脑卒中患者上肢和手功能的康复评定

本评价了当前常用的偏瘫上肢运动功能的评定方法,包括Ｂｒｕｎｎｓｔｒｏｍ方法、ＦＭＡ量表、ＳＴＥＦ方法、Ｌｉｎｄｍａｒｋ方法、Ｂａｒｔｈｅｌ指数方法,以及上肢的痉挛评定等各种检查方法的要点,以期在临床康复工作中更好的应用评定技术。     

上肢康复机器人辅助治疗在脑卒中偏瘫患者上肢功能康复中的应用

目的:分析上肢康复辅助训练系统在脑卒中偏瘫患者上肢功能恢复中的效果。方法:脑卒中偏瘫患者90例,随机分为对照组和观察组各45例,均采取常规康复训练,观察组还给予上肢康复机器人辅助治疗。比较2组患者治疗前和治疗1月后改良Ashworth量表(MAS)、Fugl-Meyer评定量表上肢部分(FMA-UE)及功能独立性评定(FIM)的评分情况。结果:观察组治疗1月后肘关节MAS评分较治疗前明显下降,且较对照组明显下降(P<0.01),对照组治疗前后评分比较差异无统计学意义(P>0.05)。2组治疗1月后肩关节MAS评分较治疗前均下降,且观察组较对照组显著降低(P<0.01)。2组治疗1月后FMA-UE评分较治疗前均升高,且观察组较对照组显著升高(P<0.01)。与治疗前相比,2组治疗1月后FIM量表评分均明显升高(P<0.01),且观察组较对照组明显升高(P<0.01)。结论:在常规康复训练的基础上,应用上肢康复机器人辅助治疗脑卒中偏瘫患者可有效改善上肢运动功能。     

上肢康复机器人训练对偏瘫患者上肢功能恢复的影响

摘要 目的：观察上肢康复机器人训练对偏瘫患者上肢功能康复的临床疗效。 方法：将56例偏瘫上肢功能障碍患者按分层随机方法分为治疗组(28例)和对照组(28例),两组均给予常规肢体功能训练,对照组进行运动疗法和作业疗法训练各45min,共90min,每天1次,每周5次,6周共30次。治疗组同样进行运动疗法和作业疗法训练各30min,同时给予上肢康复机器人训练30min,每天1次,每周5次,6周共30次。采用Brunnstorm分期上肢及手功能评定、简化Fugl-Meyer上肢运动功能评分法及改良Barthel指数进行疗效评价,比较两组疗效。 结果：治疗前,两组在Brunnstorm分期上肢及手功能评定比较、Fugl-Meyer上肢运动功能评分比较、改良Barthel指数评定比较差异均无显著性意义(P>0.05),均具有可比性。治疗后,Brunnstorm分期上肢及手功能评定比较：治疗组较治疗前均有明显改善(P<0.01),对照组较治疗前也均有改善(P<0.05),治疗组与对照组相比,治疗组改善均更明显(P<0.01);两组Fugl-Meyer及改良Barthel指数均较治疗前有改善(P<0.05),治疗组均优于对照组(P<0.05)。 结论：上肢康复机器人训练能够有效促进偏瘫患者上肢功能的恢复。     

早期应用护肩对脑卒中患者上肢功能恢复的影响

早期应用护肩对脑卒中患者上肢功能恢复的影响李恩德１病理性肩关节脱位是完全性脑卒中患者的常见并发症，一旦发生，对上肢功能的恢复有重大影响。近年来我们通过预防性康复治疗对４０例完全性脑卒中患者随机分组进行前瞻性观察，现将结果报告如下。１临床资料本组４０例...     

