一种四肢瘫轮椅手套的临床应用

目的:观察一种自行研制的四肢瘫轮椅手套(专利号ZL2015 2 0984478.2)对四肢瘫患者驱动手动轮椅功能改善情况进行效果分析。方法:入选的20例颈髓损伤所致四肢瘫痪患者分别在穿戴轮椅手套前后进行驱动手动轮椅50m所耗时间和6min驱动轮椅距离测试,并填写佩戴轮椅手套使用情况调查问卷,通过测得的客观数据及患者主观感受两方面比较自行研制的四肢瘫轮椅手套是否能改善四肢瘫患者驱动手动轮椅的功能。结果:佩戴轮椅手套后,四肢瘫患者驱动轮椅50m所耗时间、6min驱动轮椅距离及比佩戴前功能显著提高(P0.01);问卷调查结果显示四肢瘫患者认为佩戴轮椅手套驱动轮椅较为省力,能增加其自行驱动轮椅的意愿。结论:应用四肢瘫轮椅手套可明显提高四肢瘫患者驱动手动轮椅的能力,提高生活质量。     

轮椅靠背高度对颈6完全性脊髓损伤患者轮椅驱动能力的影响

目的:测试轮椅靠背高度对颈6完全性损伤患者轮椅驱动能力的影响。方法:选取19例颈6完全性脊髓损伤患者作为受试者,记录每位受试者在高、中、低3个不同高度轮椅靠背下竞速通过"L"形和"S"形路线行驶时间;并在研究后调查每位受试者主观体验感受。结果:19例患者,"L"形路线和"S"形路线用时,低靠背明显少于中靠背及高靠背(均P0.01);中靠背与高靠背用时比较无统计学差异。绝大多数受试者表示低靠背使上肢活动灵活,易于用力;高靠背对上肢活动影响明显;高靠背对身体的稳定性好于中靠背和低靠背。结论:轮椅靠背顶端位于肩胛骨下角下方5cm处,颈6完全性脊髓损伤患者轮椅驱动能力最强。     

规范化轮椅技能训练对截瘫患者的康复疗效

目的：探讨规范化轮椅技能训练方案对截瘫患者的康复治疗效果.方法：将截瘫患者27例分为观察组20例和对照组7例,2组均接受常规康复训练,观察组在此基础上给予规范化轮椅技能训练.治疗前后采用改良Bathel指数（MBI）和轮椅技能测试（WST）进行评定.结果：治疗2个月后,2组MBI及WST评分均较治疗前显著提高（P＜0.01,0.05）,且观察组更高于对照组（P＜0.01）.结论：规范化轮椅技能训练可明显提高截瘫患者日常生活能力,增强康复治疗效果.     

轮椅技能训练实用性和规范化研究

目的探讨轮椅技能训练的简单化、实用化和规范化。方法将 2 16例脊髓损伤住院患者按性别、年龄和损伤平面分为 4组进行轮椅技能训练 ,项目包括绕障碍物行走计时、10 0m竞速、40 0m竞速、2柱× 10折返跑、上下台和上下坡道 ,将各项目按成绩分为 10个级别 ,制定出不同组别患者应该达到的水平 ,评定患者的训练效果。结果训练后 ,患者的 10 0m、40 0m竞速、2柱×10跑折返、绕障碍计时成绩和上台 (坡 )的能力明显提高 (P <0 .0 1) ;训练效果明显 75人、有效 14 1人。结论轮椅技能训练可使脊髓损伤患者真正达到生活自理、自立 ,但应根据患者的损伤平面制定规范化的训练方案     

“工作坊式”轮椅技能训练对截瘫患者日常活动参与的影响

目的:研究"工作坊式"轮椅技能训练方案对截瘫患者日常活动参与的影响,并探讨其临床应用。方法:80例截瘫患者随机分为常规轮椅技能训练组(常规组)40例、"工作坊式"轮椅技能训练组(工作坊组)36例(脱落4例)。其中常规轮椅技能训练组开展为期2周,6d/周,30min/d,累积6h的系统轮椅技能训练;"工作坊式"轮椅技能训练组开展为期2d,3h/d,累积6h的集中轮椅技能训练。分别于训练前、训练后、4周随访采用轮椅技能测试(WST)、脊髓独立性评估(SCIM)、Frenchay活动量表(FAI)进行疗效评估。结果:训练后及4周后随访,2组WST、SCIM、FAI均较训练前均显著提高(均P<0.05),工作坊组WST评分均更高于常规组(均P<0.05)。4周随访,2组SCIM、FAI评分差异无统计学意义。结论:"工作坊式"轮椅技能训练,能显著提高截瘫患者轮椅操作能力,并促进其日常活动参与,具有训练周期短、维持效应好的特点,适宜在社区及康复门诊中进一步推广。     

