上肢康复机器人结合常规康复训练对急性期脑卒中患者上肢功能的疗效研究

目的:观察上肢康复机器人结合常规康复训练对急性期脑卒中患者上肢运动功能的改善情况。方法:将50例脑卒中患者随机分为对照组和观察组,对照组每天进行2次常规康复训练,观察组每天进行1次常规康复训练及1次上肢康复机器人训练,每周治疗5d,共4周,治疗前后分别用Fugl-Meyer(上肢部分,FMA-UE)、改良日常生活能力(MBI)、肩关节主动关节活动度评价康复效果。结果:治疗后,2组患者的FMA-UE、肩关节主动关节活动度和MBI评估均有明显提高(P0.05),上肢康复机器人结合常规康复训练组的FMA-UE和肩关节前屈、水平内收、水平外展主动关节活动度与对照组相比提高更加明显(P0.05)。结论:上肢康复机器人结合常规康复训练对急性期脑卒中患者上肢功能有明显改善作用。     

表面肌电在脑卒中肘关节痉挛评价中的意义

目的 采用肌电积分值（IEMG）对脑卒中偏瘫患者的肘关节屈肌（肱二头肌）痉挛进行量化评定，并建立与改良Ashworth分级相对应的肌电积分值量化区间。方法 参照改良Ashworth分级标准将90例受试者进行分组，其中0级20例、Ⅰ级16例、Ⅰ16例、Ⅱ级20例、Ⅲ级18例。记录上述受试者在肘关节持续被动屈伸时肱二头肌表面肌电积分值的变化并进行统计分析。结果 受试者各Ashworth分级所对应的肌电积分值范围如下，Ashworth分级为0级对应1．3-12．Ⅰ（6．7±5．4）νV·s；Ⅰ级对应4．6-12．3（8．5±3．9）μV·s：Ⅰ级对应15．3—28．4（21．8±6．6）μV·s；Ⅱ级对应37．2—68．9（53．1±15．6）μV·s；Ⅲ级对应82．3—144．1（113．2±30．9）μV·s。除Ashworth分级为0级与Ⅰ级所对应的IEMG范围有重叠，IEMG均数间差异无统计学意义（P〉0．05）外，其它各Ashworth分级所对应的IEMG范围均无重叠，IEMG均数间差异均有统计学意义（P〈0．05）。结论肌电积分值可对除Ashworth分级为Ⅰ级以外的脑卒中偏瘫患者肘关节屈肌痉挛进行客观评定及量化分级。     

Measuring upper limb capacity in patients after stroke: reliability and validity of the stroke upper limb capacity scale

Houwink A, Roorda LD, Smits W, Molenaar IW, Geurts AC. Measuring upper limb capacity in patients after stroke: reliability and validity of the Stroke Upper Limb Capacity Scale.

Objective

To investigate the interrater reliability and construct validity of the Stroke Upper Limb Capacity Scale (SULCS).

Design

Cohort study.

Setting

Inpatient department of a rehabilitation center.

Participants

Patients after stroke (N=21; mean age ± SD, 61.7±7.9y; 57% men), undergoing inpatient rehabilitation.

Interventions

Not applicable.

Main Outcome Measures

The SULCS was administered by occupational therapists (OTs) within 6 weeks after stroke (t1), 3 months after t1 by the same OT (t2), and within 1 week after t2 by another OT (t3). Interrater reliability, the repeatability between different raters, was assessed by calculating the intraclass correlation coefficient (ICC) based on the scores at t2 and t3. Construct validity, indicating agreement with hypotheses concerning the construct that is being measured, was assessed with Spearman rank correlation coefficient (ρ). The SULCS scores were cross-sectionally correlated with those of the Action Research Arm Test (ARAT) and the Rivermead Motor Assessment (RMA) at t1, and longitudinally with the respective change scores between t1 and t2.

