残疾儿童综合功能评定法的研究：（二）正常值

目的 确定综合功能评定法的正常值。方法 由专科医生采用该量表,对60例2-7岁健康儿童进行测试。结果 4-7岁儿童综合功能评定分值≥90分,3岁≥80分,2岁≥60分。结论 综合功能评定法能全面,具体,客观地反映健康儿童综合功能发育的情况,可以此正常值做对照,在残疾儿童康复评定和判定疗效中应用。     

综合功能评定法（CFE）的研究：（三）信度研究（下）

本文报道了综合功能评定法的评定者间一致性的研究结果。两位评定者对同一组103例正常人分别进行了评定，将评定结果进行统计学处理，Kappa值为0．75，说明两位评定者的评定结果具有高度的一致性。证明该量表具有高度的评定者间一致性，信度可靠。     

综合功能评定法(Comprehensive Functional Evaluation,CFE)的研究:(一)设计(上)

康复医学是以恢复患者功能为中心的医学分支。因此,功能评定无论是在客观地评定患者的功能方面,还是在最终评定治疗结果和康复效率方面都是极为重要的。全面的功能评定包括躯体、精神、言语和社会四个方面。其中,言语、社会功能和认知功能中的思维方式,都具有强烈的民族文化色彩。因此,每个国家都应该有切合自己国情的功能评定方法。但由于我国康复医学发展较晚,至今尚无一套既切合国情,又全面、实用和可靠的功能评定方法。有鉴于此,我们在“中心”顾问室、神经康复科、脊髓损伤康复科、言语治疗科、心理科和老年病科的通力合作下,经过近2年的研究,在吸收国际先进经验的基础上,密切结合国情,设计了本文所述的综合功能评定法。其优点有：1．在饮食、起居等生活方式方面以及在言语、社会、思维等方面,均切合我国国情。2．评定结果采用群众熟悉的100分制,使医务人员、患者和患者家属均易于理解,便于交流和沟通。3．在言语、认知等功能的评定方面,直接由言语和心理学家选择一些简易的言语和心理学测试项目,提高了量表的准确性、全面性和可靠性。4．各项评定指标的量化程度高,在言语、认知和社会方面尤其如此,克服了一些量表中对此类项目的评定指标不够具体和不易掌握的不足。5.简便实用,一次检查对正常人仅需20分钟左右,对患者则无负担。6.本法已在128名正常人中应用,并求出了正常值,据此拟定了功能障碍严重程度的等级,可供参考和应用。7.信度经过检验,证明可靠。 综合功能评定法的正常值、功能障碍严重程度分级及信度研究结果,将陆续报道。     

四肢瘫功能指数（QIF）评定法介绍

本文介绍四肢瘫功能指数的评定内容,共10项;前9项主要是与日常生活有关的各项动作,包括转移、梳洗、洗澡、进食、穿脱衣服、轮椅活动、床上活动、膀胱功能、直肠功能,第10项是护理知识测验。总分为100分。该方法内容全面,得分比例合理,能够科学、有效、准确地反映出四肢瘫患者经过康复训练而取得的重要的功能改善的细微变化。     

综合功能评定法的研究：（一）设计（上）

康复医学是以恢复患者功能为中心的医学分支。因此，功能评定无论是在客观地评定患者的功能方面，还是在最终评定治疗结果和康复效率方面都是极为重要的。全面的功能评定包括躯体、精神、言语和社会四个方面。其中，言语、社会功能和认知功能中的思维方式，都具有强烈的民族文化色彩。因此，每个国家都应该有切合自己国情的功能评定方法。但由于我国康复医学限展较晚，至今尚无一套既切合国情，又全面，实用和可靠的功能评定方法。有     