脊髓损伤患者轮椅技能训练评价法的应用

轮椅技能训练虽然在脊髓损伤的康复训练中是一项非常重要的内容 ,但是目前在国内、外还没有专门对轮椅技能训练进行评价的内容和量化指标。中国康复研究中心文体治疗科通过对大量截瘫患者的轮椅技能训练情况进行总结 ,将轮椅技能训练系统化和量化 ,制定了轮椅技能训练评价表 ,这样可以对截瘫患者所掌握的轮椅技能进行比较客观的评价。1　资料和方法1.1　一般资料155名脊髓损伤的截瘫患者 ,男 134例 ,女 2 1例。年龄 16— 51岁 ,训练时间平均 2个月。脊髓损伤情况见表 1。1.2　评价的内容和方法1.2 .1　评价内容和评价标准 :见表 2。 2 1个项…     

手动爬楼梯轮椅爬行部件的改进

１　手动爬楼梯轮椅爬行原理及存在的问题普通轮椅不具备攀登楼梯和跨越路障的功能,这大大限制了以轮椅为代步工具的下肢截瘫患者及年老体弱者的活动范围。为了解决这一问题,也考虑到我国多数轮椅使用者目前的经济承受能力,爬行装置不应过分复杂。清华大学精仪系康复研究中心首先开发了手动爬楼梯轮椅〔２〕。它是在普通轮椅上加设一套爬楼梯执行机构和驱动系统而成,即可以在平地行驶,又可以仅凭借使用者双臂的力量使轮椅上、下楼梯。该爬楼梯轮椅的结构简图见图１,其主要特点是在普通轮椅的两侧各加设一套由平行四边形机构组成的爬楼…     

轮椅技能训练在脊髓损伤患者康复中的应用

轮椅技能训练在脊髓损伤患者康复中的应用中国康复研究中心博爱医院康复部文体治疗科金宁，孙传娥，张庭军截瘫患者由于脊髓损伤导致下肢运动功能障碍，只能依靠轮椅进行移动。“轮椅就是他们的腿”这种说法是一点也不过份的。所以在脊髓损伤患者的康复训练中，操纵轮椅技...     

轮椅推动力的时空特性

<正> 在社区中的独立活动能力是脊髓完全损伤(SCI)患者康复的主要目标。目前,用于评价手动轮椅的标准只不过是确定能否推动轮椅移动一定距离,这仅是对使用手动轮椅功能的粗略评价,更详细的临床评价应包括对速度和移动距离的测量以及轮椅在不同地形下的推动力。但目前对在不同社区条件下轮椅推动力的客观测量较少。Wolfe等人曾报道轮椅在水泥平地上的移动速度相当于正常人的步速,而在地毯上的移动速度是正常人的78％。但Wolfe所研究的对象均为低位截瘫患者,并且他的调查是在15年前进行的,而当时的轮椅要笨重得多。     

胸腰椎骨折合并截瘫患者的康复护理

总结98例胸腰椎骨折合并截瘫的康复护理及功能锻炼体会.通过对腰椎骨折并截瘫患者的细致护理和功能锻炼贯穿整个治疗过程.48例能部分生活自理,44例能完全自理,并重返工作岗位,6例能使用轮椅.较好的康复护理和功能锻炼是患者康复获得成功的保证.     

Supporting the paralympic athlete: focus on wheeled sports

The complexity of wheelchair sports provides the scientist with a unique challenge. There are two major components that contribute towards ‘wheeled sports’ performance: the athlete and the chair. It is the interaction of these two components that enable wheelchair propulsion and the sporting movements required within a given sport. This article will describe three discrete case studies on how sport scientists have worked with Great Britain coaches and practitioners to help optimise training leading to a major competition through evidence base practise. A fourth area will describe on-going work designed to address the optimisation of wheelchair configurations for wheelchair court sports. It will focus on four sports: wheelchair racing, wheelchair tennis, wheelchair basketball and wheelchair rugby. The first topic will discuss the concept of pushing economy and mechanical efficiency of wheelchair propulsion. The second topic will show how technology assists the coaching process. The third topic will illustrate the concept of sports classification, and show how training volume ‘in terms of basketball shooting’ may need to be individually assigned and finally future research within wheelchair team sports and chair configurations will be examined.     

