Impact of upper limb complex regional pain syndrome type 1 on everyday life measured with a novel upper limb-activity monitor

Complex regional pain syndrome type 1 (CRPS1) often leads to serious activity limitations in everyday life. To date, however, limitations in patients with CRPS1 of an upper limb have not been objectively measured.Therefore, the aim of this study was to determine the long-term impact of upper limb CRPS1 on general mobility and upper limb usage during everyday life, as measured with a novel upper limb-activity monitor (ULAM). In ten female chronic CRPS1 patients and ten healthy control subjects, 24-h activity patterns were measured with the ULAM. This ULAM consists of body-fixed acceleration sensors, connected to a recorder worn around the waist. The ULAM automatically detects upper limb activity during mobility-related activities. Several outcome measures related to general mobility and upper limb usage were compared between patients and controls. The results showed that CRPSI in the dominant upper limb had modest impact on general mobility; i.e. on the percentages spent in body positions and body motions and on mean intensity of body activity. For upper limb usage outcome measures during sitting, there was a marked difference between CRPS1 patients and controls. Especially patients with dominant side involvement clearly showed less activity of their involved limb during sitting, indicated by significant differences for the mean intensity (P=0.014), percentage (P=0.004), and proportion (P=0.032) of upper limb activity. It is concluded that these ten chronic CRPS1 patients still had limitations in upper limb usage during everyday life, 3.7 years (average) after the causative event.     

静脉输液对同侧肢体指尖血糖监测的影响

目的:探讨输液对同侧肢体指尖血糖监测的影响.方法:对单侧上肢正在静脉输液治疗的43例重症病人进行随机血糖监测.均为留置针输液,所输液体为常用的治疗性及营养性液体,用快速血糖仪先测输液端肢体的指尖血糖,然后再测非输液端肢体的指尖血糖,时间间隔控制在5 min之内.结果:输液组与非输液组血糖差异无统计学意义(P＞0.05),且这种无差异性与所输的液体无直线相关(P8＞0.05).结论:输液不影响同侧肢体指尖监测血糖,因此可以在输液一侧监测指尖血糖.     

力量训练和功能训练偏瘫阴性患者上肢神经肌肉功能的恢复：个案特点

背景：偏瘫患者上肢功能康复目前许多治疗方法,但针对患者的病症,以独立功能能力为目标的任务导向性训练方法报道不多。目的：探讨功能训练和力量训练对偏瘫阴性特征患者上肢动作能力恢复的疗效。方法：对因脑蛛网膜下腔出血,做动脉瘤栓塞时血管壁沉淀物堵塞中动脉血管造成右偏瘫致上运动神经元损伤的偏瘫阴性患者进行训练前后的BrunstormⅤ级动作测试,同时进行录像和肌电图测试,通过录像发现运动障碍,找出中枢性瘫痪肌肉,对患者瘫痪肌的功能进行运动学分析,治疗前后患侧神经肌肉功能的进步情况。结果与结论：通过150次的训练,使患者完全失用的右手能完成功能训练（吃香蕉动作）14次。说明功能训练和力量训练对偏瘫阴性特征患者上肢动作能力的康复效果显著。     

Effect of force-feedback treatments in patients with chronic motor deficits after a stroke

OBJECTIVE: To assess the effects a motor reeducation approach based on static dynamometers used to provide feedback on the force produced. DESIGN: The study design was a single-blind, randomized, controlled trial. Chronic stroke subjects participated in a 6-wk, thrice-weekly, force-feedback program of either the upper paretic limb (n = 13) or the lower paretic limb (n = 12). Baseline and postintervention assessments of the performance of both the upper and the lower limb were measured for each subject, the untreated paretic limb of each group serving as a control for the other group. RESULTS: With the exception of the handgrip force, strength measurements of the treated limb increased after completion of the treatment. The outcome measurements of the upper limb of the subjects included in the upper paretic limb were not significantly different after treatment from those measured in the lower paretic limb. In contrast, gait velocity and the distance walked in 2 min increased after treatment in the lower paretic limb as compared with the upper paretic limb, whereas the scores in the Fugl-Meyer test for the lower limb and the timed up-and-go test did not increase for either group after treatment. CONCLUSION: The results indicate that treatment of the lower limb based on force feedback produces an improvement of gait velocity.     

