穴位推拿结合抗痉挛技术对脑卒中后上肢肌痉挛改善的疗效观察

目的观察穴位推拿结合抗痉挛技术对脑卒中后上肢肌痉挛的改善情况。方法 40例脑卒中后上肢肌痉挛的患者随机分成治疗组(穴位推拿与抗痉挛技术组)和对照组(抗痉挛技术组),在治疗前和治疗后第12周运用改良的Ashworth肌痉挛量表(MAS)和Fugl-meyer(FMA)的上肢主动运动功能积分进行上肢肌痉挛和运动功能的评定。结果 2组患者治疗后MAS和FMA评分与治疗前比较,差异有统计学意义(P<0.05)。治疗组与对照组治疗后MAS和FMA评分比较,差异有统计学意义(P<0.05)。结论 2组均能改善上肢肌痉挛和运动功能,但穴位推拿结合抗痉挛技术在改善上肢肌痉挛和运动功能方面又优于单纯抗痉挛技术。     

镜像疗法对偏瘫患者上肢功能康复疗效的观察

目的 观察镜像疗法对卒中后偏瘫患者上肢功能康复的疗效。方法 选择30例入选卒中后8周内偏瘫患者随机分为两组：镜像疗法组和对照组,分别于治疗前及治疗后4周采用Fugl-Meyer运动评价（Fugl-Meyer motor assessment,FMA）（上肢部分）,上肢运动研究测试（the action research arm test,ARAT）、运动功能评估量表（motor assessment scale,MAS）对上肢运动功能进行评分,同时评定患者的视觉模拟评分（visual analogue scale/score,VAS）、痉挛程度以及改良Barthel指数,以观察镜像疗法对偏瘫患者上肢功能康复的疗效。结果 治疗4周后,两组上肢运动能力FMA评分、ARAT评分、MAS评分、改良Barthel指数均较治疗前提高（P＜0.01）;治疗组FMA评分、ARAT评分高于对照组（P＜0.05）,两组间MAS评分、改良Barthel指数提高,但差别无统计学意义（P＞0.05）。治疗组VAS评分较治疗前有下降（P＜0.05）,但对照组治疗前后,VAS评分差异无统计学意义（P＞0.05）,治疗后两组间的VAS差异有统计学意义（P＜0.05）。两组治疗前后及治疗后组间痉挛改善差异无统计学意义（P＞0.05）。结论 镜像疗法能提高偏瘫患者的上肢运动功能,且能减轻患者偏瘫上肢的疼痛,但对患者日常生活活动能力（activity of daily living scale,ADL）及患肢痉挛程度的改善无明显影响。     

A型肉毒毒素注射联合运动疗法治疗脑卒中后肘关节屈曲痉挛的疗效观察

目的观察A型肉毒毒素注射运动疗法治疗对于脑卒中后肘关节屈肌痉挛患者肌张力和运动功能的影响。方法对20例脑卒中后肘关节屈曲痉挛患者,随机分为治疗组和对照组各15例。治疗组患者采用对于肘关节屈曲痉挛肌肉进行A型肉毒毒素注射结合运动疗法治疗,对照组采用口服巴氯芬药物治疗结合运动疗法治疗。在治疗前、治疗后第1周、第6周和第12周应用改良Ashworth量表(MAS)和Fugl-Meyer量表(FMA)上肢评估量表进行比较。结果 2组治疗后MAS评分及FMA评分均较治疗前呈持续下降趋势(P0.05,0.01),且治疗组更低于对照组(P0.05,0.01)。结论 A型肉毒毒素注射结合运动疗法对降低脑卒中患者肘关节屈肌肌张力,提高运动功能及生活自理能力更加优于普通治疗。     

