运动再学习训练对脑卒中急性期偏瘫患者运动功能的康复作用

目的探讨运动再学习训练对脑卒中急性期偏瘫患者运动功能的康复作用。方法共64例脑卒中急性期(病程≤14 d)偏瘫患者随机接受脑卒中常规药物治疗和常规康复训练(对照组,32例)以及在此基础上联合运动再学习训练(观察组,32例),采用Fugl-Meyer平衡功能评价量表(FMA-Balance)、改良Rivermead移动指数(MRMI)和改良Barthel指数(m BI)评价训练前后运动功能。结果 64例患者均顺利完成康复训练,无一例发生严重不良事件,仅少数患者训练后偶有轻度疲劳感,休息后缓解。与训练前相比,训练后两组患者FMA-Balance评分(P=0.000)、MRMI评分(P=0.000)和m BI评分(P=0.000)增加;与对照组相比,训练后观察组患者FMA-Balance评分(P=0.031)、MRMI评分(P=0.013)和m BI评分(P=0.049)亦增加。结论脑卒中患者早期进行运动再学习训练有助于运动功能的康复。     

综合针法对卒中偏瘫患者运动功能的影响

目的探讨综合针法对卒中偏瘫患者运动功能的影响。方法将我院2010-01—2011-12收治的80例卒中偏瘫患者随机分为对照组和观察组,2组患者均采取体针作为基础性治疗,而观察组在基础治疗上增加头针与腹针综合治疗,而对照组不给予头针与腹针综合治疗,观察2组患者运动功能和临床疗效。结果治疗前2组FMA评分比较差异无统计学意义(t=0.2313,P>0.05);治疗后观察组FMA评分明显高于对照组,2组比较差异有统计学有意义(t=9.3022,P<0.05)。治疗前2组患者MBI评分比较差异无统计学意义(t=1.3121,P>0.05);治疗后观察组MBI评分明显高于对照组,2组比较差异有统计学意义(t=11.3012,P<0.05)。结论临床对于卒中偏瘫患者采取综合针法治疗具有较好的应用效果,能够有效改善运动功能,提高患者生活能力,值得临床应用与推广。     

早期康复治疗对卒中偏瘫患者运动功能和日常生活活动能力影响的临床研究

目的：探讨早期康复治疗对卒中患者运动功能和日常生活活动能力（ADL）的影响。方法：88例卒中偏瘫患者随机分为早期康复治疗组（43例）和对照组（45例），两组均进行常规药物治疗，康复组加以康复治疗；每例患者入组时和治疗第30天分别用Fugl-Meyer运动功能（FMA）量表评价运动功能和Barthcl指数（BI）评价ADL。结果：康复组和对照组治疗后BI评分和FMA评分均较治疗前显著增加，但康复组较对照组更为显著（P〈0．05）。结论：早期康复治疗可显著改善卒中偏瘫患者的运动功能和ADL。     

镜像疗法对偏瘫患者上肢功能康复疗效的观察

目的 观察镜像疗法对卒中后偏瘫患者上肢功能康复的疗效。方法 选择30例入选卒中后8周内偏瘫患者随机分为两组：镜像疗法组和对照组,分别于治疗前及治疗后4周采用Fugl-Meyer运动评价（Fugl-Meyer motor assessment,FMA）（上肢部分）,上肢运动研究测试（the action research arm test,ARAT）、运动功能评估量表（motor assessment scale,MAS）对上肢运动功能进行评分,同时评定患者的视觉模拟评分（visual analogue scale/score,VAS）、痉挛程度以及改良Barthel指数,以观察镜像疗法对偏瘫患者上肢功能康复的疗效。结果 治疗4周后,两组上肢运动能力FMA评分、ARAT评分、MAS评分、改良Barthel指数均较治疗前提高（P＜0.01）;治疗组FMA评分、ARAT评分高于对照组（P＜0.05）,两组间MAS评分、改良Barthel指数提高,但差别无统计学意义（P＞0.05）。治疗组VAS评分较治疗前有下降（P＜0.05）,但对照组治疗前后,VAS评分差异无统计学意义（P＞0.05）,治疗后两组间的VAS差异有统计学意义（P＜0.05）。两组治疗前后及治疗后组间痉挛改善差异无统计学意义（P＞0.05）。结论 镜像疗法能提高偏瘫患者的上肢运动功能,且能减轻患者偏瘫上肢的疼痛,但对患者日常生活活动能力（activity of daily living scale,ADL）及患肢痉挛程度的改善无明显影响。     

