综合治疗脑卒中后肩手综合征的疗效

Background:The patients after hemodialysis may be caused malnutrition for decreased nutrition intake, nutrition loss during the hemodialysis, consumption caused by the disease, metabolic disorder and endocrine disorder etc. Malnutrition may caused lowered immunological function, long terms of anemia and hypoproteinemia may cause malnutrition of the cardiac muscle, lower cardiac function and risk heart failure. Malnutrition may also harm appetite and cause the malnutrition worse. Malnutrition caused insufficient vigor in the patients and affect their daily living abilities directly. So to regulate the nutrition level scientifically is important for ameliorating nutrition condition of the patients and to increase their daily living abilities.     

综合康复疗法在脑卒中后肩手综合征治疗中的应用

[目的]探讨综合康复疗法对脑卒中后肩手综合征的治疗效果。[方法]将536例脑卒中后并发肩手综合征的病人分为试验组287例和对照组249例,试验组给予综合康复训练,对照组给予单一运动训练,观察两组治疗后1个月、3个月和6个月病人的FMA评分、Fenchary活动指数、Barthel指数和肌电图检查情况。[结果]试验组治疗6个月后FMA评分、Fenchary活动指数、Barthel指数和肌电图检查结果均优于对照组,差异有统计学意义(P0.05)。[结论]综合康复治疗可提高脑卒中后肩手综合征病人的上肢运动功能及神经功能。     

脑卒中后肩关节半脱位的康复治疗与护理

[目的]探讨康复治疗与护理对脑卒中病人肩关节半脱位的影响.[方法]60例脑卒中后肩关节半脱位病人,通过心理干预、良肢位摆放、悬吊固定、纠正肩胛骨位置、促进肩周稳定肌肌力和维持肩关节活动等措施进行康复治疗及护理,在治疗后进行肩关节半脱位的测定.[结果]60例脑卒中病人治疗后肩关节半脱位情况明显改善.[结论]恰当的康复治疗及护理措施能促进脑卒中后肩关节半脱位病人上肢功能的恢复.     

Systematic review of aetiology and treatment of post-stroke hand oedema and shoulder-hand syndrome

Studies on the aetiology and treatment of post-stroke hand oedema and shoulder-hand syndrome (SHS) published from January 1973 until August 1998 were identified. Eleven studies were included with at least some control for confounding. These were evaluated on 11 methodological criteria and by standardized effect sizes. There were five aetiological studies: four cohort studies and one study consisting of two case series using a within-subjects design. The matters investigated included lymph scintigraphy in hand oedema, bone scintigraphy, putative risk factors and the existence of autonomic dysregulation and peripheral nerve lesions in SHS. There were six therapeutic studies: one randomized controlled trial, one non-randomized controlled trial, one cohort study and three case series, of which two studies used a within-subjects design. These studies investigated continuous passive motion and neuromuscular stimulation in hand oedema as well as oral corticosteroids, intramuscular calcitonin and trauma prevention in SHS. A great diversity of pathophysiological and therapeutic insight was found. Based on systematic analysis of the literature, the following conclusions seem justified: (i) the shoulder is involved in only half of the cases with painful swelling of wrist and hand, suggesting a "wrist-hand syndrome" between simple hand oedema and SHS; (ii) hand oedema is not lymphoedema; (iii) SHS usually coincides with increased arterial blood flow; (iv) trauma causes aseptic joint inflammations in SHS; (v) no specific treatment has yet proven its advantage over other physical methods for reducing hand oedema; and (vi) oral corticosteroids are the most effective treatment for SHS.     