老年运动功能障碍行综合康复治疗的效果观察

目的观察老年运动功能障碍患者行综合康复治疗的效果。方法综合康复治疗包括按摩、肢体被动运动、增强肌力训练、坐位和站位平衡及转移训练、步行和上下楼梯训练、日常生活活动能力训练等。采用康复护理日常生活活动能力评定量表及日常生活活动能力障碍程度评定,评价康复治疗效果。结果患者入院时康复护理日常生活活动能力总分(32.35±13.17)分,康复治疗2月时(55.46±12.18)分、4月时(71.64±38.25)分,治疗前后比较有统计学意义(P0.01);治疗前后日常生活活动能力障碍程度评定比较,x2CMH=168.73,P0.001。结论综合康复治疗可使老年运动功能障碍患者的残存功能得以最大程度发挥,提高其日常生活质量。     

阿尔茨海默症病人康复锻炼后的效果观察

[目的]探讨阿尔茨海默症病人康复锻炼的效果。[方法]选取60例阿尔茨海默症病人为对照组,未实施康复锻炼;选取60例阿尔茨海默症病人为观察组,实施康复锻炼。采用简易智能状态检查量表(MMSE)评定病人的精神状况,采用Barthel指数评定病人的日常生活能力,采用SF-36量表评定病人的生活质量,采用阿尔茨海默症评估量表认知分量表(ADAS-cog)评定病人的认知功能,采用功能独立性评价量表(FIM)评定病人的躯体功能,采用总体衰退量表(GDS)评定病人的痴呆程度,比较两组病人治疗前后各评定指标的改变情况、康复治疗效果。[结果]治疗后两组病人的精神状况总评分、生活质量总评分、日常生活能力评分、躯体功能评分均明显升高,而认知功能评分、痴呆程度评分均明显下降。治疗后观察组病人的精神状况总评分、生活质量总评分、日常生活能力评分、躯体功能评分均明显高于对照组,观察组病人的认知功能评分、痴呆程度评分均明显低于对照组,观察组病人总有效率(93.3%)明显高于对照组(63.3%),经比较差异均有统计学意义(P0.05)。[结论]康复锻炼可明显改善阿尔茨海默症病人的精神状况,显著改善病人的认知功能和躯体功能,显著提高病人的日常生活能力和生活质量,临床效果显著。     

本期继教园地思考题(1)

选择题１．颅脑损伤后运动功能障碍的康复评定的主要包括哪几项内容（）A．手、上下肢、躯干的运动功能B．综合运动功能的评定C．异常肌张力的评定D．共济失调障碍E．手足徐动障碍的评定２．目前国际上对偏瘫运动功能评定的方法包括（）A．Brunnstrom运动功能评定法B．上田敏评价法C．简化Fugl－Meyer评定法D．躯干控制的Sheikh评定法E．Rivermead运动指数评定３．坐的姿势与腰痛有密切的关系，平时生活中要保持正确的坐姿，坐在椅子上保持多少度倾斜（）A．９０～１００°B．１００～１１０°C．１１０～１２０°D．１２０～１３０…     

感觉运动训练在老年精神分裂症病人护理中的应用

目的:探讨感觉运动训练在老年精神分裂症病人护理中的应用效果。方法:选取2020年1月—8月我院精神科收治的老年精神分裂症病人60例作为研究对象，采用信封法将病人分为对照组（30例）和观察组（30例）。对照组采取常规的康复护理，观察组在常规康复护理基础上开展感觉运动训练。采用蒙特利尔认知量表（MoCA）、功能独立性评定量表（FIM）、世界卫生组织生存质量测定量表简表（WHOQOL-BREF）分别评价病人的认知功能、独立生活能力、生存质量。结果:干预后10周，观察组MoCA总分及各维度得分高于干预前及同期对照组（P<0.05）；观察组FIM总分及进食、梳洗修饰、洗澡、穿裤子、穿上衣、上厕所、膀胱管理、床或椅或轮椅间转移、入厕、盆浴或淋浴、步行/轮椅、上下楼梯、理解、表达、社会交往、解决问题、记忆维度得分高于干预前及同期对照组（P<0.05）；观察组WHOQOL-BREF中的生理领域、心理领域、社会关系领域维度得分高于干预前及同期对照组（P<0.05）。结论:对老年精神分裂症病人实施感觉运动训练，能够提升病人认知功能，提高病人独立生活能力和生存质量。     

