Neck Proprioceptive Training for Balance Function in Patients with Chronic Poststroke Hemiparesis: A Case Series

[Purpose] This study investigated the effects of neck proprioceptive training on the balance of patients with chronic poststroke hemiparesis. [Subjects] Three patients with chronic stroke were recruited for this study. [Methods] The subjects underwent neck proprioceptive training using the red light of a laser pointer (30 min daily, five times per week for 4 weeks). Outcome measures included the stability and weight distribution indices measured with a Tetrax system and Timed Up and Go (TUG) and proprioception tests. [Results] For all subjects, the stability and weight distribution indices increased by 1.87–9.66% in the eyes-open and eyes-closed conditions, and the TUG and proprioception test scores improved by 2.49–15.27%. [Conclusion] Neck proprioceptive training may be a good option for improving the balance function of patients with chronic poststroke hemiparesis.Key words: Neck proprioceptive training, Balance, Stroke     

Analysis of the Applicability of an Ankle-Foot Orthosis during Gait in Poststroke Patients

[Purpose] The aim of this study was to develop and assess the applicability of an experimental ankle-foot orthosis during gait in patients with hemiparesis. [Subjects and Methods] This was a noncontrolled cross-sectional study. Ten adult patients with hemiparesis but who were capable of independent gait were included in the study. Gait assessment was performed using two platforms (EMG System do Brasil), an electromyograph (EMG System do Brasil), and a video camera. The experimental orthosis consisted of a single piece that fit over the foot and 1/3 of the distal tibia and had a steel spring. [Results] There was greater activation of the rectus femoris and vastus lateralis muscles in the stance and mid-stance phases with the use of the experimental ankle-foot orthosis in comparison with the use of a polypropylene ankle-foot orthosis and no orthosis. Regarding spatial and temporal gait parameters, the individuals achieved an increase in stride length with the use of the experimental ankle-foot orthosis in comparison with the use of a polypropylene ankle-foot orthosis. [Conclusion] The results of the present study demonstrate that individuals with hemiparesis achieved an improvement in the stance and mid-stance phases of gait with the use of the experimental ankle-foot orthosis.Key words: Orthosis, Hemiparesis, Gait     

神经干刺激疗法联合康复训练对脑卒中患者下肢运动功能的影响分析

目的:分析神经干刺激疗法联合康复训练对脑卒中患者下肢运动功能的影响。方法:将56例脑卒中恢复期患者随机分为2组,每组28例。2组患者均予以一般的内科药物治疗及康复训练,在此基础上,对照组采取常规针刺治疗,观察组采取神经干刺激疗法,比较2组患者治疗前及治疗4周后的Fugl-Meyer运动功能(FMA)下肢部分评分、Fugl-Meyer平衡功能评分(FBS)及改良Barthel指数(MBI)评分。结果:经过4周的治疗后,2组FMA下肢部分评分、FBS及MBI评分均较治疗前有显著提高(均P0.05),而观察组的各项指标的提高程度相对于对照组更明显(P0.05)。结论:神经干刺激疗法联合康复训练对脑卒中患者的下肢运动功能、平衡功能及日常生活活动能力(ADL)有显著改善效果,可提高患者的生活自理能力,改善生活质量,治疗价值显著,值得在临床上推广。     

New Approaches to Enhance Motor Function of the Upper Limb in Patients with Hemiparesis

A common finding in patients with hemiparesis due to stroke is that they may use altered movement strategies to perform functional arm and hand movements. Altered movement strategies may be considered compensatory if they substitute the movements that are impaired at the behavioural level and yet lead to the accomplishment of the task at the functional level. Motor compensation may be maladaptive in that it may limit recovery of pre-morbid movement patterns. Studies in patients with stroke suggest that, given optimal training strategies and environments, behavioural recovery (re-appearance of pre-morbid movement patterns) may occur even in patients with chronic hemiparesis. On the other hand, it has also been shown that non-guided therapy may lead to the reinforcement of compensatory movements. The challenge facing rehabilitation professionals is to create optimal training environments based on current notions of plasticity and re-organisation in the central nervous system to maximise behavioural and functional recovery.     

