社区康复对脑卒中后典型偏瘫步态的疗效观察

目的观察社区康复中步行训练对脑卒中后典型偏瘫步态的疗效。方法符合入选标准的50例脑卒中患者分为两组:治疗组25例,在社区医院接受系统的步行训练,每周5次,连续干预3个月;对照组25例,在家中自行步行训练,每周随访1次。分别在入组时和治疗1个月、3个月后进行"起立-行走"计时测试、Fugl-Meyer下肢运动功能评测及生活满意度评分(SWLS)。结果两组在治疗1个月后,"起立-行走"计时测试、Fugl-Meyer下肢运动功能评测、生活满意度评分无显著差异。治疗3个月后治疗组较治疗前有明显好转,并优于对照组(P<0.05)。结论在社区中开展步行训练能改善脑卒中后典型偏瘫步态,提高患者的步行质量。     

低负荷运动训练对帕金森病患者步态及平衡功能的效果

目的探讨低负荷运动训练对帕金森病患者步态及平衡功能的影响。方法 2015年5~8月,12例住院帕金森病患者在用药不变,未接受其他物理康复训练情况下,接受2周共14次低负荷帕维尔康复训练器运动训练。训练前后进行三维步态分析,采用Berg平衡量表进行评估。结果患者训练后步长、跨步长、步速均较训练前改善(P0.05),受累严重侧的改善率优于次严重侧;步频、跨步周期、步行时间、单支撑相、双支撑相、脚离地百分比、脚触地百分比等训练前后对比无显著性差异(P0.05)。训练后Berg平衡量表评分改善(P0.05)。结论低负荷运动训练能改善帕金森病患者的步态及平衡功能。     

Valpar训练对帕金森病患者认知功能及平衡功能的疗效分析

摘要 目的：观察Valpar职业评估训练系统（VCWS）对帕金森病患者认知功能及平衡功能的临床疗效。 方法：选择40例帕金森病存在轻度认知功能障碍（MCI）的患者,随机分为观察组和对照组,各20例,对照组进行常规康复治疗,观察组在此基础上给予Valpar训练。分别于治疗前和治疗8周后采用洛文斯顿认知功能测验（LOTCA）评估患者的认知功能,Berg平衡量表（BBS）评估患者的平衡能力,计时起立—行走测试（TUGT）评估患者的步行能力,帕金森病生活质量量表（PDQ—39）评估患者的生活质量。 结果：两组患者治疗后的LOTCA评分（总分和各项评分）、BBS评分、起立—行走时间以及PDQ—39评分较治疗前均有改善（P<0.05）,观察组改善程度优于对照组,差异具有显著性意义（P<0.05）。 结论：应用Valpar职业评估训练系统可以改善帕金森患病者的认知功能,从而进一步提高平衡、步行功能及生活质量。     

帕金森病患者采用Synapsys静动态平衡仪进行平衡和步态训练的效果观察

目的对帕金森病患者运用Synapsys静动态平衡仪进行康复训练,并采用三维步态分析系统进行效果评价。方法选取帕金森病患者共90例,按入院顺序随机分为对照组、训练1组和训练2组各30例。对照组采用药物治疗联合常规护理模式;训练1组在对照组的基础上,实行暗示训练联合运动训练的护理方法;训练2组在对照组和训练1组方法的基础上,采用Synapsys静动态平衡仪进行平衡训练、步态训练。干预2周末,采用帕金森病综合评分量表第3部分评价3组患者功能状态,采用Synapsys静动态平衡仪及Berg平衡量表评价患者平衡能力,采用三维步态分析系统评价3组患者的步态。结果(1)干预前,3组帕金森病量表评分、Synapsys静动态平衡仪平衡评分、Berg平衡量表评分和三维步态分析系统检测时间-距离参数比较,差异无统计学意义(P0.05);(2)干预后,帕金森病量表评分两两比较,差异有统计学意义(P0.05);对照组与训练2组在静态异常、动态异常2个指标分别比较,差异有统计学意义(P0.05);(3)干预后,3组间Berg平衡量表评分两两比较,差异有统计学意义(P0.05);(4)干预后,站立相百分比、摆动百分比、步频3个指标在3组比较以及两两比较,差异均有统计学意义(P0.05);步长、跨步长和步速3个指标在3组间差异有统计学意义(P0.05),经两两比较,对照组和训练1组步长、跨步长和步速差异不显著,其余指标经两两比较,差异均具有统计学意义(P0.05)。结论利用Synapsys静动态平衡仪进行平衡训练,结合护理干预模式对提高帕金森病患者的平衡能力和运动功能有积极的作用。     

