Quadriplegia from spinal cord injury in muscular dystrophy

Recommendations for exercise programs in patients with muscular dystrophy are controversial. These programs are designed to keep a patient ambulatory or functional for as long as possible. There have been no reports of a patient with muscular dystrophy who incurred a spinal cord injury. This report details the course of recovery and rehabilitation of a man with facioscapulohumeral muscular dystrophy with quadriplegia from a traumatic spinal cord injury. The patient was admitted to a spinal cord injury unit. After prolonged bedrest, he participated in physical and occupational therapy that was designed to exercise him just short of fatigue. Except for one incident, when the patient reinjured his spinal cord, he did not lose function that he had already attained. The rehabilitation of this patient demonstrates that it is possible for a patient with facioscapulohumeral muscular dystrophy who sustains a traumatic quadriplegia to enter a rehabilitation program with expectations for a good outcome despite a double disability.     

Psychosocial Issues Following Serious Head Injury: A Case Study of an Adolescent Girl

This article is a case study of an adolescent girl who sustained a serious head injury following an attack by strangers. The head injury caused an epidural hemorrhage that exerted pressure on her brain stem and resulted in spastic quadriplegia. In this case, the major issues in rehabilitation were the patient's ability to learn to communicate and normalize and gain control over various aspects of her life. Because of the lack of a specialized rehabilitation setting for children and adolescents, rehabilitation took place in an acute care setting, which makes this story unusual in many ways. Staff issues were significant because of the nurses' inexperience with rehabilitation issues and because of the setting. This article describes the primary nurse's experience with this patient over several months. During this phase of rehabilitation, psychosocial issues were a major concern. Fifteen months after rehabilitation began, the patient moved back home and returned to high school. She communicates by using a computer and by using her eyes, and she uses a wheelchair. Despite everything, she is determined to get better and to prepare herself for the future.     

三级康复对脑损伤后运动功能恢复的疗效观察

目的探讨三级康复体系对脑损伤患者神经功能缺损减轻、运动功能恢复及生存质量改善的影响。方法将72例脑损伤偏瘫患者分为三级康复组和对照组。三级康复组在病情稳定后即行早期康复治疗(一级康复),恢复期到疗养院继续进行康复治疗(二级康复),维持期在干休所或家庭延续康复治疗(三级康复);对照组恢复期到疗养院开始进行康复治疗,维持期自行在家练习。病程的不同阶段行神经功能缺损评分、运动功能评定和日常生活活动能力评定。结果 72例脑损伤患者开始康复治疗前和一级康复治疗后,三级康复组与对照组神经功能缺损评分、运动功能和日常生活活动能力的改善程度,差异无统计学意义(P0.05);二级康复治疗后,三级康复组运动功能恢复明显好于对照组;三级康复治疗后随访时,三级康复组的生存质量明显改善,与对照组相比差异有统计学意义(P0.05)。结论三级康复体系对脑损伤患者降低神经功能缺损程度、提高运动功能有良好的促进作用,可明显提高患者日常生活能力和生存质量。     

Spastic hemiplegia in a quadriplegic patient: treatment with phenol nerve block

A quadriplegic patient with a C6 lesion had a stroke with aphasia and right hemiplegia 20 years after his cervical cord injury. The combination of hemiplegia and quadriplegia created unusual rehabilitation problems, the most disabling of which was a painful flexion contracture of the right elbow that prevented any useful right arm function. A sequence of phenol nerve blocks produced almost complete resolution of this contracture and was a key factor in his successful return to independent living. Although phenol block is much less commonly performed in the upper than lower extremities, its judicious use in carefully selected cases may be beneficial to the patient's functional outcome.     

Increasing sensory and motor stimulation for the patient with quadriplegia

The common perception about the individual with quadriplegia (having a lesion at C5 and above) as a fragile, immobile, and medically unstable individual is in direct conflict with the concept of successful rehabilitation. Long hospitalizations, constant medical attention, and profound physical dependence often work against the efforts of those providing rehabilitation to ease the patient's transition back to as normal a life style as possible. This paper describes a successfully executed sensory and motor stimulation program, designed to meet the needs of the sensory-deprived individual with quadriplegia and to deemphasize the perception of both physical and psychological fragility.     