早期作业治疗对脑卒中偏瘫患者上肢功能与ADL的影响

目的 探讨早期作业治疗对脑卒中偏瘫患者3个月后上肢功能与日常生活活动能力的影响.方法 选择初发型脑卒中偏瘫患者64例,随机分为康复组和对照组,2组患者在年龄、性别、疾病分型、偏瘫侧、病程和简化Fugl-Meyer运动量表及Barthel指数等方面差异均无统计学意义.2组均接受神经内科常规药物治疗,康复组在药物治疗的同时,于患者病情不再进展,生命体征稳定后即开始早期介入正规作业治疗;对照组在给于药物治疗的同时,较康复组晚的介入正规作业治疗.2组患者分别于治疗开始时(初评时)、治疗后3个月进行Fugl-Meyer运动量表上肢功能评分和日常生活能力的Barthel指数评分.结果 2组患者上肢功能及Barthel指数评分,初评时差异无显著性(P>0.05),经3个月治疗后差异有显著性(P<0.05,P<0.01).结论 早期介入正规作业治疗对脑卒中偏瘫患者上肢功能与日常生活能力的恢复具有很好的促进作用.     

镜像训练引导的运动想象疗法对急性缺血性脑卒中偏瘫患者上肢功能的康复效果

目的:本研究旨在对镜像训练引导的运动想象疗法是否能够更有效地改善急性缺血性脑卒中后偏瘫患者的上肢功能以及日常生活能力进行评价。方法:研究对象为2014年1月1日—2016年6月30日符合病例选择标准的76例急性缺血性脑卒中后偏瘫患者。将76例患者随机分入镜像训练引导的运动想象疗法组(38例)和单纯的运动想象疗法组(38例),在常规康复训练的基础上,分别接受镜像训练引导的运动想象疗法和单纯的运动想象疗法,共治疗4周。对2组治疗前后的美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分、Barthel指数、上肢动作研究量表(Action Research Arm Test,ARAT)评分和Fugl-Meyer上肢运动功能评分进行比较。结果:2组患者治疗后的NIHSS评分、Barthel指数、ARAT评分和Fugl-Meyer上肢运动功能评分均较治疗前显著改善(P值均0.05)。镜像训练引导的运动想象疗法组治疗后的NIHSS评分、Barthel指数、ARAT评分和Fugl-Meyer上肢运动功能评分的改善幅度均显著大于单纯的运动想象疗法组(P值均0.05)。结论:镜像训练引导的运动想象疗法应用于急性缺血性脑卒中后偏瘫患者上肢功能的康复治疗,与单纯的运动想象疗法相比,可以更好地改善患者的上肢功能和生活自理能力。     

下肢康复机器人训练对脑卒中偏瘫患者下肢运动功能的康复作用

目的探讨下肢康复机器人训练对脑卒中偏瘫患者下肢运动功能的康复作用。方法共60例发病6个月的脑卒中偏瘫患者随机接受常规康复训练联合减重步行训练(BWSTT组,30例)或常规康复训练联合下肢康复机器人训练(Robot组,30例),分别于训练前和训练8周时采用Fugl-Meyer下肢评价量表(FMA-LE)评价下肢运动功能、Berg平衡量表(BBS)评价平衡功能、下肢康复机器人力矩反馈系统评价下肢肌力。结果与训练前相比,两组患者训练8周时FMA-LE(P=0.000)和BBS(P=0.000)评分、步态周期中患侧髋关节(P=0.000)和膝关节(P=0.000)反馈力矩值均增加;与BWSTT组相比,训练8周时Robot组仅步态周期中患侧髋关节(P=0.000)和膝关节(P=0.000)反馈力矩值增加。结论常规康复训练联合减重步行训练和下肢康复机器人训练均可以改善脑卒中偏瘫患者下肢运动功能,下肢康复机器人训练在提高下肢肌力方面优于减重步行训练。     