生物反馈联合神经松动术改善脑卒中恢复期患者手功能

目的:探讨表面肌电生物反馈(sEMGBF)疗法联合上肢神经松动术对脑卒中恢复期患者手功能的疗效。方法:脑卒中恢复期患者84例,随机分为对照组和治疗组各42例,2组患侧上肢给予常规康复治疗,治疗组另给予sEMGBF疗法和神经松动术。每天治疗1次,其中表面肌电生物反馈20 min/次,神经松动术15 min/次,每周治疗5 d,连续治疗6周;于治疗前、治疗6周后评估2组Fugl-Meyer上肢运动功能评分(U-FMA)、患侧腕关节主动背伸关节活动度(ROM)、患侧伸腕肌力(MMT评定法)及改良Bathel指数(MBI)评分。结果:治疗6周后,2组U-FMA评分、患侧腕关节主动ROM、伸腕肌力、MBI评分均较治疗前提高(P<0.05),且治疗组提高幅度大于对照组(P<0.05)。结论:肌电生物反馈联合神经松动术可改善脑卒中恢复期患者手功能,提高上肢运动功能及日常生活自理能力。     

Effects of Endurance Exercise on Mitochondrial Function in Mice

[Purpose] The purpose of this study was to investigate the effects of 8 weeks of endurance exercise on the cardiac mitochondrial function of mice. [Subjects] Ten 129 SvJ/C57BL6 Male mice were used. The mice were randomly divided into an exercise group (n=5; mean ± SD weight, 27.4 ± 1.6 g) and a control (n=5; mean ± SD weight, 28.2 ± 1.1 g). The exercise mice ran on a motor driven treadmill 5 days per week for 30 minutes at a speed of 24 m/min for 8 weeks. Mitochondrial function as measured RCI was compared between the exercise and control group mice using an independent t test. [Results] The exercise mice had a significantly greater state 4 respiration than to the sedentary control mice. There was also a significant difference in RCI between exercise and sedentary control mice. [Conclusion] Endurance exercise decreased RCI, indicating an uncoupling of respiration and oxidative phosphorylation.Key words: Cardiac hypertrophy, Endurance exercise, Treadmill     

Effects of Thoracic Mobilization and Manipulation on Function and Mental State in Chronic Lower Back Pain

[Purpose] The aim of this study was to evaluate the changes in function and mental state after thoracic mobilization and manipulation in patients with chronic lower back pain (LBP). [Subjects and Methods] Thirty-six subjects were randomly divided into mobilization group (group A), manipulation group (group B) and control group (group C). The Oswestry disability index (ODI) was used to measure the functional impairment of patients with LBP. A multiple spinal diagnosis was used to measure the range of motion (ROM) of vertebra segments. The Fear-avoidance beliefs questionnaire (FABQ) was used to investigate the mental state of LBP patients. [Results] Group A and group B were significantly different from group C in terms of the ODI. Between groups, there was no difference in ROM during trunk flexion. Group A and group B were also significantly different from the control group in extension ROM. The FABQ of group B was significantly different from that of group A. [Conclusion] Application of mobilization or manipulation to thoracic lumbar vertebrae has a positive effect on function, mental state, and ROM in patients with lower back pain.Key words: LBP, Mobilization, Manipulation     

