日间康复训练对首发恢复期精神分裂症病人康复效果的评价

目的探讨日间康复训练对首发精神分裂症恢复期患者的康复效果。方法将100例首发精神病恢复期患者随机分为研究组和对照组各50例,对照组接受常规的维思通治疗,研究组在此基础上接受日间康复训练。采用总体幸福感量表（GWS）,临床总体印象量表（CGI）,个人与社会量表（PSP）对两组患者进行训练前后康复状态的评估。结果8周后研究组GWS、CGI、PSP评分明显优于对照组（P〈0.05）。结论日间康复训练能减轻首发精神分裂症患者病情的严重程度,提高患者的幸福度,改善生活质量,提高社交技能,降低社会功能缺损。     

Preoperative proprioceptive training in patients with total knee arthroplasty

Proprioceptive deficiencies due to osteoarthritis and arthroplasty have been repeatedly reported. Proprioceptive training, which leads to an economisation of movements and supports energy-saving movement patterns, has become popular in athletes, but not in rehabilitation yet. The aim of this randomised phase IIb study was to evaluate whether preoperative proprioceptive training would influence postoperative balance and function in activities of daily life in patients undergoing total knee arthroplasty. Subjects with severe osteoarthritis of the knee scheduled for TKA were randomised to either a control group (CG) or a training group (TG). All patients were examined 6 weeks before and 6 weeks after TKA, patients of the TG also one day before surgery, i.e. after six weeks of preoperative proprioceptive training, in order to evaluate the influence of training without TKA. Evaluation included balance assessment using the Biodex Stability System, as well as measurements of gait speed and clinical outcome using the WOMAC and Knee Society Score. As opposed to the CG, stance stability improved significantly in the TG (Biodex OSI (p = 0.045), APSI (p = 0.029)) 6 weeks after TKA. There was a significant improvement in KSS, WOMAC pain and stiffness in both groups after TKA. Preoperative proprioceptive training in patients undergoing TKA resulted in improved standing balance, but no difference in clinical outcome was observed between the two groups.     

联合声乐训练法的肺康复治疗在卒中后吞咽障碍中的应用

观察肺功能训练器结合声乐训练法的肺康复治疗对卒中后吞咽障碍的影响。方法 将2014年10月~2015年10月我院60例患者随机分为对照组和治疗组,每组30例,对照组给予常规吞咽功能训练和药物治疗,治疗组在对照组的基础上增加肺功能训练器治疗及声乐训练治疗,每组疗程为4周。治疗前后两组采用Rosenbek渗透-误吸分级量表和吞咽障碍评定标准进行评定并判断疗效。结果 治疗后, 治疗组较对照组吞咽功能有显著改善,两组间比较,差异有统计学意义（P＜0.05）;治疗组比对照组评级较低,且Ⅰ级人数比对照组多,差异有统计学意义（P＜0.05）;两组患者均较治疗前有显著改善,表现为等级分布均呈下降趋势,差异有统计学意义（P＜0.05）,且治疗组较对照组评级较低的人员多,Ⅰ级、Ⅱ级的人数占该组的46.67%,差异有统计学意义（P＜0.05）。结论 联合声乐训练法的的肺康复治疗可以改善脑卒中患者的呼吸功能、降低肺部感染率,提升其吞咽功能。     

全膝关节表面置换早期推拿的疗效评价

背景：研究推拿对类风湿性关节炎患者全膝关节表面置换后康复的疗效、探求推拿康复治疗的机制。 目的：观察类风湿性关节炎患者全膝关节表面置换后早期推拿综合康复的临床疗效,为优选康复方案提供参考。 方法：将66例接受全膝关节表面置换的类风湿性关节炎患者以1∶1的比例分为对照组和推拿组,每组33例,置换后对照组行持续被动运动训练,推拿组行持续被动运动结合推拿康复。通过HSS评分、SF-36健康问卷评分观察推拿综合康复方法对患者疗效的影响。 结果与结论：置换后3个月HSS评分组间比较：功能(P =0.020)、肌力(P =0.002)、稳定性(P =0.011)和总分(P=0.019),均显著提高,与治疗前比较差异均有显著性意义(P < 0.05)。置换后3个月SF-36评分组间比较：精神健康(P =0.003)、总体健康(P=0.008)评分均显著提高,与治疗前比较差异有显著性意义(P <0.05)。说明推拿早期干预可促进类风湿性关节炎患者全膝关节表面置换后的功能恢复、改善了置换后膝关节的肌力、增加了膝关节稳定性、提高了精神健康和总体健康水平。     