针刺结合康复训练治疗老年脑卒中后上肢功能障碍的疗效

目的观察针刺结合康复训练治疗老年脑卒中后上肢功能障碍的疗效。方法选择我院2015-09-2016-11收治的脑卒中合并上肢功能障碍患者112例,根据随机数字表法将所有患者分为2组,每组56例。对照组给予常规康复训练,观察组在此基础上联合针刺治疗,比较2组临床疗效、日常生活能力评分、疼痛评分、上肢运动功能评分及神经功能评分。结果治疗后2组临床疗效相比,观察组优于对照组,差异具有统计学意义(P0.05);2组治疗前ADL、FMA、VAS、NDS评分相比,差异无统计学意义(P0.05);治疗后ADL、FMA、VAS、NDS评分均优于治疗前,组间相比,观察组优于对照组,差异具有统计学意义(P0.05)。结论针刺结合康复训练可改善老年脑卒中后上肢功能障碍,减少神经功能损伤和疼痛,提高日常生活能力。     

A型肉毒素局部注射结合强化运动治疗对脑卒中后下肢痉挛患者步行能力的影响

目的初步观察A型肉毒素局部注射结合强化运动治疗对脑卒中后下肢痉挛患者步行能力的影响。方法将40例脑卒中后下肢痉挛患者根据随机数字表法分为治疗组和对照组,每组20例,对照组给予下肢痉挛肌群A型肉毒素局部注射加常规康复治疗,治疗组在此基础上强化运动治疗。分别于治疗前、治疗后4周、治疗后8周对2组患者进行MAS(改良Ashworth量表)、IEMG(肌表面肌电积分值)、PROM(被动关节活动度)、10m MWS(10m最快步行速度)、FMA(Fugl-Meyer运动功能)、PCI(生理消耗指数)评分。结果治疗4周及8周后,2组MAS、IEMG、PROM、10m MWS、FMA、PCI评分较组内治疗前均显著改善,差异有统计学意义(P0.05);治疗4周后,治疗组PROM(4.39±1.25)°、10 m MWS(18.12±3.47)m/s、FMA(25.16±2.55)分、PCI(0.51±0.21)等指标显著优于对照组,差异有统计学意义(P0.05),而MAS(1.54±0.48)分、IEMG(37.95±4.48)分等指标差异无统计学意义(P0.05);治疗8周后,治疗组PROM(4.42±1.01)°、10m MWS(14.11±2.83)m/s等指标显著优于对照组,差异有统计学意义(P0.05),而MAS(1.63±0.57)分、IEMG(46.94±8.17)分、FMA(26.44±2.12)分、PCI(0.47±0.15)等指标差异无统计学意义(P0.05)。结论 A型肉毒素局部注射结合强化运动治疗可改善脑卒中后下肢痉挛患者的步行能力,可作为一种康复治疗手段应用于临床。     

重复经颅磁刺激联合重复注射A型肉毒毒素对脑卒中后下肢肌肉痉挛状态的临床疗效和安全性研究

目的观察脑卒中后下肢肌肉痉挛患者行重复经颅磁刺激(rTMS)联合A型肉毒毒素(BTX-A)重复注射的治疗效果及安全性。方法选择2013年7月至2016年7月于本院康复科治疗的伴有下肢肌肉痉挛的脑卒中患者共96例,按照随机数字表法分为4组:A组,康复治疗;B组,rTMS+康复治疗;C组,重复注射BTX-A+康复治疗;D组,rTMS+重复注射BTX-A+康复治疗。治疗前及治疗后1、6和12个月对4组患者采用改良Ashworth痉挛量表(MAS)评定肌张力,Fugl-Meyer下肢运动功能量表(FMA)评定下肢运动功能,采用改良Barthel指数量表(MBI)评定患者日常生活能力,Berg平衡量表(BBS)评定患者平衡能力。并观察患者在治疗的过程中的不良反应情况。结果与治疗前相比,治疗后1、6、12个月,B、C、D组的MAS评分呈下降趋势,D组最为明显(P<0.05);4组患者治疗1个月后FMA评分、MBI评分、BBS评分均升高,治疗后6、12个月,A、B、C组的FMA评分、MBI评分、BBS评分有下降或回升,D组的评分都呈上升趋势,均高于其他3组(P<0.05);治疗过程中,4组均无严重不良反应情况发生。结论 rTMS联合重复注射A型肉毒毒素能够有效降低脑卒中后下肢肌肉痉挛患者的肌肉张力,提高患者的生活质量,治疗效果较为持久,无不良反应,有临床应用价值。     

