间歇导尿结合直立训练对脊髓损伤患者膀胱功能恢复的影响

目的:探讨间歇导尿结合直立训练对改善脊髓损伤患者膀胱功能及防治尿路感染的作用。方法:对107例脊髓损伤患者,用信封法随机分为两组,其中治疗组59例,对照组48例。治疗组采取间歇导尿结合直立训练的方法进行膀胱功能的训练,对照组依照传统方法进行间歇导尿。结果:治疗组在泌尿系感染率、导尿成功率和平均导尿时间上均明显优于对照组,两组间有明显差异(P(0.05)。结论:直立床训练结合间歇导尿可明显改善脊髓损伤患者膀胱功能。     

功能性电刺激对脊髓损伤患者肌肉泵活动的影响

比较健康人和脊髓损伤患者从仰卧位到坐位和稳定站立 30min时的血流动力学反应 ,并评价在这 2种状态下 ,肌肉收缩对血流动力学的影响。结果提示脊髓损伤患者从坐位变为站立位时 ,用功能性电刺激下肢肌肉可预防体位性低血压的出现 ,且站立期间在促进血液循环方面与健康人肌肉自主收缩运动具有同等或更好的效果。     

基于特定任务的直立训练对脊髓损伤患者骨密度影响的应用研究

脊髓损伤是指由于外界直接或者间接因素导致的脊髓结构以及功能的改变,造成损伤平面以下出现各种运动、功能的相应改变,发病特点呈高发生率、高致残率等,可导致感觉、运动等功能障碍以及各种营养代谢异常.其中骨代谢异常是脊髓损伤常见并发症,可以显著增加骨折的发生率,阻碍了患者的康复进度,增加了医疗费用,给家庭带来巨大的经济负担.研...     

局部振动治疗对脊髓损伤患者下肢痉挛及自理能力的疗效分析

目的：观察局部振动治疗对脊髓损伤患者下肢肌张力及日常生活能力的影响。方法：将64例脊髓损伤患者随机分为观察组和对照组各32例。对照组患者仅进行系统康复训练,观察组患者在接受系统康复训练的基础上给予双下肢振动治疗。治疗前后采用改良Ashworth量表（MAS）和改良Barthel指数(MBI)量表对2组患者痉挛程度及日常生活活动能力进行评定。结果：治疗后,2组MAS评分均较治疗前明显降低（P<0.05）,但观察组降低更加显著（P<0.05）;2组MBI评分亦较治疗前明显提高（P<0.05）,但2组间比较差异无统计学意义。结论：振动治疗可改善脊髓损伤患者肌痉挛,但对患者日常生活活动能力及转移能力改善证据不足。     

脊髓损伤患者恢复期皮肤的自我管理

我院康复科2005-01~2007-03收治的脊髓损伤患者36例,对脊髓损伤患者恢复期皮肤的自我管理体会如下。1临床资料本组男31例,女5例,年龄15~60岁,平均41岁。车祸伤23例,高处摔伤11例,机械碰撞伤2例。所有患者入院后意识清楚,无其他重要脏器损伤。2护理措施2.1去除潮湿,保持平整干燥选择适当的床,如:各种类型的气垫床,转动翻身床,大块海绵组合床,空气流动床等,床通气性好,身体不宜凹陷,宜活动,床的高度与轮椅同高。床单不宜使用塑料、橡胶类,以平纹棉布为宜,尿布垫子不可缠在阴部和臀部,卧位时铺在臀部之下,坐位时置于阴部和阴茎之上,注意除湿保…     

脊髓损伤患者恢复期的康复护理

我院自1985年以来共收治不同平面的脊髓损伤患者528例,经过综合性康复治疗和护理,90%以上的患者均有不同程度的功能改善,减少了并发症,提高了生活质量。1　临床资料528例患者中,男性441例,女性87例。年龄最大83岁,最小12岁,平均341岁。其中20岁以下17例,21～35岁278例,36～50例184例,51岁以上49例。损伤部位:颈髓损伤61例,胸髓损伤317例,腰髓及马尾损伤150例。致残原因:交通事故114例,重物压伤147例,高处坠落197例,脊髓炎后遗症41例,其它损伤29例。损伤时间:6个月以内106例,6～12个月89例,12～18个月67例,18～24个月36例,24个月以上230例。2…     