早期认知干预对脑损伤综合征患儿智能发育的影响

目的探讨早期认知干预对脑损伤综合征患儿智力发育的影响。方法将80例脑损伤综合征患儿分为观察组45例和对照组35例,观察组患儿接受包括早期认知干预治疗的综合康复治疗,而对照组患儿仅接受常规的康复训练治疗,两组患儿训练治疗和3个月后分别进行Gesell智力测试评估检查。结果观察组和对照组训练后与训练前比较智力各能区均有显著改善(P<0.01),训练后观察组患儿智力各能区改善优于对照组(P<0.05);观察组中2-6月组训练后智力等级的改善优于7-12月组(P<0.05),观察组中的智力正常及边缘水平组智力各能区提高的发育商差值优于智力落后组患儿(P<0.01)。结论早期认知干预训练可有效的提高脑损伤综合征患儿的智力各能区的发育水平,越早干预效果越好,不同智力发育水平患儿学习提高有差异。     

Biofeedback training versus simple instructions to reduce heart rate reactivity to a psychological stressor

The effectiveness of cardiac education and visual biofeedback of heart rate as a training procedure to teach people to control their heart rate to a psychological stressor was investigated with 36 students, half of whom acted as control subjects. Training took 5 weeks and consisted of 30-min per week of awareness training, plus exercises to increase and decrease heart rate under rest and stressful conditions, with monetary rewards for success. Effects were tested by pre-post test comparisons between the control and the experimental groups, and results indicated that the group which received training significantly lowered its heart rate reactivity even though not specifically instructed to do so. However, when instructed to control heart rate reactivity for a monetary reward, the control group also succeeded at this task, raising several issues regarding the efficacy of reactivity training.This research was supported by National Heart Foundation of Australia Grant E 11.     

下肢外骨骼康复机器人在膝关节活动受限康复治疗中的应用*

背景：下肢外骨骼康复机器人以持续主被动活动联合为理论基础,通过模拟人体运动,刺激机体的自然复原力,发挥组织代偿作用。 目的：动态观察并了解下肢外骨骼康复机器人在膝关节活动受限患者功能锻炼中的康复作用。 方法：将20例术后早期膝关节活动受限患者随机等分为实验组与对照组,实验组采用下肢外骨骼康复机器人行肢体功能锻炼,对照组采用被动训练装置CPM机行功能锻炼,治疗间隙2组均采用心理疏导、低频脉冲电疗和红外线等物理治疗。 结果与结论：治疗2个月后,实验组与对照组患者膝关节后屈、前伸活动度均较治疗前明显改善(P < 0.01),同时实验组股四头肌肌力较治疗前明显改善(P < 0.01)。2个月后的后续治疗,实验组患者膝关节后屈、前伸活动度有了进一步的改善(P < 0.05),对照组上述指标无明显改善。说明早期采用下肢外骨骼康复机器人或CPM机配合心理疏导、低频脉冲电疗和红外线等治疗均能明显提高膝关节活动受限患者膝关节活动度,同时下肢外骨骼康复机器人具有恢复患者股四头肌肌力的作用。     

Computer-assisted attention retraining in head-injured individuals: a controlled efficacy study of an outpatient program

The efficacy of a computer-assisted attention retraining program was evaluated with 29 outpatients suffering from moderate to severe traumatic brain injury. Ss who were at least 12 months postinjury were randomly assigned either to the attention training program or a memory training program that served as a control condition. Training lasted 9 weeks with two 2-hr sessions per week for both groups. The experimental design evaluated outcome by juxtaposing a multiple baseline procedure for a 1st set of measures of attention and memory with a pre and post group comparison that relied on a 2nd set of neuropsychological tests. The experimental group improved significantly in comparison with the control group on measures of attention. The reversed pattern for the memory measures was not observed. None of the treatment effects generalized to the 2nd set of dependent variables.     

