老年人平衡功能训练方法的研究进展

从肌肉力量训练、本体感觉训练、全身振动平衡训练、认知功能训练方面综述了老年人平衡功能训练方法;提出针对国内老年平衡领域研究和实践仍存在的不足,提高训练项目的趣味性,寻找便于在家庭和社区开展的、简便易行、适宜有效的综合性平衡训练方法,加强训练老年人平衡能力的实证研究。     

核心力量联合平衡训练对老年人动态平衡的影响

目的:探讨核心力量训练联合平衡训练对老年人动态平衡能力的影响。方法:选取100名健康老年人,随机分为对照组(C),其中男性11名,女性14名;力量训练组(ST),其中男性11名,女性14名;平衡训练组(BT),其中男性11名,女性14名;平衡加力量训练组(SAB),其中男性12名,女性13名。训练组进行为期6周的训练:力量训练组进行核心肌力训练,平衡训练组采用动态姿态平衡仪进行平衡训练,平衡加力量组同时进行力量与平衡训练,3组均为5d/周,共6周;在训练前以及训练后均采用富尔顿高级平衡量表(FAB)及"起立-走"计时测试(TUGT)对受试者进行评估。结果:3组的FAB量表得分在训练前后均有明显差异,但平衡加力量训练组训练前后差异更加明显(P0.01);3组训练前后"起立-走"计时测试所用时间均显著降低,其中平衡训练组与平衡加力量训练组改变较为明显(P0.01)。结论:训练组在进行为期6周的训练之后动态平衡能力均有提高。但同时进行力量训练与平衡训练效果更加。FAB平衡评定量表可用于正常老年人动态平衡能力的评定。     

八段锦结合平衡垫训练对于老年人平衡功能及跌倒风险的研究

目的:观察八段锦结合平衡垫训练疗法对老年人平衡能力及跌倒风险的影响。方法:本项目随机抽取在黑龙江中医药大学附属第二医院跃进社区中心锻炼的老年人80例,分为八段锦组、平衡垫组、联合组(八段锦结合平衡垫训练)与空白组,每组20例。训练前及训练12周后,采用单腿闭眼、睁眼站立时间评定各组平衡能力及评估跌倒风险。结果:训练12周后,八段锦组、平衡垫组及联合组的单腿闭眼、睁眼站立时间均明显高于训练前(均P0.05);联合组单腿闭眼及睁眼站立时间高于八段锦组、平衡垫组和空白组(均P0.05),八段锦组和平衡垫组比较差异无统计学意义,八段锦组与平衡垫组闭眼及睁眼时间均高于空白组(均P0.05)。结论:八段锦、平衡垫训练及两者联合训练均能够改善老年人的平衡能力,降低跌倒风险;联合训练更优于单独的八段锦、平衡垫训练。     

站立平衡训练对偏瘫患者恢复行走能力的研究

偏瘫患者的平衡训练有卧位、坐位、跪位、坐-立-坐、立位平衡训练和行走平衡训练等等,其中站立平衡训练是极为重要的;如果掌握不好站立平衡,掌握不好正确的身体对线关系,极容易形成错误的运动模式,使整个肌群的不协调活动加强,会推迟和影响以后的行走功能,所以,站立平衡训练在偏瘫的康复中是必不可少的。2007年6月～2008年6月对我科收治的116例脑卒中患者采用站立平衡训练取得良好效果,现介绍如下。     

应用PDCA模式及平衡姿势认知训练预防老年人跌倒的效果观察

[目的]观察运用PDCA管理模式及平衡姿势认知训练预防老年跌倒的效果。[方法]将2013年3月—2015年8月本院治疗的100例老年病人随机分为观察组和对照组,对照组采用传统跌倒评估方法及护理措施,观察组运用PDCA循环管理模式,采用靶向性的认知-平衡双重任务训练、认知"优先策略"训练、本体感觉训练(平衡姿势控制功能训练)、肌群协调训练(核心肌群平衡训练)的方法。12周后观察两组老年人跌倒的发生率,并应用Berg平衡量表(BBS)评价平衡功能。[结果]两组住院老年病人治疗前、后BBS评分比较,差异有统计学意义(P0.01),两组跌倒发生率比较差异也有统计学意义(P0.05)。[结论]运用PDCA循环管理模式,采用靶向性的认知-平衡双重任务训练、认知"优先策略"训练、平衡姿势控制功能训练、核心肌群平衡训练的方法,可优化老年人姿势控制,提高老年人的平衡功能,降低跌倒发生率。     

平衡板训练对偏瘫患者立位平衡的影响

目的研究脑卒中偏瘫患者使用平衡板康复训练对其立位平衡的影响。方法 2 6例脑卒中偏瘫患者作为受试者 ,分别对其使用平衡板训练前后进行平衡能力定量评定。结果患者使用平衡板训练后 ,平衡障碍明显好转 (P <0 .0 1)。结论使用平衡板训练能改善偏瘫患者的立位平衡     