Ergonomics in the transfer of patients: a study carried out with workers of a transportation center at a university hospital

The purpose of this study was to evaluate ergonomic aspects involved in using a stretcher and a wheel chair to transfer patients. 249 transfers carried out by the workers of a university hospital lifting sector were observed. The observations showed that the idea of having a team to transfer patients has to be stimulated but the members of the team require specific training in handling and transferring patients. Mechanical equipment and other devices should also be available.     

Understanding and measuring powered wheelchair mobility and manoeuvrability. Part I. Reach in confined spaces

Purpose. To determine: (1) what wheelchair manoeuvrability factors are important and (2) the effects of powered wheelchair design on the ability to reach in a confined space.

Method. The relative importance of five aspects of wheelchair manoeuvrability was determined through a survey of users of wheelchairs (N = 52) and health care professionals and others (N = 89). A single young, non-disabled subject undertook repeated trials of reach distance on to a counter at the end of a corridor whose width could be adjusted by moving Styrofoam walls.

Results. Reaching, moving in confined spaces and avoiding collisions were more important than speed and avoiding the need to drive backwards. The rear wheel drive powered wheelchair was found to allow the greatest reach when driving backwards into the space and the wheelchair which moved in a sideways direction allowed greatest reach in the narrowest corridor.

Conclusions. The survey concluded that manoeuvring in small spaces and reaching without collisions were important. The powered wheelchair with sideways capability afforded the greatest reach in confined spaces except when the rear wheel drive chair was driven in backwards. The survey respondents did not place a high priority on avoiding backwards driving but some people find this difficult to do safely.     

Defining the upper extremity range of motion for safe automobile driving

BackgroundThere are no guidelines for return to driving following upper extremity injury. A greater comprehension of the role of the upper extremity in driving is required to assist clinicians in their fitness-to-drive assessments. This research aims to assist clinicians by analyzing the motion at the upper extremity in safe automobile driving.MethodsThirty-six participants were recruited to the Monash University Accident Research Centre's driving simulator. They were tested in a realistic driving simulation using highway scenarios and traffic hazards. An OptiTrack™ motion tracking system recorded participants' upper limb movements.FindingsThe following ranges of motion were recorded (left and right arm mean whole numbers): The shoulder flexed from 14 to 54°, abducted to 18°and adducted to 9°. Shoulder rotation ranged from 6° external to 32° internal rotation. Elbow flexion ranged from 35° to 72°. Pronation reached 77° and supination to 24°. Wrist flexion reached 34° and extension reached 23°. The wrist deviated to 17°radially and 38° ulnar. To avoid simulated hazards, the steering wheel revolved 57.2° (SD 19.2). The key movements in hazard avoidance are shoulder flexion, shoulder rotation, forearm rotation and wrist deviation.InterpretationShoulder flexion, internal rotation and forearm rotation have been shown to be key upper extremity movements in safe driving. Clinicians can refer to the ranges of motion recorded in this investigation, or the driving task at hand in their fitness-to-drive assessments. The ability to revolve the steering wheel 100° exceeds the 95th percentile of the steering wheel revolution angle required to avoid simulated traffic hazards.     

Understanding and measuring powered wheelchair mobility and manoeuvrability. Part I. Reach in confined spaces

Purpose.?To determine: (1) what wheelchair manoeuvrability factors are important and (2) the effects of powered wheelchair design on the ability to reach in a confined space.

Method.?The relative importance of five aspects of wheelchair manoeuvrability was determined through a survey of users of wheelchairs (N?=?52) and health care professionals and others (N?=?89). A single young, non-disabled subject undertook repeated trials of reach distance on to a counter at the end of a corridor whose width could be adjusted by moving Styrofoam walls.

Results.?Reaching, moving in confined spaces and avoiding collisions were more important than speed and avoiding the need to drive backwards. The rear wheel drive powered wheelchair was found to allow the greatest reach when driving backwards into the space and the wheelchair which moved in a sideways direction allowed greatest reach in the narrowest corridor.

Conclusions.?The survey concluded that manoeuvring in small spaces and reaching without collisions were important. The powered wheelchair with sideways capability afforded the greatest reach in confined spaces except when the rear wheel drive chair was driven in backwards. The survey respondents did not place a high priority on avoiding backwards driving but some people find this difficult to do safely.     

