Rehabilitation implications of non-traumatic subarachnoid haemorrhage

Objective: Subarachnoid haemorrhage (SAH) remains an important cause of stroke in the rehabilitation population, whose incidence has not been changed by pre-morbid medical treatment. The understanding of the pathophysiological changes that occur after SAH has been more clearly defined, therefore the treatment and outcomes of these patients have undergone drastic changes over the past few years. The purpose of this review is to update and familiarize the rehabilitation professional on the state of the art treatment and common complications associated with this disease and how this may affect the rehabilitation programme. Also, the current literature on the outcomes of these patients will be reviewed to help advise the rehabilitation professional on potential predictors.

Data sources: Literature review.

Study selection: Articles of relevance to the current management of SAH.

Data extraction: Information that was deemed significant in the understanding of the pathophysiology, treatment and results of outcomes in patients with SAH.

Data synthesis: Subarachnoid haemorrhage (SAH) is the one sub-type of stroke whose incidence has not declined. Due to advances in medical care, mortality rate is on the decline. Outcomes data was analysed to look for common predictors for this patient population.

Conclusions: While the incidence of SAH has not declined, improving medical treatment has reduced mortality. The rehabilitation professional should be familiar with the latest advances, potential complications and likely outcomes in order to plan the most appropriate therapy course for these patients.     

Penile rehabilitation following prostate cancer treatment: review of current literature

Radical prostatectomy (RP) and radiotherapy (RT) are highly effective in improving prostate cancer survival. However, both have a detrimental effect on erectile function (EF). Penile rehabilitation consists of understanding the mechanisms that cause erectile dysfunction (ED) and utilizing pharmacologic agents, devices or interventions to promote male sexual function. For the past decade, many researchers have pursued to define effective treatment modalities to improve ED after prostate cancer treatment. Despite the understanding of the mechanisms and well-established rationale for postprostate treatment penile rehabilitation, there is still no consensus regarding effective rehabilitation programs. This article reviews a contemporary series of trials that assess penile rehabilitation and explore treatment modalities that might play a role in the future. Published data and trials related to penile rehabilitation after RP and RT were reviewed and presented. Although recent trials have shown that most therapies are well-tolerated and aid in some degree on EF recovery, we currently do not have tangible evidence to recommend an irrefutable penile rehabilitation algorithm. However, advancements in research and technology will ultimately create and refine management options for penile rehabilitation.     

Costs of Treatment of hip Fractures: A Calculation of the Consumption of the Resources of Hospitals and Rehabilitation Institutions

A series of 518 patients with hip fractures and a median age of 78 years was followed for 6 months. on admission to hospital the patients were assessed and were found to be evenly distributed among four social function groups according to their level of dependence on the social welfare system. At the 6 months follow-up the mortality rate was about 16 per cent, leaving 437 patients for a reassessment of social function.

The average hospitalization time was 23 days; thus 17 per cent of all orthopaedic hospital beds in the area were occupied by patients with hip fractures. Patients staying the longest time in hospital were those waiting for discharge to a nursing home. the average stay in rehabilitation institutions was 71 days. the total rehabilitation course was longest for the most dependent patients.

The risk of death or deterioration of social function among patients admitted from home was 48 per cent. in the case of social deterioration or technical failure following the fracture treatment the total rehabilitation course was considerably prolonged.

The resources required for the treatment of hip fractures in a suburban area of 500,000 inhabitants were calculated to be 32 hospital beds, 43 rehabilitation beds and at least 21 nursing home beds.     

