Evaluation of patient education in spinal cord injury rehabilitation: Knowledge,problem-solving and perceived importance

Purpose.?Through inpatient education programmes the person with spinal cord injury (SCI) learns to understand and monitor his or her own physical, emotional and social well-being. The purpose of this study was to determine the patients' knowledge and problem-solving skills regarding SCI at admission, discharge and follow-up at 6 months after discharge; and to determine the perceived importance of each content topic included in the education programme.

Methods.?A one-group repeated measures design was used to evaluate the outcomes. Knowledge was evaluated with a Multiple Choice Questionnaire (MCQ). Problem-solving ability based on participants' responses to Life Situation Scenarios relevant to each topic area was rated on a standardized four-point criterion reference scale. Perceived importance for each topic area was rated on a five-point Likert scale.

Results.?Twenty-three participants completed all assessments. There was significant improvement in MCQ scores from admission to discharge (P = 0.04) and admission to follow-up (P = 0.02). For problem-solving ability, there was a trend toward improvement in all content topics with significant improvement from admission to follow-up for the topic of bowel care (P = 0.004). However, many participants continued to demonstrate poor problem-solving ability. Bowel, Bladder and Skin Care were consistently perceived as the most important education topics.

Conclusions.?Improvements in knowledge do not necessarily translate to improvements in problem-solving ability even for the topics perceived as important. This may indicate the need to incorporate more active learning strategies or contextually based strategies within patient education programmes to facilitate the transfer of knowledge within life situations.     

康复健康教育对脊髓损伤患者康复治疗依从性的研究

目的探讨康复健康教育对脊髓损伤(SCI)患者康复治疗依从性的临床意义。方法 2012年1月至2013年12月该院收治的SCI患者62例,随机分为观察组与对照组,各31例。对照组予以常规治疗与康复护理,观察组在对照组的基础上实施个性化康复健康教育,比较2组患者康复治疗的依从性。结果观察组患者对SCI疾病的认知水平和康复治疗的依从性评分显著高于对照组,差异有统计学意义(P0.05),观察组患者并发症发生率显著低于对照组,差异有统计学意义(P0.05)。结论对SCI患者实施康复健康教育,有利于提高患者康复治疗的依从性,降低其并发症发生率。     

脊髓损伤患者康复期生存质量的研究

目的：测量脊髓损伤患者住院康复期的生存质量,以及康复治疗对脊髓损伤患者生存质量的影响,探讨改善脊髓损伤患者生存质量的干预方式。方法：91例符合入选标准的住院康复期的脊髓损伤患者,分为综合康复组和传统康复组;100例符合入选标准的骨关节疾患非脊髓损伤需要康复治疗的患者作为对照组。结果：脊髓损伤患者26—50岁占57.14%,损伤原因交通事故、高处坠落、重物砸伤占73.63%。比较生存质量总分及各领域得分,脊髓损伤患者明显低于骨关节疾患非脊髓损伤患者(P<0.05)。治疗前后比较,综合康复组和传统康复组生存质量总分、生理领域得分、环境领域得分均有所提高(P<0.05),但心理领域得分有所下降,社会领域得分差异无显著性意义。治疗前后生存质量总分、生理领域得分综合康复组比传统康复组提高更明显(P<0.05)。治疗后两组BI均有明显提高（P<0.01）,综合康复组比传统康复组改善更明显（P<0.05）。结论：脊髓损伤患者以青壮年为主,康复期脊髓损伤患者的生存质量比骨关节疾患非脊髓损伤人群低。现代康复治疗技术与传统中医相结合的综合康复治疗能更有效地提高康复期脊髓损伤患者的日常生活活动能力及生存质量。     

无骨折脱位型颈脊髓损伤的治疗和康复

目的探讨无骨折脱位型颈脊髓损伤手术治疗和保守治疗的临床疗效圾早期康复效果。方法48例男性患者分为手术组29例，行颈后路双开门椎管扩大成型术，并进行早期康复训练；保守治疗组19例，入院后即行康复训练。根据ASIA标准分别于治疗前和治疗后3个月、6个月、12个月对患者进行感觉和运动评分。结果两组在治疗后感觉及运动功能较治疗前提高（P〈0．05）；但手术组疗效明显优于保守治疗组（P〈0．01）。结论无骨折脱位型颈脊髓损伤患者早期施行减压及稳定手术可取得比保守治疗更好的康复效果。     

中央型颈段脊髓损伤的康复治疗

目的观察康复治疗对中央型颈段脊髓损伤患者的功能的影响。方法对7例中央型颈段脊髓损伤的患者进行6周针对性的康复治疗,治疗前、后采用Barthel指数法对患者的日常生活活动(ADL)能力进行评定。结果治疗后7例患者的ADL评分均明显高于康复治疗前(P<0.01)。结论本组患者评估结果提示,针对中央型颈段脊髓损伤所致功能障碍的特点,采取相应的康复治疗和训练有助于提高患者日常生活活动能力。     

