虚拟现实跑台训练对缺血性卒中患者肢体运动功能的影响研究

目的 探讨虚拟现实跑台训练对缺血性卒中患者肢体运动功能的影响.方法 2021年1-6月前瞻性连续选择符合入排标准的缺血性卒中患者,采用随机数字表法将患者随机分成试验组和对照组.对照组进行常规康复训练,试验组在常规康复训练基础上联合虚拟现实跑台训练.康复治疗前和治疗4周后由同一名评估者采用NIHSS、Fugl-Meyer...     

肢体功能训练对脑卒中患者生活质量的影响

为改善患者肢体功能,提高其生活质量,我科选择51例脑卒中患者进行了肢体功能康复训练,取得满意效果,现报告如下.     

高压氧结合康复训练对缺血性脑卒中患者偏瘫肢体运动能力的影响

脑卒中患者通常会存在一定的功能障碍,其中最常见症状为肢体偏瘫,严重影响患者的生活质量[1]。对于脑卒中患者来说,提高或恢复其偏瘫肢体运动能力是康复期的主要目标[2]。为加强患者神经功能及提高偏瘫肢体运动能力,本次研究选取在我院接受治疗的缺血性脑卒中患者140例,探讨高压氧结合康复训练对缺血性脑卒中患者偏瘫肢体运动能力的影响。1资料与方法1.1一般资料选取2009-03—2014-03在我院接受治疗的     

高频重复经颅磁刺激结合肢体功能训练对缺血性脑卒中患者神经电生理的影响

目的 探讨高频重复经颅磁刺激结合肢体功能训练对缺血性脑卒中患者神经电生理及平衡功能的影响。方法 纳入2021-05—2022-05沧州市人民医院诊治的106例缺血性脑卒中患者,对照组患者采取常规西药治疗和肢体功能训练,观察组患者在对照组的基础上采取高频重复经颅磁刺激结合肢体功能训练,2组各53例,对比治疗前后2组患者的NIHSS评分、Barthel指数、平衡功能（摆幅指数、轨迹长度、外周面积）、神经电生理相关指标[运动诱发电位（MEP）和中枢运动传导时间（CMCT）]。结果 治疗后观察组NIHSS评分[（9.25±0.75）分对（11.69±1.12）分]、摆幅指数（4.21±0.45对5.99±0.79）、轨迹长度[（58.62±8.52）cm对（69.77±11.52）cm]、外周面积[（10.05±1.32）mm2对（15.45±2.11）mm2]、CMCT[(7.25±1.12)ms对（8.78±1.69）ms]、MEP[(21.02±1.63)ms对（22.66±2.83）ms]低于对照组,而Barthel指数[（68.11±8.69）分对（60.02±7.02）分]高于对照...     

虚拟现实技术联合核心稳定训练对脑卒中恢复期疗效的影响

目的 探讨虚拟现实(Virtual reality,VR)技术联合核心稳定训练对脑卒中恢复期患者下肢功能、平衡能力、步行能力、日常生活能力的影响。方法 选取2017年12月-2019年12月四川大学华西医院康复医学中心治疗的脑卒中患者216例,采用随机数字表法分为观察组、对照组各108例; 对照组给予VR技术训练(1次/d,7次/周),观察组给予VR技术(1次/d,7次/周)+核心稳定训练(1次/d,5Symbol～A@7次/周)。分别于干预前及干预6周后采用简化的Fugl-Meyer量表下肢部分(The lower section of Fugl-Meyer assessment,FMA-LE)评估下肢运动功能,Berg平衡量表(Berg balance scale,BBS)评估平衡能力,采用GaitWatch三维步态分析仪测定步行能力,采用改良的Barthel指数量表(Modified barthel index,MBI)评估日常生活活动能力。结果 观察组干预前FMA-LE评分、BBS评分、MBI评分与对照组比较均无明显差异(P>0.05); 观察组和对照组干预6周后FMA-LE评分、BBS评分、MBI评分均高于干预前(P<0.05),且观察组高于对照组(P<0.05); 观察组干预前步频、步速、步幅与对照组比较均无明显差异(P>0.05),观察组和对照组干预6周后步频、步速、步幅均较干预前改善(P<0.05),且观察组变化较对照组显著(P<0.05)。结论 VR技术联合核心稳定训练可增强脑卒中恢复期患者下肢运动功能、平衡能力,改善步行能力和日常生活活动能力。     

