偏瘫患者站姿平衡和负重与鞋坡度及高度的相关性

目的 确定鞋的坡度和高度对偏瘫患者站姿平衡和负重的影响。方法 测量偏瘫患者在安静站立状态下及被迫体位转换时的重力支撑的关系。参加者：为康复医院的9例急性期一侧脑卒中后偏瘫的住院患者，要求在无协助或休患的情况下自E够独自站立3—5min，同时符合其他包括的标准。干预：在调整鞋的不同坡度(5&;#176;，7．5&;#176;，2．5&;#176;)和不同高度(0．6，0．9，1．2cm)的情况下，要求患者做体位转动，其重力支撑对称得分用来表示站姿平衡的特征。主要结果测量：重力支撑对称得分。结果在不提高鞋的高坡度时，偏瘫一侧肢体对称负重能力低[负载体重的(39．9&;#177;0．80)％]。如在患侧肢升高鞋底的高度和坡度，当人体位转动时，可以促进站姿平衡和负重的改善。倘若鞋的坡度为5&;#176;时，体质量的分配最平衡[人体质量的(51．4&;#177;1．1)％]。结论 要改善双脚站立时的平衡水平，建议应用调整患侧肢体鞋的高坡度，帮助患者克服患肢失用后的锻炼困难，从而保持运动时的身位平衡。     

自制康复枕头用于脑卒中偏瘫患者的效果观察

[目的]探讨自制康复枕头用于脑卒中偏瘫患者体位护理的效果.[方法]将160例脑出血偏瘫患者随机分成对照组和观察组,两组在常规护理同时,观察组采用自制康复枕头来进行早期、科学、正确的良姿位摆放.在住院1个月观察两组患者发生压疮、关节肌肉挛缩畸形、下肢深静脉血栓形成、足下垂等并发症情况.[结果]观察组在康复护理效果方面明显...     

脑卒中偏瘫患者早期康复护理的效果观察

本就早期康复护理干预对脑卒中偏瘫患肢体功能和生活能力的影响探讨如下. 1 对象和方法 1.1 对象 82例脑卒中偏瘫患,均符合1995年全国第四次脑血管病学术会议通过的诊断标准,并经CT或MRI检查证实.随机分为观察组41例,男26例,女15例,平均年龄53～77岁;对照组41例,男28例,女13例,平均年龄52～74岁.两组数据经统计学处理,差异无显性,具有可比性.     

脑卒中偏瘫患者的康复护理

目的：最大限度的恢复脑卒中患者的残存功能,减少残疾。方法：对224例脑卒中偏瘫患者进行心理护理、急性期康复护理、恢复期康复护理、功能锻炼等康复护理。结果：脑卒中偏瘫患者的功能得到了最大限度的康复。结论：及早、及时、有效的康复护理对改变患者的异常运动模式,尽最大限度促进肢体功能恢复有极大的意义。     

脑卒中偏瘫患者水中康复训练疗法探索

目的探讨水中康复训练疗法对脑卒中偏瘫患者肢体功能恢复的效果。方法将40例偏瘫患者随机分为康复组和对照组,两组各20例,前者采用水中康复训练和传统运动疗法相结合,后者采用传统运动疗法,两组患者治疗前后采用Brunnstrom偏瘫运动功能恢复的6期标准进行评价。结果康复组疗前疗后相比,对照组疗前疗后相比,运动功能均有显著提高,两组治疗后相比,康复组有效率明显优于对照组,P<0.01。结论早期水中康复训练对脑卒中偏瘫患者的功能恢复具有重要意义。     

偏瘫患者运动能力与日常生活能力的相关性

目的:探讨脑卒中后偏瘫患者上、下肢运动能力与日常生活能力的相关性。方法:30例脑卒中后偏瘫患者,男20例,女10例,平均年龄为(60.75±12.84)岁。其中脑出血16例,脑梗死10例,脑梗死伴出血4例。平均病程(5.4±9.6)个月。采用简易Fugl-Meyer运动功能评分方法评定患者运动能力,改良Barthel指数评定患者的日常生活能力。结果:30例患者全身Fugl-Meyer运动功能评分平均为40.96±32.04,上肢运动功能评分平均为21.78±22.87,下肢运动功能评分平均为18.43±10.29。30例患者改良Barthel指数评分平均为39.46±25.94。全身总Fugl-Meyer运动功能评分与改良Barthel指数评分的相关系数为0.65,其中上肢运动功能评分与改良Barthel指数评分的相关系数为0.62,下肢运动功能评分与改良Barthel指数评分的相关系数为0.61。结论:偏瘫患者的运动能力与日常生活能力有一定的相关性,且上、下肢运动能力对日常生活能力的影响几乎相等。     

