脑卒中偏瘫患者早期康复护理研究进展

康复训练的早期介入可促进脑卒中偏瘫患者肢体运动功能的恢复,降低致残率。对脑卒中所致偏瘫早期康复的机制、意义,训练介入的时间以及护理具体内容等方面进行综述。     

脑卒中偏瘫患者早期康复的远期疗效观察

目的 探讨脑卒中偏瘫患者早期康复的远期疗效。方法 随访对象为参加前瞻性随机对照研究后出院的２００例脑卒中患者,采用电话和书信的形式进行随访,内容包括存活者的移动能力、活动空间、日常生活活动（ＡＤＬ）能力、生活质量（ＱＯＬ）及继发性损伤。结果对照组随访到５８例,其中１例因“心脏病”去世。康复组随访到６８例,无１例死亡。康复组与对照组比较,患者的移动能力、活动空间、ＡＤＬ、ＱＯＬ及继发性损匀有显著性差     

脑卒中偏瘫患者减重平板步行训练的临床应用研究

目的探讨早期减重平板步行训练对脑卒中偏瘫患者下肢运动、平衡、步行功能障碍的影响. 方法将脑卒中偏瘫患者24例随机分为减重组(12例)和对照组(12例).减重组除给予常规康复治疗外,另给予减重平板步行训练2周,每周5次,每次20～30 min,起始减重量为30%, 平板速度为0.2 km/h;对照组仅给予常规康复治疗.采用功能性步行分级、Rivermead下肢运动功能评价、Berg平衡量表、步速和耐力于治疗前、后对2组患者进行评定. 结果治疗后减重组Rivermead下肢运动功能和Berg平衡量表得分较对照组提高,差异有显著性意义(P<0.05);同时,减重组步行分级、步速和耐力均较对照组明显提高,差异有非常显著性意义(P<0.01).治疗后对照组12名患者中有5名需要借助手杖或步行架保持平衡、辅助行走,而减重组仅有2名患者需要助步器. 结论早期减重平板步行训练结合常规康复治疗等综合应用可以更有效地改善脑卒中偏瘫患者的步行、运动和平衡功能,将成为脑卒中偏瘫后步行功能重建的有效方法.     

中风偏瘫急性期的康复护理

目的探讨康复护理对中风偏瘫急性期患者日常生活能力和肢体运动功能的作用和重要性。方法选取80例发病在2周以内的中风患者经临床和CT确诊,随机分为康复组和对照组各40例,2组治疗用药原则相同,康复组在急性期即进行康复护理,对照组于急性期过后再进行康复护理。康复护理2个月后同时对2组作效果评价。结果康复前2组Barthel指数及Fugl-Meyer运动功能评分差异均无显著性。经平均2个月的康复体疗,2组患者评分都有所提高。康复组患者评分提高幅度更大,经t检验两组差异有显著性(P<0.01)。结论早期康复可以防止和减轻废用综合征的产生并促进功能恢复,对中风有良好的预后。     

脑卒中患者就诊时间的影响因素及护理对策

脑卒中是指急性起病、迅速出现局限性或弥漫性脑功能缺失征象的脑血管性临床事件，具有较高的致死率和致残率。脑卒中的及早就诊与预后有着密切的关系。本研究收集了2004年5～9月在我院神经内科卒中单元住院的脑卒中患者88例，对患者或／和家属进行问卷调查，对影响就诊时间的因素进行研究，并提出护理对策，现报道如下。     