偏瘫治疗仪配合运动疗法在脑卒中患者肢体功能康复中的应用

1资料与方法1.1一般资料我院2011-02—2012-10收治的54例脑卒中患者均符合1995年第4届脑血管会议制定的诊断标准[1],经颅脑CT确诊脑出血或脑梗死。分为治疗组34例,对照组20例。治疗组男27例,女7例,平均年龄57.4岁;脑出血10例,脑梗死24例,发病至接受治疗平均时间27.4d。对照组男15例,女5例,平均年龄58.7岁;脑出血6例,脑梗死14例,发病至接受治疗平均时间25.6d。2组入院时在性别、年龄、病情、病程等方面比较差异均无统计学意义(P>     

早期康复治疗对急性脑卒中患者运动功能和生活能力的影响

目的探讨早期康复治疗对脑卒中患者运动功能和日常生活活动能力(ADL)的影响。方法将50例脑卒中偏瘫患者随机分成康复组(25例)和对照组(25例)进行临床对照研究,两组均进行常规神经内科药物治疗,康复组加以运动疗法,每例患者入组时、治疗第30d分别用Fugl-Meyer运动功能(FMA)量表测试运动功能和改良Barthel指数量表(MBI)测试ADL。结果MBI值:康复组治疗前、后分别为:20.68±8.98、72.36±17.39,对照组治疗前后分别为:21.24±12.59、51.29±18.52。FMA值:康复组治疗前、后分别为33.84±12.63、68.46±20.45,对照组治疗前、后分别为32.13±11.26、44.25±18.86。康复组和治疗组组间及组内比较差异具有显著统计学意义。结论康复治疗对偏瘫患者运动功能和日常生活活动能力具有良好的促进作用。可明显降低患者的依赖程度,提高其生活质量。     

急性脑卒中患者的早期中西医结合康复治疗

目的探讨3个月运动康复结合针灸治疗对急性脑卒中患者临床神经功能缺损程度(CNFD)以及日常生活能力(ADL)的影响。方法将105例急性脑卒中患者随机分为对照组、运动康复组、运动康复 针灸组,每组35例,进行3个月的康复治疗。治疗前后各进行一次临床神经功能缺损程度、日常生活能力评价。结果治疗前3组的临床神经功能缺损评分及日常生活能力评分差异均无统计学意义(P>0.05)。治疗后3组的临床神经功能缺损评分、日常生活能力评分均较治疗前差异有统计学意义(P<0.01),运动康复 针灸组的临床神经功能缺损评分最低、日常生活能力评分最高。结论3个月的运动康复结合针灸治疗能有效降低急性脑卒中患者的神经功能缺损程度,并促进日常生活活动能力的提高。     

穴位注射鼠神经生长因子结合运动疗法对外伤性截瘫患者运动功能恢复的影响

目的 观察穴位注射鼠神经生长因子结合运动疗法对外伤性截瘫患者运动功能及日常生活能力的影响.方法 按随机数字法将65例患者分为对照组和治疗组,对照组采用系列运动疗法,治疗组采用穴位注射神经生长因子及运动疗法.采用美国脊柱损伤协会（ASIA）运动评分评定截瘫患者功能障碍的程度及运动功能恢复的能力,采用改良Barthel指数评定日常生活活动能力.结果 治疗前2组ASIA运动评分及Barthel指数组间比较差异均无统计学意义（P＞0.05）,治疗3个月时2组ASIA运动评分及Barthel指数均有提高,但治疗组运动功能改善幅度明显优于对照组,差异有统计学意义（P〈0.05）.结论 穴位注射鼠神经生长因子结合运动疗法能显著改善外伤性截瘫患者的运动功能和日常生活活动能力.     