基于镜像视觉反馈疗法配合康复训练对脑卒中后偏瘫患者上肢功能及日常活动能力的影响

目的探讨镜像视觉反馈疗法配合康复训练对脑卒中后偏瘫患者上肢功能及日常活动能力的影响。方法抽取2015-02—2016-03我院64例脑卒中后偏瘫患者,根据不同干预方式分为2组各32例。对照组采用康复训练,研究组在康复训练基础上实施镜像视觉反馈疗法,2组均持续干预1个月。对比干预前后2组上肢功能评分(FMA)、前臂旋前肌群与屈肘肌群肌张力评分(MAS)、日常活动能力评分(BI)变化情况。结果干预前2组FMA评分、前臂旋前肌群与屈肘肌群MAS评分、BI评分对比差异无统计学意义(P0.05),干预后研究组FMA(46.82±18.85)分、前臂旋前肌群MAS(1.22±0.46)分、屈肘肌群MAS(1.24±0.51)分、BI(54.14±3.43)分优于对照组[(37.20±16.18)分、(1.69±0.38)分、(1.68±0.44)分、(37.18±4.03)分],差异有统计学意义(P0.05)。结论联合采用康复训练及镜像视觉反馈疗法对脑卒中后偏瘫患者进行干预效果显著,可有效改善其上肢功能,提高患者日常活动能力,具有推广价值。     

国产A型肉毒毒素治疗脑卒中后上肢痉挛的疗效

目的探讨国产A型肉毒毒素(CBTX-A)肌肉注射治疗脑卒中后上肢痉挛的疗效和安全性。方法选取43例脑卒中患者为研究对象。根据随机数字表将患者分为两组:CBTX-A +康复治疗组(治疗组)和单纯康复治疗组(对照组)。治疗组患者除康复训练外,肱二头肌肌肉注射CBTX- A。分别于治疗前及治疗后2、4、8、12周对患者上肢功能进行评价。评价内容包括改良的Ashworth计分(MAS)、关节活动度(ROM)、上肢的Fugl-Meyer(FMA-上肢)计分和上肢的FIM运动能力(mot- FIM-上肢)。结果治疗组CBTX-A局部注射治疗后,85.7%(18/21)的患者有效。两组在MAS、ROM、FMA-上肢计分和mot-FIM-上肢方面,治疗后比治疗前均有显著改善。治疗后2、4、8周MAS计分治疗组分别为1.74±0.41,1.62±0.35,1.60±0.41,对照组分别为2.50±0.51,2.27±0.53, 2.18±0.55,各期两组间差异有统计学意义(P<0.01)。但是在治疗后12周时,两组间差异无统计学意义(P>0.05)。治疗后4-12周,ROM计分治疗组分别为57.81±57.60,66.43±64.38,68.14±65.99,对照组分别为27.91±30.13,30.73±34.03,33.73±34.50,各期治疗组比对照组均有显著性增加,差异有统计学意义(P<0.05)。治疗组治疗后FMA-上肢计分和mot-FIM-上肢计分与对照组相比均无统计学意义(P>0.05)。结论通过实验可以得出CBTX-A肌肉注射结合康复治疗可以达到提前缓解局部肌张力,扩大关节活动度,减轻疼痛,改善肢体功能的目的,这种治疗方法安全有效,具有良好的耐受性。     

“痉挛三针”对痉挛型脑瘫儿童运动功能的影响

目的观察"痉挛三针"对痉挛型脑瘫儿童运动功能的影响。方法选择我院治疗的86例痉挛型脑瘫患儿,依据随机数字表法分为观察组与对照组各43例。对照组采用头针针灸结合康复训练治疗,观察组在对照组的治疗基础上加用"痉挛三针"。比较2组治疗前后的改良Ashworth评分、GMFM-88中D区与E区评分及治疗效果。结果治疗后2组改良Ashworth评分均不同程度降低,GMFM-88中D区与E区评分均有所提高,观察组显著优于对照组;观察组总有效率(90.7%)显著优于对照组(81.4%),差异有统计学意义(P0.05)。结论 "痉挛三针"可有效降低痉挛型脑瘫儿童内收肌肌张力,使患儿获得更好的独立行走及跑跳等运动功能。     