上肢康复机器人治疗脑卒中患者上肢功能的临床疗效研究

目的观察上肢康复机器人对脑卒中患者上肢功能的康复效果。方法选取2019年12月至2021年8月宁夏第五人民医院康复中心收治的98例脑卒中患者为研究对象,采用随机数字表将受试者随机分为康复机器人组(n=49)及常规康复组(n=49)。所有受试者均接受常规康复治疗,康复机器人组在此基础上增加上肢康复机器人辅助训练。于治疗前、治疗8周后分别进行Fugl-Mayer运动功能量表上肢部分(FMA-UE)评定,改良Barthel指数(MBI)评价两组患者上肢功能及日常生活能力。结果康复机器人组治疗后FMA-UE评分(47.49±7.84)分,常规康复组FMA-UE评分(33.29±9.53)分,康复机器人组治疗后MBI评分(52.49±9.45)分,常规康复组MBI评分(39.81±12.19)分,康复机器人组均高于常规康复组,差异有统计学意义(P<0.05);同时进一步实验分析发现,组间两两比较,康复机器人组肩关节前屈评分、肩关节外展评分、肩关节内旋评分均明显优于常规康复组,差异有统计学意义(P<0.05)。结论在常规功能训练的基础上应用上肢康复机器人辅助训练系统可以明显改善患者的上肢功能,提高日常生活能力。     

上肢康复机器人结合常规康复训练对急性期脑卒中患者上肢功能的疗效研究

目的:观察上肢康复机器人结合常规康复训练对急性期脑卒中患者上肢运动功能的改善情况。方法:将50例脑卒中患者随机分为对照组和观察组,对照组每天进行2次常规康复训练,观察组每天进行1次常规康复训练及1次上肢康复机器人训练,每周治疗5d,共4周,治疗前后分别用Fugl-Meyer(上肢部分,FMA-UE)、改良日常生活能力(MBI)、肩关节主动关节活动度评价康复效果。结果:治疗后,2组患者的FMA-UE、肩关节主动关节活动度和MBI评估均有明显提高(P0.05),上肢康复机器人结合常规康复训练组的FMA-UE和肩关节前屈、水平内收、水平外展主动关节活动度与对照组相比提高更加明显(P0.05)。结论:上肢康复机器人结合常规康复训练对急性期脑卒中患者上肢功能有明显改善作用。     

康复治疗在脑卒中患者上肢及手功能恢复中的应用

目的探讨康复治疗对偏瘫患者上肢功能恢复的影响.方法选择96例患者,随机分为康复组和对照组(每组48例).康复组以神经促通技术、运动再学习及适量的强制性运动为主方法,反复进行上肢的训练,必要时配合传统的按摩、功能性电刺激疗法和日常生活能力的训练,并与对照组进行比较.以Fugl-Meyer 积分法、Barthel指数进行治疗前后评定.结果康复组患者在上肢功能、手功能、日常生活能力及并发症减少方面与对照组相比,有显著性差异(P<0.01).结论康复治疗在改善偏瘫上肢功能、手功能和日常生活能力方面切实有效.     

康复治疗在脑卒中患者上肢及手功能恢复中的应用

目的　探讨康复治疗对偏瘫患者上肢功能恢复的影响。方法　选择 96例患者 ,随机分为康复组和对照组 (每组 4 8例 )。康复组以神经促通技术、运动再学习及适量的强制性运动为主方法 ,反复进行上肢的训练 ,必要时配合传统的按摩、功能性电刺激疗法和日常生活能力的训练 ,并与对照组进行比较。以Fugl-Meyer积分法、Barthel指数进行治疗前后评定。结果　康复组患者在上肢功能、手功能、日常生活能力及并发症减少方面与对照组相比 ,有显著性差异 (P <0 .0 1)。结论　康复治疗在改善偏瘫上肢功能、手功能和日常生活能力方面切实有效。     

社区康复对偏瘫患者上肢功能的治疗程序

从1996－2000年,我科开展偏瘫患的社区康复。治疗师深入社区,为偏送信患提供医疗咨询、康复评定、治疗、指导。由于社区康复的特点,现行康复中心（Team Group)的工作方式不能照搬用于社区康复。为了提高工作效率,我们逐步总结了一套治疗师单独深入社区,综合应用PT、OT心理、按摩等治疗手段,因地制宜开展社区康复工作的方法,收到良好的效果。受全科医生概念的启发,我们称之为“全科治疗师工作法”。上肢及手功能的康复是偏瘫患运动功能康复的难点。本以上肢及手功能的康复为例,介绍我科开展偏瘫社区康复的工作程序和基本思路,供基层的社区康复工作参考。     

