针刺结合运动想象疗法对脑卒中后偏侧忽略患者疗效观察

目的:探讨针刺结合运动想象疗法在脑卒中后偏侧忽略患者治疗中的疗效。方法:对本院脑卒中后偏瘫患者进行神经心理学评测,40例纳入患者随机分为3组,对照组(常规康复疗法)13例,观察组(在常规康复基础上予运动想象疗法)13例,实验组(常规康复治疗同时予针刺结合运动想象疗法)14例。3组治疗前后分别予偏侧忽略行为学量表评定(CBS)、Fugl-Meyer运动功能评定(FMA)、改良Barthel指数(MBI)评定。结果:1观察组和实验组治疗后CBS较治疗前下降(P0.01),FMA、MBI评分明显高于治疗前(P0.001),对照组治疗前后无明显差异(P0.05)。2 3组治疗前后CBS、FMA、MBI评分差值的平均效应不全相同,经过两两比较,实验组CBS、FMA、MBI评分差值均高于观察组和对照组,观察组3项评分差值均高于对照组(P0.01)。结论:针刺结合运动想象疗法治疗脑卒中后偏侧忽略患者,能够改善忽略,提高患者的运动功能和日常生活活动能力。     

脑卒中患者出院时功能结局的预测研究

目的根据患者人院时的各项资料预测脑卒中患者出院时的功能结局以及它与Fugl-Meyer平衡(FMB)得分、Berg平衡量表(Berg Balance Scale，BBS)得分的相关性。方法收集的资料包括患者的病史、体格检查、入院时FMB评分、BBS评分、日常生活活动能力(ADL)及功能独立性评定(Functional Indepen-dence Measure，FIM)得分，出院时评定FIM作为功能结局，资料采用简单线性相关分析、逐步回归分析。结果简单线性相关分析提示BBS、FMB得分与人院、出院FIM得分有较强的相关性，逐步回归分析发现人院时FIM、ADL、BBS评分可以预测脑卒中患者出院时的功能结局。结论人院时功能状态如FIM、ADL、BBS评分可以预测脑卒中患者出院时的功能结局，并且出院时的功能结局与患者人院时的BBS有较强的相关性。     

脑卒中康复运动功能评定量表的有效性研究

目的探讨脑卒中康复运动功能评定量表(STREAM)对脑卒中偏瘫患者进行运动功能评定有效性和可行性.方法应用STREAM对41例脑卒中偏瘫患者进行评定,并与FIM中的运动类评分及Barthel指数评定法进行相关分析比较.结果入院时STREAM评分与FIM运动分、FIM总分、BI得分显著相关(r=0.830、0.759、0.809,P＜0.001),出院时STREAM评分与FIM运动分、FIM总分、BI得分显著相关(r=0.830、0.807、0.806,P＜0.001).结论STREAM是有效的,并且方法简单、易操作,能敏感地反映偏瘫患者患肢运动功能的变化,很适合作为物理治疗部门常规的临床评定,值得在国内推广应用.     

视动刺激治疗视空间偏侧忽略的临床研究

摘要 目的：探讨视动刺激对视空间偏侧忽略患者的治疗效果及长期疗效。 方法：将16例首次脑卒中后出现左侧视空间偏侧忽略的患者随机分为2组,治疗组（n=8）和对照组（n=8）,治疗组应用视动刺激技术（optokinetic stimulation,OKS）及传统视空间偏侧忽略的针对性训练。对照组患者仅进行传统视空间偏侧忽略的针对性训练,治疗周期均为2周。分别在基线期、治疗前、治疗后及随访末4个阶段对两组患者进行偏侧忽略纸笔测试及行为学评定。 结果：OKS组患者治疗后纸笔测试和CBS评定明显优于治疗前(P<0.01),且效果比对照组明显(P<0.01),治疗后2周的随访,发现治疗组效果改善持续保持(P>0.05)。 结论：视动刺激可显著改善卒中后忽略患者的忽略症状及日常行为能力。     