早期康复对脊髓损伤患者步行功能恢复的临床观察

目的探讨早期康复对脊髓损伤患者步行能力的影响及运动和感觉功能与步行能力之间的相关性。方法对 47例脊髓损伤患者给予综合康复治疗 ,在入院时和治疗过程中根据美国脊髓损伤学会 (ASIA) 1992年的标准评定患者的运动与感觉功能 ,采用Hoffer步行能力分级评定步行能力。结果伤后 12个月时患者的运动功能和感觉功能比入院时显著增加 (P <0 0 5 ) ,入院时的运动功能与患者最终获得的步行能力相关 (P <0 0 5 )。结论早期康复能改善脊髓损伤患者的运动功能和感觉功能 ,入院时的运动功能与患者最终获得的步行能力相关     

应用ASIA标准等评价脊髓锐器伤早期康复疗效

目的 对脊髓锐器伤的早期康复疗效进行初步分析。方法 对1992~2004年40例脊髓锐器伤患者和50例脊髓挫裂伤患者的临床资料进行回顾性分析,采用ASIA标准(2000年修订)评价脊髓神经功能,FIM评分评价脊髓损伤患者日常生活活动(ADL)能力。结果 经过综合治疗,脊髓锐器伤患者出院时的ASIA评分和 ADL评分均较入院时提高,且提高的幅度明显大于脊髓挫裂伤( P <0.05~0.01)。结论 脊髓锐器伤应采取综合康复方法,其预后优于脊髓挫裂伤。     

Establishing a super-link system: spinal cord injury rehabilitation nursing

AIM: This paper reports a study to identify the needs of clients with spinal cord injury and their family/carers during rehabilitation, and the strategies used by rehabilitation nurses to meet those needs. BACKGROUND: In Taiwan, spinal cord injury is a major problem with financial implications for the state and major bio-psycho-social and spiritual implications for the individual. Rehabilitation nurses do not have an appropriate nursing theory to guide their care. METHODS: Using a grounded theory approach, data were collected from October 2002 to March 2003 in a rehabilitation hospital in Taiwan by means of interviews, participant observations and documentary resources; analysis was an interrelated process. A total of 39 interviews was carried out with 31 individuals, including eight rehabilitation nurses, one nurse supervisor, seven clients with tetraplegia, eight with paraplegia and seven family/carers. There were 18 participant observations. Data were analysed using a multi-step analytic procedure, based on the works of Glaser, Charmaz, and Strauss and Corbin. FINDINGS: The core category, 'establishing a super-link system', explained the complex structure of interactions observed during the investigation and the importance of developing a middle-range theory entitled the 'Super-Link System Theory'. This theory includes the following four links: 'linking to client', 'linking to family/carer', 'linking to interdisciplinary rehabilitation team' and 'linking to community'. CONCLUSION: This Super-Link System Theory will help rehabilitation nurses to organize their thinking about spinal cord injury rehabilitation nursing, to transfer their thinking into practice by making links effective, and to promote their professional position in the interdisciplinary rehabilitation team.     

Effect of rehabilitation treatment during different pe-riod on recovery of patients with spinal cord injury

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Outcomes of nurse caring as perceived by individuals with spinal cord injury during rehabilitation.

A study was undertaken to describe the meaning, process, and consequences of nurse caring from the perspective of persons with spinal cord injuries (SCI) during rehabilitation. The constant comparative method, or grounded theory, was used in this prospective, exploratory project. In-depth tape-recorded interviews were conducted with 22 participants throughout their initial rehabilitation stay. A process of knowledge acquisition and decision making, facilitated by nurses and therapists in special caring relationships with the persons with SCI, resulted in outcomes of well-being, self-care, autonomy in decision making, independence, and hope, all of which contributed to the persons with SCI's reintegration of self before their discharge from inpatient rehabilitation.     

康复护理在颈脊髓损伤伴有呼吸功能障碍患者中的干预效果

目的研究康复护理在颈脊髓损伤伴有呼吸功能障碍患者中的干预效果。方法选取2016年10月至2018年10月我院收治的52例颈脊髓损伤伴呼吸功能障碍患者作为研究对象,随机分为对照组(26例,常规护理干预)和观察组(26例,常规护理干预+康复护理干预)。比较两组患者的护理效果。结果观察组患者的训练依从率显著高于对照组(P<0.05)。护理后,两组患者的FVC、FEV1、MVV水平、SCIM-Ⅲ评分、生活质量评分明显升高,且观察组显著高于对照组(P<0.05)。结论康复护理干预应用于颈脊髓损伤伴有呼吸功能障碍患者中可有效改善患者依从性和肺功能指标,促进患者呼吸功能和脊髓功能的恢复,提高患者生活质量水平,值得临床推广应用。     