介入性超声与微波治疗脑卒中后肩手综合征疗效比较研究

目的探讨介入性超声和微波治疗脑卒中后肩手综合征的有效性和安全性。方法共42例脑卒中后肩手综合征Ⅰ期患者随机接受微波联合常规康复训练(19例)和介入性超声联合常规康复训练(23例),于治疗前、治疗后3和10 d采用视觉模拟评分(VAS)评价肩关节疼痛程度、测量手背和掌指小关节水肿程度,于治疗前和治疗后10 d采用Fugl-Meyer上肢评价量表(FMA-UE)评价上肢运动功能、Barthel指数(BI)评价日常生活活动能力。结果两组患者不同时间点VAS评分(P=0.000)以及手背和掌指小关节水肿程度(P=0.000)差异有统计学意义,其中,治疗后3和10 d VAS评分(对照组:P=0.000,0.000;治疗组:P=0.000,0.000)以及手背和掌指小关节水肿程度(对照组:P=0.042,0.000;治疗组组:P=0.000,0.000)低于治疗前,治疗后10 d VAS评分(P=0.000,0.000)以及手背和掌指小关节水肿程度(P=0.000,0.000)亦低于治疗后3 d。治疗后两组患者VAS评分(P=0.031)以及手背和掌指小关节水肿程度(P=0.000)低于治疗前,FMA-UE(P=0.000)和BI(P=0.000)评分高于治疗前。结论介入性超声和微波联合常规康复训练均可以改善脑卒中后肩手综合征患者肩关节疼痛程度、手背和掌指小关节水肿程度、上肢运动功能和日常生活活动能力,且介入性超声联合常规康复训练较微波联合常规康复训练在改善肩关节疼痛程度以及手背和掌指小关节水肿程度方面疗效更佳。     

Efficacy of a Virtual Reality Commercial Gaming Device in Upper Limb Recovery after Stroke: A Randomized,Controlled Study

Objective: To compare the efficacy of a virtual reality commercial gaming device, Nintendo wii (NW) with conventional therapy and customary care in facilitating upper limb recovery after stroke.

Design: Randomized, controlled, single-blinded study. Setting: Tertiary rehabilitation center.

Participants: 105 subjects admitted to in inpatient rehabilitation program within 6 weeks of stroke onset.

Interventions: Subjects were randomly assigned to one of three groups of upper limb exercises: (1) NW gaming; (2) conventional therapy; (3) control. NW gaming and conventional therapy were provided fourtimes a week for 3 weeks.

Main outcome measure(s): The main outcome measure was Fugl-Meyer assessment (FMA) of upper limb function. Secondary outcome measures included Action Research Arm Test, Functional Independence Measure, and Stroke Impact Scale. These measures were assessed at baseline, completion of intervention (week 3) and at 4 weeks and 8 weeks after completion of intervention. The primary outcome measure was the change in FMA scores at completion of intervention.

Results: The mean age was 57.5±9.8 years, and subjects were enrolled at a mean of 13.7±8.9 days after stroke. The mean baseline FMA score was 16.4±14.2. There was no difference in FMA scores between all 3 groups at the end of intervention, and at 4 and 8 weeks after completion of intervention. Similar findings were also noted for the secondary outcome measures.

Conclusion(s): Twelve sessions of augmented upper limb exercises via NW gaming or conventional therapy over a 3-week period was not effective in enhancing upper limb motor recovery compared to control.     