Jones-Hedman walker modification for C7 quadriplegic patient: case study in team cooperation

A 20-year-old man with C7 quadriplegia was admitted to a tertiary care rehabilitation facility 1.5 months after discharge from an acute care community hospital. The patient's goals were to improve his skills in activities of daily living to a level of maximum independence, and to walk. Although his high level of spinal cord injury made ambulation unlikely, an occupational therapist and a rehabilitation engineer, working together, devised a method to help the patient meet his ambulation goal. They modified an ordinary walker by fabricating polyvinyl chloride-acrylic alloy guards lined with foam to reduce palmar pressure. The patient was then able to use wrist and finger extension during walker advancement and was able to ambulate 300m with Craig-Scott orthosis. The case illustrates the importance of a skilled interdisciplinary team in a specialized center for management of spinal cord injured patients.     

Spinal cord injury in an inner city hospital

During the first six years of existence of the rehabilitation unit in a black inner city major municipal hospital, 53 patients with spinal cord injury were admitted. A retrospective study of these patients sought answers to questions concerning etiology, patient characteristics, services provided and method of delivery, and advantages and disadvantages of rehabilitation in a community hospital. Findings revealed differences in causation of spinal cord injury between women and men and between patients with paraplegia and quadriplegia. tthe male paraplegic patients were the youngest; their life style led to spinal cord injury. Social factors such as inadequate housing, lack of transportation, and insufficient financial resources were deterrents to rehabilitation. An approach that emphasized consideration of all the psychosocial factors was developed. Evaluation and treatment were extended into the community. Lack of peer groups and multiphasic programs were the major disadvantages.     

农村脑卒中患者居家康复模式探索及成效分析

目的:探索农村脑卒中患者居家康复的模式及其对日常生活活动能力、生活质量、焦虑和抑郁情绪的影响。方法:随机选择100例脑卒中偏瘫患者分为观察组(48例)与对照组(52例)。2组患者均接受常规药物治疗及乡村医生的健康宣教和康复咨询,观察组在此基础上增加医务人员的综合康复治疗及心理辅导,时间为3个月,治疗前后均采用改良Barthel指数(MBI)、生活质量指数(QLI)、Zung焦虑自评量表(SAS)及Zung抑郁自评量表(SDS)进行评定。结果:观察组治疗后与治疗前比较,MBI评分和QLI评分明显提高,SAS和SDS评分明显降低(P0.05);对照组治疗3个月后与治疗前比较,MBI评分明显提高(P0.05)。治疗后,与对照组比较,观察组MBI评分和QLI评分明显提高,SDS和SAS评分明显降低(P0.05)。结论:居家综合康复治疗及心理辅导对农村脑卒中患者的日常生活活动能力、生活质量、焦虑和抑郁情绪具有明显的改善作用,值得进一步深入推广。     

提高老年髋部骨折患者生活质量的家庭护理干预

目的探讨家庭护理干预对提高老年髋部骨折患者生活质量的影响。方法选择髋部骨折行人工关节置换术及动力髋系统内固定术患者60例,随机分为干预组30例和对照组30例,均在出院前进行评估及专科康复健康教育,干预组在出院后6个月内进行家庭护理干预,对照组出院后只定期进行门诊复查,不行家庭护理干预。2组在术后6个月进行日常生活活动能力的问卷调查。结果干预组日常生活能力评分高于对照组,统计学分析示有显著性差异。结论家庭护理干预可以促进老年髋部骨折患者的康复,提高其生活质量。     

早期康复护理干预对脑卒中偏瘫患者日常生活活动能力的影响

目的:探讨早期康复护理干预对脑卒中偏瘫患者日常生活活动能力(ADL)的影响。方法:将118例脑卒中偏瘫患者随机分为康复组和对照组各59例,对照组按神经内科护理常规进行护理,康复组由责任护士按护理程序实施系统化早期康复护理干预,包括基础护理、心理护理、早期患肢康复锻炼、语言功能锻炼、吞咽功能锻炼、日常生活能力训练。采用Barthel指数对两组患者干预前后ADL进行评定比较。结果:两组干预后Barthel指数均较干预前明显升高(P<0.01),康复组干预后Barthel指数明显高于对照组(P<0.01)。结论:早期康复护理干预能提高脑卒中偏瘫患者ADL,降低致残率,改善生活质量。     

Rehabilitation considerations in the care of the acute burn patient

To be burned is to suffer one of the most dehumanizing events known. Adult burn patients have gone from independent, healthy individuals to totally dependent patients who may survive but be severely disfigured. The ultimate rehabilitation goal is to provide extensively burned patients with the training necessary for them to resume as much of their preburn lifestyle as possible. Prevention and control of scarring processes are the initial vital phases of the process. Reconditioning continues that process by preparing the patients to function within the limits of their present physical ability. All of the activities of daily living that the patient is able to perform with a minimum amount of assistance or independently with the use of assistive devices also move the patient toward independent living. The rehabilitation process is a critical element in the daily care of the burn-injured patient, and all team members providing that care should be encouraged to view the patient as a whole, giving early consideration to the final rehabilitation outcome.     