Evaluation of postural stability in the elderly with stroke

OBJECTIVE: To compare clinical and biomechanical measures of balance in elderly stroke patients with those of healthy elderly people. DESIGN: Two-group comparison design. SETTING: Laboratory environment. PARTICIPANTS: Fifteen poststroke patients and 15 healthy age-matched older adults (N=30). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The biomechanical variable COP-COM, which represents the distance between the center of pressure (COP) and the center of mass (COM) in terms of root mean square. The mean of 4 trials of the COP-COM variable for each test condition was used for statistical analysis. Furthermore, the different systems (sensory, motor, central processor) related to postural stability were evaluated. RESULTS: Statistical significance of the COP-COM variable was larger in the stroke group than in healthy subjects, in both the anteroposterior (AP) and mediolateral (ML) directions. Furthermore, statistically, stroke subjects showed amplitudes of the COP-COM variable that were significantly larger in the eyes-closed condition. The significant negative correlation demonstrated between COP-COM amplitude and the balance scales (Berg, Tinetti) indicated that the patients with larger COP-COM amplitudes had lower clinical balance score. Furthermore, correlation coefficient scores between COP-COM variables in both AP and ML directions and motor performance using Fugl-Meyer Assessment (rho=-.53, rho=-.51, respectively) and reaction time (rho=-.53, rho=-.44, respectively) were significant. Vibration (rho=.41) and touch-pressure (rho=.42) perception thresholds correlated significantly only in the AP direction. CONCLUSIONS: Evaluating postural stability with COP-COM variable provided an accurate measure of postural stability in poststroke elderly people. Furthermore, postural stability in quiet stance, as measured by COP-COM amplitude, was related to functional measures of balance as well as physiologic factors relating to balance, such as visual conditions, lower-extremity peripheral sensibility, motor recovery, and simple reaction time.     

Effect of attention focus on acquisition and retention of postural control following ankle sprain

OBJECTIVE: To examine the effect of attentional focus instructions and dynamic balance training on ankle sprain recovery. DESIGN: Randomized controlled trial. SETTING: Outpatient physical therapy department. PARTICIPANTS: Forty volunteers (age range, 19-33y) referred to treatment within 4 months after sustaining a grade 1 or 2 ankle sprain with no concurrent impairments. Participants were randomly allocated to 1 of 2 groups differing in training instructions. INTERVENTION: Postural control training consisted of ten 20-second trials, performed on 3 consecutive days, at 2 stability levels of the Biodex Stability System (BSS). Training instructions directed the participants to either an internal or an external focus of attention. Assessments were conducted on the BSS pre- and post-training, and 48 hours after the last session (retention test). MAIN OUTCOME MEASURES: Overall stability as indicated by variance in platform displacement in all directions; anteroposterior (AP) variance of platform displacement; and mediolateral variance of platform displacement. RESULTS: Increases in overall and AP stability were observed immediately following training in both groups and were maintained at the retention test. Interaction effect indicates greater improvement in the external-focus group. CONCLUSIONS: Our results suggest that external focus of attention is advantageous for the learning of a postural control task following an ankle injury.     

偏瘫后强化上肢本体感觉刺激的价值

目的：观察偏瘫患者接受本体感觉强化刺激的治疗及疗效。方法：６０例偏瘫患者随机分为治疗组和对照组各３０例，二组患者均接受一般的康复治疗，治疗组还接受上肢各关节本体感觉强化刺激疗法。上肢综合功能评定采用ＦｕｇｌＭｅｙｅｒ积分法和Ｂａｒｔｈｅｌ指数法。结果：治疗组患者上肢综合功能与日常生活活动能力均明显提高，上肢合并症的发生明显减少，与对照组比较差异有非常显著性（Ｐ＜０．０１），治疗组疗效明显优于对照组。结论：在偏瘫患者进行康复治疗中，应对上肢本体感觉进行强化刺激，以提高上肢综合性运动功能并减少合并症的发生     

早期康复护理干预对脑卒中偏瘫患者日常生活活动能力的影响

目的:探讨早期康复护理干预对脑卒中偏瘫患者日常生活活动能力(ADL)的影响。方法:将118例脑卒中偏瘫患者随机分为康复组和对照组各59例,对照组按神经内科护理常规进行护理,康复组由责任护士按护理程序实施系统化早期康复护理干预,包括基础护理、心理护理、早期患肢康复锻炼、语言功能锻炼、吞咽功能锻炼、日常生活能力训练。采用Barthel指数对两组患者干预前后ADL进行评定比较。结果:两组干预后Barthel指数均较干预前明显升高(P<0.01),康复组干预后Barthel指数明显高于对照组(P<0.01)。结论:早期康复护理干预能提高脑卒中偏瘫患者ADL,降低致残率,改善生活质量。     