运动体操训练对老年人平衡及运动能力的影响研究

[目的]探讨运动体操训练对老年人平衡及运动能力的影响。[方法]选择2014年6月—2014年12月老干部病房长期住院病人72例,坚持运动体操训练12周,比较训练前后Tinetti平衡步态量表得分、单腿平衡时间、特定动作平衡信心、计时"起立-行走"时间、日常生活活动能力(ADL)得分情况。[结果]训练12周后,Tinetti平衡步态量表中平衡及总分明显提高;单腿平衡时间明显延长;平衡信心有所增加;"起立-行走"测试完成时间明显缩短,ADL评分增加,与训练前比较差异有统计学意义(均P0.05)。[结论]运动体操训练可以改善老年人平衡能力及运动能力、增强平衡信心,是预防跌倒的有效措施之一。     

加强腰腹部肌肉力量对脑卒中患者平衡能力的影响

目的：探讨腰腹部力量训练对脑卒中患者平衡的影响。方法对符合条件的20名观察组患者进行腰腹部力量训练,20名对照组患者接受传统的康复训练,采用Berg平衡量表比较训练前后两组患者平衡状况。结果训练后观察组患者BBS得分优于对照组(P＜0.05),效果显著。结论加强腰腹部力量训练对脑卒中患者平衡能力有较好的康复疗效。     

平衡仪反馈训练法和Bobath平衡训练法对偏瘫患者平衡和功能性行走能力的影响

目的：探讨平衡仪反馈训练法和Bobath平衡训练法对偏瘫患者平衡和功能性行走能力的影响。方法：将符合试验条件的住院卒中患者分层随机分为试验组（20例）和对照组（20例）,两组对象在试验开始前Berg平衡得分（BBS）、“起立-走”计时试验（Up＆Go）比较差异无显著性意义。试验组的平衡训练使用平衡仪视觉反馈法,对照组平衡训练使用Bobath平衡训练法,测试指标采用BBS和Up＆Go,在试验开始前和训练6周后各评定1次。结果：训练6周后试验组的BBS、Up＆Go均优于对照组比较差异具有显著性意义。结论：使用平衡仪训练对改善脑卒中患者的平衡和行走功能比单纯的Bobath平衡训练法更有效。     

可穿戴式智能足底压力视觉反馈技术对脑卒中患者平衡功能的影响

目的:研究可穿戴式智能足底压力视觉反馈技术对脑卒中患者平衡功能的影响,并探讨此技术在临床平衡功能训练中的应用方式和价值。方法:选择病程为8个月内的脑卒中患者30例,随机分配到试验组和对照组,每组15例。对照组接受常规平衡训练,试验组在可穿戴式智能足底压力视觉反馈技术配合下进行平衡训练,每次30min,每周5次,共训练4周。比较训练前及训练4周后两组患者的平衡功能评分,包括Berg平衡量表(BBS),"起立—行走"计时测试(TUG)和采用可穿戴式智能足底压力视觉反馈鞋垫记录的睁眼和闭眼静态平衡率,以评估训练的有效性和对照组与试验组间训练效果的差异。结果:训练前两组患者的一般资料、BBS及TUG评分和静态平衡率均无显著性差异(P0.05);训练后,试验组和对照组患者各观察指标与训练前相比均有显著改善(P0.05)。试验组的训练后与训练前各平衡功能评分差值与对照组相较更大,且有显著性差异(P0.05)。结论:应用可穿戴式智能足底压力视觉反馈技术进行平衡功能训练可以改善偏瘫患者的平衡功能,且较常规方法更有效。     

Peripheral labyrinthine causes of dizziness

A patient's complaint of dizziness must be defined specifically. Many dizzy patients do not have labyrinthine or balance system disease. The patient with dysequilibrium, on the other hand, often has a balance system disease but not necessarily a labyrinthine disorder. The patient with vertigo most likely has labyrinthine disease. Vertigo is accompanied by nystagmus, which can be identified only when the examiner specifically looks for it. Although vertigo is the classic symptom of labyrinthine disease, not all labyrinthine diseases have associated vertigo. Careful history taking, physical examination, audiometry, caloric testing, electronystagmography, and radiographic studies will identify patients with labyrinthine disorders. Treatment depends on the diagnosis. Usually it is medical, but occasionally it may be surgical. Most patients have no residual problems; a few have permanent disability.     

Pneumococcal purpura fulminans successfully treated with activated protein C

Evidence suggests that sepsis is a systemic inflammatory condition complicated by dysequilibrium in coagulation and fibrinolytic homeostasis, with a shift in the balance towards increased coagulation over fibrinolysis. Protein C is a natural anticoagulant consumed and inactivated during sepsis. We present the case of a 33-year-old female, postsplenectomy, with pneumococcal sepsis and purpura fulminans, successfully treated with activated protein C.     