压力衣治疗对乳腺癌术后上肢淋巴水肿的影响

目的:观察压力衣佩戴治疗对乳腺癌术后并发上肢淋巴水肿患者的长期疗效和对上肢功能的影响。方法:60例乳腺癌术后并发上肢淋巴水肿的患者随机分为2组各30例。观察组患者穿戴治疗师为其量身订制的压力衣进行治疗,每天佩戴时间不少于23h,同时在治疗师或护士指导下在家中进行上肢的向心性按摩及功能锻练;对照组患者只在治疗师或护士指导下在家中进行上肢的向心性按摩及功能锻练。分别在治疗前和治疗6个月后采用上肢淋巴水肿程度分级和上肢功能指数(UEFI)评分进行评估。结果:治疗6个月后,观察组水肿程度较治疗前及对照组均有下降(P0.01,0.05),对照组治疗前后差异无统计学意义。治疗后,2组UEFI评分均较治疗前明显提高(P0.01),且观察组优于对照组(P0.01)。结论:长期佩戴压力衣可明显减轻乳腺癌术后上肢淋巴水肿程度,并更有利于上肢功能的恢复。     

康复机器人训练对脑卒中偏瘫患者上肢功能的影响

目的:探讨上肢康复机器人训练结合常规康复治疗对脑卒中偏瘫患者上肢功能的影响。方法:80例脑梗死患者随机分为2组,均接受基础药物治疗和常规康复治疗;观察组增加上肢康复机器人训练。治疗前后分别进行上肢肌张力改良Ashworth量表(MAS)评分、上肢运动功能(FMA)评分及改良Barthel指数(MBI)评定。结果:治疗1个月后,2组患者上肢MAS评分均较治疗前明显下降(P<0.05),且观察组更低于对照组(P<0.05);FMA及改良Barthel指数(MBI)评分均较治疗前明显提高(P<0.05),且观察组较对照组更加显著(P<0.05)。结论:上肢康复机器人训练结合常规康复治疗不仅能改善脑梗死患者上肢功能,而且能促进日常生活活动能力的恢复。     

低频重复经颅磁刺激结合作业疗法对卒中患者 上肢功能恢复的疗效

目的:探究低频重复经颅磁刺激(r TMS)结合作业疗法(OT)治疗后卒中患者的上肢痉挛和运动功能的变化。方法:选择卒中后伴上肢偏瘫患者47例,按Brunnstrom分期量表分为3期组(12例)、4期组(15例)、5期组(20例),进行低频r TMS结合OT治疗15 d。在治疗前、治疗后及30 d随访时对受影响的上肢痉挛和运动功能进行评估。结果:所有患者治疗后及30 d后随访发现MAS评分和WMFT评分明显下降(P<0.01),FMA评分明显提高(P<0.01),4期组最明显。同时发现偏瘫上肢痉挛改善的患者较未改善的患者上肢运动功能提高更明显。结论:卒中后伴有上肢偏瘫的患者经低频r TMS结合OT治疗15 d后可明显改善受损上肢的偏瘫和运动功能,其中Brunnstrom偏瘫分期为4期的患者受益最明显。且改善受损上肢的痉挛症状有助于提高其运动功能。     

上肢神经损伤患者功能恢复的动态评估与干预

目的 通过上肢神经损伤患者功能恢复的动态评估与干预促进患肢功能恢复.方法运用上肢功能评定表(Disability of Arm-Shoulder-Hand,DASH),对36例上肢神经损伤患者在术后第1天、术后8周每周末、3个月末、6个月末、12个月末进行上肢功能评估,术后8周根据评估的DASH值水平进行相应护理干预,以后继续评估,跟踪调查患肢功能恢复的程度.结果本组DASH评分在3个月末为37.59±2.04,6个月末为22.56±2.07,12个月末为4.30±3.50,32例治愈,4例好转,治愈率为88.89％.结论应用DASH评定表对上肢神经损伤患者进行动态评估和及时的护理干预,促进了患者的上肢功能恢复.     