Results

The SULCS (range, 0–10) had a high ICC (.94; 95% confidence interval, .86–.97) and strong cross-sectional correlation with both the ARAT and the RMA (ρ=.91 and ρ=.85, respectively), while the respective change scores showed a strong correlation with the ARAT (ρ=.71) and a moderate correlation with the RMA (ρ=.48).

Conclusions

The SULCS has good interrater reliability and construct validity.     

Predicting the oxygen cost of walking in hemiparetic stroke patients

Objective

To verify the relation between spontaneous walking speed (Sfree) and oxygen cost of walking at Sfree (Cwfree) in post-stroke hemiparetic patients and to test the validity of a prediction model to estimate Cwfree based on Sfree.

Reliability of treadmill exercise testing in older patients with chronic hemiparetic stroke

OBJECTIVE: To assess the test-retest reliability of cardiopulmonary measurements during peak effort and submaximal treadmill walking tests in older patients with gait-impaired chronic hemiparetic stroke. DESIGN: Nonrandomized test-retest. SETTING: Hospital geriatric research stress testing laboratory. PARTICIPANTS: Fifty-three subjects (44 men, 9 women; mean age, 65+/-8y) with chronic hemiparetic gait after remote (>6mo) ischemic stroke. Patients had mild to moderate chronic hemiparetic gait deficits, making handrail support necessary during treadmill walking. INTERVENTIONS: Peak effort and submaximal effort treadmill walking tests were conducted and then repeated on a separate day at least a week later.Main outcome measures Reliability coefficients (r) were calculated for heart rate, systolic blood pressure (SBP), oxygen consumption (Vo(2) [L/min]), Vo(2) (mL.kg(-1).min(-1)), respiratory exchange ratio (RER), rate-pressure product (RPP), and oxygen pulse during peak effort testing. The reliability coefficients for all but SBP and RPP data were calculated from the submaximal tests. RESULTS: Heart rate (r=.87), Vo(2)peak (L/min) (r=.92), Vo(2)peak (mL.kg(-1).min(-1)) (r=.92), and oxygen pulse (r=93) were highly reliable parameters during maximal testing in this population. Submaximal testing produced highly reliable results for V.o(2) (L/min) (r=.89) and oxygen pulse (r=.85). All cardiopulmonary measures except RER had a reliability coefficient greater than.80 during submaximal testing in this population. CONCLUSION: Our study provides the first evidence that peak effort treadmill testing provides highly reliable oxygen consumption measures in chronic hemiparetic stroke patients using minimal handrail support. The submaximal tests were at or near the threshold level of reliability for the 2 most important measures of V.o(2) (L/min) and V.o(2) (mL.kg(-1).min(-1)) (r=.89, r=.84, respectively), with the remaining measures falling above.70.     

虚拟现实技术训练对脑卒中患者上肢功能恢复的影响

目的：探讨虚拟现实技术训练对脑卒中患者上肢功能恢复的影响。方法选取脑卒中患者34例,根据Mini -mize软件随机分为试验组和对照组各17例,均接受为期4周的康复治疗,试验组在此基础上加用虚拟现实技术训练,根据康复治疗前后的Fugl-Meyer上肢运动功能和Barthel指数的评定结果,比较两组患者上肢功能和日常生活能力的改变。结果两组患者治疗后的Fugl-Meyer上肢运动功能和Barthel指数较治疗前均有提高,试验组的功能改善程度明显优于对照组,差异均有统计学意义（ P＜0.05）。结论虚拟现实技术训练对脑卒中患者上肢运动功能和日常生活活动能力有较好的改善。     