调神益髓针刺法结合康复训练治疗脑卒中后 平衡功能障碍的临床分析

目的 探讨调神益髓针刺法结合康复训练治疗脑卒中后平衡功能障碍的临床疗效。方法 抽取2015年6月~2017年1月天津港口医院收治的80例脑卒中后平衡功能障碍患者进行观察,根据单双号分为观察组和对照组,每组40例。对照组患者仅接受康复训练治疗,观察组则采用调神益髓针刺法结合康复训练治疗,评价比较两组患者ADL评分、BBS评分及Fugl-Meyer评分情况。结果 治疗前两组ADL评分、BBS评分及Fugl-Meyer评分比较,差异无统计学意义（P＞0.05）。4个疗程后两组较治疗前均有显著改善,但观察组各项评分均高于对照组,差异有统计学意义（P＜0.05）。结论 采用调神益髓针刺法结合康复训练治疗脑卒中后平衡功能障碍患者,能够更有效地促进患者平衡功能的改善,同时还能够提高患者日常生活能力及改善下肢功能,值得推广。     

老年性痴呆康复训练对患者静脉血TGF-β1的影响

目的 探讨老年性痴呆行为康复训练效果与患者静脉血浆中转化生长因子β1(TGF-β1)水平的相关性.方法 将84例诊断为老年性痴呆的患者,随机分为康复组和对照组.康复组根椐认知功能减退MMSE评分、ADL水平、CMAI评定等综合评估结果参加不同康复训练小组,并对比一年康复训练前、后的血浆TGF-β1水平.结果 两组患者康复训练前MMSE评分、ADL Barthel指数评分和血浆TGF-β1水平比较差异无统计学意义(P＞0.05);康复训练后两组MMSE评分、ADL barthel指数评分和血浆TGF-β1水平差异均有统计学意义(P＜0.05).康复组康复训练前与对照组CMAI评定、血浆TGF-β1水平比较,差异无统计学意义(P＞0.05);康复训练后两组比较,差异有统计学意义(P＜0.01).康复训练后血浆中TGF-β1水平与MMSE评分、barthel指数均无明显相关性,但与CMAI呈强烈负相关(r=-0.903).结论 行为康复训练在延缓老年性痴呆患者的认知功能和自我照顾能力随龄减退的同时,可显著提高静脉血浆中TGF-β1的水平.静脉血浆中TGF-β1水平的测定,对老年性痴呆的诊断及对康复治疗效果的评价有积极的临床参考价值.     

The efficacy of problem solving therapy in reducing mental and physical health problems: a meta-analysis

This paper describes a meta-analysis of 31 studies that examined the efficacy of problem solving therapy (PST). The meta-analysis, encompassing 2895 participants, showed that PST is significantly more effective than no treatment (d=1.37), treatment as usual (d=0.54), and attention placebo (d=0.54), but not significantly more effective than other bona fide treatments offered as part of a study (d=0.22). Significant moderators included whether the PST included problem-orientation training, whether homework was assigned, and whether a developer of PST helped conduct the study.     

Rehabilitation training improves exercise tolerance after percutaneous coronary intervention

The aim of this present study was to investigate the effects of training on exercise tolerance of patients with coronary heart disease after percutaneous coronary intervention.Fifty-seven cases of coronary heart disease after percutaneous coronary intervention were divided randomly into the rehabilitation training group(26 cases) and control group(31 cases).Patients in the rehabilitation training group received rehabilitation training at different stages and exercise intensities 3 d after percutaneous coronary intervention for 3 months.The heart rate,blood pressure,ECG changes in treadmill exercise test,and the frequency of anginal episodes were observed.The results showed that NST and ΣST of ECG and the frequency of anginal episodes were significantly reduced in the rehabilitation training group.In addition,exercise tolerance was improved and the total exercise time was lengthened in these patients.Moreover,ST segment depression time and emergence time of angina with exercise were also lengthened compared with controls(P < 0.05,or 0.01).However,the heart rate and blood pressure before and after exercise of the two groups were similar.The study indicated that rehabilitation training could significantly relieve angina,amend ischemic features of ECG,and improve exercise tolerance of coronary heart disease patients after percutaneous coronary intervention.     