综合护理干预对脑卒中后抑郁患者的影响

目的探讨综合护理干预对脑卒中后抑郁（PSD）的影响。方法将66例PSD患者随机分为治疗组和对照组各33例,对照组进行常规抗抑郁治疗和护理,干预组在此基础上实施综合护理干预措施。两组干预前后进行汉密尔顿抑郁量表（HAMD）评分,改良Barthel指数（MBI）评分和护理效果比较。结果两组患者实施干预前HAMD、MBI评分差异无统计学意义（t=1．07,0．24;P〉0．05）。护理干预后1,2,3个月HAMD评分干预组分别为（21．7±3．3）,（18．6±3．7）,（13．2±3．5）分,均低于对照组评分（31．5±5．4）,（27．3±5．1）,（22．3±4．1）分,差异具有统计学意义（t=8．90,7．93,9．70;P〈0．01）;MBI干预前、干预后1个月两组比较差异无统计学意义（P〉0．05）;干预后2,3个月干预组分别为（51．3±14．7）,（67．3±15．6）分,均高于对照组评分（42．2±12．8）,（43．2±13．5）分,差异具有统计学意义（t=2．68,6．71;P〈0．01）。患者临床疗效干预组总有效率为78．78％,对照组为51．51％,差异有统计学意义（x2=5．405,P〈0．05）。结论综合护理干预措施可以减轻PSD患者症状,有利于治疗与护理方案的实施,恢复患者的生活自理能力。     

超声介导药物（祛湿止痛液）联合肌电生物反馈对卒中后肩痛患者的肩痛、肩关节运动功能改善效果

目的 观察超声介导药物（祛湿止痛液）联合肌电生物反馈对卒中后肩痛患者的肩痛、肩关节运动功能改善效果。方法 选择2019年1月至2020年1月我院收治的60例卒中后肩痛患者作为研究对象,按照入院号奇偶数字法将其随机分为对照组和观察组,各30例。对照组采用肌电生物反馈治疗,观察组在对照组治疗基础上联合超声介导药物（祛湿止痛液）治疗。比较两组的肩痛程度、肩关节活动度、上肢功能、生命质量及日常生活能力。结果 治疗前,两组的肩痛程度VAS评分无显著差异（P>0.05）;治疗后2、4、8周,观察组的肩痛程度VAS评分低于对照组（P<0.05）。治疗前,两组的肩关节前屈、外展、外旋活动度无显著差异（P>0.05）;治疗后,两组的肩关节前屈、外展、外旋活动度均较治疗前增大,且观察组大于对照组（P<0.05）。治疗前,两组患者的FMA、CMS、肩关节Neer评分、QOL-BREF及Barthel指数评分无显著差异（P>0.05）;治疗后,两组的FMA、CMS、肩关节Neer评分、QOL-BREF及Barthel指数评分均较治疗前升高,且观察组均高于对照组（P<0.05...     

Central post-stroke pain--neurological symptoms and pain characteristics

The intention of the present study was to characterize patients with central post-stroke pain (CPSP) with regard to type and location of the cerebrovascular lesion (CVL), the characteristics of the pain and the neurological symptoms and signs in addition to the pain. Twenty men and 7 women with a mean age of 67 years and a mean pain duration of 44 months were examined 9-188 (mean 53) months after their stroke. The clinical symptoms and signs and the CT scans indicated that the CVL were located in the lower brain-stem in 8 patients, involved the thalamus in 9 patients and were located lateral and superior to the thalamus in 6 patients. In the remaining 4 patients the location of the CVL could not be determined with certainty. The 3 identified hematomata were all located in the thalamus. The onset of the pain was immediate in 4 patients, within the first post-stroke months in 10 patients and delayed by 1-34 months in the rest. The pain was on the left side in 18 patients. Twenty patients had hemipain. Most patients experienced more than one type of pain. The most common qualities were burning, aching, pricking and lacerating, with some differences in the frequencies according to the location of the CVL. Burning pain was most common, except among the patients with thalamic CVL, in whom lacerating pain was more common. Aching and pricking pain were also frequent. All patients considered the pain to be a great burden and most rated the pain intensity as high on a visual analogue scale. The intensity was increased by external stimuli, the most common being joint movements, cold and light touch. Five patients reported aggravation by emotional stimuli. Besides pain, the only neurological symptom common to all patients was decreased temperature sensibility, as shown by quantitative methods. It is possible that pain sensibility was also abnormal in all. Hypersensitivities to cutaneous stimuli, including evoked dysesthesias were found in 88% of the patients, while the detection thresholds for touch and vibration were abnormal in only 52% and 41%, respectively. Similarly, low figures were found for paresis and ataxia, which were present in 48% and 62%, respectively. It is concluded that only a minority of patients with central pain after stroke have thalamic lesions.(ABSTRACT TRUNCATED AT 400 WORDS)     

颈肩肌劳损60例综合康复治疗体会

BACKGROUND:In treatment of muscle strain at neck and shoulder,dynamic balance disturbance must be dealed with and needle can detach adhesion,relax muscle,resume local blood circulation.Combined physiotherapy can improve local circulation and promote absortion of exudation.     