脑卒中偏瘫患者55例的康复护理

笔者2006/2007年对55例脑卒中致偏瘫患者实施康复护理,取得了较好的效果,现报道如下。 1临床资料 1.1一般资料 脑卒中患者55例,男35例,女20例,平均年龄54岁。脑出血8例,占14.54%,蛛网膜下腔出血17例,占30.91%,脑梗死30例,占54.55%。平均住院天数48 d。     

协同护理在脑卒中偏瘫患者康复期的应用

协同护理模式即在责任制护理的基础上,充分发挥患者自我护理的能力,鼓励患者参与健康护理,有利于提高治疗效果,缩短治疗周期[1].本文通过将协同护理模式应用于脑卒中患者康复治疗护理中,实施效果分析,探讨协同护理模式在脑卒中患者康复期的应用价值.现总结如下.     

康复综合护理对脑卒中偏瘫患者的影响

目的 探讨康复综合护理对脑卒中偏瘫患者的疗效观察.方法 选择急性脑卒中患者140例,随时分为康复综合护理组(观察组)和对照组,每组70例.康复综合护理组在给予常规治疗的同时,还进行正规的康复综合护理,对照组则给予药物治疗和常规护理.分别于人选治疗前24 h和治疗后12周进行效果评定.结果 康复综合护理组脑卒中患者继发功能障碍的发生率明显低于对照组,肢体功能改善明显高于对照组.结论 对脑卒中患者急性期实施康复综合护理方案可减少致残,明显改善肢体功能,提高生活质量.     

脑卒中偏瘫病人的康复护理

脑卒中是指一组起病急骤的脑部血液循环障碍,常伴有神经系统局限性功能改变.是神经系统的多发病和常见病,脑卒中大多数发生于中老年人,它与心脏病,恶性肿瘤构成人类三大致死病因,脑卒中病人虽经救治得以存活,但其中80%遗留不同程度的残疾,因此康复治疗的及早介入具有重要的意义,通过采取以功能训练为主的综合措施,最大限度地促进偏瘫病人的功能恢复,同时防治并发症,并充分发挥其残余功能,以争取病人达到生活自理,重返社会的目的.     

The effect of shoe wedges and lifts on symmetry of stance and weight bearing in hemiparetic individuals

OBJECTIVE: To determine the effect of shoe wedges and lifts on symmetry of stance and weight bearing in hemiparetic individuals. DESIGN: Weight bearing on the paretic side was measured in patients with hemiparesis during quiet standing and in conditions of compelled weight shift. SETTING: Free-standing acute inpatient rehabilitation hospital. PARTICIPANTS: Nine individuals with hemiparesis as a result of unilateral stroke who were able to stand for 3 to 5 minutes without assistance or rest, and satisfied other inclusion criteria. INTERVENTIONS: Compelled shift of the body weight was induced with different shoe wedges (5 degrees, 7.5 degrees, 12.5 degrees) or shoe lifts (0.6, 0.9, 1.2cm), which extended under the entire shoe of the unaffected limb. Weight-bearing symmetry scores were used to characterize the symmetry of stance. MAIN OUTCOME MEASURES: Weight-bearing symmetry scores. RESULTS: Without a shoe wedge or a shoe lift, weight-bearing symmetry was characterized by underloading of the paretic limb (39.90% +/-.80% of body weight). Weight shift induced by shoe wedges or shoe lifts applied to the unaffected limb promoted improved symmetry of weight bearing and stance. A shoe wedge of 5 degrees provided the most symmetrical weight distribution (51.44% +/- 1.88% of body weight). CONCLUSION: Shoe wedges and shoe lifts under the unaffected limb induced compelled weight shift toward the paretic limb, resulting in improved symmetry of stance of individuals with mild hemiparesis. We suggest that improved symmetry of bipedal standing obtained with a shoe wedge or a shoe lift applied to the unaffected limb can help overcome the learned disuse of the affected limb. We further suggest that weight distribution induced by shoe wedges or shoe lifts may help in the treatment of ambulatory hemiparetic individuals with asymmetrical stance caused by unilateral stroke.     

The effect of shoe lifts on static and dynamic postural control in individuals with hemiparesis