简易步态训练预防老年帕金森病病人跌倒的临床研究

[目的]探讨简易步态训练对老年帕金森病病人平衡的影响及其预防跌倒的临床效果。[方法]选取60例60岁以上原发性帕金森病病人,对病人采用5m步行训练法,用步速和步长、计时"起立-行走"测试(TUGT)评估病人的步行能力及动态平衡能力,用重心摇摆面积评估静态平衡能力。[结果]训练后步速加快,步长增长,TUGT时间缩短,重心摇摆面积缩小,差异均有统计学意义(P<0.05)。[结论]简易步态训练能改善老年帕金森病病人的平衡能力,可有效地预防跌倒。     

Lokomat全自动机器人步态训练与评定系统对不完全性脊髓损伤患者步行功能的影响

背景：机器人设备能够在精确控制的环境下为患者提供安全可重复性的高强度较长时间的步态训练,其在康复领域的应用有其明显的优势。目的：探讨Lokomat-全自动机器人步态训练与评定系统在改善不完全性脊髓损伤患者步行功能方面的作用。方法：2名男性不完全性脊髓损伤患者参加Lokomat步态训练5.5个月,于训练前、训练后6,12周及训练5.5个月后对患者进行下肢运动功能评分（Lower Extremity Motor Scores,LEMS）、10m最快步速、6min步行耐力及Berg平衡量表测试。结果与结论：两名患者经过Lokomat自动步态训练,虽然LEMS分数无明显提高,但其10m最快步速、6min步行耐力、Berg平衡量表评分均较训练前改善。这说明机器人自动步态训练能够有助于改善不完全性脊髓损伤患者的步行能力。     

节律性听觉刺激及视觉刺激对帕金森病患者步态的影响

目的:探讨节律性听觉刺激及视觉刺激对帕金森病患者步态的影响。方法:帕金森病患者90例,随机分为观察组和对照组各45例,2组均给予常规药物治疗,观察组加用在节律性听觉及视觉刺激下步行训练。训练前后进行步行参数测试,帕金森病综合评分量表(UPDRS)第2、3部分,Berg平衡量表(BBS),6min步行测试(6minwT)评价患者的步行、运动功能。结果:治疗4周后,观察组步频、步长、步速、6min wT及BBS评分均较治疗前及对照组治疗后明显提高(P<0.05),UPDRS评分第2及第3部分均较治疗前及对照组治疗后明显下降(P<0.05);对照组治疗前后各项评分比较均差异无统计学意义。结论:节律性听觉刺激及视觉刺激可改善帕金森病患者的步态运动功能。     

Lokomat下肢康复机器人对改善帕金森病患者步行能力的疗效研究

目的:观察Lokomat下肢康复机器人对改善帕金森疾病患者步行能力的临床疗效。方法:将40例帕金森疾病患者随机分成对照组和观察组各20例。2组均接受常规康复训练,观察组在此基础上进行Lokomat下肢康复机器人步行训练,步行持续时间30min/次,1次/d,5次/周。在治疗前后分别采用Berg平衡量表(BBS)评定平衡功能、计时起立-行走测试(TUGT)评定功能性步行能力及预测跌倒风险、6min步行测试(6MWT)评价步行耐力。结果:治疗10周后,观察组BBS、6MWT较治疗前及对照组明显提高(P0.05),TUGT较治疗前及对照组明显降低(P0.05);对照组BBS评分较治疗前提高(P0.05),6MWT及TUGT评分治疗前后比较差异无统计学意义。结论:Lokomat下肢康复机器人辅助步行训练可提高帕金森疾病患者平衡能力和提高步行能力,是治疗帕金森病患者步行障碍的有效方法。     