Verification of spatial recognition ability of stroke patients required to resume automobile driving

[Purpose] To help patients who had a stroke resume automobile driving, we evaluated their ability to recognize three-dimensional space like that experienced in actual driving situations, with a focus on sensing car width. [Participants and Methods] Seven patients who had a stroke and 29 healthy adults participated in the study. Three 50-cm-wide chairs and 2 panels, 3 m apart, were placed 9 m from the chair in which the participant sat. One panel was fixed and the other panel could be moved toward the fixed panel in a horizontal direction. The participants were asked to signal when they believed that the width of the chair was the same as the space between the panels. [Results] In the simulation of driving a real car, the mean error in judging distance was 13.2 ± 10.4 cm for the Healthy group and that of the Stroke group was two times greater than that of the Healthy group. [Conclusion] These findings show that spatial recognition cannot be evaluated using paper-based two-dimensional higher brain function tests. To help patients who had a stroke resume driving requires evaluation of three-dimensional spatial recognition ability under circumstances that simulate actual driving situations.Key words: Driving, Stroke, Spatial recognition     

偏瘫患者应用步行训练

为了降低脑卒中偏瘫患者的致残率,提高偏瘫病人的平衡能力、步行能力及日常生活活动能力(ADL),我们通过分析步行障碍的原因,探讨开始步行的条件,尽早采取应用步行训练项目,实施步行前训练项目、独立步行训练项目及应用步行训练项目.采取急性期患肢功能位及被动运动,步行前站立位平衡训练,适时进行坐椅动作训练,单腿站立动作训练,斜面步行训练,上下台阶动作训练,交叉迈步训练,上下阶梯动作训练,开关门动作,入厕,上下交通工具动作等行之有效的训练方法,使更多的脑卒中偏瘫患者的日常生活能力接近正常人的水平.     

Trunk Muscle Activity During Wheelchair Ramp Ascent and the Influence of a Geared Wheel on the Demands of Postural Control

Howarth SJ, Polgar JM, Dickerson CR, Callaghan JP. Trunk muscle activity during wheelchair ramp ascent and the influence of a geared wheel on the demands of postural control.

Objectives

To quantify levels of torso muscular demand during wheelchair ramp ascent and the ability of a geared wheel to influence trunk muscle activity.

Design

Repeated-measures design. Each participant completed manual wheelchair ramp ascents for each combination of 4 ramp grades (1:12, 1:10, 1:8, and 1:6) and 3 wheel conditions (in gear, out of gear, and a standard spoked wheel) in a block randomized order by wheel condition.

Setting

Biomechanics laboratory.

Participants

Healthy novice wheelchair users (N=13; 6 men) from a university student population.

Interventions

Not applicable.

Main Outcome Measures

Peak electromyographic activity, expressed as a percentage of maximal voluntary isometric contraction (MVIC) of the abdominals, latissimus dorsi, and erector spinae during ramp ascent. Temporal location of peak electromyographic activity (EMG) within a propulsive cycle and integrated electromyographic activity for a single propulsive cycle.

Results

Abdominal peak activity increased 13.9% MVIC while peak posterior trunk muscle activity increased 4.9% MVIC between the shallowest and steepest ramp grades (P<.05). The geared wheel prevented increased peak activity of the rectus abdominis and external oblique (P>.05). Only peak electromyographic timing of the erector spinae was influenced during the push phase by increasing ramp slope.

Conclusions

Increased trunk muscular demand as a result of increasing ramp slope is required to enhance stiffness of the spinal column and provide a stable base during manual propulsion. Manual wheelchair users with compromised activity capacity, compromised abdominal muscle strength, or both, may be able to navigate more difficult terrains while using a geared wheelchair wheel because of reduced demands from the abdominal musculature in the geared wheel condition.     

Wheelchair racing: an important modality in acute rehabilitation after paraplegia

Sports rehabilitation has been proven effective with patients having spinal cord injury. This case discusses a man with T12/LI paraplegia who had acute rehabilitation augmented by competitive long distance wheelchair racing. Stress testing was used to evaluate cardiorespiratory fitness and to develop parameters whereby maximally efficient training could occur. Wheelchair modifications for racing were necessary. Competitive wheelchair racing was found valuable for this patient's physical, emotional and social rehabilitation. Patient involvement in racing has continued since discharge and the Boston Marathon was completed by wheelchair less than 1 year after onset of spinal cord injury.