OBJECTIVE: To determine the effect of lifts to the shoe of the nonaffected leg on weight symmetry and dynamic posturography in individuals with hemiparesis. DESIGN: Quantitative posturography was performed to determine subjects' response to sudden perturbations. Subjects received graded forward and backward perturbations while standing on a movable force platform. Compelled shift of the body weight was induced with sized lifts to the shoe of the nonaffected leg. Balance responses were analyzed in terms of latency and strength of neuromuscular response. Symmetry scores were used to characterize the symmetry of stance. SETTING: Free-standing acute inpatient rehabilitation hospital. PARTICIPANTS: Ten individuals with hemiparesis as a result of unilateral stroke. MAIN OUTCOME MEASURES: Weight symmetry scores, latencies of each leg's active response to the support surface translations, and response strength scores of each leg to the platform translations. RESULTS: When no lift was used, weight symmetry was characterized by underloading of the affected limb, as well as by longer onset latencies for the affected limb compared with the stronger one (158.5 +/- 3.9 vs 151.1 +/- 3.5 ms; p < .01 for large backward translations; 165.7 +/- 7.2 vs 158.0 +/- 5.1 ms; p < .01 for large forward translations). Response strength of the nonparetic limb was 2 times greater than the response strength of the weaker extremity (p < .05). Compelled weight shift induced by lifts applied to the shoe of the nonparetic limb promoted improved weight symmetry, shortened latencies, and increased magnitudes of the response strength. CONCLUSION: Lifts applied to the shoe of the stronger limb induced a body weight shift toward the paretic limb and resulted in improved symmetry of stance and postural control of individuals with hemiparesis. We suggest that compelled weight distribution induced by lifts to the shoe of the stronger limb could help treat ambulatory individuals with asymmetric stance and hemiparesis caused by unilateral stroke.     

The effects of dynamic ankle-foot orthoses on functional ambulation activities,weight bearing and spatio-temporal characteristics of hemiparetic gait

Purpose. To investigate the effects of dynamic ankle-foot orthoses (DAFOs) on functional ambulation activities, weight bearing and spatio-temporal characteristics of hemiparetic gait and to inquire whether wearing a DAFO for 3 months has a carryover effect.

Method.?Fourteen chronic hemiparetic patients who could walk independently with or without a cane were the subjects of the study. Patients were assessed initially with tennis shoes and were given custom fabricated DAFOs which they wore for three months and were retested under two conditions: with tennis shoes only and with DAFOs worn in these shoes. All patients were assessed for weight bearing percentage of the affected side, cadence, step length of the involved and uninvolved sides, step width, functional reach, timed up and go, timed down stairs, timed up stairs, physiologic cost index and velocity.

Results.?Comparison of initial and third month assessments with shoes only condition showed that there was no significant improvement for the measured parameters. When comparison was made at the third month while patients were wearing tennis shoes only and when they were wearing DAFO's in their shoes there was a significant difference in favour of the condition where patients were wearing DAFOs.

Conclusion.?The benefits of using DAFOs in chronic hemiparetic patients are lost when the patients are not wearing their orthoses.     

Immediate effects of an individually designed functional ankle-foot orthosis on stance and gait in hemiparetic patients

OBJECTIVE: To evaluate the immediate effects of individually designed functional in-shoe ankle-foot orthoses (AFO) made of soft and hard cast on balance, standing, and gait parameters in hemiparetic patients. DESIGN: Crossover design with randomized order of the intervention. SETTING: A rehabilitation centre for adults with neurological disorders. SUBJECTS: Twenty-eight patients with hemiparesis due to stroke or traumatic brain injury. MEASURES: Postural sway, standing and gait parameters based on ground reaction forces in two conditions: Patients were randomly assigned to varying sequences of wearing AFO in footwear or wearing footwear alone. RESULTS: AFO significantly improved weight-bearing on the affected leg (affected/ unaffected side symmetry: 2.25 +/- 1.5 with AFO versus 3.4 +/- 2.5 without AFO, P<0.05) and postural sway in stance (12.5 mm +/- 5.2 with AFO versus 15.7 mm +/- 6.7 without AFO, P < 0.05), double stance duration (21.1 +/-14.4% of gait cycle with AFO versus 25.9 +/- 21.6% of gait cycle without AFO, P < 0.05), and symmetry ratios of gait parameters such as stance duration (2.0 +/- 1.5 s with AFO versus 3.3 +/- 3.6 s without AFO, P < 0.05) and deceleration forces (1.6 +/- 0.5 with AFO versus 1.9 +/- 0.6 without AFO, P < 0.05) during gait. No significant differences were observed in all other symmetry ratios of gait parameters. CONCLUSION: An individually designed functional in-shoe AFO can improve stance and gait parameters, even in a single use, in patients with hemiparesis.     

Influence of weight bearing visual feedback on movement symmetry during sit to stand task