脑卒中偏瘫患者3 种步行训练方法的效果比较

目的评价目前常用的脑卒中患者步行功能训练方法对患者步行功能恢复的影响。方法60 例脑卒中患者分别运用常规步行训练法(常规组,n=20)、使用辅助工具(四脚拐)训练法(辅具组,n=20)、减重步行训练法(减重组,n=20)对患者进行步行功能训练。在训练前、训练后1 个月、训练后3 个月,分别采用10 m最大步行速度(MWS)、“起立-行走”计时测定(TUGT)、功能独立性测量(FIM)、Fugl-Meyer 下肢运动功能评定(FMA-L)进行评价。结果训练1 个月和3 个月后,3 组的MWS、TUGT、FIM、FMA-L评分均改善,依次为辅具组、常规组和减重组。总体上减重组效果最佳。结论减重步行训练法能更快更好地提高脑卒中偏瘫患者的步行能力。     

视觉反馈平衡训练对髋部骨折术后患者平衡和行走功能的影响

目的:观察视觉反馈平衡功能训练对髋部骨折术后患者平衡和行走功能的影响。方法:髋部骨折术后患者120例,随机分为观察组和对照组各60例,均配合常规康复训练,观察组于术后2～12周时利用MTD平衡仪进行视觉反馈法静、动态平衡功能训练。训练1周和12周时2组分别采用MTD平衡测定训练仪进行站立平衡功能评定,采用Tinetti步态及平衡试验和"起立-走"计时试验评定步态和静动态平衡、行走能力。结果:治疗1周时2组各项评定指标比较差异无统计学意义。治疗12周时2组MTD平衡测定,其平均压力峰值差和百分比差均较1周时明显缩小;Tinetti步态及平衡试验评分明显提高;"起立-走"计时试验所需时间明显减少(均P0.05),且观察组较对照组表现更显著(P0.05)。结论:在常规康复训练的基础上加MTD平衡仪进行视觉反馈平衡功能训练对改善髋部骨折术后患者的平衡和行走功能有明显促进作用。     

The Effectiveness of Utilizing a Combination of External Visual and Auditory Cues as a Gait Training Strategy in a Pharmaceutically Untreated Patient with Parkinson's Disease: A Case Report

ABSTRACT

One major functional problem that many individuals with Parkinson's disease (PD) face is gait difficulties, including a shuffling gait and freezing episodes. Proposed treatment options in physical therapy (PT) include teaching PD patients to utilize external cues in order to allow for a more efficient gait. The purpose of this case study was to compare the effectiveness of visual cue alone and combined visual and auditory cues on various gait parameters in a patient with PD, who was not receiving pharmaceutical treatment. The patient was a 71-year-old male who presented with a diagnosis, signs and symptoms of PD. The patient was seen in PT for 5×/week for 7 weeks. The main focus on the intervention was improved gait through gait strategies such as visual and auditory cues. Outcomes showed increased gait velocity, distance ambulated, and decreased frequency of freezing with visual and auditory cues compared to visual cues alone.     

Finger tapping as a proxy for gait: Similar effects on movement variability during external and self-generated cueing in people with Parkinson's disease and healthy older adults

BackgroundRhythmic auditory cueing has been widely studied for gait rehabilitation in Parkinson's disease (PD). Our research group previously showed that externally generated cues (i.e., music) increased gait variability measures from uncued gait, whereas self-generated cues (i.e., mental singing) did not. These different effects may be due to differences in underlying neural mechanisms that could be discerned via neuroimaging; however, movement types that can be studied with neuroimaging are limited.ObjectiveThe primary aim of the present study was to investigate the effects of different cue types on gait, finger tapping, and foot tapping, to determine whether tapping can be used as a surrogate for gait in future neuroimaging studies. The secondary aim of this study was to investigate whether rhythm skills or auditory imagery abilities are associated with responses to these different cue types.MethodsIn this cross-sectional study, controls (n = 24) and individuals with PD (n = 33) performed gait, finger tapping, and foot tapping at their preferred pace (UNCUED) and to externally generated (MUSIC) and self-generated (MENTAL) cues. Spatiotemporal parameters of gait and temporal parameters of finger tapping and foot tapping were collected. The Beat Alignment Task (BAT) and Bucknell Auditory Imagery Scale (BAIS) were also administered.ResultsThe MUSIC cues elicited higher movement variability than did MENTAL cues across all movements. The MUSIC cues also elicited higher movement variability than the UNCUED condition for gait and finger tapping.ConclusionsThis study shows that different cue types affect gait and finger tapping similarly. Finger tapping may be an adequate proxy for gait in studying the underlying neural mechanisms of these cue types.     