电针结合耳针治疗急性脊髓损伤的临床研究

目的评估电针结合耳针治疗急性脊髓损伤的疗效和安全性。方法我院1999年1月～2004年5月期间急性脊髓损伤美国脊髓损伤学会（ASIA）损伤分级A级和B级患者56例，随机分为针灸治疗组和对照组。针灸治疗组采用双侧后溪和申脉点电针，与脊髓相关耳穴的耳针，同时配合康复治疗。对照组仅仅采用康复治疗。分别记录入院时、出院时及出院后1年ASIA损伤分级及ASIA神经（运动、感觉）功能状况评分、独立性功能评定（FIM）及不良反应。结果在神经（感觉和运动）功能和FIM评分方面针灸治疗组优于对照组（P〈0．05），无明显不良反应。结论早期采用电针结合耳针治疗急性脊髓损伤有较好的疗效和安全性。     

脊髓损伤病人的康复护理

从心理护理、制定康复护理目标、饮食指导、体位护理、膀胱功能训练、并发症的预防和护理、肢体功能训练、康复教育等8个方面介绍了脊髓损伤病人的康复护理。     

脊髓损伤病人的康复护理

从心理护理、制定康复护理目标、饮食指导、体位护理、膀胱功能训练、并发症的预防和护理、肢体功能训练、康复教育等8个方面介绍了脊髓损伤病人的康复护理。     

康复护理对脊柱骨折伴脊髓损伤患者日常生活能力及住院时间的影响

目的分析康复护理对脊柱骨折伴脊髓损伤患者日常生活能力及住院时间的影响。方法将我院2018年1月至2019年12月收治的80例脊柱骨折伴脊髓损伤患者按照护理方案的不同分为对照组(n=40)与试验组(n=40)。对照组给予常规护理干预,试验组在常规护理干预的基础上行康复护理。比较两组干预前、后的日常活动能力、运动功能改善情况、疼痛程度、生活质量及康复效果、护理满意度。结果干预后,试验组ODI、VAS评分低于对照组,Fugl-Meyer、SF-36评分高于对照组(P<0.05)。试验组的住院时间、骨折愈合时间、脊髓损伤恢复时间均明显短于对照组(P<0.05)。试验组护理满意度为95.00%,明显高于对照组的80.00%(P<0.05)。结论给予脊柱骨折伴脊髓损伤患者康复护理,能够增强患者的日常生活能力,缩短住院时间,值得临床推广。     

综合康复治疗对脊髓损伤患者运动功能及日常生活能力的影响

目的探讨综合康复治疗对脊髓损伤后运动功能恢复的影响。方法采用中药、针灸、按摩、脉冲电场刺激和PT、OT康复训练等综合治疗方法对58例脊髓损伤患者进行康复治疗,以FIM功能独立测量方法进行治疗前后的功能评定。结果58例脊髓损伤患者的运动功能ADL能力方面在治疗后得到显著改善,与治疗前相比,差异有非常显著性(P<0.005)。结论脊髓损伤患者进行综合康复治疗能明显地改善运动功能,提高日常生活能力。     

撑开支具在胸腰段脊髓损伤患者早期康复中作用的影像学评价

目的:评价胸腰椎撑开支具在胸腰段脊髓损伤患者早期康复中的影像学表现。方法:自行研制胸腰椎撑开支具,25例患者均为胸腰段脊柱脊髓损伤术后第3-4周,分别在卧位无支具、卧位戴撑开支具和立位戴撑开支具等三种状态下拍摄胸腰椎正侧位CR片,分别测量损伤椎体的上一正常椎体前(后)下缘至上一正常椎体前(后)下缘的高度。结果:三种不同状态下损伤椎体的前缘高度分别是118.257±13.524mm、121.414±12.879mm、119.237±12.527mm,三者之间差异有显著性意义(P0.01)。卧位戴撑开支具与卧位无支具、立位戴撑开支具相比差异均有显著性意义(P0.01);卧位无支具与立位戴撑开支具相比差异无显著性意义(P0.05)。三种状态损伤椎体的后缘高度差异无显著性意义(P0.05)。结论:自行研制的胸腰椎撑开支具,能有效地与后路内固定器协同发挥减少自身体重对受损椎体的压力,增强受损脊柱的稳定性,保证早期康复训练的安全性。     

康复训练对脊髓损伤大鼠外源性移植的骨髓源性神经干细胞的影响

目的:研究康复训练对移植到脊髓损伤大鼠体内的骨髓源性神经干细胞的存活、迁移、分化以及大鼠功能恢复的影响.方法:制作40只T10脊髓损伤动物模型,随机分成4组,分别为移植组(Y组)、康复训练组(K组)和康复训练联合细胞移植组(L组)、对照组(C组),在脊髓损伤后第7天将培养并标记好的骨髓源性神经干细胞移植到Y、L组中.分别在脊髓损伤后1、3、7 d及2、3、4、5、6周对所有动物进行BBB评分.免疫荧光染色观察移植的细胞在脊髓内的迁移、分化的情况.结果:BBB评分显示.细胞移植2周后,L组评分明显高于其他各组(P<0.01).免疫荧光染色显示,L组动物的神经干细胞存活率较Y组好.分化为神经元的比例更高.结论:康复训练能够促进移植的神经干细胞在脊髓中的存活并能促进其分化.有益于脊髓损伤大鼠后肢功能的恢复.