脑卒中患者姿势评定量表的效度及信度研究

目的探讨脑卒中患者姿势评定量表(PASS)的效度和信度,为临床应用提供客观依据。方法2组受试对象参加了测试,一组为病例组(27例),另一组为对照组(30例)。1周内对两组对象用PASS和Fugl-Meyer量表中的平衡部分(FM-B)进行2次评定,病例组同时用Berg平衡量表(BBS)评定。将PASS结果与FM-B、BBS作相关性检验来验证PASS的效度;对2次PASS结果作相关性分析来测试PASS的重复测量信度。结果PASS和FM-B、BBS总分高度相关(r=0.943-0.944、r=0.957);PASS各项内容2次重复测试结果高度相关,其组内相关系数ICC=0.945-0.962,组间相关系数ICC=0.982-0.992;病例组和对照组的PASS总分分别为(16.43±10.44)分、(35.32±0.95)分,两者间差异有显著性(P<0.05)。结论PASS具有良好的效度和信度,可用于姿势控制能力的评价。     

三种平衡评定量表在脑卒中早期患者中的应用及其相关性研究

目的:探讨三种常用平衡评定量表在脑卒中早期患者中的应用情况,为临床提供客观依据。方法:对48例脑卒中早期患者进行评定,包括脑卒中患者姿势评定量表(PASS)、Berg平衡量表(BBS)、Brunel平衡量表(BBA),同时评定Fugl-Meyer下肢运动功能(FMA)和改良Barthel指数(MBI)。所有患者均评定4次,评定时间分别为入选时、入选1周后、2周后及3周后。各量表在不同时间点评分比较采用单因素重复测量方差分析,用Spearman统计法分析三种平衡量表之间的相关性以及三者与MBI和FMA间的相关性。结果:各量表在不同时间点评分比较,差异均有统计学意义(均P0.01)。PASS、BBS和BBA之间呈高度相关性(r=0.742~0.962,均P0.01);PASS、BBS和BBA与MBI和FMA之间均呈高度相关(r=0.503~0.938,均P0.01)。结论:3个平衡量表之间具有较好的相关性,均能客观地反映脑卒中早期患者的平衡和功能结局。PASS更适合评定病情较重的脑卒中患者,特别是不具备站立能力的患者;BBS更适合具有站立、行走能力的患者;BBA虽然敏感性不如PASS和BBS,但因其评测省时方便,适宜患者在进行康复训练前进行快速评估。     

脑卒中偏瘫患者下肢功能与ADL移动动作能力的关系

目的:改善ADL能力是脑卒中康复主要目标。本文通过对脑卒中偏瘫患者ADL移动动作能力与患侧下肢功能之间关系的研究,判别影响ADL移动动作能力的下肢功能因素。方法:对55例患者用功能独立性测量中的转移和行进项目来评价患者的ADL移动动作能力,用简式Fugl-Meyer评价法评价下肢运动功能,用Motricity指数评价患侧下肢肌力,用Berg平衡量表评价患者的平衡能力。用Pearson相关分析方法来确定ADL移动动作能力和下肢功能之间的相关性;然后以ADL移动动作能力作为因变量用多元回归分析法的逐步回归法和路径分析法来确定影响ADL移动动作能力的下肢功能因素。结果:患者患侧下肢功能与ADL移动动作能力之间呈高度相关(r=0.541—0.670,P<0.001);其中平衡功能是影响ADL移动动作能力最重要的直接因素(R2=0.45,P<0.05)。结论:脑卒中偏瘫患者的下肢功能尤其是平衡功能是影响ADL移动动作能力的重要因素。     

三种常用平衡量表评估脑卒中偏瘫患者平衡和功能结局的一致性

背景对脑卒中患者平衡评定有助于康复目标与治疗计划的制定.目的探讨脑卒中偏瘫患者常用的3个平衡量表各参数与其他功能评价变量之间的相互关系.设计平衡量表间变量参数.单位解放军总医院耳鼻咽喉科、康复医学科.对象2002-09/2003-07在解放军总医院康复医学科进行康复治疗的57例脑卒中偏瘫患者.均为首次发病、颈内动脉系统一侧大脑半球病变的患者,其中男45例,女12例,年龄14～79岁,病程0.3～11个月.方法对57例患者于康复训练后进行Berg平衡量表、改良Fugl-Meyer平衡量表、脑卒中患者姿势控制量表、下肢运动功能、日常生活活动能力和步行功能评定.用Pearson相关分析方法来确定3种平衡量表之间的相关性;确定3种平衡量表与下肢运动功能、日常生活活动能力和步行功能之间的相关性.主要观察指标①3种平衡量表之间的相关性.②3种平衡量表与下肢运动功能、日常生活活动能力之间的相关性.结果57例脑卒中偏瘫患者均进入结果分析.①Berg平衡量表评分(46.70±5.15),Fugl-Meyer平衡量表评分(10.26±1.58),脑卒中患者姿势控制量表评分(32 56±2.06),Fugl-Meyer评价法中下肢运动功能评分(22.35±5.82),功能独立性测量中的转移和行进项目评分(24.95±5.2),10 m最大步行速度为[(49.06±24.68)m/s].3种平衡量表之间呈高度相关(r=0.613～0.766,P＜0.001).②3种平衡量表与患者的下肢运动功能、日常生活活动能力和步行功能之间呈高度相关(r=0.479～0.718,P＜0.001).结论Berg平衡量表、Fugl-Meyer平衡量表和脑卒中患者姿势控制量表在评定脑卒中患者平衡功能方面具有良好的一致性和良好的效度,均可以反映脑卒中患者的平衡和功能结局,对患者下肢运动功能、日常生活活动能力及步行功能的恢复具有预测性.     