两种骨科入院患者心态评估方法分析比较

目的 通过主观和量表评定法的分析和比较，使临床评估更具科学性、准确性。方法 对骨科2001年8－10月份新入院患者51例经主观评定法评估为焦虑、抑郁、正常的患者，同时采用量表评定法（SAS＋SDS）进行心理测验。结果 两种评估法差异显著。单纯为焦虑者仅为1．96％、抑郁者占31．38％，两者均有者占21．57％与主观评定法的符合率为10％。结果 对于骨科入院患者的特殊心态临床护理人员应将主观评定法与量表评定法综合起来进行心态的评估，提出不同的护理问题，辩证施护，因人施护，确保心理护理具有科学性。     

综合功能评定法（CFE）的研究：（三）信度研究（上）

本文报告综合功能评定法评定者内信度研究的初步结果。作者对同一组１０５例正常人间隔１个月进行两次评定,将评定结果进行统计学处理,Ｋａｐｐａ值为０．７９,ｕ＝７．９３８〉２．５６,Ｐ〈０．０１。证明两次评定的结果具有高度一致性。     

Contents of physical therapy,occupational therapy,and sports therapy sessions for patients with a spinal cord injury in three Dutch rehabilitation centres

Purpose.?To describe the contents of interventions to improve self-care and mobility for patients with spinal cord injury (SCI) in early post-acute rehabilitation, using the Spinal Cord Injury-Interventions Classification System (SCI-ICS), and to compare these interventions between rehabilitation centres. The SCI-ICS describes therapy to improve self-care and mobility at three levels of functioning and consists of 25 categories with a total of 139 different interventions.

Methods.?Fifty-three physical therapists, occupational therapists and sports therapists of three Dutch SCI rehabilitation centres recorded interventions with the SCI-ICS for patients with SCI in early post-acute rehabilitation for four consecutive weeks.

Results.?Therapists recorded 1640 treatment sessions of 48 patients with a SCI. The mean number of treatment sessions per patient per week (8.9 overall) differed between centres (p?<?0.05), unlike the mean therapy time in minutes per patient per week (259 overall). Highest frequencies for individual categories were found for ‘Muscle Power’, ‘Walking’, and ‘Hand rim wheelchair propulsion’.

Conclusions.?We described the specific contents of therapy of patients with a SCI in three Dutch rehabilitation centres. The largest proportion of time was spent on interventions to improve muscle power, walking, and hand rim wheelchair propulsion.     

Incontinence after brain injury: prevalence, outcome and multidisciplinary management on a neurological rehabilitation unit

OBJECTIVE: To investigate the prevalence, outcome and multidisciplinary management of incontinence in patients with acquired brain injury. DESIGN: Retrospective case notes review. SETTING: Regional neurological rehabilitation unit. SUBJECTS: Two hundred and thirty-eight patients with acquired brain injury. MAIN MEASURES: Bladder and bowel subscores of the Barthel Index and Functional Independence Measure; number of multidisciplinary goals addressing bladder and bowel function. RESULTS: Fifty per cent of patients (n=112) had impaired bladder or bowel subscores on admission. Significant improvement was seen at discharge but 36% of patients (n=77) still had some degree of impairment. Over 90% of patients were set multidisciplinary goals addressing self-care (n=213) and mobility (n=205) but only 3.5% (n=8) were set multidisciplinary goals addressing bladder and bowel function. CONCLUSIONS: Incontinence was common in patients with brain injury on a neurological rehabilitation unit. Significant improvement was seen following rehabilitation. Bladder and bowel management was not well incorporated into the multidisciplinary management process.     