视频镜像疗法对卒中后肩痛的疗效观察

目的:观察视频镜像疗法对卒中后肩痛的疗效。方法:将符合纳入标准的40例患者随机分为对照组和镜像组各20例,进行为期4周,每周5d的康复训练。对照组患者仅接受常规康复训练,镜像组在常规康复训练基础上每天增加30min镜像训练。在治疗前以及治疗后4周对2组患者进行数字分级量表(NRS)评估肩关节在主动和被动运动下的疼痛程度;Fugl-Meyer运动功能评分上肢部分(FMA-UE)进行上肢运动功能评定;功能独立性评分(FIM)运动部分评估日常生活独立能力。结果:治疗4周后,2组NRS评分均较治疗前显著降低(均P<0.01),FMA-UE及FIM评分均较治疗前显著提高(均P<0.01);治疗4后,镜像组的主、被动NRS评分显著低于对照组(P<0.05),而镜像组的FMA-UE及FIM评分显著高于对照组(P<0.05)。结论:视频镜像疗法可显著改善卒中患者的肩痛、上肢运动功能以及日常生活独立能力。     

Kinematics of the contralateral and ipsilateral shoulder: a possible relationship with post-stroke shoulder pain.

OBJECTIVE: Post-stroke shoulder pain is a common phenomenon in hemiplegia and impedes rehabilitation. The aim of this study was to identify a possible relationship between post-stroke shoulder pain, scapula resting position and shoulder motion. METHODS: Shoulder kinematics of 27 patients after stroke (17 men) were compared with 10 healthy age-matched control subjects. Using an electromagnetic tracking device, the kinematics of both the contralateral and ipsilateral (i.e. paretic and non-paretic) arm during active and passive abduction and forward flexion were measured and expressed in Euler angles. RESULTS: Scapular lateral rotation relative to the thorax was increased in patients with post-stroke shoulder pain compared with both patients without post-stroke shoulder pain and control subjects at rest as well as during arm abduction and forward flexion. Additionally, glenohumeral elevation was decreased in patients with post-stroke shoulder pain during passive abduction. No differences were found regarding scapula position (displacement relative to the thorax). CONCLUSION: In patients with post-stroke shoulder pain a particular kinematical shoulder pattern was established, characterized by enhanced scapular lateral rotation and diminished glenohumeral mobility.     

Ultrasonographic measurement of shoulder subluxation in patients with post-stroke hemiplegia.

OBJECTIVE: To evaluate the ultrasonographic measurement of shoulder subluxation in patients with post-stroke hemiplegia. DESIGN: Prospective, single blind study. PATIENTS: A total of 41 patients with post-stroke hemiplegia were included (24 men and 17 women, mean age 56 years (standard deviation 11), age range 34-78 years). METHODS: Clinical evaluation of the affected shoulder was assessed using the Motricity Index scores and the Modified Ashworth Scale. Two ultrasonographic measurements were taken to check intra-rater reliability. The shoulder subluxation ratio was determined as the ratio of the radiographic vertical and horizontal distance, and the ultrasonographic lateral and anterior distances in the affected shoulder divided by that in the unaffected shoulder. RESULTS: Intraclass correlation coefficients of the repeated ultrasonographic lateral/anterior distance measurements in the unaffected and affected shoulders were 0.979/0.969 and 0.950/0.947, respectively. Ultrasonographic lateral/anterior distance ratios were negatively correlated with Motricity Index scores of the affected shoulder abduction (r = -0.490, p < 0.001/ r = -0.671, p < 0.001). Ultrasonographic anterior distance ratio was negatively correlated with Modified Ashworth Scale score of the affected shoulder (r = -0.374, p < 0.05). However, there was no correlation between radiographic distance ratios and clinical evaluation scores. CONCLUSION: We strongly recommend ultrasonography as a diagnostic tool to measure the degree of shoulder subluxation in patients with post-stroke hemiplegia.     