Control strategies for effective robot assisted gait rehabilitation: The state of art and future prospects

A large number of gait rehabilitation robots, together with a variety of control strategies, have been developed and evaluated during the last decade. Initially, control strategies applied to rehabilitation robots were adapted from those applied to traditional industrial robots. However, these strategies cannot optimise effectiveness of gait rehabilitation. As a result, researchers have been investigating control strategies tailored for the needs of rehabilitation. Among these control strategies, assisted-as-needed (AAN) control is one of the most popular research topics in this field. AAN training strategies have gained the theoretical and practical evidence based backup from motor learning principles and clinical studies. Various approaches to AAN training have been proposed and investigated by research groups all around the world. This article presents a review on control algorithms of gait rehabilitation robots to summarise related knowledge and investigate potential trends of development.There are existing review papers on control strategies of rehabilitation robots. The review by Marchal-Crespo and Reinkensmeyer (2009) had a broad cover of control strategies of all kinds of rehabilitation robots. Hussain et al. (2011) had specifically focused on treadmill gait training robots and covered a limited number of control implementations on them. This review article encompasses more detailed information on control strategies for robot assisted gait rehabilitation, but is not limited to treadmill based training. It also investigates the potential to further develop assist-as-needed gait training based on assessments of patients’ ability.In this paper, control strategies are generally divided into the trajectory tracking control and AAN control. The review covers these two basic categories, as well as other control algorithm and technologies derived from them, such as biofeedback control. Assessments on human gait ability are also included to investigate how to further develop implementations based on assist-as-needed concept. For the consideration of effectiveness, clinical studies on robotic gait rehabilitation are reviewed and analysed from the viewpoint of control algorithm.     

Multimodal patient education program with stress management for childhood and adolescent asthma

The present study aimed to evaluate a multimodal patient education program carried out during inpatient rehabilitation. The program included cognitive-behavioral stress management training as a main component. The efficacy was examined in comparison to an education program without stress management. In total N=68 patients aged between 8 and 16 years were included in the post-treatment and N=46 patients in the 6 months follow-up assessment. Short- and long-term intervention effects of the multimodal education program were observed in relation to patients' age. The experimental treatment elicited significant improvements in adaptive coping in adolescents aged from 14 to 16 years. In contrast, substantial effects were not yielded for the control treatment. The results suggest that the multimodal patient education training has beneficial effects on stress management in adolescents with asthma. Results are discussed with regard to predictive factors for rehabilitation outcome.     

A multi-joint lower-limb tracking-trajectory test for the assessment of motor coordination

This study aimed to determine whether a lower-limb trajectory-tracking task performed on a leg press machine, that is commonly adopted in both rehabilitation and resistance training settings, could yield reliable assessment of motor coordination in able-bodied individuals. Twenty-two female subjects allocated to two experimental groups were tested and retested after 48-72 h. Group A was fully familiarized with the experimental procedures before each test while group B received only verbal instructions. The unilateral coordination test consisted of target tracking during a simulated half squat including eccentric and concentric actions. In both groups, tracking error showed significant test-retest reliability with ICC values of 0.77-0.80 (p < 0.05). Significant group (A < B) and time (day 2 < day 1) main effects were found for tracking error, while there was no significant influence of action mode and dominance. Tracking error significantly decreased in the group A ( approximately 15%) but not in the group B on retest. Action mode (eccentric versus concentric), side dominance and familiarization on day 1 had no effect on tracking error. However, movement control significantly improved at day 2, thus confirming the occurrence of short-term motor learning and the sensitivity of the present trajectory-tracking test. For the first time, a simple test for the assessment of motor coordination during multi-joint closed-kinetic chain action of lower limb muscles has been proposed. Its uniqueness is represented by the specificity for rehabilitation and resistance training settings. Further studies with larger sample groups (e.g., male subjects and patients) and including neurophysiological measurements are needed.     

The benefits of cognitive training after a coronary artery bypass graft surgery

Cognitive deficits are frequent after coronary artery bypass graft surgery (CABG) in the elderly population. In fact, memory and attention deficits can persist several months after the surgery. Recent studies with healthy older adults have shown that memory and attention can be improved through cognitive training programs. The present study examined whether memory training (method of loci and story generation) and attentional training (dual-task computerized training) could improve cognitive functions in patients aged 65 years and older who underwent CABG surgery. Participants (n = 51) were assigned to one of three groups: (1) control group (tested at 1, 3 and 6 months after the surgery), (2) attention training followed by memory training, (3) memory training followed by attention training (groups 2 and 3: tested at 1, 2, 3 and 6 months after the surgery). The trainings took place between the 6th and 10th week following the surgery. The three groups were compared before and after each training program using attention and memory tests and neuropsychological tests. The results showed that attention and memory trainings lead to significant improvement in the cognitive domain that was trained. It thus seems that cognitive training can be a promising tool to enhance cognitive functions after a CABG surgery.     