Non-verbal cues to osteoarthritic knee and/or hip pain in elders

Behavioral cues are believed to be useful to identify pain among elders who may be experiencing pain but unable to express it. To examine this assumption, we recruited 192 elders who could verbally express pain to determine whether regression models combining behavioral cues (motor and gait patterns) predicted verbal pain reports. In the best model, age (p < .01) and subscales that measured guarding (p < .001) and joint flexion (p < .01) motor patterns were significant predictors of verbal pain reports. The receiver operating characteristic curve indicated that the best cutoff for predictive probability was 40–44%, with a fair to good C statistic of .78 (SD = .04). With a 40% cutoff, sensitivity and specificity were 71.6% and 71.0%, respectively. The investigators concluded that the final model could serve as a building block for the development of a tool using behavioral cues to identify elders' pain. © 2011 Wiley Periodicals, Inc. Res Nurs Health 34:218–227, 2011     

高频重复经颅磁刺激联合吸烟相关线索诱发对香烟成瘾的影响

目的:探讨作用于左侧背外侧前额叶皮质区(DLPFC)的高频重复经颅磁刺激(H-F rTMS)联合吸烟相关线索诱发对香烟成瘾患者香烟渴求度(VAS评分)、呼出气CO浓度(CO ppm)和睡眠质量(PSQI评分)的影响。 方法:60例香烟成瘾患者随机分为A组(相关线索诱发rTMS组)、B组(非相关线索...     

The heightened role of external responsiveness in the alcohol consumption of restrained drinkers

Restrained drinking, a style of drinking control that is characterized by a psychological conflict between impulses to drink and effortful resistance to these impulses, may be an early diagnostic clue that intervention efforts are needed to prevent the development or worsening of alcohol problems. This study examined an important aspect of the drinking behavior of individuals with a restrained drinking style — that is, the role of differential responsiveness to external beverage preference cues. Fifty-nine social drinkers, classified on the basis of a pretest as restrained or unrestrained drinkers, were given access to brands of beer that had been identified through pretesting as preferred and nonpreferred for that individual. In the guise of a tasterating task, the level of consumption of each beverage was unobtrusively measured. Restrained drinkers showed heightened differential responsiveness to the external beverage preference cues, drinking significantly more of their preferred beers and similar amounts of their nonpreferred beers compared with unrestrained drinkers. This pattern of heightened preferential drinking was also individually associated with three separate measures of drinking experience: present habitual drinking level, lifetime amount of alcohol consumption, and variety of beer-testing experiences. However, differences in drinking experience did not seem to be responsible for the obtained relationship between drinking restraint and heightened differential responsiveness. Prevention efforts with those social drinkers who may be at increased risk for alcohol problems should consider the important role of heightened responsiveness to situational factors such as the availability of a preferred alcoholic beverage as stimuli for increased levels of consumption.This research was supported by National Institute on Alcohol Abuse and Alcoholism Research Grant No. AA-06319. We would like to thank Claude Steele for his valuable comments on various aspects of the study, and Kirsten Christ, Bill Jochim, Brent Henneman, and Karen Livingston for their help in the data-collection phase. Parts of this study were presented at the annual meeting of the American Psychological Association, Atlanta, Georgia, August 1988.     