角型钢板在股骨髁上和髁间骨折的应用（附32例报告）

股骨髁上和髁间骨折是一种受伤暴力较大治疗比较困难的骨折。其特点是骨折涉及膝关节、多呈粉碎性、而且骨折很不稳定。５年来我科采用角型钢板（即国产９５°髁钢板）治疗这类骨折３８例，获得随访者３２例，疗效优良率为８４．４％。因而强调对本类型骨折的治疗要争取做到：①尽早手术将骨折解剖复位；②牢靠的内固定；③早期进行膝关节功能锻炼。而角型钢板固定符合股骨髁部的生物力学，其优点是能使骨折端牢靠固定、有利于膝关节早期活动和促进骨折愈合。     

COPD患者拒绝肺康复治疗影响因素的质性研究

目的探讨COPD患者拒绝肺康复治疗的影响因素,为推广肺康复治疗寻求方略。方法采用半结构式访谈法,对18例拒绝参与或中途退出某项肺康复项目的 COPD患者进行深入访谈,根据扎根理论方法,应用NVIVO9.0质性分析软件辅助分析资料。结果 COPD患者拒绝肺康复治疗的影响因素可归纳为以下4个主题:个人因素、客观阻碍因素、家庭与社会支持、医护人员的影响。结论医护人员应识别COPD患者拒绝肺康复治疗的影响因素,有的放矢地采取应对措施,以提高COPD患者参与肺康复治疗的积极性与依从性,保证肺康复治疗效果。     

Outcome of early active mobilization after extensor tendon repair

Background:

Traditionally the repaired extensor tendons have been treated postoperatively in static splints for several weeks, leading to formation of adhesions and prolonged rehabilitation. Early mobilization using dynamic splints is common, but associated with many shortcomings. We attempted to study the results of early active mobilization, using a simple static splint, and easy-to-follow rehabilitation plan.

Materials and Methods:

In a prospective study 26 cases of cut extensor tendons in Zone V to VIII were treated with primary or delayed primary repair. Following this, early active mobilization was undertaken, using an easy-to-follow rehabilitation plan. The results were assessed according to the criteria of Dargan at six weeks and one year.

Results:

All the 26 patients were followed up for one year. 20 out of 26 patients were below 30 years of age, involving the dominant hand more commonly (16 patients, 62%). Agriculture instruments were the most common mode of injury (13 patients, 50%). The common site for injury was extensor zone VI (42%, n = 11).

Conclusion:

Rehabilitation done for repaired extensor tendon injuries by active mobilization plan using a simple static splint has shown good results.     

重视骨质疏松性骨折后康复治疗

近些年,随着人口老龄化的加剧,骨质疏松性骨折的发病率随之上升,全球范围对骨质疏松性骨折防治的关注度也大大提高.目前,越来越多的研究认为对于骨质疏松性骨折的治疗,除了常规的骨折相关治疗和抗骨质疏松症药物干预之外,康复治疗也是影响骨折愈合非常重要的一环.但是,长期以来领域内的临床医生对骨质疏松性骨折后的康复治疗还存在认识程...     

移动医疗用于脑卒中患者居家康复的范围综述

目的 对移动医疗在脑卒中患者居家康复中应用的研究进行范围审查，识别移动医疗的要素及应用效果，为未来脑卒中患者居家康复的实践提供参考。方法 以范围综述指南为方法学框架，检索PubMed、Embase、CINAHL、Web of Science、Cochrane Library、Scopus、中国知网、万方数据库、维普数据库和中国生物医学文献数据库中移动医疗在脑卒中患者居家康复中应用的相关研究。检索时限为建库至2023年3月20日。对纳入文献进行汇总和分析。结果 共纳入18篇文献，包含13篇随机对照试验和5篇类实验研究。移动医疗在脑卒中患者居家康复中应用的类型主要有应用程序、可穿戴设备、远程康复系统、网络信息化平台及社交媒体；居家康复内容涉及运动功能康复、语言功能康复、吞咽功能康复及心理康复；结局指标包括康复效果指标、生活质量、自我管理及患者体验。结论 移动医疗在脑卒中患者居家康复中的应用可行，且具有积极效果。未来应探索合适的脑卒中患者居家康复服务规范，在多学科团队协作的基础上，开发出具有专业性及普适性的移动医疗设备，提升移动医疗在脑卒中患者居家康复中应用的质量。     