早期康复治疗对脑卒中偏瘫患者上肢功能恢复的影响

目的观察早期综合康复治疗对脑卒中偏瘫患者上肢功能以及肌张力的影响。 方法将87例脑卒中患者按康复介入时间分为早期康复组及对照组,早期康复组于脑卒中发病7~30 d内给予综合康复治疗,对照组于脑卒中发病30~60 d内给予综合康复治疗,2组患者康复治疗措施基本一致,包括康复训练、中频电疗及针刺等。全部患者均于治疗前及治疗3个月后采用简式Fugl-Meyer运动功能评分对偏瘫侧上肢功能进行评定,采用改良Ashworth痉挛量表对肩内旋肌、肘屈肌及屈腕肌张力水平进行评定。 结果治疗前2组患者上肢功能及痉挛程度组间差异均无统计学意义（均P&rt;0.05）;经3个月治疗后,发现2组患者上肢功能及痉挛程度均较治疗前明显改善(均P<0.05),且以早期康复组上肢功能及痉挛症状的改善幅度较显著,明显优于对照组水平(均P<0.05)。 结论早期综合康复治疗能显著改善脑卒中患者肢体痉挛及活动功能。     

Effects of mobilization and tactile stimulation on recovery of the hemiplegic upper limb: a series of replicated single-system studies

Hunter SM, Crome P, Sim J, Pomeroy VM. Effects of mobilization and tactile stimulation on recovery of the hemiplegic upper limb: a series of replicated single-system studies.

Objective

To explore the effects on motor function and impairment of mobilization and tactile stimulation for the paretic arm and hand after stroke.

Design

Replicated single-system series, ABA design.

Setting

The stroke rehabilitation ward of a community hospital in the United Kingdom.

Participants

Consecutive sample, men and women (N=6) with stroke (left or right), within 3 months of onset.

Intervention

Sixty minutes of daily mobilization and tactile stimulation to the paretic arm and hand for 6 weeks in addition to the usual rehabilitation program.

Main Outcome Measures

Focal disability (Action Research Arm Test [ARAT]) and motor impairment (Motricity Index arm section).

Results

All participants showed visual change in 1 or more of trend, level, or slope between baseline and intervention phases for both the ARAT and the Motricity Index. The visual analysis was confirmed through statistical testing (c statistic and/or Mann-Whitney U test) for 5 of 6 participants (statistical analysis was precluded for 1 participant). No further improvements were made on intervention withdrawal.

Conclusions

This study shows proof of concept for using mobilization and tactile stimulation to improve motor recovery after severe paresis, justifying conducting dose-finding studies as a precursor to multicenter phase III clinical trials.     

Effects of intensive arm training with an electromechanical orthosis in chronic stroke patients: a preliminary study

de Araújo RC, Junior FL, Rocha DN, Sono TS, Pinotti M. Effects of intensive arm training with an electromechanical orthosis in chronic stroke patients: a preliminary study.

Objectives

To evaluate the use of an electromechanical device, comprising an exoskeleton, a static orthosis, and a glove, for functional rehabilitation of the elbow and hand in patients with hemiparesis, and to compare it with physical therapy rehabilitation.

Design

Pretest-posttest design.

Setting

Rehabilitation laboratory.

Participants

Volunteer sample of persons (N=12) with persistent hemiparesis from a single, unilateral stroke within the past 3 to 36 months.

Interventions

The volunteers were randomly divided into 2 groups. One group was treated with a conventional program of physiotherapy, and another group participated in a training program in which an electromechanical orthosis was used. All volunteers received 24 sessions, held 3 times a week for 8 weeks.

Main Outcome Measures

Modified Ashworth Scale (MAS), Fugl-Meyer Assessment (FMA), and electromyogram (EMG) amplitude.