Arthrographic and clinical findings in patients with hemiplegic shoulder pain

OBJECTIVES: To identify the etiology of hemiplegic shoulder pain by arthrographic and clinical examinations and to determine the correlation between arthrographic measurements and clinical findings in patients with hemiplegic shoulder pain. DESIGN: Case series. SETTING: Medical center of a 1582-bed teaching institution in Taiwan. PARTICIPANTS: Thirty-two consecutive patients with hemiplegic shoulder pain within a 1-year period after first stroke were recruited. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Clinical examinations included Brunnstrom stage, muscle spasticity distribution, presence or absence of subluxation and shoulder-hand syndrome, and passive range of motion (PROM) of the shoulder joint. Arthrographic measurements included shoulder joint volume and capsular morphology. RESULTS: Most patients had onset of hemiplegic shoulder pain less than 2 months after stroke. Adhesive capsulitis was the main cause of shoulder pain, with 50% of patients having adhesive capsulitis, 44% having shoulder subluxation, 22% having rotator cuff tears, and 16% having shoulder-hand syndrome. Patients with adhesive capsulitis showed significant restriction of passive shoulder external rotation and abduction and a higher incidence of shoulder-hand syndrome (P=.017). Those with irregular capsular margins had significantly longer shoulder pain duration and more restricted passive shoulder flexion (P=.017) and abduction (P=.020). Patients with shoulder subluxation had significantly larger PROM (flexion, P=.007; external rotation, P<.001; abduction, P=.001; internal rotation, P=.027), lower muscle tone (P=.001), and lower Brunnstrom stages of the proximal upper extremity (P=.025) and of the distal upper extremity (P=.001). Muscle spasticity of the upper extremity was slightly negatively correlated with shoulder PROM. Shoulder joint volume was moderately positively correlated with shoulder PROM. CONCLUSIONS: After investigating the hemiplegic shoulder joint through clinical and arthrographic examinations, we found that the causes of hemiplegic shoulder pain are complicated. Adhesive capsulitis was the leading cause of shoulder pain, followed by shoulder subluxation. Greater PROM of the shoulder joint, associated with larger joint volume, decreased the occurrence of adhesive capsulitis. Proper physical therapy and cautious handling of stroke patients to preserve shoulder mobility and function during early rehabilitation are important for a good outcome.     

躯干强化训练对脑卒中偏瘫患者运动功能的影响

目的　观察躯干强化训练对脑卒中偏瘫患者运动功能的影响。方法　将 5 0例脑卒中偏瘫患者随机分为躯干强化组和对照组。所有患者每日均接受常规的药物、电疗、针灸、按摩、PT和OT治疗 ,每日 1次。躯干强化组在此基础上接受躯干强化训练 ,每次 3 0min ,每日 1次。治疗前、后采用Rivermead运动指数(RMI)量表及修订的Barthel指数 (MBI)量表对 2组患者进行评定。结果　治疗 2个月后 ,2组患者的RMI评分均较治疗前显著提高 (均P <0 .0 0 1) ,躯干强化组患者运动功能的恢复情况明显优于对照组 (P <0 .0 1)。结论　躯干强化训练可明显提高脑卒中偏瘫患者的运动功能。     

Rehabilitation of postural stability in ataxic/hemiplegic patients after stroke

Purpose.?This study assesses the postural stability and the effect of balance training using a force platform visual biofeedback among outpatients with postural disturbances following stroke.

Method.?A tilting multiaxial force platform was used to assess bilateral postural stability in 38 outpatients (mean age 69.50?±?8.57 years) with hemiplegia and/or ataxia after stroke. Stability indexes were obtained. Afterwards, a subgroup of 12 patients with the poorest overall stability index (OASI) started a balance training programme in the force platform. Postural control training consisted of a 30-min training session once a week for a 15-week period. The test was then repeated.

