康复治疗时机对脑梗塞患者脑血流量和脑电图的影响

目的　研究康复治疗时机对脑梗塞患者脑血流量（ＣＢＦ） 和脑电图（ＥＥＧ）的影响。方法１３８ 例脑梗塞患者随机分为Ａ组４６ 例,发病１ 周内开始康复治疗;Ｂ组４６ 例,发病１ 个月后开始康复治疗;Ｃ 组４６ 例,无康复治疗。总疗程均２ 个月,其中康复治疗１ 个月。治疗前后检查脑电图、１３３Ｘｅ吸入法测定脑血流量。结果　Ａ组疗效显著高于其他组,Ｒｉｄｉｔ 分析,Ｐ＜ ０．０５ 。各组治疗前ＥＥＧ 和ＣＢＦ相似,治疗后均有所改善,Ｐ＜ ０．０５～０．０１,Ａ 组改善优于其他组,Ｐ＜ ０ ．０５ ～０．０１ 。结论　康复治疗开始早晚均能改善脑梗塞患者脑血流量和脑功能,早期康复尤为明显,康复治疗应尽早开始     

高压氧治疗对脑梗塞患者脑血流量脑电图的影响

目的：研究高压氧治疗对脑梗塞患者脑血流量、脑电图等的影响。方法：脑梗塞患者８６例，随机分为高压氧组和对照组各４３例，均给予复方丹参１６毫升，加入５％葡萄糖生理盐水注射液２５０毫升内静脉滴注，每日１次。高压氧组并增加高压氧治疗，压力０．２ＭＰａ，加压２０分钟，戴面罩吸纯氧６０分钟，中间休息１０分钟，减压３０分钟，共１２０分钟，每日１次，两组疗程均１０天。治疗前后检测脑血流图、脑电图、血液流变学指标和超氧化物歧化酶。结果：高压氧组总有效率９３％，对照组６７％，两组疗效差异有非常显著性（Ｐ＜０．０１）。高压氧组治疗后患者脑血流量、脑电图、血液流变学、超氧化物歧化酶均明显改善（Ｐ＜０．０５～０．０１），对照组仅血液流变学有改善。结论：高压氧治疗可提高脑梗塞患者的脑血流量和超氧化物歧化酶水平，改善脑电图和血液流变学，并有较好的临床治疗效果。     

小儿脑梗塞康复日常生活活动能力的预测

根据小儿脑梗塞患儿发病及入院的资料来预测出院时日常生活活动能力 ,判断患儿出院后回到家庭及社会的可能性 ,有助于临床医师充分利用综合医院中有限的康复资源 ,制定适当的康复治疗方案。通过回顾性分析对影响小儿脑梗塞出院时日常生活活动能力的因素进行探讨。1　对象和方法1.1　对象　 1996 - 0 1- 0 1～ 2 0 0 2 - 12 - 31在我科住院的小儿脑梗塞 86例 ,男 4 6例 ,女 4 0例。年龄 3月龄～ 1岁 18例 ,～ 3岁 35例 ,～ 6岁 2 3例 ,>6岁 10例。急性起病 81例 ,慢性起病 5例。有上感史者 32例 ,肠道感染史 16例 ,余无前驱症状呈卒中型发病 …     

尼莫地平对轻和中型脑梗塞脑血流量及脑功能的影响

目的 研究尼莫地平治疗轻、中型急性脑梗塞的疗效和对患脑血流量（CBF）、脑干听觉诱发电位（BAEP）和脑电图（EEG）的影响。方法 80例发病48h以内脑梗塞患，随机分为治疗组和对照组各40例。各组均予以丹参注射液20mL＋0.9%氯化钠注射液250mL,iv drip,Qd，治疗组加用20％尼莫地平注射液50mL,iv drip,Qd,2组疗程均10d。治疗前和治疗后1mo均测定CBF、BAEP和EEG等。结果 治疗1mo后，治疗组和对照组总有效率分别为92．5％和80％，Ridit分析，P＜0．01；CBF、BAEP和EEG虽2组均有所改善，但以治疗组明显，两组比较，P＜0．05、0．01。结论 尼莫地平能有效治疗轻、中型急性脑梗塞，改善患脑血流量和脑功能。     

