强制性使用运动疗法在不同程度上肢功能障碍脑卒中患者中的效力

目的 探讨强制性使用运动疗法（CIMT）在不同程度上肢运动障碍的脑卒中患者中的康复效力。方法 27例脑卒中偏瘫患者（平均病程8．3个月）参与此研究。在CIMT治疗期间，要求患者健侧穿戴吊带和夹板来限制健侧肢体动作，每天清醒时固定时间不少于90％，连续12d。同时接受塑形训练，密集地训练患侧肢体活动，完成日常生活中的动作，连续两周共10个工作日。在接受CIMT治疗前和治疗后用上肢功能测验（UEFT）评价患者的上肢运动功能。根据CIMT治疗前UEFT评定结果进行上肢运动功能障碍程度分类。结果 在CIMT治疗后，上肢运动功能障碍重度组和中度组患者的UEF得分较治疗前均显著提高（P〈0．001），而且CIMT在重度组患者中比在中度组患者显现出更大的康复效力（ES分别为2．2和1．8）。在UEFT的改善值方面，重度组和中度组患者间无显著性差异（P〉0．05）。结论 CIMT可以有效地改善不同障碍程度脑卒中患者的上肢运动功能，特别是在上肢运动功能障碍严重的脑卒中患者中显现出更大的康复效力。     

基于Fitts定律的人体上肢运动功能评定方法

目的：探讨在临床医学和康复工程等领域中人体运动功能评定的有效方法及原理。方法：基于Fitts定律,参照代表动作执行情况某方面唯一特性的指标--执行度,结合速度、能量等其它物理量,提出了具有普遍意义的运动功能量化评定方法。选取人体上肢触点运动,用Vicon系统对5名健康男性进行了上肢触点运动实验,并通过一组运动功能评定指标,对人体上肢触点运动功能进行了量化评定。结果及结论：人体上肢运动是包含肌肉骨骼和神经系统的高冗余度的系统运动,选取基于大系统性能理论的宏观特征作为评定指标对人体上肢运动功能进行量化评定是可行和现实的。鉴于人体结构的复杂性和运动的多样性,在对不同动作的评定中,各评定指标的使用必须进行相应的侧重和组合。     

脑卒中运动功能评价

脑卒中患中约有80％遗有肢体运动障碍和日常生活活动能力降低，对其运动功能进行早期而全面的评价，有助于了解病人运动障碍的程度，指导制定康复方案，观察治疗效果分析预后。因此，运动功能评定是脑卒中临床康复不可忽视的重要内容。     

脑卒中偏瘫患者患侧和健侧上肢关节的等速肌力特征研究

摘要 目的：分析脑卒中患者患侧和健侧上肢肩关节和腕关节周围肌力特征。 方法：选取脑卒中偏瘫患者30例作为观察组，同时选取同龄健康人30例作为对照组。观察组患者双侧均进行肩和腕关节等速肌力测试（60°/s和120°/s）、握力及捏力测试、经颅磁刺激检测上肢运动诱发电位（motor evoked potential， MEP）。健康人对照组选择与观察组患侧相应的肢体侧进行检测。对观察组患侧等速肌力与Fugl-Meyer上肢运动功能评定量表（FMA-UE）和MEP进行相关性分析。 结果：①等速肌力测试：在60°/s和120°/s时，与健侧和对照组相比，观察组患侧肩屈伸肌、肩内收外展肌和腕屈伸肌的峰力矩（peak torque， PT）、总功（total work， TW）和平均功率（average power， AP）均显著下降（均P<0.05）；在60°/s时，与健康人相比，观察组健侧肩屈伸肌、肩内收外展肌和腕屈伸肌的PT、TW和AP均具有下降趋势，其中肩内收肌的PT、TW和AP下降具有显著性意义（P<0.05）；在120°/s时，与健康人相比，观察组健侧肩屈伸肌和肩内收外展肌的PT、TW和AP均具有下降趋势，其中，肩伸肌的PT、AP与肩内收肌的PT、TW和AP下降具有显著性意义（P<0.05）；腕屈肌的PT和AP、腕伸肌PT均有下降趋势。②握力及捏力测试：观察组患侧握力、指头—指侧捏力和指尖—指尖捏力较健侧和健康人均明显下降（均P<0.05）；观察组健侧握力、指头—指侧捏力和指尖—指尖捏力较健康人均明显下降（P<0.05）。③神经电生理检测：患侧上肢MEP潜伏期和中枢运动传导时间（central motor conduction time， CMCT）较健侧和健康人均明显延长（均P<0.05）；与健康人相比，健侧上肢MEP潜伏期和CMCT差异无显著性意义（P>0.05）。④相关性分析：观察组患侧上肢肩和腕关节周围肌群的等速肌力与FMA-UE均有明显正相关（P<0.05）；但与患侧上肢MEP潜伏期和CMCT无相关性。 结论：脑卒中偏瘫患者双侧均存在肌力下降的现象，且在Brunnstrom Ⅲ期之后，肌力可能与运动神经传导速度无关。未来的研究和临床治疗应该扩大关注范围，不局限于患侧，提倡双侧评估及训练。     

