FES)对急性脑卒中偏瘫患者下肢运动和步行能力的影响。方法 46例初发脑卒中患者,年龄71岁±8岁,发病后9d±4 d,随机分为 FES 组(13例)、安慰电刺激组(15例),对照组(13例)。3组常规治疗相同,FES 组给予功能性电刺激治疗,每天1次,每次30 min,共3周(15次);安慰组给予没有电流输出的电刺激,对照组不给电刺激。用综合痉挛量表(CSS)评定踝跖屈肌群肌张力,用表面肌电图评定踝背伸和跖屈肌群最大等长收缩(MIVC)时的力矩、积分肌电图和肌肉的协同收缩率,以及患者在住院期间独自行走的能力。结果 3组患者一般资料及治疗前各项评定结果的差异无统计学意义。治疗3周后,FES 组踝跖屈肌群痉挛增加程度最低,CSS 增加率3组分别为30%±35%、50%±88%、65%±65%。踝背伸时胫前肌 MIVC 明显增加(9 Nm±5 Nm、5 Nm±3 Nm、4 Nm±5 Nm),踝背伸时的协同收缩率明显降低(8%±5%、27%±26%、28%±19%)。治疗3周内,FES 组恢复行走能力的时间较其他2组平均早2～3 d(18 d±8 d,20 d±7 d,21d±8 d)。结论 FES 能明显改善初发脑卒中急性期偏瘫患者下肢的运动功能和步行能力。     

脑卒中偏瘫早期床边肢体康复训练

目的:探讨早期床边肢体康复训练对脑卒中病人的影响。方法:120例脑卒中偏瘫病人随机分为康 复组合对照组各60例,两组病人均接受神经内科常规治疗,对康复组病人同时进行康复训练。结果:康复训练后, 康复组病人肢体肌力恢复提高明显(P<0．05)。结论:在脑卒中病人生命体征稳定后,及早、正确地实行早期床边 肢体康复训练对肢体恢复有重要意义。     

功能性电刺激对脑卒中偏瘫患者肩关节半脱位及上肢运动功能的作用

目的探讨功能性电刺激对脑卒中偏瘫患者肩关节半脱位及上肢运动功能恢复的影响。方法48例脑卒中偏瘫患患者随机分为功能性电刺激（FES）治疗组和肩托治疗组，治疗后6周测定患者肩关节半脱位与上肢运动功能，比较两种治疗方法的疗效。结果两组肩关节半脱位与上肢运动功能均较治疗前有改善（P〈0．01），且功能性电刺激组改善更明显，与肩托组比较差异有显著意义（P〈0．01）。结论功能性电刺激应用于治疗偏瘫患者的患侧上肢，可改善患侧肩关节半脱位和上肢的运动功能。     

恢刺肌起止点对脑卒中后患者肌肉痉挛及肢体功能的改善作用分析

目的 分析恢刺肌起止点对脑卒中后患者肌肉痉挛及肢体功能的改善作用.方法 选取2019年3月—2019年12月黑龙江中医药大学附属二院针灸科就诊的90例脑卒中后痉挛期患者,均给予解语丹、补阳还五汤、左归丸合地黄进行中药治疗,采用随机数字分组法分为两组,每组45例,常规用药基础上采用恢刺手法的患者为研究组,常规基础上进行针...     

培土生金综合治疗对慢性阻塞性肺病稳定期患者呼吸肌疲劳的影响

目的:观察培土生金法综合治疗慢性阻塞性肺病(COPD)稳定期患者呼吸肌疲劳的治疗作用,并初步探索其作用机制。方法:治疗组在常规治疗基础上予健脾益肺冲剂口服,综合疗法在常规治疗基础上予健脾益肺冲剂口服,同时隔姜灸双足三里与参麦液穴位注射双足三里交替进行,疗程2个月。结果:综合治疗组有效率为93.3%,治疗组为86.7%,均明显高于对照组56.7%;综合治疗组、治疗组患者血二氧化碳分压明显降低(P<0.05),综合治疗后患者血氧分压升高(P<0.01)。对照组治疗后除FVC外,肺功能各项指标及呼吸肌肌力指标MIP明显下降(P<0.01);综合治疗组治疗后FEV1.0%及MIP变化不显著(P>0.05);FVC、MVV有明显改善(P<0.01);综合治疗组治疗后FVC、MVV和MIP与对照组比较,差异有显著性(P<0.01)。结论:中医培土生金理论为指导,采用健脾益肺冲剂口服为主治疗COPD稳定期患者能明显缓解呼吸肌疲劳,延缓肺功能的进行性下降。     