脑超声改善脑梗死患者肢体功能和日常生活活动能力

应用脑超声治疗脑梗死144例,观察其肢体功能和日常生活活动能力(ADL)改变,并与158例不接受该治疗的患者对照。治疗1个月后发现接受脑超声治疗者总有效率93.1%,优于治疗组82.9%(χ2=7.21,P<0.01)。证明超声辅助治疗脑梗死偏瘫患者疗效优于单纯药物治疗,且具有无痛苦、无损伤、对中枢神经进行直接治疗等优点。     

二次住院脑性瘫痪儿童日常生活活动能力分数变化的相关因素

目的分析脑性瘫痪儿童出院后影响患儿日常生活活动能力的相关因素。方法对1999—01／2001—12在中国康复研究中心儿童康复科2次住院的脑性瘫痪儿童40例进行日常生活活动能力评价，与第1次出院前日常生活活动能力分数比较，并对患儿家长进行相关问卷调查。结果①不同年龄患儿第2次住院与第1次出院前日常生活活动能力分数相比，3-5岁降低明显。②重度脑性瘫痪对日常生活活动能力有影响（肢体障碍程度越重，影响就越大，以四肢瘫和双重瘫最明显）。③两次住院间隔时间在两三个月之内日常生活活动能力分数没有显著性变化；大于6个月时差异有显著性。④出院后是否坚持康复训练及家庭社会环境对脑性瘫痪儿童日常生活活动能力均有影响。结论脑性瘫痪儿童日常生活活动能力受年龄、病情严重程度、前后两次住院时间间隔等因素的影响，提示脑性瘫痪儿回归家庭后仍要坚持康复训练。     

早期康复治疗对脑梗塞患者脑血流量等的影响

本文研究早期（发病１周以内）康复治疗对脑梗塞患者脑血流量及脑功能的影响。随机选择８９例脑梗塞患者，分层随机抽样分为康复组４９例，对照组４０例，治疗前后分别采用￣（１３３）Ｘｅ吸入法测定脑血流量，检查脑电地形图。结果发现康复组总有效率９３．９％，对照组７７．５％。两组治疗后脑血流量均明显改善，但康复组比对照组高（ｔ＝４．９９，Ｐ＜０．０１），神经功能缺损评分亦为康复组明显改善。康复组脑电地形图改善率９５．９％，对照组７７．５％（Ｘ２＝５．３０，Ｐ＜０．０５）。认为早期康复治疗可以促进脑梗塞患者脑血流量的恢复及脑功能的改善。     

二次住院脑性瘫痪儿童日常生活活动能力分数变化的相关因素

目的分析脑性瘫痪儿童出院后影响患儿日常生活活动能力的相关因素。方法对1999-01/2001-12在中国康复研究中心儿童康复科2次住院的脑性瘫痪儿童40例进行日常生活活动能力评价,与第1次出院前日常生活活动能力分数比较,并对患儿家长进行相关问卷调查。结果①不同年龄患儿第2次住院与第1次出院前日常生活活动能力分数相比,3～5岁降低明显。②重度脑性瘫痪对日常生活活动能力有影响(肢体障碍程度越重,影响就越大,以四肢瘫和双重瘫最明显)。③两次住院间隔时间在两三个月之内日常生活活动能力分数没有显著性变化;大于6个月时差异有显著性。④出院后是否坚持康复训练及家庭社会环境对脑性瘫痪儿童日常生活活动能力均有影响。结论脑性瘫痪儿童日常生活活动能力受年龄、病情严重程度、前后两次住院时间间隔等因素的影响,提示脑性瘫痪儿回归家庭后仍要坚持康复训练。     