功能独立性评定在脑卒中病人日常生活活动能力评估中的应用

[目的]探讨功能独立性评定对脑卒中病人日常生活活动能力评价的有效性和可行性.[方法]采用功能独立性评定量表(FIM)对200例住院脑卒中病人日常生活活动能力进行评定,并与改良Barthel指数(MBI)评定进行相关分析.[结果] 病人FIM总评分与MBI总评分具有显著的相关性(r＝0.935,P＜0.01);病人FIM运动功能评分与MBI总评分具有显著的相关性(r＝0.947,P＜0.01);FIM与MBI日常生活活动能力评定具有显著的相关性(r＝0.809,P＜0.01).[结论] FIM量表更能全面反映脑卒中病人的日常生活活动能力情况.     

镜像治疗对脑卒中偏侧忽略症改善的疗效观察

目的:探讨镜像治疗对于脑卒中偏侧忽略患者功能的影响。方法:脑卒中偏侧忽略患者24例,随机分为对照组12例和镜像组12例,2组患者均接受常规的针对偏侧忽略的康复训练,镜像组在此基础上增加镜像治疗。治疗前和治疗3周后采用中国行为性忽略测试-香港版(CBIT-HK)量表进行评估,并分别比较常规测试评分、行为测试评分及总评分。结果:治疗3周后,2组患者CBIT-HK常规测试评分、行为测试评分及总评分均较治疗前有显著提高(均P0.01),且观察组3项评分均更高于对照组(均P0.01)。结论:镜像治疗结合常规康复训练短期可以明显改善脑卒中偏侧忽略症状。     

线分法与行为偏侧忽略的相关性研究

目的 研究线分法与行为偏侧忽略的相关性，探讨线分法能否预测行为偏侧忽略。方法 根据行为偏侧忽略的评估量表——凯瑟林一波哥量表将30例脑卒中致左侧偏瘫的患者分为4组：严重偏侧忽略组，中度偏侧忽略组，轻度偏侧忽略组和无偏侧忽略组。11例年龄匹配的健康成人作为对照组。进行线分法检查时，在A4纸的左侧、中央和右侧分别画6条水平线段，让患者用右手持圆珠笔在线的中央划一垂直分隔线。计算分隔线右侧长度占该线段全长的百分比。结果 除轻度偏侧忽略组外，被分割线段空间的位置对其它各组人员的线分结果有明显影响。严重偏侧忽略组、无偏侧忽略组、对照组出现线分法中的位置“反转效应（crossovereffect）”。严重偏侧忽略组的患者在分隔A4纸左侧及中央的线段时出现向右的偏差，而在分隔A4纸右侧的线段时出现向左的偏差。在无偏侧忽略组及对照组，被检人员在分隔A4纸左侧线段时出现向左的偏差，而在分隔中央及右侧线段时出现向右的偏差。结论 本研究表明线分法中的位置“反转效应”若出现在位于患者右侧的线段，则强烈提示患者有重度行为偏侧忽略。     

脑卒中后单侧空间忽略对偏瘫康复疗效的影响

目的:探讨脑卒中后单侧空间忽略的发生及其对偏瘫康复疗效的影响。方法:对住入本院的脑卒中偏瘫患者采用神经心理学方法进行评测,确定18例单侧空间忽略患者为观察组,将27例无忽略的右侧大脑半球病变致脑卒中偏瘫患者列为对照组,两组均予常规康复治疗,并在治疗前后进行简式Fugl-Meyer运动功能评定(FMA)、功能独立性评定(FIM)、简易精神状态检查(MMSE)。结果:观察组的MMSE评分在治疗后虽有提高(P<0.05),但其FMA、FIM评分无明显提高(P>0.05),治疗前后FMA、FIM、MMSE均明显低于对照组(P<0.05或P<0.01)。结论:单侧空间忽略的存在直接影响了脑卒中偏瘫康复疗效,常规康复治疗无助于提高日常生活活动能力。     

功能综合评定量表的信度与效度的初步研究

目的应用功能综合评定量表(FCA)和功能独立性测定量表(FIM)对脑卒中患者的功能测定结果进行比较研究,以测定FCA的信度和效度. 方法随机对20例脑卒中后遗症期患者进行FCA和FIM评定,主要内容包括运动功能和认知功能二大项,对10例脑卒中患者进行FCA的组内相关系数的研究. 结果FCA和FIM的比较研究得出t=0.0451,P>0.05,显示FCA与FIM评定结果无显著差别,相关系数r=0.997,P<0.001,呈极显著相关,表明FCA量表的效度较好,FCA的组内相关系数各单项平均为0.929(P<0.001),显示有很好的可重复性. 结论 FCA与FIM相比,同样有较好的效度,FCA也有较好的信度,可供临床医师选择.     