The effect of an outdoor powered wheelchair on activity and participation in users with stroke

Purpose.Persons with disabilities after stroke are often restricted in activity and participation in society because of mobility limitations. An outdoor powered wheelchair may be one among other interventions in a rehabilitation programme. The aim of this study was to describe and compare activity limitations and participation restrictions in persons with stroke from their own perspective, before and after using an outdoor powered wheelchair.

Method. At baseline and follow-up two instruments were used: Individually Prioritized Problem Assessment (IPPA) and World Health Organization Disability Assessment Schedule II (WHODAS II).

Results. The results indicated that the powered wheelchair has a great positive effect on activity and participation assessed with IPPA. The results also showed that most of the participants' problems could be categorised as belonging to the domain of ‘Community, social and civic life’ according to the International Classification of Functioning, Disability and Health (ICF), and the effect size in this domain was large (2.4) after the participants had used the wheelchair.

Conclusion. An outdoor powered wheelchair is an essential device for persons with disability after stroke with regard to overcoming activity limitations and participation restrictions in everyday life.     

The Wheelchair Circuit: Construct validity and responsiveness of a test to assess manual wheelchair mobility in persons with spinal cord injury

OBJECTIVE: To assess the validity and responsiveness of the Wheelchair Circuit, a test to assess manual wheelchair mobility in persons with spinal cord injury (SCI). DESIGN: Longitudinal. Subjects performed the Wheelchair Circuit at the start (T1) and at the end (T3) of inpatient functional rehabilitation. Construct validity and responsiveness were assessed. SETTING: Eight rehabilitation centers in the Netherlands. PARTICIPANTS: Seventy-four subjects with SCI admitted for inpatient rehabilitation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Wheelchair Circuit consists of 8 wheelchair skills and results in 3 test scores: ability, performance time, and physical strain. The construct validity of the Wheelchair Circuit was assessed by testing whether the test scores were significantly related to the subjects' functional status, physical capacity, lesion level, motor completeness of the lesion, and age. To prove the test's responsiveness, it was assessed whether the test scores had significantly improved between T1 and T3. RESULTS: For construct validity, 4 of the 5 hypotheses were confirmed. For test responsiveness, all 3 test scores had significantly improved during rehabilitation, and the standardized response mean values ranged from 0.6 to 0.9. CONCLUSIONS: The Wheelchair Circuit is a valid and responsive instrument with which to measure manual wheelchair mobility in subjects with SCI.     

Dependence and perceived difficulty in activities of daily living in adults with cerebral palsy and spina bifida

Purpose : The purpose of this study was to identify differences between two groups of subjects: one with cerebral palsy, the other with spina bifida in their dependence and their perceived difficulty in performing daily activities according to the Functional Independence Measure (FIM) and the Instrumental Activity Measure (IAM), and to compare these findings with the reported use of assistance. Method : Community-living persons, 53 with cerebral palsy and 20 with spina bifida, aged 20 to 39 years, participated in semistructured interviews in their homes, where rating was performed using items from FIM and IAM. Results : Differences were found for the reported use of assistance and the dependence rated according to FIM and IAM. Significant differences for dependence were found between the CP and SB subjects concerning Eating, Bladder and Bowel items and for perceived difficulty concerning toileting, bladder and bowel. There was close overall agreement between dependence and perceived difficulty, except for the item walk/wheelchair. Conclusions : Subjects in both groups needed help in basic and instrumental ADL. The ability of spina bifida subjects was more influenced in toileting, bladder, bowel than the cerebral palsy subjects and tended also to be so in mobility instrumental tasks. FIM and IAM do not cover all aspects of significance in community-living adults. Further items have to be developed, covering personal care and occupational as well as leisure domains.     

A pilot study of functional access to public buildings and facilities for persons with impairments

Purpose: To compare functional access to public buildings and facilities for persons with and without impairments.