Intracranial cholesteatoma: a case report and review

A cholesteatoma can be a complication of ear infection, eustachian tube dysfunction, prior ear surgery, or tympanic membrane perforation. It is typically associated with otorrhea and conductive hearing loss; sensorineural hearing loss, dysequilibrium, facial nerve paralysis, and altered mental status signify advanced disease. The treatment is surgical and recurrences are common. A case of cholesteatoma is presented that was associated with extension into the posterior fossa and presented with only a headache and localized pain.     

干部老年病科开展出入院全程陪同护理的调查

目的 对干部老年病科开展出入院全程陪同护理进行调查.方法 对我院干部病房老年患者进行随机抽样调查,采用自制量表调查老年患者对干部老年病科开展出入院全程陪同护理的感受.结果 患者对出入院全程陪同患者的护理服务需求较高,对入院出院全程陪同护理的满意度明显增高,病房床位使用率明显提高.结论 护士陪同老年患者入、出院体现了医院护理服务理念.提高护士人性化护理意识,提高护理质量及满意度.促进护患关系的融洽.     

陪伴教育对提高青少年1型糖尿病患者生活质量及家庭亲密度和适应性的效果

目的探讨由青少年1型糖尿病患者和家属共同参与的陪伴教育对提高青少年1型糖尿病患者生活质量及家庭亲密度和适应性的效果。方法便利抽样法选择2014年3月至2015年3月选择在吉林大学第一医院内分泌代谢科住院治疗的儿童青少年1型糖尿病患者45例及患者家属45名作为研究对象。在教育前后采用儿童生活质量普适性量表和家庭亲密度和适应性量表进行调查。结果青少年1型糖尿病患者生活质量及家庭亲密度和适应性较低;陪伴教育有利于提高患者的生活质量及家庭亲密度和适应性(P0.05)结论以家庭为中心的陪伴教育模式有利于提高青少年患儿及其家属对1型糖尿病的自我管理能力,对提高家庭亲密度和适应性、改善青少年1型糖尿病患者生活质量和心理社会能力有较好的效果,值得推广。     

Pharmacologic treatment of fibromyalgia

Fibromyalgia is a chronic syndrome characterized by widespread pain, unrefreshed sleep, disturbed mood, and fatigue. Until such time as we have a clearer understanding of the trigger and/or pathophysiologic mechanisms producing these symptoms, pharmacologic treatment should be aimed at individual symptoms. Such treatment should ideally be offered as part of a multidisciplinary treatment program using both pharmacologic and nonpharmacologic treatment modalities. Critical components of any successful fibromyalgia treatment program include addressing physical fitness, work and other functional activities, and mental health, in addition to symptom-specific therapies. The main symptoms that should be addressed include pain, sleep disturbances including restless leg syndrome, mood disturbances, and fatigue. Pharmacologic therapy should also be considered for syndromes commonly associated with fibromyalgia including irritable bowel syndrome, interstitial cystitis, migraine headaches, temporomandibular joint dysfunction, dysequilibrium including neurally mediated hypotension, sicca syndrome, and growth hormone deficiency. This article provides general guidelines in initiating a successful pharmacologic treatment program for fibromyalgia.     

Extracorporeal treatment of acute renal failure in the intensive care unit: a critical view

Acute renal failure in critically ill patients is seldom an isolated problem but is more usually associated with multiple organ failure. When choosing an extracoporeal kidney replacement therapy, these other failing organs must be taken into account. Therefore the choice of an artificial kidney in patients requiring intensive care depends on both the efficacy of the technique and its possible adverse effects on cerebral, pulmonary and cardiovascular function. The most important pathogenic factors in the development of dysequilibrium syndromes, arterial hypoxemia and hypotension are treatment timing, diffusive solute transfer, bio-incompatible membranes and some specific dialysate components (buffer, electrolyte concentrations). It is important to understand the mechanisms by which these factors exert their adverse effects. Application of these pathophysiological mechanisms to the cardiopulmonary and neurologic status of the individual patient permits the prediction of their clinical outcome. This approach will lead to individualised treatment selection, thereby avoiding deleterious side-effects without loss of efficacy.     

Clinical findings in patients with acoustic neurinoma

Herein we review the symptoms, physical findings, and test results in 131 patients with acoustic neurinoma. The earliest symptoms are unilateral hearing loss, tinnitus, and dysequilibrium. As the disease progresses, facial numbness, facial weakness, and headaches become more prominent. Physical findings other than hearing loss are uncommon; the most frequently observed are a decreased corneal reflex, nystagmus, and facial hypoesthesia. Routine audiometry provides objective information about the hearing loss. Some degree of asymmetry is found in the pure-tone tests. In addition, the speech discrimination scores are frequently lower than expected. Special audiometric tests should be performed on those patients with residual hearing; at the present time, acoustic reflex tests and the brainstem-evoked response yield the most information. Computed tomography with dye enhancement with or without the use of air contrast has become the most accurate roentgenographic test. Our goal is to identify acoustic neurinomas sufficiently early so that surgical removal is safe and leaves minimal deficit.