视觉扫描阅读训练对脑卒中偏侧忽略患者认知功能及日常生活活动能力的影响

目的观察视觉扫描阅读训练对脑卒中偏侧忽略患者认知功能及日常生活活动能力的影响。方法 2012年1月~2014年6月在本科住院的脑卒中偏侧忽略患者24例,随机分为对照组(n=12)和观察组(n=12)。对照组接受常规康复训练,观察组另外接受视觉扫描阅读训练,共3周。采用简易精神状态检查(MMSE)、蒙特利尔认知评估量表(Mo CA)、改良Barthel指数(MBI)和中国行为性忽略测试-香港版(CBIT-HK)进行评价。结果两组各评分均在治疗后显著提高(t5.375,P0.001);除MMSE(P0.05)外,治疗组各评分均高于对照组(t2.120,P0.05)。结论视觉扫描阅读训练不仅能提高脑卒中患者的偏侧忽略症状,还能改善患者的认知功能和日常生活活动能力。     

Reliability and validity of a wheelchair collision test for screening behavioral assessment of unilateral neglect after stroke

OBJECTIVE: To examine the reliability and validity of a new wheelchair collision test (WCT) for screening behavioral unilateral neglect in people with stroke. DESIGN: A total of 19 patients with left hemiplegia resulting from first-ever stroke (mean +/- SD, 61.9 +/- 25.8 days after onset) were examined with the WCT, whereby the patient was asked to propel a wheelchair to pass four round chairs arranged in two rows. Separate tests were done using two different distances between the chairs: 120 and 140 cm. The number of collisions with the chairs was recorded. The Catherine Bergego Scale was used to evaluate behavioral unilateral neglect. Because unilateral neglect has an unfavorable impact on rehabilitation, the FIMtrade mark instrument was used to determine the function of daily activities. RESULTS: Test-retest reliability ranged from 0.68 to 0.97 in different situations in the WCT. The rate of agreement tested by Kappa statistics between the WCT and Catherine Bergego Scale was higher when the distance between chairs was 120 cm than when the distance was 140 cm (0.68 vs. 0.58). Spearman's rank-correlation coefficient between the WCT and Catherine Bergego Scale was 0.72 (P < 0.001) if the distance between the chairs was 120 cm and 0.75 (P < 0.001) if the distance was 140 cm. The WCT and Catherine Bergego Scale correlated well with the FIM instrument. Spearman's rank-correlation coefficient between the Catherine Bergego Scale and FIM total score was -0.70 (P < 0.001). CONCLUSION: The WCT is a simple screening test with high test-retest reliability and validity to evaluate behavioral unilateral neglect.     

An interface to enhance mobility for people with hemispatial neglect

The objective was to develop and test a control interface to enable people with hemispatial neglect to maneuver a powered wheelchair with increased attention to their environment. A single case study was conducted using a female (aged 72 years) who had a right cerebro vascular accident five years earlier. She drove a powered wheelchair through 20 different test courses (mazes) while a computer recorded frequency of looking to the left (left checks) and an observer recorded visual targets missed and wheelchair collisions with walls and obstacles. The Mann-Whitney test was used to determine significant differences in left checks, left collisions, right collisions, and percent left checks targets missed between baseline and strategy phases. With the interface strategy, the subject significantly increased the number of left checks and missed fewer left targets in the test course. These results indicate that a powered-wheelchair control interface shows promise in enabling people with mild hemispatial neglect to maneuver a powered chair with greater environmental awareness and ease.     