移动医疗用于脑卒中患者居家康复的范围综述

目的 对移动医疗在脑卒中患者居家康复中应用的研究进行范围审查，识别移动医疗的要素及应用效果，为未来脑卒中患者居家康复的实践提供参考。 方法 以范围综述指南为方法学框架，检索PubMed、Embase、CINAHL、Web of Science、Cochrane Library、Scopus、中国知网、万方数据库、维普数据库和中国生物医学文献数据库中移动医疗在脑卒中患者居家康复中应用的相关研究。检索时限为建库至2023年3月20日。对纳入文献进行汇总和分析。 结果 共纳入18篇文献，包含13篇随机对照试验和5篇类实验研究。移动医疗在脑卒中患者居家康复中应用的类型主要有应用程序、可穿戴设备、远程康复系统、网络信息化平台及社交媒体；居家康复内容涉及运动功能康复、语言功能康复、吞咽功能康复及心理康复；结局指标包括康复效果指标、生活质量、自我管理及患者体验。 结论 移动医疗在脑卒中患者居家康复中的应用可行，且具有积极效果。未来应探索合适的脑卒中患者居家康复服务规范，在多学科团队协作的基础上，开发出具有专业性及普适性的移动医疗设备，提升移动医疗在脑卒中患者居家康复中应用的质量。     

综合康复治疗出租车驾驶员腰间盘突出症的临床研究

目的观察综合康复治疗出租车驾驶员腰间盘突出症的临床疗效。方法应用药物、牵引、特定肌深层按摩疗法以及易化牵伸术等综合治疗出租车驾驶员腰间盘突出症,与常规牵引按摩作对照。结果经过2个疗程治疗,综合康复治疗出租车驾驶员腰间盘突出症明显优于常规牵引按摩组,组间比较有统计学意义（P〈0．05）。结论髂腰肌、胭绳肌以及胫骨前肌损伤可能为增剧出租车驾驶员腰间盘突出症的因素之一,针对其综合康复效果显著。     

综合康复治疗对小儿脑瘫患者的疗效观察

目的探讨综合康复治疗对小儿脑瘫患者的治疗效果。方法 40例脑瘫患儿为对照组,使用运动治疗;40例脑瘫患儿为治疗组,采用综合康复治疗,比较两组患儿的康复效果。结果治疗组总有效率为91,对照组总有效率为81;两组患儿治疗后GMFM评分与治疗前相比均有提高（P〈0.05）;其中治疗后评分,治疗组高于对照组（P〈0.05）。结论对小儿脑瘫患者综合康复治疗较单一运动法治疗有更好疗效。     

他达拉非用于前列腺术后阴茎康复的研究进展

前列腺癌根治性切除术(RP)是治疗绝大多数临床局限性前列腺癌的标准术式,保留神经的NSRRP术式的广泛采用使得RP的疗效得到了显著的提升,但是对RP术后勃起功能的保护仍是泌尿外科的难题。RP术后及早开始阴茎康复可显著改善RP术后勃起功能障碍(ED)对患者的术后生活质量。作为唯一的长效选择性磷酸二酯酶-5抑制剂(PDE5Is),他达拉非在RP术后阴茎康复中的显著疗效在临床试验和基础研究中均得到了证实。本文旨在回顾目前RP术后ED的相关进展,及他达拉非在RP术后阴茎康复中的有效性和安全性证据。     

Effectiveness of video-based rehabilitation program on pain,functionality, and quality of life in the treatment of rotator cuff tears: A randomized controlled trial