A critical review of shoulder subluxation and its association with other post-stroke complications

Abstract

Objectives: Shoulder subluxation affects up to 81% of patients with stroke and has been the subject of clinical research studies for decades. Despite this, its role in upper limb recovery is poorly understood. Subluxation has been linked to other post-stroke complications such as pain, restricted range of motion, poor motor recovery and reflex sympathetic dystrophy. The aim of the present study is to synthesise research findings on the association between subluxation and other post-stroke complications.

Methods: A critical review of the relevant literature was undertaken.

Results: The association between shoulder subluxation and post-stroke complications is equivocal. The majority of studies were found to have methodological limitations such as heterogeneous patient recruitment criteria, small sample sizes, lack of a standardised definition of subluxation and the use of varied and insensitive clinical measures of assessment.

Discussion: Although the association between subluxation and post-stroke complications is uncertain, when present in combination, these complications could have a significant impact on upper limb function. Early rehabilitation programmes which target shoulder muscle function may be the best approach to the prevention of secondary complications and the facilitation of motor recovery in the upper limb. Future longitudinal studies with more homogenous samples are needed. These should consider assessing patients at multiple times and follow them up for at least 1 year. The use of prediction models would allow understanding of a causal association between subluxation and other post-stroke complications. This would inform the effective rehabilitation of upper limb dysfunction in patients with stroke.     

Scapular-focused exercise treatment protocol for shoulder impingement symptoms: Three-dimensional scapular kinematics analysis

BackgroundThe present study aimed to describe the effects of a periscapular strengthening and neuromuscular training protocol in three-dimensional scapular kinematics and resting positioning in participants with shoulder impingement symptoms. Self-reported function was also evaluated.MethodThe study group comprised 50 subjects with shoulder impingement syndrome (control group, n = 25; treatment group, n = 25). The treatment group underwent 8 weeks of neuromuscular training and periscapular strengthening. Scapular kinematics was measured using an electromagnetic tracking device, and the Brazilian version of the Shoulder Pain and Disability Index (SPADI-Br) questionnaire was carried out before and after the treatment.FindingsIn the resting position, treated subjects had lower (p < 0.01) internal rotation of the scapula compared to the control group, with a large effect size (2.4). On the coronal plane, the treated group had less scapular upward rotation (p < 0.01) and less internal rotation (p < 0.05), with a medium effect size. On the sagittal plane, the treated group had less internal rotation (p < 0.01), less upward rotation (p < 0.05), and less scapular anterior tilt (p < 0.01), with a medium effect size. On the scapular plane, a reduction in upward rotation (p < 0.01) after the intervention was observed, with a large effect size. Moreover, a reduction in the total SPADI-Br score was found, with a mean difference of 32.4 [24.4; 40.4] points (p < 0.01) after the implementation of the protocol and a large effect size (2.0).InterpretationThe results provide biomechanical support for the clinical rationale for indicating therapeutic exercises focused on the periscapular muscles to improve scapular dynamics.     

改变流质性状联合吞咽治疗对脑卒中吞咽障碍患者进食安全影响及治疗作用

目的:观察改变流质性状联合吞咽治疗对脑卒中致吞咽障碍(饮水呛咳)患者的进食安全影响及治疗作用。方法:将80例脑卒中致饮水呛咳患者随机分为观察1组、观察2组、观察3组及对照组,每组20例。观察1组采用改变流质性状(增稠流质)治疗,观察2组采用吞咽治疗,观察3组采用改变流质性状(增稠流质)+吞咽治疗,对照组不改变流质性状、不行吞咽治疗。于治疗前、治疗1周、2周及4周(或治疗终点)时对各组患者行洼田饮水试验及才藤氏吞咽障碍分级评估,并对比各组患者的治愈率、肺部感染率、留置胃管率及治愈患者的治疗周期。结果:洼田饮水试验及才藤氏吞咽障碍评估显示:治疗2周、4周后,观察3组后一时间节点治愈率较前一时间节点有显著增加(P0.05),同时观察3组治愈率较对照组、观察1组及观察2组相同时间节点有显著增加(P0.05);治疗4周后观察2组与对照组比较治愈率显著提高(P0.05)。治疗4周后,3个观察组肺部感染及留置胃管率较治疗前及对照组治疗后显著下降(P0.05),观察2组、观察3组痊愈率高于观察1组(P0.05),观察2组与观察3组比较差异无统计学意义;观察3组治愈患者平均治疗天数较观察1组、观察2组治愈患者平均治疗天数均有显著下降(P0.05)。结论:改变流质性状、吞咽治疗、改变流质性状联合吞咽治疗对脑卒中致饮水呛咳患者安全进食流质食物均有一定帮助作用,但改变流质性状联合吞咽治疗对于早期改善患者饮水呛咳、减少误吸及肺部感染、保证患者安全进食流质食物有显著效果,并能明显改善患者的吞咽功能、缩短治疗周期。     