Use of fresnel prism glasses to treat stroke patients with hemispatial neglect

OBJECTIVE: To explore the functional effects of prism adaptation training on patients with hemispatial neglect after stroke. DESIGN: Observational study. SETTING: Inpatient rehabilitation unit in rural Australia. PARTICIPANTS: Four subjects with hemispatial neglect, recruited from consecutive admissions of patients less than 60 days poststroke. INTERVENTION: Prism adaptation treatment, consisting of five 10-minute training sessions over 12 to 17 days. MAIN OUTCOME MEASURES: The FIM instrument, Catherine Bergego Scale (CBS), subjective straight ahead pointing, Albert's line cancellation, letter cancellation, and line bisection. Ambulatory patients also performed the Timed Up & Go test. RESULTS: Immediate effects of prism adaptation training included improvements in both subjective straight ahead pointing and in the Albert's line cancellation task. Letter cancellation, line bisection, FIM, and CBS scores improved in all subjects. Improvements in a functional task were also observed immediately following prism adaptation treatment. Obstacle avoidance while walking improved after prism adaptation training in 2 ambulatory subjects. CONCLUSIONS: Prism adaptation training shows promise as a new treatment to supplement current strategies for the clinical management of hemispatial neglect after stroke. This study is limited by small sample size and absence of a control group. Further research will be needed to demonstrate efficacy for this inexpensive and relatively safe device.     

Recovery of functional status after right hemisphere stroke: relationship with unilateral neglect

OBJECTIVE: To evaluate relationships between unilateral spatial neglect and both overall and cognitive-communicative functional outcomes in patients with right hemisphere stroke. DESIGN: Assessment of overall and cognitive-communicative function was conducted on admission to acute rehabilitation, at discharge, and at 3-month follow-up. SETTING: Urban, acute inpatient rehabilitation facility. PATIENTS: Fifty-two consecutive admissions of adult right-handed patients with a single, right hemispheric stroke, confirmed by computed tomography scan. MAIN OUTCOME MEASURES: The FIM instrument and reading comprehension and written expression items of the Rehabilitation Institute of Chicago Functional Assessment Scale(R). RESULTS: Patients made significant functional gains between admission and discharge, and between discharge and follow-up on the FIM. Severity of neglect was correlated with total, motor, and cognitive FIM scores at admission, discharge, and follow-up. Subjects with neglect had significantly more days from onset to admission and a longer length of rehabilitation stay than subjects without neglect. FIM outcomes were significantly different for subject groups with more severe neglect. Both the presence of neglect and its severity were significantly related to functional outcomes for reading and writing. CONCLUSIONS: Patients with neglect show reduced overall and cognitive-communicative functional performance and outcome than patients without neglect. Further studies are needed to explore causal relationships between these factors.     

脑卒中患者偏侧忽略线分法试验中线段位置对结果的影响

目的研究线分法试验中线段位置对不同程度偏侧忽略脑卒中患者线分结果的影响，探讨线段位置对线分结果影响的机制。方法根据凯瑟林一波哥量表（CatherineBergegoScale，CBS）检出26例首发脑卒中致左侧偏侧忽略的患者，分为轻度忽略组（15例）和重度忽略组（11例），20例年龄匹配的健康成人作为对照组。进行线分法检查时，让患者中分在Ag纸的左侧、中央和右侧的长度为10cm的水平线段。然后在另外一张同样的Ag纸上，先让患者标出他所看到的线段两端，然后再在标出的线段中央划一条垂直分隔线。计算分隔线右侧长度占所分隔线段长度的百分比。结果轻度忽略组与对照组在上述线分试验中所有结果的差异均无统计学意义。在标出线段两端前，重度忽略组患者分隔左侧及中央线段时分隔线较实际中点出现明显右移。重度忽略患者标记后的3条线段长度均明显短于对照组和轻度忽略组，缩短的原因是标记左侧端点时标记点明显右移。结论线段位置主要对重度偏侧忽略患者的线分结果有影响，其主要机制是重度偏侧忽略患者所看到的线段均较实际线段短，忽略了所有位置线段的左侧端，这种忽略程度白左向右逐渐减轻。     