运动想像对脑梗死偏瘫患者下肢功能恢复的影响

目的探讨运动想像结合运动再学习方法对脑梗死偏瘫患者下肢功能恢复的影响。方法将62例脑梗死偏瘫患者分为运动想像组（32 例）和对照组（30例）,两组患者均接受神经内科常规药物治疗和运动再学习治疗,运动想像组同时采用运动想像训练。治疗前、后采用Fugl-Meyer运动功能评分法（FMA）、改良Barthel指数（MBI）进行评定。结果治疗前后运动想像组FMA评定分别为（17.43±5.98）、（27.22±6.18）,对照组分别为（18.36±6.23）、（24.58±5.88）;运动想像组MBI分别为（48.86±8.78）、（75.96±9.48）,对照组分别为（47.98±6.65）、（67.52±9.54）。运动想像组患者FMA及MBI优于对照组（P<0.05）。结论运动想像结合运动再学习有利于提高脑梗死偏瘫患者下肢的综合能力。     

针刺配合神经促进技术对脑卒中患者下肢功能及日常生活活动能力的影响

目的探讨针刺配合神经促进技术对脑卒中患者下肢功能及日常生活活动能力（ADL）的影响。方法将120例脑卒中下肢瘫患者分为4组,每组30例：Ⅰ组应用针刺和促进技术治疗,Ⅱ组应用针刺治疗,Ⅲ组应用促进技术治疗,Ⅳ组应用单纯药物治疗。观察治疗前后各组功能性步行分级（FAC）,简式Fugl-Meyer评分（FMA）,改良Barthel指数（MBI）的变化。结果治疗10周后,各组指标均有明显变化。Ⅰ组明显优于其他3组（P〈0.01）,Ⅰ、Ⅱ、Ⅲ组明显优于Ⅳ组（P〈0.01）,Ⅱ、Ⅲ组之间比较无显著性差异（P〉0.05）。结论针刺配合神经促进技术能更有效地提高脑卒中患者下肢功能及日常生活活动能力。     

Effect of Different Walking Aids on Walking Capacity of Patients With Poststroke Hemiparesis

Allet L, Leemann B, Guyen E, Murphy L, Monnin D, Herrmann FR, Schnider A. Effect of different walking aids on walking capacity of patients with poststroke hemiparesis.

Objective

To examine the effects of 3 different walking aids on walking capacity, temporo-spatial gait parameters, and patient satisfaction.

Design

Observational study.

Setting

University Hospital of Geneva.

Participants

Hemiparetic inpatients (N=25) with impaired gait, at an early stage of rehabilitation, unfamiliar with any of the walking aids tested.

Interventions

On 3 consecutive days subjects used, in random order, 1 of 3 walking aids: 4-point cane, simple cane with ergonomic handgrip, and Nordic stick.

Main Outcome Measures

Maximal walking distance in 6 minutes, temporo-spatial gait parameters determined with a commercial electronic gait analysis system, and patients' preference on a subjective ranking scale.

Results

Walking distance was greatest with the simple cane with an ergonomic handgrip, followed by the 4-point cane and the Nordic walking stick. Walking velocity was highest with the simple cane, which was also indicated as the preferred walking aid by the patients. There was no significant difference in step length symmetry.

Conclusions

The simple cane with the ergonomic handgrip was not only preferred by patients, but was also the most efficient among 3 commonly used walking aids. It appears justified to take patients' subjective preference into account when prescribing a walking aid.     

吸气肌训练对脑卒中患者呼吸功能和下肢运动功能的影响

目的：探讨吸气肌训练应用于脑卒中患者康复治疗中的效果。方法：将84例脑卒中患者按随机数字表法分为观察组和对照组各42例,对照组接受脑血管病常规药物治疗和常规康复训练,观察组在此基础上予以吸气肌训练,疗程均为6周。比较2组治疗前后最大吸气压（MIP）、吸气峰值流速（PIF）和吸气肌能量（Energy）、用力肺活量（FVC）、第1秒用力呼气量（FEV1）和每分钟最大通气量（MVV）,比较2组Berg平衡量表（BBS）评分、Fugl-Meyer量表下肢部分（FMA-LE）评分、日常生活活动能力（ADL）评分,比较2组步幅、步频和步速。结果：治疗后观察组MIP、PIF、Energy、FVC、FEV1、MVV均高于对照组（P<0.01）,且高于本组治疗前（P<0.01）;对照组治疗前后MIP、PIF、Energy、FVC、FEV1、MVV差异无统计学意义。治疗后2组BBS、FMA-LE、ADL评分及步幅、步频和步速均显著增加（P<0.05,0.01）,观察组各项指标均高于对照组（P<0.01）。结论：吸气肌训练可改善脑卒中患者吸气肌力量、肺功能和下肢运动功能,提高日常生活活动能力,应用于脑卒中偏瘫患者的康复治疗效果显著。     