配戴腕手矫形器进行爬行训练对脑卒中患者偏瘫上肢功能的影响

目的研究腕手矫形器配合爬行训练对脑卒中患者偏瘫上肢的临床疗效。方法42例脑卒中偏瘫患者随机分成2组：治疗组2l例，配戴腕手矫形器进行爬行训练，配合常规康复训练；对照组2l例，仅进行常规康复训练。评价指标采用Fugl-Meyer评价法（FMA）、Ashworth徒手测量法和Barthel指数法。每天1次．每次60min，每周训练5次，共8周。每例患者均在治疗开始前和全部治疗结束后进行评定。结果2组对象在治疗开始前各项评价指标比较差异无统计学意义．训练8周后治疗组的运动功能、肌痉挛和13常生活活动能力均有明显改善，与对照组比较．差异有统计学意义（P〈0．05）。结论腕手矫形器配合爬行训练治疗陆壅审偏瘫卜肘№堂缔童柙唐每训练且右可住的疗特．     

脑卒中偏瘫患者静脉输液部位与偏瘫肢体功能恢复的相关性研究

目的探讨不同静脉输液部位对脑卒中偏瘫患者的偏瘫肢体功能恢复的影响,以寻求合理有效的输液途径。方法将116例脑卒中并肢体瘫痪的患者随机分为实验组(A组,n=60,采用健侧肢体输液)和对照组(B组,n=56,采用在瘫痪一侧肢体输液)。观察瘫痪一侧肢体功能恢复情况。结果实验组运动功能及日常活动能力评定明显高于对照组(P<0.05)。结论脑卒中偏瘫患者输液时,不同的输液部位对其偏瘫肢体功能的恢复有明显影响,建议常规采用健侧肢体静脉输液。     

Anticipatory postural adjustment in selected trunk muscles in post stroke hemiparetic patients

OBJECTIVES: To study electromyographic characteristics of anticipatory postural adjustment in axial and lateral, posterior and anterior trunk muscles during the performance of upper-and lower-limb flexion tasks, in subjects with hemiparesis after stroke and to determine the relationship between anticipatory activity and subjects' motor and functional status. DESIGN: A nonrandomized control study. SETTING: Geriatric rehabilitation center in Israel. PARTICIPANTS: Fifty poststroke hemiparetic patients and 30 healthy control subjects. INTERVENTION: Electromyographic activity of the lumbar erector spinae and of the latissimus dorsi muscles was recorded bilaterally during flexion of either arm and from the 2 rectus abdominis and obliquus externus muscles during flexion of either hip. MAIN OUTCOME MEASURES: Muscles' onset latency, cross-correlation values between the temporal activation profile of corresponding pairs and between ipsilateral muscular pairs, symmetry in activation magnitude of corresponding muscles, and relation between electromyographic activity and motor and functional performance RESULTS: Onset latencies of trunk muscles were partially delayed in the patients with longest hindrance displayed by the erector spinae ipsilateral to the flexing arm (P<.04). Temporal synchronization between pertinent muscular pairs was lower in the patients than in the healthy subjects, with significant group differences (P<.05 or lower) in the correlations between ipsilateral pairs of trunk muscles. Activation of the corresponding lateral trunk muscles in the patients was significantly less symmetrical than in the controls (P<.03 or lower) because of reduced activity on the paretic body side, especially on flexing of the paretic limbs. Conversely, in the controls as well as on the nonparetic side of the patients, limb flexion was associated with increased activity in the ipsilateral lateral trunk muscle. The erector spinae muscle in both groups and on both sides was more active on the contralateral side than on the ipsilateral side to the flexing arm. The reduced activity level in trunk muscles on the paretic body side was associated with deficiencies in motor and functional abilities. CONCLUSIONS: Major impairments in the activity of trunk muscles in hemiparetic subjects were manifested in the reduced activity level of the lateral trunk muscles, in delayed onset, and in reduced synchronization between activation of pertinent muscular pairs. These problems were associated with motor and functional deficits and warrant specific consideration during physical rehabilitation of post stroke hemiparetic patients.     