BackgroundVideo-based rehabilitation programs, which are also used in the treatment of neurological disorders, could be a beneficial treatment option for patients who cannot receive treatment.PurposeTo determine the efficacy of video-based rehabilitation program in the conservative treatment of partial rotator cuff tears in comparison to a physiotherapist-supervised rehabilitation program.Study DesignA randomized controlled clinical trial.MethodsThirty-three voluntary patients with partial rotator cuff tear were randomized into two groups: video-based rehabilitation (VBR) group and physiotherapist-supervised rehabilitation (PSR) group, for a common 6 weeks rehabilitation program. After drop outs, thirty participants (mean ± SD age, 50.60 ± 8.54 years; 10 female) were finally completed the trial. Active shoulder range of motion, pain, functional status, and health-related quality of life of the patients were assessed before and after treatment. Also, treatment satisfaction level was assessed at the end of the treatment.ResultsThere was statistically significant improvement in terms of active shoulder range of motion values (mean differences at 95% confidence interval for abduction: 30.75-51.37 in the VBR group, 34.20-54.45 in the PSR group, P = .001 in both groups) and secondary outcome measures within both groups (P < .05). However, there were no statistically significant differences in terms of all outcome measures between groups (P > .05). The level of satisfaction from treatment in the PSR group was higher than that in the VBR group.ConclusionA video-based rehabilitation program is an effective option in terms of shoulder range of motion, pain, functionality, and quality of life and has a comparable success level with a PSR program in the conservative treatment of partial rotator cuff tears.     

Does cognitive function influence alaryngeal speech rehabilitation?

BACKGROUND: We sought to define the cognitive domains that influence valved speech rehabilitation. METHODS: Sixteen laryngectomees with primary tracheoesophageal punctures were randomly recruited from one head and neck unit. They were assessed by a consultant neuropsychologist and a speech therapist. Speech therapy time was determined from speech therapy notes. RESULTS: The Digit Symbol Substitution Test, assessing learning speed and processing speed, correlated significantly with speech therapy time in the first (p = .002) and third (p = .014) postoperative years, respectively. Categorical fluency assessment correlated positively with speech therapy time in the first year (p = .009). Learning speed (p = .007) and categorical fluency (p = .041) correlated positively with the fall in speech therapy input between the first and third year after laryngectomy. CONCLUSIONS: Learning speed, processing speed, and categorical fluency strongly influence alaryngeal speech rehabilitation. This study highlights the potential for pre-laryngectomy cognitive assessment to help plan alaryngeal speech rehabilitation. This has significant resource implications.     

Elbow rehabilitation in traumatic pathology

The elbow, intermediate joint of the upper limb, frequently undergoes to pathological events and is especially prone to stiffness. Rehabilitation plays an important role in recovering functional activities. For the rehabilitation team, this goal always represents a challenge, as the treatment has to be continuously modeled and calibrated on the needs of the individual patient, even many times during the same rehabilitation cycle. Containing the effects of immobilization, avoiding to excessively stress the healing tissues, satisfying specific clinical criteria before moving to the next rehabilitation stage, basing the rehabilitation plan on up-to-date clinical and scientific data that can be adapted to each patient and to his/her needs are the basic principles of the rehabilitation plan, which can be chronologically grouped into four rehabilitation stages. After summarizing the general principles of elbow treatment, the specific principles of rehabilitation after elbow fractures and elbow instability are presented, and then the rehabilitative approach to the most frequent and feared pathological conditions of the elbow, namely stiffness, is described.     

超早期康复护理防治偏瘫患者肩手综合征效果观察

目的观察超早期康复护理对预防和治疗脑卒中偏瘫患者肩手综合征的作用.方法将238例脑卒中偏瘫患者随机分为康复组(122例)和对照组116例),两组均给予常规药物治疗和护理,康复组在此基础上予超早期康复护理,包括保持功能和做医疗体操和向心性缠绕压迫手指法、冷-温水交替浸泡法、上举患侧上肢、利用意念促使肢体功能恢复等多种康复训练措施.最后根据患者手指肿胀发生率、患手指肿胀程度以及简易手功能检查(STEE)评定康复效果.结果康复组患者肩手综合征发生率显著低于对照组(P<0.01);康复组治疗后较治疗前手指肿胀程度显著减轻(P<0.01);两组治疗后患肢运动功能均较前显著恢复(P<0.05,P<0.01),而康复组更显著(P<0.05).结论超早期康复护理对脑卒中偏瘫患者肩手综合征的预防和治疗具有积极的促进作用.     