BackgroundWeight-bearing asymmetry is common in individuals with hip osteoarthritis and after total hip arthroplasty. Including symmetry training to the rehabilitation programs may normalize movement strategies during dynamic tasks. The purpose of this study was to evaluate the immediate influences of real-time visual feedback of weight distribution on the interlimb movement symmetry during the sit-to-stand task, before and after total hip arthroplasty, and to determine whether physical impairments affect the response to visual feedback.MethodsSubjects before and after total hip arthroplasty participated in three- dimensional motion analysis. Subjects completed 3 trials of sit-to-stand task in two conditions; “without visual feedback” and “with visual feedback”. Outcome measures were the interlimb symmetry of vertical ground reaction force, and joint kinematics and kinetics. Pain and strength of lower limbs were assessed.FindingsCompared to “without visual feedback” condition, subjects moved with greater symmetry of vertical ground reaction force and joint kinetics when visual feedback was received. However, subjects continued to demonstrate interlimb difference for joint kinetics and vertical ground reaction force in the visual feedback condition. The increase in symmetry was not strongly influenced by physical impairments and subjects before and after total hip arthroplasty responded similarly to the feedback.InterpretationsWe concluded that in a single session, the visual feedback of weight bearing distribution had a positive immediate effect on movement symmetry during the sit-to-stand task. Future studies that assess long-term retention and functional benefits are warranted before visual feedback is incorporated in rehabilitation for this patient population.     

Effect of heel lifts in elderly individuals with spinal kyphosis

BackgroundThe present study aimed to elucidate the effects of heel lifts on spinal alignment, walking, and foot pressure pattern in elderly individuals with spinal kyphosis.MethodsThe spinal alignment, walking speed, step length and foot pressure of 33 community-dwelling elderly individuals with spinal kyphosis (3 men, 30 women; mean age 77.3 years) were examined before and after the application of 10-mm moderately elastic heel lifts.FindingsSpinal alignment of total inclination (mean value 6.9°vs 4.5°) and thoracic angle (43.6°vs 36.2°) were significantly lower after the application of heel lifts than before the application. The lumbar angle (7.3°vs 10.0°) was significantly higher after the application than before the application. Walking speed (0.78 vs 0.88 m/s) and step length (0.42 m vs 0.45 m) were significantly higher after the application. The partial foot pressure as a percentage of body weight of the hallux (6.7% vs 9.0%) and lateral toes (6.5% vs 9.0%) was significantly higher after the application of heel lifts than before the application. The partial foot pressure as a percentage of body weight of the heel (68.9% vs 57.5%) was significantly lower after the application than before the application.InterpretationIn conclusion, heel lifts influenced the sagittal spinal alignment of elderly individuals. Walking speed and step length increased after the application of these devices. Increase in foot pressure in the hallux and lateral toe areas was probably related to these improvements in walking parameters.     

The effect of immediate decreasing of weight bearing asymmetry on quiet standing postural control in individuals with chronic stroke

The main patterns characterizing standing posture of hemiparetic patients include: weight-bearing asymmetry (WBA), larger postural sway, asymmetrical contribution of lower limbs to balance control, and increased visual dependency to balance control. The aim of this study was to evaluate the effect of decreasing WBA with the use of a shoe lift, on quiet standing postural control in patients with chronic stroke. Twenty-seven patients participated in this study. Patients completed two tests: 1) quiet standing; and 2) quiet standing while a lift was placed under the non-paretic limb. The following tests were completed on force plates for evaluation: asymmetry of the balance measures (weight bearing, root mean square (RMS) of anterior-posterior (AP) and medial-lateral (ML) center of pressure (COP) velocity), RMS of total AP and ML COP velocity, and AP and ML Romberg quotients. Paired t-tests were used to analyze the data. The mean value of WBA index decreased significantly after using a lift (p < 0.05). However, the changes of the mean value of other postural control parameters were not significant (p > 0.05). The results indicate that there may not be an association between decreased WBA and improved postural control during quiet standing in patients with stroke.     

Comparison of strength measurements under single-joint and multi-joint conditions in hemiparetic individuals

OBJECTIVE: It has been suggested that the measurement of strength is inappropriate in patients with stroke, in large part because of the presence of abnormal synergy patterns. The aim of the present study was to characterize force production during multi-joint maximal exertion involving different combinations of activation between shoulder and elbow flexors and extensors. DESIGN: Cross-sectional study. SETTING: Rehabilitation centre. SUBJECTS: A convenience sample of 16 chronic hemiparetic stroke subjects. MAIN OUTCOME MEASURES: Maximal torques in flexion and extension at the shoulder and the elbow were measured using static dynamometers (single-joint condition). In addition, the maximal forces produced at the wrist were measured in four directions in the sagittal plane requiring different torque combinations between shoulder and elbow flexors and extensors (multi-joint condition). RESULTS: No difference was found across directions for the ratios of maximal forces (paretic/nonparetic) in the multi-joint condition (p = 0.227; mean ratios (+/- SD) for each direction ranging from 0.59+/-0.23 to 0.68+/-0.27), suggesting that the ability to produce force did not change as a function of the required torque combination. In addition, relative torques (% of the maximal torque in the single-joint condition) exerted during the multi-joint exertions were similar on the paretic and the nonparetic side. CONCLUSIONS: These results do not support the assumption that force production is limited by abnormal synergy patterns between flexors and extensors at the shoulder and the elbow in hemiparetic patients.