肌内效贴对不同恢复阶段脑卒中患者下肢功能的影响

观察肌内效贴对不同恢复期的脑卒中偏瘫患者下肢运动功能的临床疗效。     

Relationship between Lower Limb Muscle Structure and Function in Cerebral Palsy

[Purpose] The purpose of the study was to provide information for intervention by comparing lower limb muscle thickness, gross motor function and functional level of activity daily living between cerebral palsy (CP) and mental retardation (MR). [Subjects] Sixty subjects participated: 38 CP and 9 MR subjects and 13 normally developing infants. [Methods] Ultrasonography and a manual muscle tester were used for measuring the thickness and strength of knee extensor and ankle plantar flexor muscles. The Gross Motor Function Measure (GMFM) and Wee Functional Independence Measure (WeeFIM) were used to evaluate level of gross motor and independence level. [Results] Knee extensor thicknesses of CP and MR subjects were thinner than those of normally developing infants. Strengths of knee extensor and ankle plantar flexor showed differences being strongest in normally developing infants, followed by MR, and CP. Subjects in the examination of GMFM, there were no significant differences between CP and MR. A decline in social cognition of MR subjects was found in the examination of WeeFIM. [Conclusion] CP and MR subjects had smaller muscle thicknesses and strengths than those of normally developing infants, and lower gross motor function and functional independent level.Key words: Cerebral palsy, Mental retardation, Muscle thickness     

下肢智能康复机器人对脑卒中偏瘫患者下肢运动功能的影响

目的:观察下肢智能康复机器人训练对脑卒中偏瘫患者下肢运动功能、平衡功能及步行能力的影响。方法:将80例脑卒中偏瘫患者随机分成对照组和干预组,各40例。2组均采用常规康复治疗,干预组在此基础上加用下肢智能康复机器人训练。采用简式Fugl-Meyer评分法(FMA)、Berg平衡量表(BBS)、功能性步行分级(FAC)、10 m最大步行速度、改良Barthel指数(MBI)、胫骨前肌表面肌电积分(iEMG)进行结局指标评价。结果:治疗12周后,2组患者BBS、FMA、MBI和iEMG评分均较治疗前明显升高(P=0.000),治疗后干预组评分明显高于对照组(P=0.000)。治疗后干预组FAC步行功能分级3级及以上者所占比例、10 m最大步行速度均优于对照组。结论:下肢智能康复机器人结合常规康复训练能明显提高脑卒中偏瘫患者的下肢运动功能、平衡功能及步行能力。     

Effects of Visual Display Terminal Works on Cervical Movement Pattern in Patients with Neck Pain

[Purpose] This study examined changes in the onset of neck movement in young adults with and without mild neck pain (MNP) during visual display terminal (VDT) work. [Subjects] Ten control subjects and 10 subjects with MNP who were VDT workers were recruited. The upper (UC) and lower cervical (LC) spine angles in the sagittal plane were collected using an ultrasound-based motion analysis system during VDT work for 5 min. [Results] The MNP group had faster movement initiation in the UC and LC compared with the control group during VDT work. [Conclusion] These findings suggest that young adults with MNP should be cautious when performing VDT work while sitting.Key words: Movement onset time, Neck pain, VDT work     