Results.?In the 38 outpatients sample, the mean OASI was 4.7?±?2.0 and 42.1% of the patients used their hands for support. In the 12 outpatients group, the initial OASI was 5.8?±?2.3 and half of the patients used their hands for support. The final OASI was 3.3?±?1.0 (p?=?0.005) and only two of the patients used their hands for support (p?=?0.046).

Conclusion.?Our results suggest that a training programme using force platform visual biofeedback improves objective measures of bilateral postural stability in patients with hemiplegia and/or ataxia after stroke.     

颅脑创伤单元模式在偏瘫患者康复中的应用

目的：探讨在颅脑创伤单元模式下对偏瘫患者进行分期康复训练的效果。方法选取2012年6月-2013年5月收治的颅脑损伤并发偏瘫患者120例,其中选取60例常规治疗模式患者为对照组,建立颅脑创伤单元模式后选取60例为观察组。入院24 h内及5周后分别行格拉斯哥昏迷量表（GCS）、改良的Rankin量表（MRS）、Barthel指数（BI）评分。两组均接受一般神经外科常规治疗,对照组采用常规护理;观察组采用颅脑创伤单元模式下的分期康复指导。结果两组患者治疗前后GCS、MRS、BI 3个方面评分差异均有统计学意义,治疗后观察组 GCS、MRS、BI 分别为（8．25±5．01）,（3．49±2．13）,（45．84±15．48）分,优于对照组治疗后（10．21±4．11）,（3．00±1．24）,（54．72±17．74）分,差异有统计学意义（t值分别为2．343,2．074,2．922;P＜0．05）。干预组BI＞65分比例为65．0％、回家自理者占70．0％,均高于对照组（40．0％,41．7％）,两组比较差异有统计学意义（χ2值分别为7．519,9．766;P＜0．01）。结论在颅脑创伤单元模式中,更强调医护联合,护士进行专业康复指导,保证了患者在入院时即开始正规康复治疗,为日后进一步系统的康复治疗做好准备,最大限度避免影响预后不良事件的发生,使患者在病情稳定之后,能够顺利进入下一阶段的康复治疗,缩短急性期住院时间,改善康复预后,使患者获得最大限度的功能恢复。     

痉挛性斜颈对脑卒中偏瘫患者平衡功能的影响及其治疗效果观察

目的 观察继发痉挛性斜颈对脑卒中偏瘫患者平衡功能的影响及不同治疗方法的疗效对比.方法 采用随机数字表法将56例继发痉挛性斜颈的脑卒中偏瘫患者分为肉毒毒素组(给予常规肢体康复训练、肉毒毒素注射及一般性支持治疗)19例、药物治疗组(给予常规肢体康复训练、巴氯芬口服及一般性支持治疗)18例、常规康复组(仅给予常规肢体康复训练)19例,另选取无痉挛性斜颈的脑卒中偏瘫患者19例纳入对照组,仅给予常规肢体康复训练.于治疗前、治疗2个月后分别采用Berg平衡量表、Tsui量表对各组患者平衡功能及痉挛性斜颈症状改善情况进行评定.结果 治疗前肉毒毒素组、药物治疗组及常规康复组BBS评分[分别为(28.68±6.23)、(30.17±5.04)及29.84±5.29)分]均显著低于对照组[(36.05±6.36)分];经相应康复治疗2个月后,各组患者BBS评分均较治疗前显著改善(p＜0.05),以肉毒毒素组及对照组BBS评分[分别为(45.16 ±5.26)和(46.32 ±6.52)分]恢复较好,药物治疗组BBS评分[(41.11 ±5.09)分]次之,常规康复组BBS评分[(37.47 ±530)分]恢复相对较差.治疗后肉毒毒素组和药物治疗组Tsui评分[分别为(3.79±1.03)和(6.50±1 43)分]均较治疗前明显下降(P＜0.05),且肉毒毒素组Tsui评分的下降幅度显著超过药物治疗组及常规康复组(P＜0.05).常规康复组Tsui评分治疗前、后差异无统计学意义[分别为(13.95 ±2.12)和(14.00±1.97)分,P＞0.05)].结论 痉挛性斜颈对脑卒中偏瘫患者平衡能力具有影响作用,针对继发痉挛性斜颈进行治疗可显著提高脑卒中偏瘫患者平衡能力,缓解痉挛性斜颈症状,其中以联用常规康复训练、肉毒毒素注射及一般性支持干预的疗效尤为显著.     