肢体协调辅助装置结合VR训练对急性脑梗死颅内血管介入治疗患者步态平衡和表面肌电图的影响

目的 研究肢体协调辅助装置结合虚拟现实技术（virtual reality,VR）对急性脑梗死颅内血管介入治疗患者步态平衡和表面肌电图的影响。方法 前瞻性连续纳入2019年6月—2021年6月于邢台医学高等专科学校第二附属医院神经内科收治的颅内血管介入术后的急性脑梗死患者,按照随机数字表法分为对照组和观察组。对照组患者采用肢体协调辅助装置训练联合常规训练,观察组患者则采用肢体协调辅助装置训练联合VR训练。训练2个月后,采用躯干障碍量表（trunk impairment scale,TIS）、Fugl-Meyer平衡测试评分（Fugl-Meyer balance assessment score,FMA-B）、Holden功能性步行分级（functional ambulation classification,FAC）、改良Barthel量表（modified Barthel index,MBI）评估患者的躯干功能、平衡功能、步行能力和日常生活能力,记录患者的三维步态参数和表面肌电图（surface electromyography,sEMG）情况。结果 共纳入152例急性脑梗死患者,平...     

早期康复治疗对脑卒中患者肢体运动功能的影响

2006—08-200908笔者通过对临床52例脑卒中患者早期康复治疗的疗效进行观察,效果显著,现报告如下。     

脑卒中患者早期肢体功能训练的护理干预

脑卒中特点是发病急而恢复慢，且易留不同程度的肢体功能障碍，给家庭和社会增加了极大的负担。因此，早期进行肢体功能训练，对减轻病人的致残率，改善自我形象，增加日常生活活动(ADL)能力，提高生活质量具有重要意义。     

平衡仪训练对脑卒中患者运动功能的影响

目的 观察Pro-Kin平衡仪训练对脑卒中患者运动功能的影响。方法 将符合纳入标准的脑卒中患者48例随机分为观察组和对照组各24例,2组均给予综合康复训练,观察组另外给予Pro-Kin平衡仪训练,对照组另外给予常规平衡训练; 治疗前、治疗6周后采用Fugl-Meyer运动功能量表(FMA)、日常生活活动能力量表(BI指数)评定疗效。结果(1)治疗6周后2组患者的FMA、BI评分均较治疗前有所改善(P<0.05),但治疗组的各项指标较对照组改善更明显(P<0.05);(2)FMA下肢(FML)功能改善优于上肢(FMU)(P<0.05),ADL主要改善在步行、转移、上下楼梯(P<0.05)。结论 平衡训练能够改善脑卒中患者的运动功能,Pro-Kin平衡训练效果更佳。     

个性化护理方式对缺血性脑卒中患者认知功能和生活自理能力的影响

目的：探讨个性化护理方式对缺血性脑卒中（IS ）患者认知功能和生活自理能力的影响。方法将80例IS患者按随机数字表法分为常规护理模式组和个性化护理组,每组各40例。常规护理组予以常规对症护理,而个性化护理组患者则采取全方位的个性化护理方式,分别比较2种护理方式对IS患者认知功能和生活自理能力的影响。结果个性化护理组IS并发症的发生率5.0％（2/40）显著低于常规护理组（27.5％,11/40）,平均住院时间和费用亦低于常规护理组（ P＜0.05）。与入院时相比,出院时2组HDS和ADL评分均显著增高（P＜0.05）,且出院时个性化护理组 HDS和ADL评分显著高于常规护理组,差异有统计学意义（P＜0.05）。而出院时2组NIHSS评分则均显著低于入院时（P＜0.05）,个性化护理组NIHSS评分也显著低于常规护理组（ P＜0.05）。结论个性化护理方式能够改善IS患者的认知功能,提高生活自理能力,降低并发症和疾病负担,值得在临床推广应用。     

Mechanism of Kinect-based virtual reality training for motor functional recovery of upper limbs after subacute stroke

The Kinect-based virtual reality system for the Xbox 360 enables users to control and interact with the game console without the need to touch a game controller, and provides rehabilitation training for stroke patients with lower limb dysfunctions. However, the underlying mechanism remains un- clear. In this study, 18 healthy subjects and five patients after subacute stroke were included. The five patients were scanned using functional MRI prior to training, 3 weeks after training and at a 12-week follow-up, and then compared with healthy subjects. The FugI-Meyer Assessment and Wolf Motor Function Test scores of the hemiplegic upper limbs of stroke patients were significantly increased 3 weeks after training and at the 12-week follow-up. Functional MRI results showed that contralateral primary sensorimotor cortex was activated after Kinect-based virtual reality training in the stroke patients compared with the healthy subjects. Contralateral primary sensorimotor cortex, the bilateral supplementary motor area and the ipsilateral cerebellum were also activated during hand-clenching in all 18 healthy subjects. Our findings indicate that Kinect-based virtual reality training could promote the recovery of upper limb motor function in subacute stroke patients, and brain reorganization by Kinect-based virtual reality training may be linked to the contralateral sen- sorimotor cortex.     