多体位智能化下肢康复机器人对脑卒中患者下肢运动功能的影响

目的探讨多体位智能化下肢康复机器人对下肢运动功能、下肢肌张力以及步行能力的改善情况。方法 40例脑卒中偏瘫患者随机分成对照组和治疗组,各20例。对照组进行常规康复训练;治疗组在此基础上增加多体位智能化下肢康复机器人训练,每天20 min,共10周。采用Berg平衡量表(BBS)、简式Fugl-Meyer评分法(FMA)、改良Barthel指数(MBI)、功能性步行分级(FAC)、10 m最大步行速度、改良Ashworth评分量表(MAS)进行评价。结果两组患者BBS、FMA和MBI评分均较治疗前明显升高(P<0.01),治疗后治疗组评分明显高于对照组(P<0.01)。治疗组治疗后FAC步行功能分级3级及以上者、10 m最大步行速度均优于对照组,MAS评分明显低于对照组(P<0.01)。结论多体位智能化下肢康复机器人对患者下肢运动功能和平衡功能的提高有一定的作用。     

重复性下肢训练对脑梗死患者下肢功能改善的作用

目的：观察重复性训练对改善脑梗死偏瘫患者下肢肌痉挛的作用。方法：51例脑梗死偏瘫患者随机分为观察组25例及对照组26例,均采用平衡协调训练,体位转移及步行训练等常规康复治疗。观察组同时配合MOTOmed（类似踏车）智能训练系统进行重复性训练。2组治疗前后进行功能性步行量表（FAC）、下肢运动功能评定量表（Fugl-Meyer）及Ashworth痉挛分级法评定。结果：治疗6周后,2组患者的FAC及Fugl-Meyer评分均较治疗前明显提高,Ashworth评分明显下降（P〈0.05、0.01）,与对照组比较观察组表现更明显（P〈0.05）。结论：常规康复治疗配合重复性训练对脑梗死偏瘫患者下肢痉挛的改善和整体功能的恢复有更显著的效果。     

水中运动疗法联合电针对恢复期脑卒中患者下肢肌力和平衡功能的影响

目的:观察水中运动疗法对恢复期脑卒中下肢肌肉力量、痉挛程度及平衡功能的影响。方法:选取62例恢复期脑卒中患者,分为治疗组(水中运动疗法+常规康复治疗+电针治疗)、对照组(常规康复治疗+电针治疗),每组31例。治疗前及治疗6周后,分别采用等速肌力评定、改良Ashworth痉挛量表(MAS)、临床痉挛指数(CSI)、10m最大步行速度测定(MWS)、Berg平衡量表(BBS)对2组患者进行评定。结果:治疗后,2组患者下肢肌肉力量、MWS、BBS评分均较治疗前显著增加(均P0.05),MAS分级评分、临床痉挛指数CSI均较治疗前显著降低(P0.05);治疗后组间比较,观察组下肢肌肉力量、MWS、BBS评分均明显高于对照组(均P0.05),观察组MAS分级评分、CSI指数均低于对照组(均P0.05)。结论:水中运动疗法联合电针疗法可有效提高恢复期脑卒中患者下肢肌力,改善患者平衡功能。     

下肢骨折患者术后应用床上康复操的效果观察

目的探讨床上康复操对下肢骨折患者术后卧床期间肢体功能康复的效果。方法120例符合条件的下肢骨折患者,按入院先后顺序随机分为康复操组和对照组各60例。康复操组于骨折固定术后24h由责任护士指导并协助患者做床上康复操;对照组术后常规在肢体疼痛消失后进行康复训练,主要训练受伤局部肌肉和关节。两组患者于手术当日、术后1周、术后2周、术后1个月测量下肢膝关节活动度、膝屈伸肌力、股四头肌周径,观察有无并发症的发生以及患者术后下床时间。结果术后2周和术后1个月,康复操组膝关节活动度和膝屈伸肌力优于对照组（P〈0．01）,未发生肌肉萎缩等并发症,下床时间提前。结论床上康复操能够促进下肢骨折患者肢体功能康复,预防并发症发生。