A型肉毒毒素在治疗儿童脑外伤后肢体痉挛中的应用

目的：探讨A型肉毒毒素（BTX-A）配合康复训练治疗儿童脑外伤后肢体痉挛性运动障碍的疗效。方法采用前瞻性随机对照研究,选取脑外伤后肢体痉挛性运动障碍的患儿44例。随机分为两组。治疗组：注射A型肉毒毒素+康复训练组22例（其中上肢痉挛12例、下肢痉挛10例）。对照组：单纯康复训练组22例（其中上肢痉挛10例、下肢痉挛组12例）。分别观察治疗前、治疗后4周、8周、12周时用改良Ashworth量表、粗大运动功能评估量表（GMFM）进行评估。结果治疗组与对照组之间同期比较,其改良Ashworth量表、粗大运动功能评估量表评估均优于对照组,差异有统计学意义（P<0.05）。治疗组中上肢痉挛患儿改良Ashworth评估及粗大运动功能评估量表评估优于下肢痉挛患儿,差异有统计学意义（P<0.05）。结论 A型肉毒毒素注射治疗联合康复训练对儿童脑外伤后痉挛性运动障碍的改善有较好作用,且上肢痉挛者获益可能优于下肢痉挛者。     

机器人辅助上肢康复运动训练的代偿运动研究

摘要 目的：通过仿真计算和实验的方法探讨上肢不同自由度转动关节的代偿运动可能,为在康复运动训练过程中有效防止代偿运动的出现提供依据。 方法：采用人体上肢的4自由度关节-连杆简化模型,应用变换矩阵计算得到上肢在直线轨迹的运动训练中各关节可能的角度运动变化范围。对正常人分别进行自由状态下和约束状态下的被动直线运动训练,对采集到的关节角度信号进行函数拟合和相关性分析。 结果：人体上肢各关节的运动角度变化规律具有高度的相似性;在约束条件下,人体上肢运动会在肩关节内收外展和上臂旋转两个自由度上产生明显的代偿运动。 结论：可以在中枢神经损伤患者上肢训练中引入肩关节外展矫形器等辅助器具,强制患者增加肩关节外展角度,使患者可以在这种状态下,以与正常人相似的运动规律进行康复运动训练,从而最终恢复或建立正确的运动模式。     

强制性使用运动疗法对慢性期脑卒中患者上肢运动功能的康复疗效

目的 探讨强制性使用运动疗法（CIMT）对慢性期脑卒中患者上肢运动功能的康复疗效。方法 15例慢性期脑卒中偏瘫患者（平均病程13．5个月）在CIMT治疗期间健侧穿戴吊带和夹板限制肢体动作，每天清醒时固定时间不少于90％，连续12d；同时接受塑形训练，密集训练患侧肢体活动，完成日常生活动作，连续两周共10个工作日。在CIMT治疗前2周的基线期、治疗前和治疗后采用上肢功能测验（UEFT）和简易上肢机能检查（STEF）评价患者的上肢运动功能。结果 患者在CIMT治疗前2周的基线期内，UEFT和STEF显现出微小改善（ES；0．11，0．13）；接受2周CIMT治疗后，UEFT和STEF显现出较为明显的改善（ES：0．8，0．5）。结论 C1MT是改善慢性期脑卒中患者上肢运动功能的一种有效治疗方法，短期CIMT介入可以促进患侧上肢功能多方面的改善。     