Results

No statistical difference was found in the initial and final values of the MAS. Both groups showed a significant increase for the total scores of the FMA. However, only the group treated with the orthosis showed an increase in FMA scores related to the wrist and hand joint. The EMG analysis showed increased EMG amplitudes for all muscles in the group treated with the orthosis, whereas the group treated with physiotherapy showed gains in electromyographic activity only in the extensor digitorum communis. Intergroup comparison showed that the initial FMA scores of the wrist/hand were higher in the group treated with physiotherapy. However, after training, the scores in the group that used the orthosis were equivalent to those of the physiotherapy group.

Conclusions

The results suggest that this device can be an auxiliary tool to help the conventional rehabilitation program of motor function of the affected upper extremity.     

Robotic therapy for chronic motor impairments after stroke: Follow-up results

OBJECTIVES: To study the effects of robotic rehabilitation in persons with chronic motor impairments after stroke and to examine whether improvements in motor abilities were sustained 4 months after the end of therapy. DESIGN: Pretest-posttest design. SETTING: Rehabilitation hospital, outpatient care. PARTICIPANTS: Volunteer sample of 42 persons with persistent hemiparesis from a single, unilateral stroke within the past 1 to 5 years. INTERVENTION: Robotic therapy for the paretic upper limb consisted of either sensorimotor active-assistive exercise, or progressive-resistive training during repetitive, planar reaching tasks, 3 times a week for 6 weeks. MAIN OUTCOME MEASURES: Modified Ashworth Scale, Fugl-Meyer Assessment (FMA), Motor Status Scale (MSS) score, and Medical Research Council motor power score. RESULTS: No significant differences were found among pretreatment clinical evaluations. Statistically significant gains from admission to discharge and from admission to follow-up (P<.05) were found on the FMA, MSS score for shoulder and elbow, and motor power score. CONCLUSIONS: Short-term, goal-directed robotic therapy can significantly improve motor abilities of the exercised limb segments in persons with chronic stroke that are sustained 4 months after discharge. This suggests that motor recovery can be enhanced by repetitive exercise training more than 1 year after stroke.     

Hemi-inattention and the recovery patterns of stroke patients

A series of stroke patients (n = 31) were assessed at four stages: 4 weeks, 8 weeks, 12 weeks and 18 months post-trauma. Significant recovery was noted at 8 weeks, although a trend towards recovery continued throughout the assessment phases. Patients presenting with hemi-inattention at the 4-week assessment achieved significantly poorer levels of functional ability at the final assessment although in some cases the inattention had resolved on neuropsychological tests.     

早期康复对重度偏瘫的脑卒中患者运动功能恢复的影响

目的：观察早期主动性康复治疗对重度偏瘫的脑卒中患者运动功能恢复的影响。方法：在沧州市两所二级医院选重度瘫痪的脑卒中偏瘫患者１０１例,康复组５７例,对照组４４便。在残损和残疾两个水平上评测患者功能。比较康复治疗后两组间的差异。结果：初次评测的各主要指标两组间无明显差别;末次评测的运动功能的ＦＭＡ上肢、ＦＭＡ下肢１、ＦＩＭ－ＡＤＬＳ、ＦＩＭ－Ｍｏｂｉｌｉｔｙ和ＦＩＭ每周增加值的结果,对照组分别为１１．     

Rehabilitation of somatic sensation and related deficit of motor control in patients with pure sensory stroke