Effectiveness of commercially available gaming devices in upper limb stroke rehabilitation

Background: Hemiparesis of the upper extremity is estimated to affect 50–75% of individuals who experience a stroke. Recently the use of commercially available off-the-shelf (COTS) gaming technology has shown promise for providing interactive rehabilitation. The existing evidence however, has not yet been reviewed systematically to determine the effectiveness of such gaming devices in upper limb (UL) rehabilitation post-stroke.

Objectives: To determine the effectiveness of COTS gaming technology for UL rehabilitation in post-stroke patients and to assess the feasibility, and effect on quality of life (QoL).

Methods: A systematic search of the databases CINAHL, MEDLINE, PsycINFO, Pubmed, SPORTDiscus, and SCOPUS was conducted. Quality scoring of the included articles was based on the Effective Public Health Practice Project (EPHPP) quality assessment tool for quantitative studies.

Results: In total, eight studies were included for review. The commercial gaming devices were found to be feasible for use among post-stroke individuals. The devices were found to be effective as an adjunct to conventional stroke rehabilitation, and were feasible in relation to time taken, cost-effectiveness, safety, and the positive effect on the QoL of the stroke population.

Conclusions: As the findings of the current review are primarily based on lower levels of research, it is not possible to make recommendations regarding the use of these devices in clinical practice. However, findings of the included studies did indicate that rehabilitation including gaming technology had a positive effect on the UL rehabilitation of stroke patients.     

Visual feedback therapy for restoration of upper limb function of stroke patients

ObjectiveTo investigate the effects of mirror neuron theory-based visual feedback therapy (VFT) on restoration of upper limb function of stroke patients and motor-related cortical function using functional magnetic resonance imaging (fMRI).MethodsHemiplegic stroke patients were randomly divided into two groups: a VFT group and a control (CTL) group. Sixteen patients in the VFT group received conventional rehabilitation (CR) and VFT for 8 weeks, while 15 patients in the CTL group received only CR. The Barthel Index (BI) was used to assess the activities of daily living at baseline and the 8^th week of the recovery training period. The Fugl–Meyer assessment (FMA) scale, somatosensory evoked potential (SEP), and fMRI were used to evaluate the recovery effect of the training therapies. The latencies and amplitudes of N9 and N20 were measured. Before recovery training, fMRI was performed for all patients in the VFT and CTL groups. In addition, 17 patients (9 in the VFT group and 8 in the CTL group) underwent fMRI for follow-up 2 months after treatment. Qualitative data were analyzed using the χ² test. The independent sample t-test was used to compare normally distributed data among different groups, the paired sample t-test was used to compare data between groups, and the non-parametric test was used to comparing data without normal distribution among groups.ResultsThere were no significant differences between the VFT and CTL group in all indexes. However, after 8 weeks of recovery training, these indexes were all significantly improved (P < 0.05). As compared with the CTL group, the FMA scores, BI, and N9/N20 latencies and amplitudes of SEP in the VFT group were significantly improved (P < 0.05). Two months after recovery training, fMRI showed that the degree of activation of the bilateral central anterior gyrus, parietal lobe, and auxiliary motor areas was significantly higher in the VFT group than the CTL group (P < 0.05).ConclusionsVFT based on mirror neuron theory is an effective approach to improve upper extremity motor function and daily activity performance of stroke patients. The therapeutic mechanism promotes motor relearning by activating the mirror neuron system and motor cortex. SEP amplitudes increased only for patients who participated in visual feedback. VFT promotes sensory-motor plasticity and behavioral changes in both the motor and sensory domains.     