D-amphetamine enhances skilled reaching after ischemic cortical lesions in rats

Unilateral sensorimotor cortical (SMC) lesions in rats impair reaching and grasping movements of the contralateral forelimb. These impairments can be improved using motor rehabilitative training on a skilled reaching task, but the training may be far from sufficient to return animals to pre-lesion levels of performance. Because D-amphetamine (AMPH) has been found to promote neuroplastic responses to injury and to be very beneficial when combined with some (but not all) types of rehabilitative training, we asked in this experiment whether it could improve the efficacy of rehabilitative training in skilled reaching. Ten to 14 days after unilateral ischemic (endothelin-1 induced) lesions of the SMC, adult rats were given a 3-week regimen of AMPH (1mg/kg) coupled with daily rehabilitative training on a skilled reaching task, the single pellet retrieval task. AMPH treatment not only dramatically improved reaching performance compared with saline-injected controls, the AMPH treated rats surpassed pre-lesion levels of performance by the end of the rehabilitative training period. The greater performance in AMPH compared to saline-treated rats was still evident at 1 month, but not at 2 and 3 months, after the end of rehabilitative training. Thus, AMPH treatment can greatly enhance the efficacy of rehabilitative training on a skilled reaching task after unilateral SMC lesions, but alternate injection and training regimes may be needed to produce permanent improvements.     

重心移动式截瘫步行矫形器对胸腰段脊髓损伤患者的疗效分析

目的　观察胸腰段完全性脊髓损伤患者应用重心移动式截瘫步行矫形器（AGO）后对步行能力、日常生活活动能力和生存质量的临床疗效。 方法　胸腰段完全性脊髓损伤患者60例,随机分为AGO组和对照组,各30例。所有患者均进行SCI常规康复训练和处理,AGO组在常规治疗的基础上,装配AGO及进行步行训练。两组分别在入院时、装配AGO前、装配AGO后8周进行步行能力评定、ADL评定和生存质量评定。 结果 经4个月的治疗前后,进行组间比较,AGO及训练后,均可借助肘拐或步行器步行,患者10 m步行时间平均87.27s,6 min步行距离平均46.35 m;ADL能力在装配后比较治疗组明显优于对照组（P<0.01）;生存质量评分中的生理和心理方面改善具有统计学意义（P<0.05）。 结论 AGO配合系统的康复治疗对改善胸腰完全性脊髓损伤患者日常生活活动能力、步行能力及生存质量有一定效果, 值得临床进一步应用。     

Effects of sustained cognitive activity on white matter microstructure and cognitive outcomes in healthy middle-aged adults: A systematic review

Adults who remain cognitively active may be protected from age-associated changes in white matter (WM) and cognitive decline. To determine if cognitive activity is a precursor for WM plasticity, the available literature was systematically searched for Region of Interest (ROI) and whole-brain studies assessing the efficacy of cognitive training (CT) on WM microstructure using Diffusion Tensor Imaging (DTI) in healthy adults (> 40 years). Seven studies were identified and included in this review. Results suggest there are beneficial effects to WM microstructure after CT in frontal and medial brain regions, with some studies showing improved performance in cognitive outcomes. Benefits of CT were shown to be protective against age-related WM microstructure decline by either maintaining or improving WM after training. These results have implications for determining the capacity for training-dependent WM plasticity in older adults and whether CT can be utilised to prevent age-associated cognitive decline. Additional studies with standardised training and imaging protocols are needed to confirm these outcomes.     

早期康复对脑卒中偏瘫合并心理障碍疗效观察

目的探讨综合康复治疗对脑卒中偏瘫合并心理障碍患者的临床价值。方法选择脑卒中导致偏瘫合并心理障碍患者112例,随机分为治疗组和对照组各56例,两组患者入院后均行神经内科常规治疗、肢体功能康复训练及低频电刺激治疗;治疗组在康复治疗的基础上再进行认知功能和心理治疗。在患者治疗前和治疗1个月时应用简式Fugl-Meyer运动功能积分(FMA)、简易精神状态检查(MMSE)、汉密尔顿抑郁量表(HAMD)进行评定。结果治疗1个月后,治疗组FMA和MMSE评分明显提高(t=-7.93,P0.01,t=2.98,P0.01),HAMD评分显著下降(t=-7.93,P0.01)。结论对于脑卒中偏瘫合并心理障碍的患者,在进行早期康复训练的同时,积极开展心理治疗,不仅有利于患者的认知功能和心理状态的改善,同时也能促进其肢体运动功能的恢复。