Efficacy of forced-use therapy in hemiplegic cerebral palsy

OBJECTIVE: To determine the efficacy of forced-use therapy (FUT) on the improvement of upper-extremity function in children with hemiplegic cerebral palsy (CP). DESIGN: Prospective case series. SETTING: Outpatient ambulatory clinic in South Korea. PARTICIPANTS: Thirty-one patients with hemiplegic CP were assigned to the FUT group (n=18) or to the control group (n=13). The mean age of the patients in the FUT group was 33.2 months and in the control group it was 43.2 months. INTERVENTIONS: The FUT group wore a short-arm Scotchcast on the unaffected arm for 6 weeks and also participated in a conventional rehabilitation program that included stretching exercises and functional occupational therapy for the upper extremity. The control group underwent the conventional rehabilitation program only. MAIN OUTCOME MEASURE: Hand function tests, including the box and block test (BBT), Erhardt Developmental Prehension Assessment (EDPA), and WeeFIM instrument taken before and after 6 weeks of treatment. RESULTS: Before treatment, there was no significant difference between groups in the BBT, EDPA, and WeeFIM scores. After 6 weeks of treatment, however, the FUT group showed significant improvement in the affected arm in the BBT and EDPA scores, compared with the control group (P<.05). The self-care score on the WeeFIM was also significantly improved in the FUT group (P<.05). CONCLUSIONS: FUT combined with a conventional rehabilitation program appears to be more effective than a rehabilitation program alone in improving affected hand function in children with hemiplegic CP.     

偏瘫患者失认症和失用症的康复

目的　观察康复训练对偏瘫患者失认症和失用症的疗效。方法　对 75例偏瘫患者按失认症和失用症量表进行评定 ,观察各类失认症所占的比例 ,对存在失认症或失用症的患者进行有针对性的康复训练 ,每日训练 1次 ,每次 30min ,1～ 3个月为 1个疗程 ,疗程前后分别进行评价。结果75例偏瘫患者有 2 1例存在失认或失用 ,阳性率为 2 8%。康复治疗前后两次评价结果 ,分别为32 .5 6± 3.12和 45 .0 2± 2 .72 ,差异有显著性 (P <0 .0 5 ) ,说明失认症、失用症患者经过系统的康复训练 ,疗效确切。结论　偏瘫患者中 ,失认症、失用症存在一定的比例 ,应列为常规检查 ,早期发现 ,及时康复治疗     

Reliance on visual information after stroke. Part II: Effectiveness of a balance rehabilitation program with visual cue deprivation after stroke: a randomized controlled trial

OBJECTIVE: To test the hypothesis that balance rehabilitation with visual cue deprivation improves balance more effectively than rehabilitation with free vision. DESIGN: Single-blind, randomized controlled trial. SETTING: Public rehabilitation center in France. PARTICIPANTS: Twenty patients with hemiplegia after a single-hemisphere stroke that occurred at least 12 months before the study. INTERVENTION: Patients were randomly assigned to 1 of 2 balance rehabilitation programs-with and without visual cue deprivation. In all other respects, the programs were identical. Each lasted for 1 hour and was implemented 5 days a week for 4 weeks. All patients completed the program. Mean outcome measures Balance under 6 sensory conditions was assessed by computerized dynamic posturography (EquiTest), gait velocity, timed stair climbing, and self-assessment of ease of gait before and after program completion. RESULTS: After completing the program, balance, gait velocity, and self-assessment of gait improved significantly in all patients. The improvements in gait velocity (P= .03) and timed stair climbing (P= .01) correlated significantly with improved balance. Balance improved more in the vision-deprived group than in the free-vision group. CONCLUSIONS: Balance improved more after rehabilitation with visual deprivation than with free vision. Visual overuse may be a compensatory strategy for coping with initial imbalance exacerbated by traditional rehabilitation.