镜像训练引导的运动想象疗法对急性缺血性脑卒中偏瘫患者上肢功能的康复效果

目的:本研究旨在对镜像训练引导的运动想象疗法是否能够更有效地改善急性缺血性脑卒中后偏瘫患者的上肢功能以及日常生活能力进行评价。方法:研究对象为2014年1月1日—2016年6月30日符合病例选择标准的76例急性缺血性脑卒中后偏瘫患者。将76例患者随机分入镜像训练引导的运动想象疗法组(38例)和单纯的运动想象疗法组(38例),在常规康复训练的基础上,分别接受镜像训练引导的运动想象疗法和单纯的运动想象疗法,共治疗4周。对2组治疗前后的美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分、Barthel指数、上肢动作研究量表(Action Research Arm Test,ARAT)评分和Fugl-Meyer上肢运动功能评分进行比较。结果:2组患者治疗后的NIHSS评分、Barthel指数、ARAT评分和Fugl-Meyer上肢运动功能评分均较治疗前显著改善(P值均0.05)。镜像训练引导的运动想象疗法组治疗后的NIHSS评分、Barthel指数、ARAT评分和Fugl-Meyer上肢运动功能评分的改善幅度均显著大于单纯的运动想象疗法组(P值均0.05)。结论:镜像训练引导的运动想象疗法应用于急性缺血性脑卒中后偏瘫患者上肢功能的康复治疗,与单纯的运动想象疗法相比,可以更好地改善患者的上肢功能和生活自理能力。     

三级康复训练对脑卒中偏瘫患者肢体功能恢复及生活质量的影晌

目的探讨三级康复训练对脑卒中偏瘫患者肢体功能恢复及生活质量的影响。方法选择我院2010一08—2012—10收治的116例脑卒中偏瘫患者,观察组58例采用三级康复训练措施,对照组58例采用常规护理措施,比较2组患者的肢体功能恢复情况和生活质量改善情况。结果治疗前、治疗1个月与3个月后,2组患者的上肢和下肢FMA评分、MBI评分均基本相当,组问差异无统计学意义;而6个月后,2组患者的上肢和下肢FMA评分、MBI评分均出现明显提高,且观察组改善程度更为显著,2组比较差异具有统计学意义（P〈O．05）。结论三级康复训练措施通过循序渐进的护理措施指导脑卒中患者进行机体的康复联系,有利于患者的肢体功能恢复,并在一定程度上提高患者的生活质量,有利于患者的预后恢复,值得临床应用。     

功能性电刺激结合康复踏车训练对卒中急性期患者下肢功能的影响

目的 观察和探讨功能性电刺激（functional electrical stimulation,FES）结合康复踏车训练对卒中急性 期患者下肢功能的影响。 方法 将120例卒中急性期偏瘫患者采用随机数字表法分为对照组和观察组。两组均接受常规药物 治疗。对照组患者采用Bobath技术为主的常规康复训练,主要包括桥式训练、坐站训练、常规踝背屈 训练等,每日训练1次,每次45 min,每周训练5 d,训练2周。观察组患者在对照组康复治疗基础上给予 FES结合康复踏车系统训练,每次20 min,每周训练5 d,训练2周。分别于治疗前和治疗后采用功能性 步行量表（functional ambulation category,FAC）、Fugl-meyer下肢功能评定量表（Fugl-Meyer assessment, FMA）、Barthel指数评定量表进行评分并比较。 结果 ①治疗前,2组患者各项指标组间比较差异均无统计学意义;②治疗后,对照组和治疗组患者 的FAC评分、下肢FMA评分、Barthel指数评分均较本组治疗前有显著改善;治疗后,观察组上述指标显 著优于对照组（均P＜0.001）。 结论 功能性电刺激结合康复踏车训练能显著地提高卒中急性期患者下肢功能,从而提高患者日 常生活活动能力。     

表面肌电信号对脑卒中患者远程居家康复指导的效果研究

目的探讨表面肌电信号对指导脑卒中患者居家远程康复的效果。方法筛选2014年7月至2015年6月在上海市第五人民医院神经内科住院治疗的脑卒中患者78例,78例患者通过SPSS统计软件按1:1的比例分成两组,分别为表面肌电信号指导进行居家康复的治疗组(39例)与无表面肌电信号指导居家康复的常规组(39例)。采用简化FuglMeyer运动功能量表(FMA)评定上肢功能,通过均方根值(RMS)测定肌肉收缩时的收缩强度。结果康复治疗前,两组患者上肢FMA评分与RMS评分比较,差异无统计学意义(P0.001)。康复治疗后,两组患者上肢FMA评分与RMS评分均较康复治疗前增加,差异具有统计学意义(P0.001)。康复治疗后,治疗组上肢FMA评分与RMS评分均较常规组增加,差异具有统计学意义(FMA:P=0.02;RMS:P=0.018)。结论康复过程中进行表面肌电信号调整康复方案可增强运动功能康复的效果。     