Motor relearning program and Bobath method improve motor function of the upper extremities in patients with stroke

BACKGROUND: In the natural evolution of cerebrovascular disease, unconscious use of affected extremity during drug treatment and daily life can improve the function of affected upper extremity partially, but it is very slow and also accompanied by the formation of abnormal mode. Therefore, functional training should be emphasized in recovering the motor function of extremity. OBJECTIVE: To observe the effects of combination of motor relearning program and Bobath method on motor function of upper extremity of patients with stroke. DESIGN: Comparison of therapeutic effects taking stroke patients as observation subjects. SETTING: Department of Neurology, General Hospital of Beijing Jingmei Group. PARTICIPANTS: Totally 120 stroke patients, including 60 males and 60 females, averaged （59±3） years, who hospitalized in the Department of Neurology, General Hospital of Beijing Jingmei Group between January 2005 and June 2006 were recruited. The involved patients met the following criteria: Stroke attack within 2 weeks; diagnosis criteria of cerebral hemorrhage or infarction made in the 4th National Cerebrovascular Disease Conference; confirmed by skull CT or MRI; Informed consents of therapeutic regimen were obtained. The patients were assigned into 2 groups according to their wills: rehabilitation group and control group, with 30 males and 30 females in each group. Patients in rehabilitation group averaged （59±2）years old, and those in the control group averaged （58±2）years old. METHODS: ① Patients in two groups received routine treatment in the Department of Neurology. When the vital signs of patients in the rehabilitation group were stable, individualized treatment was conducted by combined application of motor relearning program and Bobath method. Meanwhile, training of activity of daily living was performed according to the disease condition changes of patients at different phases, including the nursing and instruction of body posture, the maintenance of good extremity position, bed exercise, bedside sit up and sitting position balance, sit up exercise, dynamic and static balance exercise, walking exercise, active training and passive training. The strength, time and speed of training were increased gradually according to their physical abilities. Patients were trained 45 to 60 minutes once, 5 times a week, within 2 weeks. ② Evaluation criteria of therapeutic effect: The motor function of upper extremity was evaluated by Fugl-Meyer method on the day of beginning and end of treatment. Higher points indicated better function of upper extremity. ③ t test and paired t test were used for comparing the difference of intergroup and intragroup measurement data, respectively. MAIN OUTCOME MEASURES: Changes in Fugl-Meyer scoring of two groups before and after treatment. RESULTS: Totally 120 stroke patients participated in the final analysis. Before treatment, Fugl-Meyer scoring was close between rehabilitation group and control group [（14.47±2.38）,（14.16±2.39） points, P > 0.05]; Fugl-Meyer scoring of rehabilitation group after treatment was significantly higher than that before treatment and that of control group[（37.93±2.67）,（18.36±2.43） points, t =11.053, 5.408, P < 0.01]; There were no significant differences in Fugl-Meyer scoring between before treatment in the control group and control group (P > 0.05). CONCLUSION: Combined application of motor relearning program and Bobath method can significantly improve the motor function of upper extremity of patients with stroke.     

A one-year follow-up after modified constraint-induced movement therapy for chronic stroke patients with paretic arm: a prospective case series study

Abstract

Background:

Despite the confirmed short-term effects of constraint-induced movement therapy, the long-term effects have not been sufficiently verified in terms of functional improvement of the affected arm.

Objective:

To evaluate the long-term effects and relationship between arm use in activities of daily living and arm improvement with modified constraint-induced movement therapy in chronic stroke patients.

Methods:

At 1 year after completing modified constraint-induced movement therapy, arm function (Fugl-Meyer Assessment) and amount of daily arm use (motor activity log) were assessed.

Results:

Fourteen post-stroke patients with mild to moderate impairment of arm function were analyzed. One year after completing modified constraint-induced movement therapy, participants consistently showed improvements in arm function and amount of daily arm use (analysis of variance: Fugl-Meyer Assessment, P?<?0.001; Motor Activity Log, P?<?0.001). For the Fugl-Meyer Assessment, post-hoc tests detected significant improvements (pre versus post, P?=?0.009; pre versus 1 year, P?<?0.0001; post versus 1 year, P?<?0.036). For the Motor Activity Log, post-hoc tests also detected significant improvements (pre versus post, P?=?0.0001; pre versus 1 year, P?<?0.0001; post versus 1 year, P?=?0.0014). The magnitude of the change in Fugl-Meyer Assessment score correlated significantly with the change in Motor Activity Log score (R?=?0.778, P?=?0.001).

Conclusions:

Among post-stroke patients with mild to moderate impairments of arm function, modified constraint-induced movement therapy without any other rehabilitation after intervention may improve arm function and increase arm use for 1 year. In addition, increasing arm use may represent an important factor in improving arm function, and vice versa.     