OBJECTIVE: To assess the effectiveness of a rehabilitative training program for deficits in somatic sensation and motor control of the hand in patients with pure sensory stroke. DESIGN: Multiple baseline and before-after follow-up trial with behavioral analysis of single cases. SETTING: Rehabilitation unit of a university hospital in Italy. PARTICIPANTS: Four patients were studied: 2 had a unilateral lesion confined to the parietal lobe (patients 1, 2), and 2 had a unilateral lesion of the thalamus (patients 3, 4) that also lapped the posterior limb of the internal capsule. All 4 patients had chronic deficits in somatic sensation and motor control of the contralesional hand. INTERVENTION: Behavioral training consisting of exercises aimed at improving somatic sensation and motor control of the affected, contralesional hand. Thirty treatment sessions, each lasting 50 minutes, were performed. MAIN OUTCOME MEASURES: Somatic deficit was evaluated with 5 tests, and motor control deficit was assessed with 4 tests. One functional test estimated the influence of somatic deficit on daily activities. A visual analog scale (VAS) was also submitted to the patients' relatives to evaluate the amount of use of the affected arm in daily life activities. A baseline was obtained by recording each measure, except for the VAS, 4 times at the first evaluation session. Evaluation sessions were conducted before, after, and 6 months after the end of the experimental treatment. RESULTS: All patients showed a stable baseline in at least 8 of the outcome measures. Patients 1 and 2 significantly improved in 9 and 7 outcome measures, respectively. Patients 3 and 4 improved in 4 and 7 outcome measures, respectively. With the exception of case 3, all patients considerably increased their use of the affected arm during daily life. The improvement was generally stable over a 6-month period, suggesting that the treatment had a long-term effect. CONCLUSIONS: Results suggest the possible effectiveness of our training program for treating somatic and motor control deficits of the hand in patients with cortical or subcortical pure sensory stroke.     

Comparison of the action research arm test and the Fugl-Meyer assessment as measures of upper-extremity motor weakness after stroke

OBJECTIVE: To assess the relative responsiveness of 2 commonly used upper-extremity motor scales, the Action Research Arm Test (ARAT) and the Fugl-Meyer Assessment (FMA), in evaluating recovery of upper-extremity function after an acute stroke in patients undergoing inpatient rehabilitation. DESIGN: Prospective. SETTING: An acute stroke rehabilitation unit. PARTICIPANTS: One hundred four consecutive admissions (43 men, 61 women; mean age +/- standard deviation, 72+/-13y) to a rehabilitation unit 16+/-9 days after acute stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The following assessments were completed within 72 hours of admission and 24 hours before discharge: ARAT, upper-extremity motor domain of the FMA, National Institutes of Health Stroke Scale, FIM instrument total score, and FIM activities of daily living (FIM-ADL) subscore. RESULTS: The Spearman rank correlation statistic indicated that the 2 upper-limb motor scales (ARAT, FMA) correlated highly with one another, both on admission (rho = .77, P < .001) and on discharge (rho = .87, P < .001). The mean change in score from admission to discharge was 10+/-15 for the ARAT and 10+/-13 for the FMA motor score. The responsiveness to change as measured by the standard response mean was .68 for the ARAT and .74 for the FMA motor score. The Spearman rank correlation of each upper-limb motor scale with the FIM-ADL at the time of admission was as follows: ARAT, rho equal to .32 (P < .001) and FMA motor score, rho equal to .54 (P < .001). CONCLUSIONS: Both the FMA motor score and the ARAT were equally sensitive to change during inpatient acute rehabilitation and could be routinely used to measure recovery of upper-extremity motor function.     

早期康复及针刺对急性脑卒中患者运动功能的影响

目的 观察早期康复和针刺治疗对急性脑卒中偏瘫患者运动功能的影响。方法 125例急性期脑卒中患者随机分为早期康复针刺治疗组（34组）,早期康复治疗组（39例）、单纯针刺治疗组（21例）、药物治疗对照组（31例）。应用Bobath疗法和针刺疗法治疗,以神经功能缺损评分（NFI）、简式Fugl-Meyer评分（FMA）、Barthel指数（MBI）、临床疗效和治疗效率作为观察疗效指标。结果 早期康复针刺组疗效明显优于单纯早期康复组、单纯早期针刺组和对照组。单纯早期康复组明显优于单纯早期针刺组和对照组,单纯早期针刺组明显优于对照组。结论 急性脑卒中早期介入康复治疗和针刺治疗,二种疗法相互结合应用,优于单一治疗,因此二者合用是促进脑卒中康复的有效方法。