脑卒中患者偏瘫侧下肢肌力与运动功能、平衡、步行速度及ADL的关系

目的探讨脑卒中患者偏瘫侧下肢肌力与运动功能、平衡、步行速度及日常生活活动能力 (ADL)等临床变量之间的相互关系。方法对 85例脑卒中偏瘫患者 ,用Motricity指数评测患侧下肢肌力 ;用Fugl Meyer法评测下肢运动功能 ;用Berg平衡量表测定平衡功能 ;测定 10m最大步行速度 ;用独立功能量表 (FIM )测量ADL能力。对偏瘫下肢肌力与运动功能、平衡、步行速度和ADL能力临床变量之间进行Pearson相关分析 ,然后进行逐步回归分析确定影响临床变量最重要的下肢肌力因素。结果患者偏瘫侧下肢肌力与运动功能、平衡、步行速度和ADL之间呈高度正相关 (r =0 5 92 -0 811,P <0 0 0 1) ;偏瘫侧踝屈曲肌力、膝伸展肌力和髋屈曲肌力分别是运动功能 (R2 =0 3 77,P <0 0 0 1)、平衡 (R2 =0 3 2 1,P <0 0 0 1)、步行速度 (R2 =0 173 ,P <0 0 0 1)、ADL(R2= 0 42 ,P <0 0 0 1)最重要的决定因素。结论脑卒中患者的偏瘫侧下肢肌力明显影响着患者运动功能、平衡、步行速度和ADL能力的恢复 ,合理地评价和改善偏瘫侧肌力 ,对优化康复治疗程序有重要意义。     

三种常用平衡量表评估脑卒中偏瘫患者平衡和功能结局的一致性：康复医学科

背景：对脑卒中患者平衡评定有助于康复目标与治疗计划的制定。目的：探讨脑卒中偏瘫患者常用的3个平衡量表各参数与其他功能评价变量之间的相互关系。设计：平衡量表间变量参数。单位：解放军总医院耳鼻咽喉科、康复医学科。对象：2002-09／2003-07在解放军总医院康复医学科进行康复治疗的57例脑卒中偏瘫患者。均为首次发病、颈内动脉系统一侧大脑半球病变的患者，其中男45例，女12例，年龄14-79岁，病程0．3～11个月。方法：对57例患者于康复训练后进行Berg平衡量表、改良Fugl-Meyer平衡量表、脑卒中患者姿势控制量表、下肢运动功能、日常生活活动能力和步行功能评定。用。Pearson相关分析方法来确定3种平衡量表之间的相关性；确定3种平衡量表与下肢运动功能、日常生活活动能力和步行功能之间的相关性。主要观察指标：①3种平衡量表之间的相关性。②3种平衡量表与下肢运动功能、日常生活活动能力之间的相关性。结果：57例脑卒中偏瘫患者均进入结果分析。①Berg平衡量表评分(46．70&;#177;5．15)，Fugl-Meyer平衡量表评分(10．26&;#177;1．58)，脑卒中患者姿势控制量表评分(32．56&;#177;2．06)，Fugl-Meyer评价法中下肢运动功能评分(22．35&;#177;5．82)，功能独立性测量中的转移和行进项目评分(24．95&;#177;5．2)，10m最大步行速度为[(49．06&;#177;24．68)m／s1。3种平衡量表之间呈高度相关(r=0．613-0．766，P&;lt;0．001)。②3种平衡量表与患者的下肢运动功能、日常生活活动能力和步行功能之间呈高度相关(r=0．479．0．718，P&;lt;0．001)。结论：Berg平衡量表、Fugl-Meyer平衡量表和脑卒中患者姿势控制量表在评定脑卒中患者平衡功能方面具有良好的一致性和良好的效度，均可以反映脑卒中患者的平衡和功能结局，对患者下肢运动功能、日常生活活动能力及步行功能的恢复具有预测性。     