脑卒中患者上肢运动疗法疗效分析

目的：评定运动疗法改善脑卒中患者上肢功能的可能性和有效性。方法：系统查寻数据库，收集已发表的评估脑卒中患者上肢运动疗法的随机对照研究。制定统一的标准和方法，由两位评估者抽取样本，包括患者运动功能障碍的严重程度、运动处方和疗程。结果：１３项随机对照研究入选，其中６项研究结果肯定了上肢运动疗法，还有５项研究在运动量及持续时间上有不同看法。结论：因为缺少证据，很难确定运动疗法对脑卒中后上肢功能的最终疗效。但部分研究中运动疗法的量及持续时间存在组间差异，这提示卒中偏瘫患者进行更多的运动治疗可能是有益的。…     

脑卒中运动功能评价

脑卒中患者中约有80%遗有肢体运动障碍和日常生活活动能力降低,对其运动功能进行早期而全面的评价,有助于了解病人运动障碍的程度,指导制定康复方案,观察治疗效果及分析预后。因此,运动功能评定是脑卒中临床康复不可忽视的重要内容     

强制性使用运动疗法在最低上肢运动标准慢性脑卒中偏瘫患者中的疗效

目的：探讨强制性使用运动疗法（CIMT）在最低上肢运动标准慢性脑卒中偏瘫患者中的疗效。方法：10例符合CIMT最低上肢运动标准即腕关节伸展〉10°，拇指外展〉10°，其他四指中任何两个手指伸展〉100的慢性脑卒中偏瘫患者参与此研究。在基线期接受常规康复治疗。在CIMT治疗期间，要求患者健侧穿戴吊带和夹板来限制健侧肢体动作，每天清醒时固定时间不少于90％，连续12天，同时接受塑形训练，密集地训练患侧肢体活动．完成日常生活中的动作，连续两周共10个工作日。在基线期与CIMT治疗前后用Fugl—Meyer评价法（FMA）和上肢动作研究量表（ARAT）来评价患者的上肢运动功能，用动作活动日志（MAL）来评价患者的上肢的使用量（AOU）和动作质量（QOM）。结果：患者在基线期，在FMA、ARAT、AOU和QOM上显现出微小改善，效应值（ES）分别为：0．15、0．24、0．07和0．05。但患者在接受CIMT治疗后，在FMA、ARAT、AOU和QOM上显现极为显著的改善，ES分别为：2．1、3．75、5．19和4．29。结论：CIMT可以改善最低上肢运动标准慢性脑卒巾偏瘫患者上肢运动功能，但CIMT在这些脑卒中患者中的长期功能效益尚需进一步明确。     

FUNCTIONAL MOVEMENT SCREENING: THE USE OF FUNDAMENTAL MOVEMENTS AS AN ASSESSMENT OF FUNCTION‐PART 2

Part 1 of this two‐part series (presented in the June issue of IJSPT) provided an introduction to functional movement screening, as well as the history, background, and a summary of the evidence regarding the reliability of the Functional Movement Screen (FMS™). Part 1 presented three of the seven fundamental movement patterns that comprise the FMS™, and the specific ordinal grading system from 0‐3, used in the their scoring. Specifics for scoring each test are presented.Part 2 of this series provides a review of the concepts associated with the analysis of fundamental movement as a screening system for functional movement competency. In addition, the four remaining movements of the FMS™, which complement those described in Part 1, will be presented (to complete the total of seven fundamental movements): Shoulder Mobility, the Active Straight Leg Raise, the Trunk Stability Push‐up, and Rotary Stability. The final four patterns are described in detail, and the specifics for scoring each test are presented, as well as the proposed clinical implications for receiving a grade less than a perfect “3”.The intent of this two part series is to present the concepts associated with screening of fundamental movements, whether it is the FMS™ system or a different system devised by another clinician. Such a fundamental screen of the movement system should be incorporated into pre‐participation screening and return to sport testing in order to determine whether an athlete has the essential movements needed to participate in sports activities at a level of minimum competency.Part 2 concludes with a discussion of the evidence related to functional movement screening, myths related to the FMS™, the future of functional movement screening, and the concept of movement as a system.