Impairments and activity limitations in subjects with chronic upper-limb complex regional pain syndrome type I

OBJECTIVE: To determine the degree of impairments and activity limitations and their interrelationship in complex regional pain syndrome type I (CRPS type I). DESIGN: Cross-sectional study interrelating impairments and objectively measured activity limitations. SETTING: Ambulatory and home environment. PARTICIPANTS: Thirty nonacute upper-limb CRPS type I subjects. INTERVENTIONS: Not applicable.Main outcome measures Sensory, motor, and autonomic impairments, as well as activity-limitation outcome measures. The latter were objectively measured with a novel upper-limb activity monitor (based on ambulatory accelerometry). RESULTS: All subjects were impaired to some degree but with a large variability with respect to magnitude. Regarding activity limitations, the involved upper limb was clearly less active (lower intensity and percentage of activity) than the noninvolved side. Impaired active range of motion (adjusted R(2) range, 18%-39%) and grip strength (adjusted R(2) range, 12%-45%) were the most important factors explaining variance in activity limitations. CONCLUSIONS: All subjects were still impaired nearly 3 years after the causative event. The involved upper limb was also clearly less active than the noninvolved side, especially when the subjects were sitting and when the dominant side was involved. The more impairments a subject had, especially motor impairments, the more activity limitations were present.     

不同形式上肢运动的能量消耗

背景:测量体力活动能量消耗的方法有很多,但测量上肢活动能量消耗方面的研究较少.目的:以间接热量测定法测量几种常见的上肢运动形式能量消耗,分析上肢运动能量消耗的特征以及年龄、性别等因素的影响.设计、时间及地点:对比观察,实验于2009-01/03在江苏省体育科学研究所完成.对象:无代谢性疾病的健康成年人108名,男47名,女61名,其中20-39岁65名,40-59岁43名.方法:受试者以坐姿做摆臂(60次/min)、屈肘(40次/min)、肩水平屈伸(60次/min)、直臂侧上举(30次/min)4种动作,每个动作间隔休息3 min.主要观察指标:采用德国CORTEX系列MetaMax 3B心肺功能测试仪受试者静息及不同运动形式下耗氧量值.结果:静息耗氧量男性高于女性(P<0.05),20～39岁高于40-59岁(P<0.05).摆臂的耗氧量最高男性(550.9±90.6)mL/min,女性(425.8±75.7)mL/min;屈肘最低男性(440.4±82.7)mL/min,女性(367.0±60.1)mL/min.4种运动形式的净耗氧量都低于250 mL/min(1代谢当量).结论:①4种常见上肢活动形式的耗氧量增加较少,一般不会超过1代谢当量.②年龄和体质量对静息状态能量消耗影响较大,性别的影响较小.⑨年轻人群的上肢运动效率更高,在运动中的能量更加节省.     

侧卧位血压变化的研究

目的观察侧卧位时左右臂血压的变化。方法随机抽取50人进行平卧、左侧卧、右侧卧双上肢血压测量,对数据进行统计学处理。结果侧卧位双上肢血压有明显差异;平卧位双上肢血压无明显差异;左侧卧左上肢、右侧卧右上肢的收缩压与平卧位双上肢收缩压无明显差异。结论患者不得不侧卧位时,测血压应测位于下方的上肢,并标明体位及肢体。     

Upper limb activity over time in complex regional pain syndrome type 1 as objectively measured with an upper limb-activity monitor: an explorative multiple case study.

BACKGROUND: An upper limb-activity monitor (ULAM) has been developed to determine activity limitations in complex regional pain syndrome type 1 (CRPS1). The ULAM is based on 24h ambulatory monitoring of body segment accelerations and enables valid and objective quantification of mobility and upper limb activity in transversal studies. AIMS: To explore upper limb activity over time in acute upper limb CRPS1 as measured with the ULAM in a longitudinal study, and to compare this to time courses of other outcome measures for activity limitations and impairments. METHODS: Four subjects were measured four times during a treatment protocol. Several ULAM outcome measures related to upper limb usage and mobility, three questionnaires (RASQ, DASH, RAND36), and six impairment outcome indicators (VAS-momentary pain, VAS-pain resulting from effort, volume, temperature, active range of motion, strength) were used. RESULTS: Objectively measured upper limb activity frequently improved; improvements of >5% were found for 63% of the ULAM outcome measures at final assessment. The ULAM outcome measures had a time course more similar to the body-part and CRPS1 specific questionnaire RASQ than the other questionnaires. The time course of impaired temperature was most often in accordance with the ULAM, and both VAS scores showed least accordance. CONCLUSIONS: Clear changes in upper limb activity over time were frequently found as objectively measured with the ULAM, and relationships among the time courses of the ULAM and other outcome measures were largely explainable. The ULAM can validly assess upper limb activity over time in CRPS1, but between-measurement variability needs careful consideration.     