日常生活活动能力护理对脑卒中患者日常生活活动能力的影响

目的观察日常生活活动（ADL）能力护理对脑卒中患者ADL能力的影响。 方法2组患者均采用临床常规护理,并发放康复宣教资料。观察组在上述干预方案的基础上增加ADL能力强化训练。2组患者患者在入院时、入院后第6周进行康复评价。于治疗前和治疗6周后（治疗后）采用Barthel指数量表、患者满意度调查表和简式Fugl-Meyer运动功能评定量表（FMA)分别评估2组患者的ADL能力、患者满意度（治疗后评估）和上肢运动功能。 结果治疗后,观察组患者的Barthel指数、患者满意度和上肢运动功能评分分别为（57.55±12.93）分和(43.53±5.76)分,与组内治疗前和对照组治疗后比较,差异均有统计学意义（P<0.05）。 结论ADL护理可显著提高脑卒中患者ADL能力和运动功能。     

运动训练与功能性电刺激对痉挛型脑性瘫痪患儿日常生活活动能力的影响

背景:脑性瘫痪(脑瘫)儿童70%为痉挛型,其运动能力障碍系早期上运动神经元病损所致,而且肢体远端肌肉比肢体近端肌肉运动能力减弱较明显,上肢的这种差异尤为明显,这可能与神经系统生理特性有关,肢体运动能力越精细的肌群障碍越明显,患者的日常生活自理能力低下。目的:观察综合康复治疗对痉挛型脑瘫患儿日常生活活动能力(activitiesofdailyliving,ADL)的影响。设计:以患者为观察对象的病例分析,前后对照。单位:一所省级医院的康复科及一所大学医院的康复科。对象:实验于2004-01/10在南京医科大学第一附属医院康复医学科完成。纳入标准:①年…     

急性期脑梗死患者抑郁状况与日常生活活动能力相关性研究

目的 了解急性期脑梗死患者抑郁状况与日常生活活动能力相关关系.方法 采用抑郁自评量表(SDS)和日常生活活动能力量表(ADL)对50例急性期脑梗死患者的抑郁状况和日常生活活动能力进行测评并与国内常模比较,对患者的SDS评分和ADL评分进行直线相关回归分析.结果 急性期脑梗死患者SDS评分明显高于国内常模,患者SDS评分与ADL评分呈负相关.结论 急性期脑梗死患者日常生活活动能力下降对其抑郁情绪有影响.     

脑梗死后抑郁症状与脑血流量的关系

目的探讨脑梗死后抑郁症状的发生与脑血流量的相关性。方法根据汉密顿抑郁量表评分判定标准,将首次发病的480例急性脑梗死患者分为两组,汉密顿抑郁量表总分≥8分者为研究组(脑梗死后抑郁组)224例,<8分者对照组(无抑郁症状组)256例,采用美国国立卫生研究院卒中量表评定两组神经功能缺损状况;检测两组患者脑血流量情况并进行对比分析。结果研究组左侧半球除中央区外,其他各部位脑血流量显著低于右侧对应部位;双侧半球平均脑血流量,额叶、颞叶、顶叶局部脑血流量显著低于对照组(P<0.05或0.01)。研究组脑血流量异常发生率显著高于对照组(χ2=29.02,P<0.01);抑郁程度越严重,大脑各部位脑血流量越低。研究组卒中量表评分显著高于对照组(P<0.01),抑郁程度与患者肢体运动功能、病残程度重和日常生活能力等因素密切相关。结论性脑梗死患者抑郁症状与脑血流量下降有关,脑血流量可作为评价急性脑梗死患者抑郁症状的一项客观指标。     

Predictors of basic and instrumental activities of daily living performance in persons receiving rehabilitation services