Improvements in the upper limb of hemiparetic patients after reaching movements training

Reaching movements made with hemiparetic upper limbs are often followed by compensatory trunk and shoulder-girdle movements, especially in reach-to-grasp strategies. We investigated the effect of restraint therapy on movement aiming at targets placed within arm reach. Eleven subjects were selected to participate in this study and were submitted to training with the trunk fixed to a chair during the reaching movement. Quantitative and qualitative scales (Modified Ashworth Scale, Fugl-Meyer Assessment Scale-upper limb section, Berg Balance Scale and Barthel Index) were used to evaluate reaching in three periods--pre-treatment, post-treatment and follow-up 3 months after training was completed. We found that in the arm section of the Fugl-Meyer Assessment Scale, pain (x2=8.22, P=0.016), proprioception (x2=6.00, P=0.049), flexor synergy (x2=6.07, P=0.048), wrist (x2=6.50, P=0.039), coordination velocity (x2=7.05, P=0.029) and the total score for the upper limb (x2=7.95, P=0.019) had statistical significance, especially in the pre-treatment and follow-up phases. The same happened using the Barthel Index (x2=8.33, P=0.016). Trunk restraint allowed patients with hemiparetic stroke to make use of active arm joint ranges that are present but not normally recruited during unrestrained arm reaching tasks. Appropriate treatments, such as trunk restraint, may be effective in uncovering latent movement patterns to maximize arm recovery in hemiparetic patients.     

上肢机器人辅助训练对恢复期脑卒中患者肩关节本体感觉的影响

目的 探讨上肢机器人辅助训练对恢复期脑卒中患者肩关节本体感觉的影响。 方法 采用随机数字表法将40例恢复期脑卒中患者分为实验组及对照组,每组20例。2组患者均给予常规药物治疗及康复干预,康复干预包括运动训练、作业治疗及物理因子治疗等;实验组患者在此基础上辅以上肢机器人训练,每次训练持续20min,每周训练6次,共连续训练8周。于治疗前、治疗4周、8周后分别采用MJS上肢本体感觉测试系统评估2组患者上肢平均轨迹误差值(ATE)及测试执行时间（Time）,通过等速测试仪评定患者肩关节内旋、外旋30°、60°时关节位置觉。 结果 治疗前两组患者ATE及Time值组间差异均无统计学意义（P>0.05）。治疗4周后两组患者ATE及Time值均较治疗前明显改善（P<0.05）;并且实验组上述指标亦显著优于对照组（P<0.05）。治疗8周后两组患者ATE及Time值均较治疗4周时进一步改善（P<0.05）;并且实验组上述指标亦显著优于对照组（P<0.05）。治疗前两组患者肩关节内旋、外旋30°、60°主动运动角度与参考角度相关性值组间差异均无统计学意义（P>0.05）。治疗4周后两组患者主动运动角度与参考角度相关性值均较治疗前明显改善（P<0.05）;并且实验组上述指标亦显著优于对照组（P<0.05）。治疗8周后两组患者主动运动角度与参考角度相关性值均较治疗4周时进一步改善（P<0.05）;并且实验组上述指标亦显著优于对照组（P<0.05）。 结论 上肢机器人辅助训练可促进恢复期脑卒中患者肩关节本体感觉功能恢复,该疗法值得临床推广、应用。     

双侧训练在脑卒中急性期康复中的临床效果观察

目的:观察双侧训练对于急性期脑卒中患者的康复治疗效果。方法:36例急性期脑卒中患者分成对照组和观察组各18例,均给予常规康复训练,对照组增加单侧肢体及手运动功能训练,观察组增加双侧肢体及手运动功能训练。2组患者在治疗前后采用改良Ashworth评分-肩、肘、腕、手(MAS-S,MAS-E,MAS-W,MAS-H)、Fugl-Meyer评定量表肩/肘/前臂、腕手(FM-SEF,FM-WH)及改良Bathel指数(MBI)进行评分。结果:训练12周后,2组FM-SEF,FM-WH评分,MAS各项评分及MBI评分均较训练前改善(P0.05),观察组训练后FM-SEF,及MAS-S,MAS-E,MAS-W评分较对照组改善更显著(P0.05)。结论:双侧训练应用于脑卒中急性期的患者可以有效地降低肩、肘及腕关节肌张力,并且对于上肢腕手运动功能恢复有一定效用。