Predicting those who will walk after rehabilitation in a specialist stroke unit

OBJECTIVE: To establish whether the ability to use a wheelchair shortly after a stroke or continence are related to the likelihood of walking by time of discharge. DESIGN AND SUBJECTS: An observational study in patients admitted to a stroke rehabilitation unit for under-65s over a three-year period. METHODS: Functional Independence Measure (FIM) subscores for walking were examined on all patients at time of admission and discharge. Walking was defined by an FIM > or = 5 in that section. Comparisons were then made between those who could self-propel a wheelchair within a week of admission with those who could not. Continence (defined by an FIM subscore of > or = 6 in that category) was also correlated to walking at discharge. MAIN OUTCOME MEASURE: Walking at time of discharge defined by an FIM > or = 5 in that section. RESULTS: From 393 admissions, 135 were excluded because they could already walk (FIM subscore > or = 5 in that particular section) and three died during their admission. Out of the remaining 255 patients, 108 could self-propel on admission and 147 could not. While 105 (97%) of the self-propellors could walk by time of discharge, only 91 (62%) of the non-propellors could do so (chi2 = 42.237, df = 1, P < 0.001, odds ratio (OR) 21.54 (6.52-71.51)). Although continence also predicted improved likelihood of walking, this was at a lower level of significance and correspondingly lower odds ratio (chi2=5.894, df = 1, P= 0.015, OR 1.94 (1.13-3.32)). CONCLUSIONS: The ability to self-propel a wheelchair shortly after a stroke is a significant predictor of eventually being able to walk. Our data suggest that it is even more significant than continence, which is the most consistent predictor previously found.     

强制性使用运动疗法结合电刺激对脑卒中单侧忽略的作用

目的:观察强制性使用运动疗法结合反馈式功能性电刺激对脑卒中单侧空间忽略患者的临床疗效。方法:脑卒中并伴有单侧空间忽略障碍的患者60例,随机分为2组各30例,对照组给予常规的康复治疗和强制性使用运动疗法训练,观察组在此基础上增加反馈式功能性电刺激治疗,治疗前后均进行二等分线段、删除试验和临摹图形评定,凯瑟琳-波哥量表(CBS)评价法、上下肢Fugl-Meyer评价法(FMA),评估患者的单侧空间忽略程度和运动功能。结果:治疗6周后,2组二等分线段、删除试验和临摹图形试验、CBS、FMA评定均有明显好转(P0.05),且观察组各项评定指标均优于对照组(P0.05)。结论:强制性使用运动疗法结合反馈式功能性电刺激治疗可有效改善脑卒中单侧空间忽略患者单侧忽略的程度,提高肢体运动功能,让患者能够更好地参与到日常生活中。     

Sit-and-reach test can predict mobility of patients recovering from acute stroke

OBJECTIVES: To establish the test-retest reliability of the sit-and-reach test (SRT) and to determine the capacity of the SRT to predict mobility of patients recovering from acute stroke. DESIGN: Study 1 consisted of repeating the SRT to examine its reliability over trials (same day) and sessions (alternate days). Study 2 consisted of measuring performance in the SRT 7 to 10 days poststroke and measuring mobility at discharge for prospective analysis. SETTING: Medical and rehabilitation wards in hospital in Hong Kong. PARTICIPANTS: Thirty-six subjects with acute stroke (study 1, n=10; study 2, n=26). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Between 7 and 10 days of stroke onset, distance reached on the SRT was measured. Mobility at discharge was assessed using the transfer and locomotion scale of the FIM instrument (FIM mobility) and a timed walk test. RESULTS: The intertrial and intersession reliability of the SRT were rated good, with intraclass correlation coefficients of .98 and .79, respectively. Distance reached on the SRT correlated with the FIM mobility score on discharge (r=.572, P=.002) and the distance achieved on the timed walk test (r=.524, P=.006). Distance reached on the SRT accounted for 32.7% and 27.5% of the variance in the FIM mobility score at discharge and the distance achieved on the timed walk test, respectively. CONCLUSIONS: Performance in the SRT is reliable and can significantly predict the mobility of patients with acute stroke at discharge.