Method: This is a cross-sectional pilot study with a survey design. A four-member participant team representing three impairment types: mobility impaired person using a wheelchair, mobility impaired person who was not a wheelchair user, visually impaired person, and a control with no known impairments, challenged a stratified random sample of 30 public buildings in Greater Boston. Using a task oriented data collection instrument, functional access was determined in terms of percentage of tasks performed, time, distance, barriers and facilitators.

Results: Overall, task performance was high for the team. However, the wheelchair user reported a lower task performance (81%) in comparison to the control (100%) and persons with mobility and visual impairments (97?–?98%). There was little variation in mean values for time and distance to complete tasks. More barriers were reported by the persons with mobility impairments, wheelchair user and non-wheelchair user, and; highest facilitators by the person with visual impairment and the wheelchair user. The control reported the lowest barriers and facilitators. The types of barriers and facilitators varied for the three impairments and the control – structural for wheelchair and mobility impairments, wayfinding for visual impairment and interpersonal for control.

Conclusions: Task performance by itself may not be a good predictor of functional access. Barriers and facilitators are critical to understanding issues related to functional access for persons with impairments. Knowledge of how these differ for different impairments can be useful for improving environmental access and rehabilitation.     

A pilot study of functional access to public buildings and facilities for persons with impairments

Purpose: To compare functional access to public buildings and facilities for persons with and without impairments.

Method: This is a cross-sectional pilot study with a survey design. A four-member participant team representing three impairment types: mobility impaired person using a wheelchair, mobility impaired person who was not a wheelchair user, visually impaired person, and a control with no known impairments, challenged a stratified random sample of 30 public buildings in Greater Boston. Using a task oriented data collection instrument, functional access was determined in terms of percentage of tasks performed, time, distance, barriers and facilitators.

Results: Overall, task performance was high for the team. However, the wheelchair user reported a lower task performance (81%) in comparison to the control (100%) and persons with mobility and visual impairments (97 - 98%). There was little variation in mean values for time and distance to complete tasks. More barriers were reported by the persons with mobility impairments, wheelchair user and non-wheelchair user, and; highest facilitators by the person with visual impairment and the wheelchair user. The control reported the lowest barriers and facilitators. The types of barriers and facilitators varied for the three impairments and the control - structural for wheelchair and mobility impairments, wayfinding for visual impairment and interpersonal for control.

Conclusions: Task performance by itself may not be a good predictor of functional access. Barriers and facilitators are critical to understanding issues related to functional access for persons with impairments. Knowledge of how these differ for different impairments can be useful for improving environmental access and rehabilitation.     

Dependence and perceived difficulty in activities of daily living in adults with cerebral palsy and spina bifida

Purpose: The purpose of this study was to identify differences between two groups of subjects: one with cerebral palsy, the other with spina bifida in their dependence and their perceived difficulty in performing daily activities according to the Functional Independence Measure (FIM) and the Instrumental Activity Measure (IAM), and to compare these findings with the reported use of assistance. Method: Community-living persons, 53 with cerebral palsy and 20 with spina bifida, aged 20 to 39 years, participated in semistructured interviews in their homes, where rating was performed using items from FIM and IAM. Results: Differences were found for the reported use of assistance and the dependence rated according to FIM and IAM. Significant differences for dependence were found between the CP and SB subjects concerning Eating, Bladder and Bowel items and for perceived difficulty concerning toileting, bladder and bowel. There was close overall agreement between dependence and perceived difficulty, except for the item walk/wheelchair. Conclusions: Subjects in both groups needed help in basic and instrumental ADL. The ability of spina bifida subjects was more influenced in toileting, bladder, bowel than the cerebral palsy subjects and tended also to be so in mobility instrumental tasks. FIM and IAM do not cover all aspects of significance in community-living adults. Further items have to be developed, covering personal care and occupational as well as leisure domains.