Long-term effects of injection of botulinum toxin type A combined with home-based functional training for post-stroke patients with spastic upper limb hemiparesis

The aim of this study was to assess the effects of botulinum toxin type A (BoNT-A) injection with home-based functional training for passive and active motor function, over a 6-month period in post-stroke patients with upper limb spasticity. We studied 190 patients with at least 6-month history of stroke. They received injections of BoNT-A in upper limb muscles and detailed one-to-one instructions for home-based functional training. At baseline (before therapy), and at 1-, 3- and 6-month follow-up, Fugl-Meyer assessment (FMA) and Wolf motor function test (WMFT) were used to assess active motor function, the modified Ashworth scale (MAS) for assessment of spasticity, and the range of motion (ROM) for passive motor function. The total score for upper limb and scores of categories A and B of the FMA increased significantly at 1, 3 and 6 months, while the FMA score for category D increased significantly at 3 and 6 months, but not at 1 month. Significant decreases in the MAS scores were noted in all muscles examined at 1, 3 and 6 months, compared with baseline. The ROM for elbow joint extension significantly improved at 1, 3, and 6 months, while that for wrist joint extension increased significantly at 1 month, but not 3 or 6 months, compared with baseline. The results suggest that comprehensive improvement of motor function requires improvement of motor function in the proximal part of the upper limb and that BoNT-A followed by rehabilitation reduces spasticity and improves motor function of fingers.     

Rehabilitative treatment for knee osteoarthritis in 28 hemiplegia patients after stroke

BACKGROUND: The pain of knee joint in the paralyzed leg of hemiplegic patients after stroke will affect the training of standing and walking, and delay the proceeding of rehabilitation. OBJECTIVE: To investigate the effective method for relieving pain of knee osteoarthritis and improving the function of lower limbs in hemiplegic patients after stroke. DESIGN: A randomized controlled study. SETTING: Department of Rehabilitation and Physical Medicine, Anhui Provincial Corps Hospital, Chinese People's Armed Police Forces. PARTICIPANTS: Twenty-eight hemiplegic patients after stroke with knee osteoarthritis were selected from the Department of Rehabilitation and Physical Medicine, Anhui Provincial Corps Hospital, Chinese People's Armed Police Forces from January 2003 to December 2006, including 11 males and 17 females, aged 47–77 years, they all conformed to the diagnostic criteria of stroke set by the Fourth National Academic Meeting for Cerebrovascular Disease in 1995, as well as the diagnostic standards of knee osteoarthritis. Informed consents were obtained from all the patients and their relatives. METHODS: The 28 patients were randomly divided into treatment group (n =14) and control group (n =14). All patients had received facilitative technique training, such as normal motor pattern exercising and knee joint control exercising after hospitalization, besides, the patients in the treatment group received an extra complex therapy of electro-acupuncture therapy, physical therapy and exercise therapy, once a day, and 10 days as a course. MAIN OUTCOME MEASURES： The evaluation and effectiveness of the visual analogue scale (VAS) and Fugl-Meyer Assessment (FMA) score of lower limbs function before and after therapy in the two groups. RESULTS: ① VAS results: The score of pain evaluation in the treatment group after therapy was significantly lower than that in the control group (P < 0.01), and the effectiveness of the treatment group was significantly higher than that of the control group (P < 0.01). ② FMA score of lower limbs motor function: There were no significant differences between the two groups before and after therapy (P > 0.05). CONCLUSION: The complex therapy of electro-acupuncture therapy, physical therapy, and exercise therapy based on facilitative technique training is effective in relieving pain of knee osteoarthritis in hemiplegic patients after stroke, but it is similar to the single rehabilitative training in improving the function of lower limbs.