两种平衡量表在脑卒中患者平衡功能评定的实用性研究

目的探讨Berg平衡功能评定表(BBS)和Fugl-Meyer平衡功能评定表(FM-B)在脑卒中患者平衡功能评定的临床实用性及相关性。方法对68例脑卒中患者，于平衡功能训练前后分别应用BBS和FM-B由专人进行评定，然后对每位患者进行静态姿势平衡测试仪(BPM)测试。BPM测试分别在睁眼和闭眼状态下进行，取摆幅指数(SI)、摆动的轨迹长(ing)、外周面积(area)进行分析。结果治疗前后比较，FM-B评定无显著性差异(P＞O．05)；BBS评定和BPM各检测指标均有非常高度显著性差异(P＜O．001)；FM-B与BBS之间呈中度的正相关(r=O．517，P＜O．001)，FM-B与BPM各观察指标之间无相关性(r=-O．074～-O．247，P＞O．05)；BBS与BPM各观察指标之间呈中度负相关(r=-O．410～-O．587，P＜O．01～O．001)。结论BBS与BPM在评定脑卒中患者平衡功能方面具有良好的一致性，都可以反映患者的平衡状态；但FM-B对治疗前后的效果评定敏感性较差，其临床实用性较低。     

中文版躯干损伤量表评定脑卒中患者躯干功能的信度及效度研究

目的:探讨中文版躯干损伤量表(TIS)评定脑卒中患者躯干功能的信度及效度,为该量表的临床应用提供客观依据。方法:病例组和对照组各50例参加了本研究,病例组进行TIS、Fugl-Meyer中的平衡部分(FM-B)和Berg平衡量表(BBS)评定,并在2天内完成TIS第二次评定;对照组进行1次的TIS和FM-B评定。将两次TIS的结果做相关性分析测试其信度;将TIS结果与FM-B、BBS作相关性分析检验其效度。结果:TIS两次测试结果高度相关,重测信度组内相关系数(ICC)为0.899-0.971,测量者间ICC为0.843-0.973;TIS与FM-B、BBS总分高度相关(r=0.891,r=0.858);病例组和对照组的TIS总分分别为21.7±1.3分和13.5±4.3分,两者间差异具有显著性(P<0.01)。结论:中文版TIS具有良好的效度、信度和区分度,可用于脑卒中患者躯干功能的评价。     

下肢运动控制强化训练对脑卒中患者下肢功能的影响

目的观察下肢运动控制强化训练对脑卒中患者下肢运动功能、平衡功能和步行功能的影响。方法 40例脑卒中患者随机分入治疗组(n=20)和对照组(n=20)。对照组接受常规康复,治疗组在此基础上接受下肢运动控制训练,共6周。治疗前后采用Fugl-Meyer下肢运动功能评定(FMA-L)、Berg平衡量表(BBS)、Holden步行功能分级(FAC)进行评定;足印步态分析法测量患者步行参数。结果治疗后,两组患者FMA-L、BBS、FAC及平均步长、步宽及步速较治疗前显著改善(P0.001),且治疗组均优于对照组(P0.05)。结论运动控制强化训练能进一步促进偏瘫患者下肢运动功能、平衡功能、步行能力的恢复。     

三种平衡量表在脑卒中患者评测中的天花板效应研究及相关分析

目的:探讨Berg平衡量表(BBS)、Brunel平衡量表(BBA)、简易平衡评定系统测试(mini-BESTest)应用于不同患病程度脑卒中患者时出现地板或天花板效应以及与日常生活活动能力(ADL)和肢体运动功能的相关性,为临床选择适宜的平衡量表提供客观依据。方法:对308例脑卒中患者进行BBS、BBA、mini-BESTest、ADL功能和肢体运动功能评测,分析BBS、BBA、miniBESTest在不同患病程度的脑卒中患者中是否存在地板或天花板效应;用Spearman相关系数分析BBS、BBA、miniBESTest之间的相关性以及三者与肢体运动功能和ADL功能间的相关性。结果:BBS、BBA在轻度脑卒中患者中出现天花板效应,以BBA最为明显。轻度、中度和重度脑卒中患者BBS、BBA、mini-BESTest之间的相关系数分别为0.611—0.810(P0.01)、0.314—0.568(P0.01)、0.489—0.691(P0.01)。在轻度脑卒中患者中仅BBA与ADL相关系数为0.175(P0.05),BBS、BBA、mini-BESTest与ADL能力和肢体活动能力相关系数为-0.093—0.083(P0.05),在中重度脑卒中患者中BBS、BBA、mini-BESTest与ADL能力和肢体活动能力相关系数为-0.551—0.554(P0.05)。结论:三个平衡量表之间具有较好的相关性。但BBA在轻度脑卒中患者应用时具有较高的天花板效应;miniBESTest要优于BBS,更适宜在临床上应用;BBA适宜中重度脑卒中患者在临床进行快速评估使用。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.