Wherever is my arm? Impaired upper limb position accuracy in Complex Regional Pain Syndrome

Knowledge of the position of one’s limbs is an essential component of daily function and relies on complex interactions of sensorimotor body schema-related information. Those with Complex Regional Pain Syndrome (CRPS) express difficulty in knowing where their affected limb is positioned. The aim of this study was to determine the degree to which experimental data supported the reported difficulty in limb position sense. A controlled experimental design was used to measure upper limb position accuracy amongst those with CRPS of one arm. Position accuracy was individually measured in both arms and compared to a known target position. Video captured each of 36 trials (half with arm in full view and half with vision obscured). The error in degrees between actual and known targets was determined using video analysis software. The Brief Pain Inventory measured pain. A subjective mental image representation of both upper limbs was documented. The CRPS group had moderate pain intensity and were significantly less accurate in positioning both the affected and unaffected limbs compared to controls (p < 0.001). Position accuracy of the CRPS affected limb significantly improved with vision (8.3° in view, 10.7° not in view). Subjective mental representations of the affected limb were visualised as distorted. Evidence of bilateral arm positioning impairments in unilateral arm CRPS suggests that central mechanisms are involved. Cortical reorganisation in regions associated with the body schema (i.e. primary somatosensory and parietal cortices) is proposed as an explanation. The exact relationship between pain and limb position deficits requires further exploration.     

Toileting device for patients with decreased hand function

Physical medicine and rehabilitation is involved with aiding patients in the performance of activities of daily living. The ability to independently perform the acts involved in personal hygiene is important to a disabled person's self-esteem. This report describes a patient with weak distal upper limbs secondary to Guillain-Barré neuropathy, his difficulty with independent hygiene, and the device designed to aid independence in toileting. This device is easy and inexpensive to fabricate, and simple to use. It has applications beyond the Guillain-Barré population including patients with arthritis and burns and those with limited distal upper limb function.     

彩色多普勒超声对上肢动脉病变的诊断价值

目的 探讨彩色多普勒超声对上肢动脉病变的诊断价值：方法 对我院2001年2月至2003年8月期间200例拟诊为上肢动脉疾病患者的彩色多普勒超声检查结果进行总结。结果 检出上肢动脉疾病57例，阳性率为28．5％，疾病种类包括动脉硬化斑块、动脉扭曲、多发性大动脉炎、胸廓出口综合征、肢端动脉痉挛病(雷诺氏病)、动脉瘤、急性动脉栓塞和锁骨下动脉盗血综合征。其中，以动脉粥样硬化病变常见；结论 彩色多普勒超声对上肢动脉病变的诊断和鉴别具有准确性和实用性．     

Neurology (48)

Phantom pain and phantom sensations in upper limb amputees: an epidemiological study. (University Hospital Groningen, Groningen, The Netherlands) Pain 2000;87:33–41.
This study determined the prevalence and factors associated with phantom pain and phantom sensations in upper limb amputees in The Netherlands. Additionally, the relationship between phantom pain, phantom sensations, and prosthesis use in upper limb amputees was investigated. One hundred twenty-four upper limb amputees participated in the study. Subjects were asked to fill out a self-developed questionnaire scoring the following items: date, side, level, and reason of amputation, duration of experienced pain before amputation, frequencies with which phantom sensations, phantom pain, and stump pain are experienced, amount of trouble and suffering experienced, respectively, related to these sensations, type of phantom sensations, medical treatment received for phantom pain and/or stump pain, and the effects of the treatment, self medication, and prosthesis use. The response rate was 80%. The prevalence of phantom pain was 51%, of phantom sensations 76%, and of stump pain 49%; 48% of the subjects experienced phantom pain a few times per day or more. Moderate to severe suffering from phantom pain was experienced by 64% of the respondents. A significant association was found between phantom pain and phantom sensations (relative risk 11.3) and between phantom pain and stump pain (relative risk 1.9). No other factors associated with phantom pain or phantom sensations could be determined. Only 4 patients received medical treatment for their phantom pain. Phantom pain is a common problem in upper limb amputees that causes considerable suffering for the subjects involved. Only a small number of subjects are treated for phantom pain. Conclude that further research is needed to determine factors associated with phantom pain.     