脑卒中后抑郁对康复疗效的影响

目的:通过对脑卒中后抑郁患者不同康复疗效的观察,分析其对日常生活活动能力、认知、社会功能的影响及其三者间的关系。方法:对2004-04/10上海市静安老年医院康复科住院的脑卒中患者132例进行汉密顿抑郁量表检测。62例脑卒中后抑郁患者,随机分为2组。实验组32例,观察组30例,实验组在常规康复治疗的基础上进行心理治疗和/或抗抑郁药物治疗,观察组只进行常规康复治疗,70例无脑卒中后抑郁患者为对照组。对所有入选患者在入院后1周内和治疗6周后进行功能独立性评定(总分126分为完全独立;108～125分为基本上独立;90～107分为极轻度依赖或有条件的独立;72～89分为轻度依赖;54～71分为中度依赖;36～53分为重度依赖;19～35分为极重度依赖;18分为完全依赖)、简易精神状态检查(文盲≥17分,小学≥20分,中学以上≥24分)和汉密顿抑郁量表(>8分为抑郁症状,>20分为轻中度抑郁,>35分为重度抑郁)评定。结果:132例患者全部进入结果分析。①治疗6周后功能独立性评定:观察组明显低于实验组和对照组犤64.97±17.0,78.11±20.41,82.82±22.01,(t=2.741～3.958,P<0.01～0.001)犦。②治疗6周后汉密顿抑郁量表评分:观察组均明显高于实验组和对照组犤15.87±5.23,12.20±4.15,8.99±3.81,(t=3.071～10.210,P<0.001～0.005)犦。③治疗6周。后简易精神状态检查量表评分:实验组和观察组明显低于对照组犤23.45±6.10,21.83±4.32,27.35±6.06,(t=2.910～10.210,P<0.005～0.001)犦,实验组和观察组治疗前后基本一致(t=1.042～1.558,P>0.05)。④直线相关分析:观察组治疗前后功能独立性评分与汉密顿抑郁量表评分呈明显负相关(治疗前r=-0.369,P<0.05;治疗后r=-0.376,P<0.05),实验组治疗前功能独立性评分与汉密顿抑郁量表评分呈明显负相关(r=-0.386,P<0.05)。实验组和观察组治疗前后简易精神状态检查与汉密顿抑郁量表评分均呈明显负相关(实验组治疗前r=-0.462,P<0.01,治疗后r=-0.361,P<0.05;观察组治疗前r=-0.459,治疗后r=-0.468,P<0.01)。结论:脑卒中后抑郁是影响认知功能康复的重要因素,其认知障碍可能为脑实质病损所引起,而不是抑郁所致,故实验组给予心理和药物治疗改善情绪都无助于提高认知功能。同时也提示对脑卒中抑郁患者的治疗,除了进行常规康复和抗抑郁治疗外,还应该注重对认知功能的改善。     

肩部矫形器在脑卒中后异常步态康复中的研究进展

脑卒中后偏瘫通常对人体运动能力和稳定性产生不利影响,患者常因肌无力、双侧肢体肌张力失衡、感觉异常、关节和姿势控制不良等出现肩关节半脱位、异常步态。肩部矫形器常用于脑卒中偏瘫的早期预防或治疗肩关节半脱位,但目前仍存在争议。为探索肩部矫形器除预防和治疗肩关节半脱位外的作用,为肩部矫形器的选择及佩戴提供理论依据,该文阐述了肩部矫形器可能改善脑卒中后异常步态的机制,分类对比不同类型肩部矫形器对脑卒中后异常步态的矫正效果。