Kinect4FOG: monitoring and improving mobility in people with Parkinson’s using a novel system incorporating the Microsoft Kinect v2

Abstract

Parkinson’s is a neurodegenerative condition associated with several motor symptoms including tremors and slowness of movement. Freezing of gait (FOG); the sensation of one’s feet being “glued” to the floor, is one of the most debilitating symptoms associated with advanced Parkinson’s. FOG not only contributes to falls and related injuries, but also compromises quality of life as people often avoid engaging in functional daily activities both inside and outside the home. In the current study, we describe a novel system designed to detect FOG and falling in people with Parkinson’s (PwP) as well as monitoring and improving their mobility using laser-based visual cues cast by an automated laser system. The system utilizes a RGB-D sensor based on Microsoft Kinect v2 and a laser casting system consisting of two servo motors and an Arduino microcontroller. This system was evaluated by 15 PwP with FOG. Here, we present details of the system along with a summary of feedback provided by PwP. Despite limitations regarding its outdoor use, feedback was very positive in terms of domestic usability and convenience, where 12/15 PwP showed interest in installing and using the system at their homes.

• Implications for Rehabilitation

• Providing an automatic and remotely manageable monitoring system for PwP gait analysis and fall detection.

• Providing an automatic, unobtrusive and dynamic visual cue system for PwP based on laser line projection.

• Gathering feedback from PwP about the practical usage of the implemented system through focus group events.

     

A controlled study of changes in conversation following aphasia therapy for anomia

This paper investigates the relationship between change in picture naming with anomia therapy and changes in word retrieval in conversations between adults with aphasia and a regular conversational partner. We present data from two therapy projects (Hickin et al. [] and Best et al. []). In each study, therapy involved cueing with the aim of improving retrieval of a set of nouns. Naming of the experimental items was assessed twice prior to therapy and again immediately afterwards. There was a significant change in word finding, as measured by picture naming, for the group and for 11 of the 13 participants. At the same time points, we collected conversations between the person with aphasia and a regular conversational partner. We analysed these using Profile of Word Errors and Retrieval in Speech (Herbert et al. []) and investigated a set of conversational variables predicted to change with therapy. Unsurprisingly, the conversation data is not straightforward. There is no significant change on the conversation measures for the group but some changes for individuals. We predicted change in word retrieval after therapy would relate to change in everyday conversations and tested this by correlating the change (post-therapy minus mean pre-therapy) in picture naming with the change in conversation variables. There was a significant positive relationship between the change in picture naming and change in some conversation measures including the number of nouns produced in 5?min of conversation (r?=?0.50, p?<?0.05, one-tailed) and the number of nouns produced per substantive turn (r?=?0.55, p?<?0.05, one-tailed). The findings suggest changes in word finding following therapy for aphasia can be reflected in changes in conversation. The clinical implications of the complex results are explored.     

Online Module Builds Skills for Internal Medicine Interns in Responding to Emotions During Complex Serious Illness Conversations

ContextResponding to emotion cues is an essential skill for communicating with patients and families, but many health care trainees have difficulty applying this skill within the context of a complex conversation.ObjectivesWe created an original online module to facilitate deliberate practice of a three-skill framework for responding to emotion cues during complex or nonlinear serious illness conversations.MethodsOur original online module uses a gamebook format, which prompts trainees to engage in focused and repetitive practice of three well-defined skills for responding to emotion cues in a simulated family conference. We implemented the module as a part of a communication skills curriculum for interns rotating in the intensive care unit. After completing the module, all interns answered an open-ended survey question about their perceived skill acquisition. Results were analyzed by a qualitative method and coded into themes.ResultsAbout 71% of interns (n = 65 of 92) completed the online module and open-ended survey question. About 89% of participants responded that they would use a naming, understanding, respecting, supporting, or exploring statement in response to an emotion cue. Nearly two-thirds of participants articulated their rationale for using naming, understanding, respecting, supporting, or exploring statements (e.g., preparing patients to process complex medical information, eliciting information about patient perspective.)ConclusionOur online emotion cue module is a novel tool for deliberate practice of advanced skills for responding to emotion cues in serious illness conversations. In future studies, we will investigate whether our module's efficacy is enhanced by using it as a part of a flipped classroom curriculum with an in-person simulation session.