早期介入运动想象疗法对急性脑卒中偏瘫患者下肢运动功能及日常生活活动能力的影响

目的探讨早期介入运动想象疗法对急性脑卒中偏瘫患者下肢运动功能和日常生活活动能力的影响。方法将67例急性脑卒中偏瘫患者随机分为运动疗法组(34例)、对照组(33例)。对照组采用常规西药和基础康复治疗,运动疗法组在此基础上采用运动想象疗法进行早期干预。分别于入组时,治疗后2、4、8周以及90 d,采用简化的Fugl-Meyer运动量表(FMA)和改良Barthel指数量表(MBI)评定患者的下肢运动功能和日常生活活动能力。结果两组治疗前下肢FMA及MBI评分差异无统计学意义(P0.05)。至第8周,两组患者下肢FMA及MBI评分呈增高趋势,各时间点差异有统计学意义(均P0.05),两组患者第90 d与第8周差异无统计学意义(均P0.05)。运动疗法组第2、4、8周及第90 d的下肢FMA及MBI评分均高于对照组(均P0.05)。结论在常规康复治疗基础上,早期介入运动想象训练可显著促进急性脑卒中偏瘫患者下肢运动功能和日常生活活动能力的恢复。     

Effect of intensive motor training with repetitive transcranial magnetic stimulation on upper limb motor function in chronic post-stroke patients with severe upper limb motor impairment

Background Intensive motor training with low-frequency repetitive transcranial magnetic stimulation (rTMS) has efficacy as a therapeutic method for motor dysfunction of the affected upper limb in patients with mild to moderate stroke. However, it is not clear whether this combination therapy has the same effect in chronic post-stroke patients with severe upper limb motor impairment.

Objectives The aim of this study was to test the treatment effects of intensive motor training with low-frequency rTMS in chronic post-stroke patients with severe upper limb motor impairment.

Methods A convenience sample of 26 chronic post-stroke patients with severe upper limb motor impairment participated in this study with the non-randomized, non-controlled clinical trial. All subjects were hospitalized to receive intensive motor training with low-frequency rTMS. During 2 weeks in which Sundays were excluded, a total of 24 sessions (2 sessions per day) of the intervention were conducted. The Fugl–Meyer Assessment (FMA) and Wolf Motor Function Test (WMFT) were used to assess motor impairment and function of the affected upper limb, respectively, before and after intervention. Paired t-test was used to analyze the effects of the intervention.

Results The FMA total score and WMFT log performance time significantly improved from before to after intervention (FMA: 12.6–18.0; WMFT: 3.6–3.3, p < 0.001).

Conclusions The present results suggest that intensive motor training with low-frequency rTMS could improve motor impairment in chronic post-stroke patients with severe upper limb motor impairment and contribute to the expansion of the application range of this combination therapy.     

Motor network reorganization after motor imagery training in stroke patients with moderate to severe upper limb impairment

Background

Motor imagery training (MIT) has been widely used to improve hemiplegic upper limb function in stroke rehabilitation. The effectiveness of MIT is associated with the functional neuroplasticity of the motor network. Currently, brain activation and connectivity changes related to the motor recovery process after MIT are not well understood. Aim: We aimed to investigate the neural mechanisms of MIT in stroke rehabilitation through a longitudinal intervention study design with task-based functional magnetic resonance imaging (fMRI) analysis.

Methods

We recruited 39 stroke patients with moderate to severe upper limb motor impairment and randomly assigned them to either the MIT or control groups. Patients in the MIT group received 4 weeks of MIT therapy plus conventional rehabilitation, while the control group only received conventional rehabilitation. The assessment of Fugl-Meyer Upper Limb Scale (FM-UL) and Barthel Index (BI), and fMRI scanning using a passive hand movement task were conducted on all patients before and after treatment. The changes in brain activation and functional connectivity (FC) were analyzed. Pearson's correlation analysis was conducted to evaluate the association between neural functional changes and motor improvement.

Results

The MIT group achieved higher improvements in FM-UL and BI relative to the control group after the treatment. Passive movement of the affected hand evoked an abnormal bilateral activation pattern in both groups before intervention. A significant Group × Time interaction was found in the contralesional S1 and ipsilesional M1, showing a decrease of activation after intervention specifically in the MIT group, which was negatively correlated with the FM-UL improvement. FC analysis of the ipsilesional M1 displayed the motor network reorganization within the ipsilesional hemisphere, which correlated with the motor score changes.