舒适护理干预对脑卒中患者神经功能早期康复的效果观察

目的 观察舒适护理在脑卒中患者神经功能早期康复中的应用效果,提高患者生活和生存质量。方法 选取脑卒中患者82例,随机分为康复组（n=42）和对照组（n=40）,康复组采用舒适护理加常规护理模式对患者进行早期神经功能康复训练,对照组应用常规护理模式。分别于入院时和入院后4周对患者进行Barthel指数评定和Fegl-Meyer积分对比。结果 康复组在日常生活能力（P〈0.05）和运动功能（P〈0．01）方面明显优于对照组,两组对比有显著性差异。结论 脑卒中患者入院后及早实施舒适护理干预,并贯穿于环境、心理、生理、社会等多个方面,可最大程度地提高护理质量,促进患者康复。     

Performance changes for patients with chronic obstructive pulmonary disease on long-term oxygen therapy after physiotherapy.

OBJECTIVE: To investigate whether patients with chronic obstructive pulmonary disease on long-term oxygen therapy would benefit from an early 8-week rehabilitation programme in terms of exercise performance, health-related quality of life and activities of daily living. METHODS: Two weeks after onset of oxygen therapy, 20 patients were randomized to rehabilitation (group A) or not (group B). Exercise performance was measured using a 6-minute walking test. Health-related quality of life was measured with the Chronic Respiratory Disease Questionnaire. Activity of daily living ability was measured with the Stanford Health Assessment Questionnaire. RESULTS: The mean 6-minute walking distance increased by 35% (p < 0.01) in group A after rehabilitation. The mean increase in group B was only 8% (n.s.). Patients in group A reported less overall dyspnoea after rehabilitation (p < 0.05) and, compared with group B, reported better activity of daily living ability (p < 0.01). CONCLUSION: Patients with chronic obstructive pulmonary disease on long-term oxygen treatment may improve their walking distance, experience less dyspnoea and improve activity of daily living ability with an early rehabilitation programme.     

典型护理问题版块集中处理法在高血压脑出血幸存者康复期中的应用观察

[目的]观察典型护理问题版块集中处理法在高血压脑出血幸存者康复期中的应用效果。[方法]将90例高血压脑出血幸存者随机分为对照组和观察组各45例,对照组给予常规康复护理,观察组给予典型护理问题版块集中处理法干预。采用自我护理能力测评量表、功能独立能力评价量表,比较两组病人干预前后自护能力、独立生活能力评分,采用脑卒中专门化生活质量量表,比较两组病人干预后生活质量评分。[结果]观察组病人干预后自护能力评分、独立生活能力评分和生活质量评分均高于对照组(P0.05)。[结论]采用典型护理问题版块集中处理对高血压脑出血病人实施康复期护理干预,可提高病人的自护能力、独立生活能力与生活质量。     

Qualities of life design measures with chronic illness or disability

Purpose: Rehabilitation assessment data influence decisions for the design of preferred lifestyles with a chronic illness or disability (CID). As a result, careful consideration of the source, type and scope of these data is needed in selecting appropriate procedures for their collection and use. This article proposes three essential qualities of data to assess in life design counselling with CID.

Method: A narrative analytical review approach is applied to synthesize findings from the research on person-oriented approaches to rehabilitation assessments. In addition, illustrative life design data on preferred community living solutions with CID for rehabilitation clients (n = 68) are presented. The concept of life design foregrounds the narrative analytical review on essential qualities of rehabilitation assessments to support life choices with disability.

Results: The evidence from a narrative synthesis of the person-oriented assessment literature and community living study suggests that effective life design with CID is enhanced with person-centric, resource enabling and participation focused data. Data that prioritizes personal values for participation enable persons with a disability jurisdiction in their life design choices.

Conclusion: Life design is a robust concept to understand the purposes for which rehabilitation assessment data are gathered, and the essential qualities for those data. When life design measures have person-centric qualities, people with CID are empowered to construct their own lives.

Implications for Rehabilitation

• Life design is an important process and outcome for gathering rehabilitation assessment data.

• Rehabilitation assessment measures for life design are person-oriented, resource enabling and participation focused.