OBJECTIVE: To examine the relations among cognitive and emotional function and other patient impairment and demographic variables and the performance of daily activities. DESIGN: Cohort. SETTING: Acute inpatient rehabilitation, skilled nursing facilities, home care, and outpatient clinics. PARTICIPANTS: Adults (N=534) receiving services for neurologic (32.3%), lower-extremity orthopedic (42.7%), or complex medical (24.9%) conditions. Mean age was 63.8 years; 55% were women; 88.6% were white; and the time since condition onset ranged from 0.2 to 3.9 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Activity Measure for Post-Acute Care: applied cognitive, personal care and instrumental, and physical and movement scales; Mental Health Inventory-5 (MHI-5); and patient-identified problems (vision, grasp). RESULTS: Path analyses resulted in good model fit both for the total sample and 3 patient subgroups (chi(2) test, P>.05; comparative fit index >.95). There was a significant (P<.05) direct relation between the applied cognitive, grasp, and personal care and instrumental variables in all patient groups. There were also significant indirect relations between the MHI-5, visual impairment, and grasp problems with the personal care and instrumental scale through an association with the applied cognitive scale. Strength and significance of associations between age, sex, and physical and movement and personal care and instrumental scales varied more across patient groups. The model R(2) for the personal care and instrumental scale for the total sample was .60, with R(2) values of .10, .72, and .62 for the lower-extremity orthopedic, neurologic, and complex medical groups, respectively. CONCLUSIONS: Results suggest that variations in cognitive function, along with visual impairment and lower perceived well-being are associated with a patient's ability to complete daily activities. Rehabilitation professionals should consider cognitive and emotional factors as well as physical performance when planning treatment programs to restore daily activity function.     

肌电生物反馈对于脑卒中患者肢体功能及日常生活活动能力的影响

目的探讨肌电生物反馈对于合并患肢感觉障碍的脑卒中患者肢体功能恢复及日常生活活动能力(ADL)的影响。方法将61例脑卒中所致肢体瘫痪同时合并患肢感觉障碍患者分为治疗组(30例)和对照组(31例)。对照组采取各种促通技术治疗8周;治疗组除采取各种促通技术外,利用肌电生物反馈治疗8周。治疗前、后及出院后4周末,采用Fugl-Meyer量表、改良巴氏指数(MBI)对该61例患者进行评定。利用SPSS11.5软件进行分析,比较治疗前后功能评定的差异。结果经治疗8周后及出院后4周末,61例患者Fugl-Meyer量表评分及改良巴氏指数较前均提高(P0.05);治疗组效果优于对照组(P0.05)。结论肌电生物反馈对于合并患肢感觉障碍的脑卒中患者肢体功能的恢复及日常生活活动能力的提高有积极作用。     

Effect of short-duration,limited rehabilitation on maintenance of the activities of daily living in patients with acute phase of COVID-19

[Purpose] To determine whether short-duration, limited rehabilitation is effective in patients with COVID-19. [Participants and Methods] Single-center, retrospective, observational study. Thirty-six inpatients were classified into the three groups: a close contact (CC) group with a negative polymerase chain reaction (PCR) test (n=14); a PCR–positive (PP) group (n=15); and a PCR–positive and transfer (PT) group with severe COVID-19 patients who were transferred to an acute care hospital for treatment and then returned to our hospital (n=7). Short-duration, limited rehabilitation was provided to the CC and PP groups in isolated rooms by a therapist wearing full personal protective equipment, and we assessed the changes in their activities of daily living. [Results] The patients’ clinical characteristics at baseline were similar among the three groups. Functional Independence Measure scores in the CC, PP, and PT groups were not different at baseline (69 ± 29, 53 ± 26, and 63 ± 32), but differed after control of COVID-19 (63 ± 25, 47 ± 24, and 32 ± 19). Multivariate regression analysis showed that the implementation of a customized self-exercise program and the Mini Nutritional Assessment Short-Form at baseline were independently associated with Functional Independence Measure score after control of COVID-19. [Conclusion] These results suggest that even short-duration, limited rehabilitation may be effective for preventing decreases in activities of daily living in patients with COVID-19.     

Racial and ethnic differences in activities of daily living disability among the elderly: the case of Spanish speakers

Tirodkar MA, Song J, Chang RW, Dunlop DD, Chang HJ. Racial and ethnic differences in activities of daily living disability among the elderly: the case of Spanish speakers.

Objective

To compare incident disability patterns across racial and ethnic groups.

Design

Prospective cohort study with 6-year follow-up (1998-2004).

Setting

National probability sample.