Level of Evidence:

5     

Consensus on core phenomena and statements describing Basic Body Awareness Therapy within the movement awareness domain in physiotherapy

Physiotherapists are facing complex health challenges in the treatment of persons suffering from long-lasting musculoskeletal disorders and mental health problems. Basic Body Awareness Therapy (BBAT) is a physiotherapy approach within the movement awareness domain developed to bridge physical, mental, and relational health challenges. The purpose of this study was to reach a consensus on core phenomena and statements describing BBAT. A consensus-building process was conducted using the nominal group technique (NGT). Twenty-one BBAT experts from 10 European countries participated in a concentrated weekend workshop of 20 hours. All participants signed informed consent. Participants reached a consensus on 138 core phenomena, clustered in three overarching categories: clinical core, historical roots, and research and evaluation phenomena. Of the 106 clinical core phenomena, the participants agreed on three categories of phenomena: movement quality, movement awareness practice, and movement awareness therapy and pedagogy. Furthermore, the participants reached 100 percent consensus on 16 of 30 statements describing BBAT. This study provides a consensus on core phenomena and statements describing BBAT. The data reveal phenomena implemented when promoting movement quality through movement awareness. Data provide clarity in some aspects of the vocabulary as fundamental theory. Further reearch will be developed.     

Characteristics of the scapula movement during shoulder elevation depend on posture

[Purpose] This study aimed to clarify the differences in scapular movement during flexion and abduction of the shoulder joint with different postures. [Participants and Methods] This study included 15 male participants. Their shoulder flexion and abduction and angles of the scapular upward rotation, scapular anterior tilt, scapular external rotation, and thoracic spine flexion were measured. Measurements were taken in three positions: the control, thoracic spine flexion, and thoracic spine extension positions using a three-dimensional motion capture system. [Results] In the shoulder flexion, the amount of change in the scapular external rotation was significantly greater in the thoracic flexion than in the thoracic extension. In shoulder abduction, the amount of change in the scapular anterior tilt and external rotation was significantly greater in the thoracic flexion than in the thoracic extension. A comparison of the scapular angles in shoulder flexion and abduction showed that the upward rotation, posterior tilt, and external rotation were significantly greater in abduction than flexion. [Conclusion] To avoid posture-induced incoordination of the scapula and thorax movement during shoulder elevation, postural adjustment of the thoracic spine based on the movements is necessary for the shoulder joint exercises.     

Editorial

Background: The functional movement screen (FMS) is a movement screening tool designed to assess mobility, stability, symmetry, and quality of movement patterns. It is an inexpensive and accessible screening tool. It is not known if composite FMS scores correlate with athletic performance.

Objective: To systematically review relevant literature to discover if composite FMS scores correlate with athletic performance.

Methods: A systematic review of literature indexed in the following databases: Medline, CINAHL, SportsDiscus, and PubMed was conducted. The risk of bias was assessed using the QUADAS-2 assessment tool.

Results: Six studies satisfied the eligibility criteria and were included in this review. The studies population age range was twenty to twenty-four years old. Risk of bias per the QUADAS-2 tool determined that five out of six studies (83%) were deemed relatively low risk of bias for the risk of bias indicators, and one study (17%) was of unclear risk due to lack of reporting. For the applicability concerns aspect of the QUADAS-2 tool, all studies (100%) scored relatively low risk of bias for most indicators. Composite FMS scores generally did not correlate with athletic performance. Certain individual components of the FMS, such as deep squat (DS), did correlate with certain athletic performance measures.