Conclusions

MIT could help decrease the compensatory activation at both hemispheres and reshape the FC within the ipsilesional hemisphere along with functional recovery in stroke patients.     

氟西汀对急性缺血性脑卒中患者运动功能的影响

目的 探讨氟西汀改善急性缺血性脑卒中患者肢体运动功能的作用.方法 急性缺血性脑卒中患者60例,随机分成氟西汀组和对照组,对照组予常规药物治疗和康复治疗,氟西汀组加用氟西汀20 mg qd po,分别在给药前、给药后30 d、给药后90 d进行FMMS评分,评价2组运动功能情况.结果 发现在给药后90 d,氟西汀组FMMS评分明显高于对照组,2组比较差异有统计学意义（P＜0.05）.结论 对于以运动功能障碍为主要表现的急性缺血性脑卒中患者,早期给予小剂量氟西汀口服（20 mg/d）并配合物理疗法,对患者的运动功能恢复有一定帮助.     

针刺结合康复训练治疗老年脑卒中后上肢功能障碍的疗效

目的观察针刺结合康复训练治疗老年脑卒中后上肢功能障碍的疗效。方法选择我院2015-09-2016-11收治的脑卒中合并上肢功能障碍患者112例,根据随机数字表法将所有患者分为2组,每组56例。对照组给予常规康复训练,观察组在此基础上联合针刺治疗,比较2组临床疗效、日常生活能力评分、疼痛评分、上肢运动功能评分及神经功能评分。结果治疗后2组临床疗效相比,观察组优于对照组,差异具有统计学意义(P0.05);2组治疗前ADL、FMA、VAS、NDS评分相比,差异无统计学意义(P0.05);治疗后ADL、FMA、VAS、NDS评分均优于治疗前,组间相比,观察组优于对照组,差异具有统计学意义(P0.05)。结论针刺结合康复训练可改善老年脑卒中后上肢功能障碍,减少神经功能损伤和疼痛,提高日常生活能力。     

Effects of active and passive training apparatus combined with rehabilitation training on lower limb function of stroke patients during recovery period

BACKGROUND: Stroke patients always spontaneously do some learning and training of motor functions; however, learning and training are not prompt and right, while patients do not have enough activity amounts. Active and passive motor training apparatus is aimed directly at lower limb training so as to stimulate nerve function through stimulating muscular movement. Based on motor mileage, motor time, various power supplies and velocity of active and passive training apparatus, we can understand the training condition and adjust training program. OBJECTIVE: To observe the effects of grade-Ⅲ rehabilitation training combining with active and passive training apparatus on lower limb function, muscle strength and activity of daily living (ADL) in stroke patients during recovery period. DESIGN: Contrast observation. SETTING: Department of Rehabilitation, Jilin Academic Institute of Traditional Chinese Medicine. PARTICIPANTS: A total of 80 patients with stroke-induced hemiplegia after stabilizing vital signs for 2 weeks were selected from Department of Rehabilitation, Jilin Academic Institute of Traditional Chinese Medicine from January to June 2007. There were 47 males and 33 females, and their ages ranged from 41 to 75 years. All patients met the diagnostic criteria of the Fourth National Cerebrovascular Disease Academic Meeting in 1995 and were diagnosed as cerebral hemorrhage or cerebral infarction through CT or MRI examinations in clinic. Patients and their parents provided the confirmed consent. Based on therapeutic orders of hospitalization, patients were randomly divided into treatment group and control group with 40 patients in each group. METHODS: Patients in the control group received physical therapy and occupational therapy combining with rehabilitative treatment based on grade-Ⅲ rehabilitative treatment program, which was set by the National Cerebrovascular Disease Topic Group. In addition, patients in the treatment group were trained with active and passive motor training apparatus based on therapeutic procedures in the control group. The active and passive motor training apparatus was designed as the therapeutic style of nervous system; otherwise, the treatment was performed once a day, 30 minutes once and 6 times per week. Four weeks were regarded as a course. MAIN OUTCOME MEASURES: Before treatment, at 2 weeks after treatment and after the first course, bare-handed muscle strength examination was used to check muscle strength and muscular tension; in addition, simple Fugl-Meyer assessment (FMA) and diagnostic criteria which were set by the Fourth National Cerebrovascular Disease Academic Meeting were used to evaluate motor function of limbs and total ADL. RESULTS: All 80 stroke patients were involved in the final analysis. ① Muscle strength of lower limbs was improved in both treatment group and control group. After the first course, muscle strength in the treatment group was obviously superior to that in the control group (χ2=6.64, P < 0.05). ② After the first course, Fugl-Meyer scores in the treatment group were higher than those in the control group, and there was significant difference (t =2.82, P < 0.05). ③ Muscular tension of lower limbs was not changed in both treatment group and control group after treatment (P > 0.05). ④ After the first course, ADL in the treatment group was superior to that in the control group (P < 0.05). Among patients in the treatment group, 24 cases (60%) had obvious progress, 16 (40%) had progress, and 0 (0%) did not have any changes. On the other hand, among patients in the control group, 13 cases (32.5%) had obvious progress, 26 (65%) had progress, and 1 (2.5%) did not have any changes. CONCLUSION: Rehabilitation training combining with active and passive motor training apparatus can promote the recovery of lower limb disorder, increase muscle strength, control spasm, improve ADL and cause satisfactorily clinical effects in stroke patients during recovery period.     