经颅磁刺激抑制健康人初级运动皮质后双侧中央前回精细分区的脑有效连接变化

目的观察经颅磁刺激抑制右侧初级运动皮质(M1)后双侧中央前回精细分区有效连接变化情况。方法选取21例健康志愿者纳入本研究,于持续短阵脉冲刺激(cTBS)干预前、后分别行静息态功能磁共振(rs-fMRI)检查,参照中科院自动化研究所制订的脑图谱对受试者双侧中央前回进行精细分区,选用Granger因果分析观察受试者双侧中央前回有效连接变化情况。结果经cTBS抑制右侧M1区后受试者双侧中央前回各亚区有效连接呈显著变化,右上肢功能区对左上肢、左头面部功能区的有效连接减弱,左上肢功能区对右侧头面部及右上肢功能区的有效连接增强。结论经cTBS抑制右侧M1区后,受试者双侧M1区上肢功能区的有效连接变化反映了半球间交互抑制,同时M1躯干功能区也发生了与上肢功能区方向相反的有效连接改变。     

Treatment of upper limb deep vein thrombosis with low molecular weight heparin

Upper limb deep vein thrombosis has been an under-recognized disease; however, physicians' awareness of it as a cause of arm pain and edema is increasing. Previously thought of as benign, upper limb deep vein thrombosis has been shown in recent studies to pose a significant risk for pulmonary embolus and death. The need for treatment is now recognized; however, effective treatments for upper limb deep vein thrombosis have not been fully defined. Anticoagulation with oral agents is known to be successful in preventing complications and recurrence. This report presents the first case of upper limb deep vein thrombosis successfully treated with only low molecular weight heparin.     

上肢康复机器人治疗脑卒中患者上肢功能的临床疗效研究

目的观察上肢康复机器人对脑卒中患者上肢功能的康复效果。方法选取2019年12月至2021年8月宁夏第五人民医院康复中心收治的98例脑卒中患者为研究对象,采用随机数字表将受试者随机分为康复机器人组(n=49)及常规康复组(n=49)。所有受试者均接受常规康复治疗,康复机器人组在此基础上增加上肢康复机器人辅助训练。于治疗前、治疗8周后分别进行Fugl-Mayer运动功能量表上肢部分(FMA-UE)评定,改良Barthel指数(MBI)评价两组患者上肢功能及日常生活能力。结果康复机器人组治疗后FMA-UE评分(47.49±7.84)分,常规康复组FMA-UE评分(33.29±9.53)分,康复机器人组治疗后MBI评分(52.49±9.45)分,常规康复组MBI评分(39.81±12.19)分,康复机器人组均高于常规康复组,差异有统计学意义(P<0.05);同时进一步实验分析发现,组间两两比较,康复机器人组肩关节前屈评分、肩关节外展评分、肩关节内旋评分均明显优于常规康复组,差异有统计学意义(P<0.05)。结论在常规功能训练的基础上应用上肢康复机器人辅助训练系统可以明显改善患者的上肢功能,提高日常生活能力。     

虚拟现实技术在脑卒中患者上肢功能康复中的应用进展

脑卒中后上肢功能障碍的发生率较高,恢复困难,严重影响患者生活能力和质量,随着虚拟现实技术的发展和成熟,这项技术渗透到了越来越多的领域,特别是在康复医学领域发挥了巨大的作用。本文主要综述虚拟现实技术在脑卒中患者上肢功能康复方面的应用进展,发现虚拟现实技术可以改善脑卒中后患者的上肢功能,如关节活动度和运动精准性,可以提高患者上肢的功能,改善生活质量。