Participants

A 1998 Health and Retirement Study sample of 12,288 non-Hispanic whites, 1952 African Americans, 575 Hispanics interviewed in Spanish (Hispanic-Spanish), and 518 Hispanics interviewed in English (Hispanic-English), older than 51 years, and free of disability at baseline.

Interventions

Not applicable.

Main Outcome Measure

Disability in activities of daily living (ADL) tasks (walking, dressing, transferring, bathing, toileting, feeding).

Results

Hispanic-Spanish reported disproportionately lower rates of walking disability (standardized rates, 4.31% vs Hispanic-English [8.57%], black [7.54%], white [7.20%]) despite higher reported Hispanic-Spanish frequencies of lower-extremity dysfunction than other racial and ethnic groups. Across the 6 ADL tasks, the development of walking disability was most frequent among Hispanic-English subjects, African Americans, and whites. In contrast, Hispanic-Spanish subjects reported dressing as the most frequent ADL task disability, whereas walking ranked fourth.

Conclusions

Aggregating all Hispanics, regardless of interview language, may be inappropriate. Future research on linguistic group differences in self-reported health outcomes is necessary to ensure that health status measures will be appropriate for use in diverse racial and ethnic groups.     

早期康复治疗对脑卒中偏瘫患者肢体功能及日常生活能力的影响

目的探讨早期康复治疗对急性脑卒中偏瘫患者上下肢功能恢复及日常生活能力的影响。方法选择急性脑卒中偏瘫患者76例,随机分为康复组和对照组(每组38例)。用前瞻性研究方法对两组进行比较分析。康复组在临床药物治疗的同时进行正规的康复训练,对照组给予临床药物治疗及未经指导的自我锻炼。分别于入选治疗前24h及治疗后6~8周进行测评。运动功能采用Fugl-M eyer运动功能积分法(FMA)测评,日常生活能力用Barthel指数评分。结果经6~8周治疗后,Barthel指数及FMA评分均有一定程度的改善,但康复组明显优于对照组(P<0.01)。康复组治疗后FMA的提高程度上下肢差异无统计学意义。结论急性脑卒中偏瘫患者进行早期康复治疗能明显改善肢体运动功能、提高日常生活能力。     

Conductive education for children with cerebral palsy: effects on hand motor functions relevant to activities of daily living

Blank R, von Kries R, Hesse S, von Voss H. Conductive education for children with cerebral palsy: effects on hand motor functions relevant to activities of daily living.

Objective

To study the effects of conductive education, a combined educational and therapeutic task-oriented approach for children with cerebral palsy (CP), on their hand motor functions and activities of daily living (ADLs).

Design

Individual cohort study (B-A-B design).

Setting

Ambulatory, referral center.

Participants

Sixty-four children with CP, severity Gross Motor Function Classification System levels II through IV, ages 3 to 6 years.

Interventions

Phases B: a 4.5-month period of special education, including 2 hours of individual physiotherapy or occupational therapy per week (special education). Phase A: during a 9-month period, conductive education was administered in 3 blocks of 4 weeks (7 hours daily from Monday through Friday); between the blocks, special education was applied as in the B phases.

Main Outcome Measures

Transformed sum scores (0.00-1.00) for coordinative (eg, force-movement synergy during object manipulation, aiming) and for elementary hand functions (eg, maximum grip force, tapping), based on kinetic and kinematic measures; standardized parent questionnaire to measure ADL competence scores from 0.00 (dependence) to 1.00 (independence). Outcome parameters were changes in these parameters during phase A (intervention) compared with average changes during the B phases (pre- and postintervention). Student t tests were used for dependent samples.

Results

Conductive education improved coordinative hand functions by 20% to 25% from baseline, compared with no improvement during special education; the preferred hand improved from .38 to .48 (mean, .10; 95% confidence interval [CI], .086−.114) and the nonpreferred hand improved from .39 to .47 (mean, .08; 95% CI, .034-.116). There were no changes in elementary hand motor functions. ADL competence improved by .11 (95% CI, .070-.149), from .50 to .61 (≈20%), compared with no significant improvement under special education.

Conclusions

Conductive education improved coordinative hand functions and ADLs in children with CP. There was no effect on elementary hand functions.