Conclusions: The results of this review suggest that the FMS is not a predictive indicator of athletic performance. The DS and in-line lunge components of the FMS might be an indicator of athletic performance for certain athletic performance measures.     

高压氧联合运动想象和舱内运动治疗脑梗死偏瘫病人的研究

[目的]探讨高压氧联合运动想象和舱内运动治疗对脑梗死偏瘫病人神经功能恢复的效果。[方法]将60例脑梗死偏瘫病人随机分为两组,治疗组30例,在高压氧治疗稳压阶段联合运动想象和舱内运动治疗;对照组30例,行常规高压氧治疗。[结果]两组治疗前后MMT肌力分极、Brunnstrom功能分期、改良巴氏指数比较差异有统计学意义(P<0.05或P<0.01)。[结论]高压氧联合运动想象和舱内运动治疗脑梗死偏瘫,可让病人在轻松愉快的心情下接受治疗,并明显增加疗效,减少后遗症。     

Modified four-pass differential SAR interferometry for estimating mountain glacier surface velocity fields

Conventional four-pass differential synthetic aperture radar interferometry (DInSAR) assumes that there are no significant changes in the ground during the period between the acquisition times of SAR images for topographic DInSAR pairs. This assumption can rarely be satisfied for glacial areas due to their continuous movement. This letter proposes a modified four-pass DInSAR method without an external digital elevation model (DEM), taking into account glacier movement between the acquisition times of SAR images used to form topographic DInSAR pairs. An explicit expression of theoretical formulas for a modified four-pass DInSAR technique was derived for the first time, revealing that four-pass DInSAR considering ground movement of topographic pairs was equivalent to that of conventional four-pass DInSAR with a spatially varying nominal wavelength. Then the proposed method was tested with four Advanced Land Observing Satellite (ALOS) SAR images covering Dongkemadi glacier located on the Tibetan Plateau, China. An experiment with real data showed that the proposed method could obtain glacial flow patterns efficiently, and that the difference between two-pass DInSAR and the proposed method is a result of DEM bias and glacial thinning. The approach presented in this letter proved to be appropriate for monitoring glacial motion and provides a valuable tool for glacier studies, without the need of an external DEM.     

主动运动治疗腰椎间盘突出症疗效分析

目的探讨主动运动治疗腰椎间盘突出症的临床疗效。方法将 6 8例经手法推拿按摩、腰椎牵引和电疗等治疗 ,病情已明显好转或已痊愈出院的腰椎间盘突出症患者 ,分为主动运动治疗组 ( 31例 )和对照组 ( 37例 )进行为期 1年的追踪观察 ,比较两组患者 1年后的复发率和F波传导速度的变化情况。结果主动运动治疗组患者的复发率低于对照组 (P <0 .0 5 ) ,F波传导速度明显快于对照组 (P <0 .0 1) ,与治疗前比较也有非常高度显著性差异 (P <0 .0 0 1)。结论腰椎间盘突出症患者症状和体征好转后配合主动运动治疗 ,可巩固疗效、减少复发 ,并进一步改善神经根的功能。     

Basic elements and dimensions to the phenomenon of quality of movement – a case study

Quality of movement is frequently referred to as a phenomenon in the European movement tradition, underlining the close connection between outer expression and inner, lived experience. Within physical therapy little is clarified about the phenomenon from the point of view of lived experience. A case study has been undertaken focusing on the lived experience of the phenomenon, searching for basic elements and dimensions. An interpretive phenomenological approach was the method chosen for research. A qualitative interview was conducted involving one movement expert with an understanding and knowledge of the phenomenon. Analysis of the data revealed three levels of views on the quality of movement: basic elements and dimensions, functional use and personal integration. The phenomenon could be understood by the relation between three key elements, postural stability, free breathing and awareness; all contributing to a refinement in movement as well as a greater experience of well-being. The key elements were considered prerequisites to a four-dimensional therapeutic approach involving personal integration of bodily and mental aspects in movement. The basic element and dimensions of the phenomenon of quality of movement can be regarded as a starting point for research in this area.