脑血流动力学与缺血性脑卒中患者脑白质病变严重程度的相关性研究

目的 研究缺血性脑卒中患者脑血流动力学与脑白质病变严重程度之间相关性。方法 分析2015年7月至2019年8月收治的108例缺血性脑卒中患者资料,采用Fazekas量表对患者脑白质病变严重程度进行分级。比较不同脑白质病变严重程度、患者颅内大动脉硬化程度和脑血流动力学指标,进行患者脑血流动力学与脑白质病变严重程度之间相关性分析,并分析脑白质中重度病变的危险因素。结果 Fazekas量表<3分者61例纳入轻度病变组,≥ 3分者47例纳入中重度病变组。中重度病变患者颅内大动脉硬化严重程度高于轻度病变组（P<0.05）。中重度病变组脑部动脉搏动指数（PI）显著高于轻度病变组;收缩期峰值血流（Vs）、平均血流（Vm）以及舒张末期血流（Vd）等脑血流动力学指数显著低于轻度病变组（P<0.05）。颅内大动脉硬化程度、PI与脑白质病变严重程度正相关（r=0.416,0.527;P<0.05）,Vs、Vm以及Vd等脑血流参数与脑白质病变严重程度负相关（r=-0.316,-0.524,-0.668;P<0.05）。颅内大动脉硬化程度与PI为脑白质中重度病变的危险因素（P<0.05）。结论 缺血性脑卒中患者脑白质病变严重程度与患者脑血流动力学指标异常有关,而颅内动脉硬化会加重患者脑白质病变严重程度。     

巴曲酶联合疏血通治疗进展型脑梗死的效果及对神经功能的影响

目的观察巴曲酶联合疏血通对进展型脑梗死患者神经功能及治疗效果的影响。方法 70例进展型脑梗死患者随机分成观察组与对照组各35例,2组患者均采取常规对症治疗,观察组给予巴曲酶联合疏血通静滴治疗,对照组给予疏血通静滴治疗。观察2组患者血流动力学指标、纤维蛋白原含量、神经功能缺损(NIHSS)评分、治疗效果及药物不良反应。结果观察组全血黏度(7.34±2.14)mPa·s、血小板聚集指数(21.32±4.45)、凝血酶原时间(8.74±3.12)s、纤维蛋白原含量(2.02±0.70)g/L、NIHSS缺损评分(11.73±8.08)均明显低于对照组;治疗有效率(94.29%)明显高于对照组;2组不良反应比较差异无统计学意义(P0.05)。结论巴曲酶联合疏血通有助于改善血流动力学指标,降低纤维蛋白原,促进神经功能恢复,提高治疗效果。     

Bilateral and unilateral movement training on upper limb function in chronic stroke patients: A TMS study

The use of activity-dependent interventions has shown some success in promoting recovery of upper limb function in chronic stroke patients. This study compared the neurophysiological and behavioural changes associated with two such rehabilitation protocols: unilateral and bilateral movement training. Twelve chronic stroke patients were randomly assigned to the two training protocols involving six daily practice sessions. Each session consisted of 50 trials of a dowel placement task performed either with both impaired and unimpaired arm moving synchronously (bilateral training group) or with only the impaired arm moving (unilateral training). Kinematic measurements of upper limb movements were made in four unilateral test trials performed prior to and following each practice session. Functional assessments of the impaired upper limb and neurophysiological assessments, using transcranial magnetic stimulation (TMS), of the affected and non-affected cortical hemispheres were made prior to and following the intervention sessions. Individuals receiving bilateral training showed a reduction in movement time of the impaired limb and increased upper limb functional ability compared to individuals receiving unilateral training. In some patients changes to upper limb function were associated with changes to the cortical representation of a target muscle in the non-affected hemisphere. Overall, these findings suggest that a short-term bilateral training intervention may be effective in facilitating upper limb motor function in chronic stroke patients.