Improved quality of life following constraint-induced movement therapy is associated with gains in arm use,but not motor improvement

Background. Constraint-induced movement therapy (CI therapy) is one of few treatments for upper extremity (UE) hemiparesis that has been shown to result in motor recovery and improved quality of life in chronic stroke. However, the extent to which treatment-induced improvements in motor function versus daily use of the more affected arm independently contribute to improved quality of life remains largely unexplored.

Objective. The objective of this study is to identify whether motor function or daily use of a hemiparetic arm has a greater influence on quality of life after CI therapy.

Methods. Two cohorts of participants with chronic stroke received either in-person CI therapy (n = 29) or video-game home-based CI therapy (n = 16). The two cohorts were combined and the motor-related outcomes (Wolf Motor Function Test, Action Research Arm Test, Motor Activity Log [MAL]) and quality of life (Stroke-Specific Quality of Life) were jointly modeled to assess the associations between outcomes.

Results. The only outcome associated with improved quality of life was the MAL. Improvements in quality of life were not restricted to motor domains, but generalized to psychosocial domains as well.

Conclusions. Results suggest that improved arm use during everyday activities is integral to maximizing quality of life gains during motor rehabilitation for chronic post-stroke UE hemiparesis. In contrast, gains in motor function were not associated with increases in quality of life. These findings further support the need to implement techniques into clinical practice that promote arm use during daily life if improving quality of life is a main goal of treatment.

ClinicalTrials.gov Registration Numbers: NCT01725919 and NCT03005457     

早期综合康复治疗对急性脑卒中患者运动功能的影响

目的:探讨早期康复治疗对急性脑卒中患者运动功能的影响。方法:将219例急性脑卒中患者随机分为康复治疗组和对照组。康复治疗组116例,对照组103例。两组患者均采用常规药物治疗,而康复治疗组在患者生命体征稳定24-48小时内采用神经肌肉促进技术、功能性电刺激、心理治疗等综合康复治疗措施,于治疗前及治疗3个月时采用Fugl-Meyer(Fugl-Meyer Assessment,FMA)评分评定患者的运动功能;用Barthel指数(Modified Barthel Index,MBI)评定患者的日常生活活动功能(ADL)。结果:康复治疗组患者的FMA评分及MBI评分均较对照组明显提高,其差异具有非常显著性意义(P<0.01)。结论:早期康复治疗可明显改善急性脑卒中患者的运动功能及日常生活活动能力。     

不同运动功能障碍对帕金森病患者日常生活活动能力的影响

目的探讨影响帕金森病(PD)患者日常生活活动(ADL)的运动症状。方法 93例PD患者接受了调查。采用PD统一评分量表第2、3、4部分,分别评估患者的ADL、运动功能障碍和运动并发症。将帕金森病综合评分量表(UPDRS)运动评分分为6部分:震颤、肌强直、动作缓慢、面部表情、语言表达和中轴(步态和姿势)损伤。采用逐步线性回归来评估患者ADL与各具体运动功能障碍之间的相关性。结果中轴损伤是PD患者UPDRS II评分最主要的预测因子,语言表达、动作缓慢和震颤也有一定的预测作用。4项因素相加能够解释72%的UPDRS II评分变化。结论 PD治疗过程中应重视患者的中轴运动损伤症状,加强康复治疗,以提高患者的ADL。     

神经发育疗法配合改进的运动再学习疗法对脑卒中后偏瘫患者功能恢复的影响

目的探讨神经发育疗法（NDT）配合改进的运动再学习疗法（MRP）对脑卒中后偏瘫患者功能恢复的影响。方法选择本院神经内科和康复医学科住院的脑卒中后偏瘫患者132例,随机分为观察组与对照组各66例,对照组采用NDT进行治疗;观察组在应用DNT治疗基础上加用MRP治疗。2组均于治疗前1周及治疗2个月后采用脑卒中病损评估量表（SIAS）和巴塞尔指数（BI）进行评定。结果2组患者治疗后的SIAS、BI评分均较治疗前有所提高,差异有统计学意义（P〈0.05）;观察组较对照组提高更为明显,2组差异有统计学意义（P〈0.05）。结论DNT配合改进的MRP能更有效地促进脑卒中后偏瘫患者的功能恢复。