脑卒中后肌痉挛的针刺治疗及肌电图评价

脑卒中后肌痉挛是上运动神经元损伤导致高级中枢失去对脊髓牵张反射的抑制,脊髓反射性增高引起牵张反射增强为特征的肌肉张力异常。脑卒中急性期肌张力低,针灸治疗时多遵循＂治痿独取阳明＂的理论选穴治疗,恢复期后出现患侧肌张力增高,表现为阴阳失调的特点,治疗应调和阴阳并适当结合电针以缓解痉挛。肌电图在评估神经肌肉功能状态时,可用于实时评价患者受损神经肌肉功能的状况,并可观察治疗前后的进步情况。针刺治疗脑卒中后肌痉挛可更好的恢复患者肢体功能,肌电图可客观评价痉挛程度及治疗效果。     

Intramuscular injection of botulinum toxin for the treatment of wrist and finger spasticity after stroke

Botulinum toxin is effective in reducing spasticity post stroke. As there are limited data on post stroke spasticity in Asia, we undertake this study to determine the effectiveness and safety of intramuscular injection of botulinum toxin type-A (BTX-A), in the treatment of chronic focal post-stroke hand spasticity, and the impact of BTX-A on the activities of daily living and quality of life, in comparison to placebo, in Malaysian stroke patients. This was a randomized, double-blind, placebo-controlled study to assess the efficacy and safety of BTX-A in 27 subjects with wrist and finger spasticity after a stroke. The outcome measures were assessed with the Modified Ashworth Scale (MAS) to assess spasticity of the flexor muscles, Barthel Index (BI) for activities of daily living and EQ-5D and EQ VAS for quality of life. Assessments were performed at baseline and 1 and 3 months after injection. Compared to placebo, the BTX-A group had greater improvement in the flexor tone of the wrist and fingers (p = 0.001 and p < 0.001, respectively), at first month follow-up visit and sustained the improvement through to three months. Although there was an improvement in the measures of global function and quality of life in the BTX-A group, there was no significant improvement in between the two groups. No serious BTX-A related adverse effects were reported. The results of this study demonstrate that intramuscular injection of botulinum toxin A is safe and effective in the treatment of chronic focal post-stroke spasticity of the hand.     

Expression and location of intracellular tissue factor in atherosclerosis stable plaque of ApoE<Superscript>−/−</Superscript> mice

In the ApoE^-/- mouse model of atherosclerosis （AS） stable plaque, the expression and location of intracellular tissue factor （TF） in the cellular components of AS stable plaque were investigated in order to explore the cellular mechanism of AS thrombosis. Pathological changes of the stable plaque were observed under a microscope. The expression of TF protein was examined in aortic stable plaque of mice by using immunohistochemistry. Color image planimetric system was used to analyze the histological components of the stable plaque and the TF distribution. Under the confocal microscope, the intracellular TF location in the stable plaque of mice was observed. The results showed the cellular area was the major part of stable plaque （67.36%±6.52%, P〈0.01）. The percentage of total area occupied by cellular area was significantly larger than atheromatous gruel and acellular area （P〈0.01）. Macrophages and smooth muscle cells （SMC） were major cells in the cellular area. The percentage of total area occupied by SMC was significantly larger than by macrophages （P〈0.01）. Multiple linear regression analysis showed there was a positive correlation between TF area and SMC area （r=0.616, P=-0.008）, and no correlation was found between TF area and macrophage area （r=0.437, P=0.08）. Pictures of color image planimetric analysis of TF and SMC were merged to highlight areas with co-localization （yellow）, it was concluded that the process could be a cell-mediated TF expression in the stable plaque. SMC may be the major source of TF in AS without plaque rupture.     

巴氯酚直肠给药配合综合康复对脑卒中恢复期偏瘫痉挛状态的干预效应

目的探讨改善脑卒中恢复期偏瘫痉挛状态更为有效的方法。方法100例研究对象在实施神经内科常规治疗以及病情和生命体征稳定的情况下,采用巴氯酚直肠给药（即保留灌肠）＋综合康复措施治疗肌痉挛状态。用药第1天剂量为15mg,次,然后每天增加5～10mg,灌肠14d为1个疗程,连续治疗3个疗程。综合康复措施具体内容包括良肢位的摆放、保持关节的活动度、缓解身体运动控制点周围痉挛、肌肉痉挛的静态牵拉、被动运动与按摩。治疗前和治疗后32d进行疗效评定。结果治疗后32d与治疗前比较,患者的肌张力改善情况有差异（P〈0．01）,提示治疗后的肌张力明显改善,逐渐恢复正常;ADL评分结果比较差异显著（P〈0．01）,提示治疗后32d患者日常活动能力明显提高。结论对脑卒中患者偏瘫痉挛采用巴氯芬直肠给药配合综合康复训练有利于脑卒中患者的神经康复,改善预后。