人工髋关节置换术患者康复期下肢关节的运动功能锻炼

目的：探讨人工髋关节置换术患者康复期下肢关节的运动功能锻炼方法与效果。方法：2011年7月到2015年1月选择在我院行择期人工髋关节置换术患者104例,根据随机数字表法分为治疗组与对照组各52例,两组都顺利完成人工髋关节置换术,术后对照组给予常规护理在此基础上治疗组采用积极地流程化运动功能锻炼。结果：治疗组的第1次下地时间明显少于对照组(P<0.05),而在手术之后两周治疗组的最长步行距离要比对照组高很多,P<0.05。痊愈后在髋关节功能优良率方面,治疗组和对照组分别是86.5%和61.5%,治疗组明显高于对照组(P<0.05)。治疗组康复期间的尿潴留、便秘、感染、褥疮、肌肉萎缩等并发症发生情况明显少于对照组(P<0.05)。康复后在总体健康、躯体疼痛、生理职能、生理功能等方面,治疗组的得分均要比对照组高很多,P<0.05。结论：人工髋关节置换术患者康复期下肢关节的运动功能锻炼能减少术后卧床时间,提高髋关节康复的速度,减小并发症出现的几率,使患者的生活品质得到改善。     

卒中患者机器人辅助步态训练康复方案的最佳证据总结

目的 提取并汇总国内外卒中患者机器人辅助步态训练康复护理及管理的最佳证据，为制订适合我国的卒中患者机器人辅助步态训练康复方案提供参考。方法 按照循证资源“6S”模型，系统检索国内外各数据库及指南网关于卒中患者机器人辅助步态训练的证据，包括临床决策、指南、证据汇总、系统评价、专家意见/共识、随机对照试验，检索时间为2016年1月1日至2021年12月31日。由2名研究人员独立对文献进行整体评价，选择符合纳入标准的文献，纳入并提取证据。结果 共检索文献3 314篇，去除重复、结果指标不明确或不相关、质量不达标及不完整的文献，最终纳入19篇，包括指南4篇、证据总结3篇、系统评价8篇、随机对照试验4篇。总结的最佳证据包括评估、干预计划、干预时机、干预频率、干预前准备、参数调整、注意事项、效果评价和健康教育9个方面23条推荐意见。结论 该研究总结的卒中患者机器人辅助步态训练康复方案最佳证据具有一定的前沿性与科学性，可以为临床医护人员实施机器人步态康复训练提供相应的循证依据。     

早期康复治疗在Ⅱ～Ⅴ区指屈肌腱损伤术后的临床应用

目的：报道指屈肌腱修复后早期康复介入的疗效。方法对73例Ⅱ～Ⅴ区指深屈肌腱损伤患者,随机分为观察组37例和对照组36例,两组患者性别、年龄、致伤原因、损伤指别、神经损伤比较,差异均无统计学意义（P＞0.05）,具有可比性。对照组给予临床常规治疗,术后4周再行康复治疗;观察组在急诊修复后第4天即在使用支具情况下开始进行物理治疗及康复训练。两组采用相似康复治疗方法,应用手指总主动活动度（TAM）测定法评定疗效。结果术后3--6个月,按TAM法评定患指功能,观察组优良率明显高于对照组（P〈0.01）,活动度及手指感觉、两点辨别觉均优于对照组,差异有统计学意义（P＜0.05）。结论指屈肌腱修复术后功能锻炼开始的时间愈早,手功能恢复的优良率愈高。     

康复专科常用护理技术确立及难度系数评定

目的 确立康复专科常用的护理技术及评价各技术难度系数。方法 通过文献回顾、专家会议法确立19项常用康复专科护理技术，便利选取507名康复科高年资护士进行问卷调查，采用加权线性和法计算各项康复专科护理技术难度系数。结果 被调查护士熟悉程度、判断系数和权威程度分别为0.70、0.88、0.79。康复专科护理技术难度系数0.96~1.23；其中困难类13项，普通类4项，简单类2项。结论 康复专科常用护理技术及难度系数的确定，可为康复专科护士分层次培训、护理技术工作量统计及人力资源调配提供依据。