• People with chronic illness and disability consider their personal values important to rehabilitation assessments for community living with chronic illness or disability.

     

早期康复训练对冠状动脉旁路移植术后病人生存质量的影响

[目的]探讨早期康复训练对冠状动脉旁路移植术后病人生存质量的影响。[方法]选择行冠状动脉旁路移植术病人40例,随机分为康复组和对照组。康复组实施系统规范的康复训练;对照组给予常规护理和随意自我锻炼。比较两组病人术后并发症、监护时间、住院时间、术后15 d的6 min步行试验(6-MWT)结果和生存质量指标(SF-36)。[结果]康复组病人监护时间、住院时间明显缩短,术后并发症少,术后15 d的6-MWT结果和生存质量评分与对照组比较均有统计学意义(P<0.01)。[结论]早期康复训练可以促进冠状动脉旁路移植术后病人的心脏康复,明显提高病人生存质量。     

Cosmetic, functional, independent: self-help aids

Self-help orthotics have been developed to assist functional activities for high-level spinal cord injured patients. The goal of rehabilitation has been to do this with as little intrusion on independence and cosmesis as possible. This paper describes devices to help a patient with C6 quadriplegia independently place his own utensils and eat with an almost normal appearance. The new self-help aids are made from standard silverware, a rivet, and two one-eighth-inch Kydex loops. The loops are riveted centrally on the utensil, allowing for free rotation. The device was evaluated on a patient with C6, complete quadriplegia. The subject demonstrated independence in donning and doffing the device and in eating with an almost normal appearance.     

早期良肢位摆放在脑卒中患者中的应用

目的:探讨脑卒中偏瘫患者早期良肢位摆放的意义。方法:对84例脑卒中患者随机分为康复组和对照组,对照组42例按常规治疗和护理,康复组42例除常规治疗和护理外,在患者入院早期开始进行良肢位设计与摆放。结果:康复组运动功能及生活自理能力改善程度与对照组比较有显著差异,P<0.05。结论:早期良肢位摆放可明显改善脑卒中患者瘫痪肢体运动功能,提高脑卒中患者的生活自理能力。     

系统性康复护理对Miles手术病人生活质量的影响

[目的 ]探讨系统性康复护理对Miles手术病人生活质量的影响。 [方法 ]将 5 0例行Miles手术的病人随机分为两组 ,观察组给予系统性康复护理 ,对照组行常规护理 ,术后 3个月采用WHO生活质量测定量表简表评价病人生活质量。[结果 ]两组病人生活质量评分比较有统计学意义 (P <0 .0 1) ,观察组生活质量明显高于对照组。 [结论 ]系统性康复护理有利于Miles手术病人建立规律排便行为 ,从而改善病人的生活质量。     

卒中单元内早期规范化康复治疗对缺血性脑卒中患者功能恢复的影响

目的:探究卒中单元内早期规范化康复治疗对缺血性脑卒中患者功能恢复的影响。方法:前瞻性选取2017年1月至2019年1月宜兴市人民医院收治的100例缺血性脑卒中患者,按照随机数表法将所有患者分为对照治疗组和康复治疗组,各50例。对照治疗组患者行临床常规方法治疗,康复治疗组患者行卒中单元内早期规范化康复治疗。评价两组患者住院时间、治疗费用、神经功能、肢体功能、日常生活能力、生活质量、疗效及预后情况。结果:康复治疗组住院时间短于对照治疗组,治疗费用高于对照治疗组,差异有统计学意义(P<0.05)。治疗后康复治疗组神经功能缺损评分量表(Neurological Deficit Scale,NDS)、国立卫生研究院卒中量表(NIH Stroke Scale,NIHSS)评分均高于对照治疗组(均P<0.05)。治疗后康复治疗组运动功能、上肢运动功能、下肢运动功能、平衡能力评分均高于对照治疗组(均P<0.05)。治疗后康复治疗组日常生活能力、生活质量均高于对照治疗组(P<0.05)。康复治疗组治疗总有效率显著高于对照治疗组(P<0.05)。康复治疗组复发率、病死率均低于对照治疗组(P<0.05)。结论:卒中单元内早期规范化康复可显著改善缺血性脑卒中患者神经功能,促进肢体功能的恢复,预后较好,但治疗费用相比常规治疗高,临床上在对缺血性脑卒中患者行卒中单元内早期规范化康复治疗时,应同时关注运用效果和治疗费用,综合患者实际情况实施。