早期康复护理干预对脊髓损伤患者直立性低血压的影响

直立性低血压是脊髓损伤患者在康复训练过程中经常遇到的问题，由于患者卧床时间长，脊髓损伤患者康复训练中经常发生直立性低血压，尤其是高位损伤患者更多见。随着康复理念的发展，我们对脊髓损伤的患者进行早期康复宣教和治疗，取得较好的康复效果。研究早期康复护理干预和无人施加干预对直立性低血压的发生率进行比较，制定以直立床站立及下肢缠绕弹力绷带为主的护理措施。此项研究对脊髓损伤患者的早期康复，改善疾病的预后，重返社会具有重要意义，社会效益十分显著。     

低频振动对脊髓损伤继发骨质疏松的影响

目的了解低频振动对脊髓损伤（SCI）继发骨质疏松（OP）大鼠骨代谢和骨质量的影响。方法50只SD大鼠采用脊髓全切横断法在第10胸椎处横断脊髓制作完全性SCI模型,并随机分为SCI6周对照组（SCI6w）、SCI12周对照组（SCI12w）、振动6周组（Vi6w）、振动12周组（Vi12w）和SCI6-12周振动组（Vi6-12w）,每组10只;振动组分别于SCI后第4天（Vi6w组、Vi12w组）、第7周（Vi6-12w组）开始接受振动干预,振动频率20Hz,加速度0.15g,10min/次,2次/d,6d/周,Vi6w组和Vi6-12w组共振动6周,Vi12w组振动12周。分别在振动结束1d后处死动物,进行骨代谢血生化指标、骨密度（BMD）、骨形态计量学和生物力学性能测试。结果Vi6w组大鼠血Ca和股骨近端BMD较对照组改善（P〈0.05）;Vi12w组第5腰椎最大载荷较对照组升高（P〈0.05）;Vi6-12w组大鼠骨代谢和骨质量未见明显变化。结论早期开始的低频振动干预可改善SCI继发OP,但存在部位差异;后期进行的振动干预不能改善SCI继发OP,但可防止其进展。     

康复治疗对脊髓损伤患者ADL的影响

目的：观察康复治疗对脊髓损伤（SCI）患者ADL能力的影响。方法：30例SCI患者予以运动、作业和物理治疗及正规的康复护理，治疗前后采用Barthel指数进行康复评定。结果：经过90d的康复治疗，30例患者ADL均较治疗前有明显改善（P〈0．001）。结论：康复治疗能显著促进SCI患者ADL能力的提高。     

全身振动训练对前交叉韧带损伤重建术后患者下肢运动控制的影响

目的:研究全身振动训练对膝关节前交叉韧带损伤(ACL)重建术后患者下肢肌力和运动控制的影响。方法:选取符合纳入标准的40例前交叉韧带损伤重建术后患者为研究对象,所有患者术后12周进行常规康复训练。第13周开始将患者用数字法随机分为对照组和试验组,每组20例。对照组继续给予常规康复训练,试验组在对照组的基础上,加入每天1次,每次10min,每周5次,持续4周的全身振动训练。两组患者第12周和第16周,均进行等速肌力测试训练系统膝关节屈伸肌群的峰力矩、拮抗肌比值检测和动态平衡仪中本体感觉评估。结果:1两组患者膝关节屈伸峰力矩,治疗前后和治疗后组间对比均有显著性差异(P0.05);2两组患者动态平衡测试的平均轨迹误差值,治疗前后和治疗后组间对比有显著性差异(P0.05)。结论:全身振动训练能够促进ACL重建术后患者的下肢肌力和运动控制的恢复。     

The effect of body position on bioelectrical resistance in individuals with spinal cord injury

The purpose of this study was to determine the effect of four different body positions on the resistance of the human body as assessed by Biodynamicsr` Model 310 Body Composition Analyzer in a healthy population (Group A, n = 69) and long-term spinal cord injured (Group B, n = 13). Group A were tested in four body positions: supine, half-lying, standing and sitting in a wheelchair, while Group B were tested in supine and sitting positions. Testing order was randomized. A oneway repeated measures analysis of variance and a paired t-test demonstrated significant differences between position (p<0·0001, Group A; p<0·01, Group B respectively). In both groups, the greatest reduction in resistance was demonstrated for the sitting position. These differences were similar for both groups, as demonstrated by covariant analysis. Regression analysis demonstrated that supine resistance can be accurately predicted (R² = 0·98) from assessments in a wheelchair. Such data transformations may be indicated where supine positioning is problematic or when wheelchair assessment procedures are more appropriate.     

Effect of functional neuromuscular stimulation on postural related orthostatic stress in individuals with acute spinal cord injury

The purpose of the study was to evaluate the cardiovascular responses of functional neuromuscular stimulation (FNS) on postural-related orthostatic stress in individuals with acute spinal cord injury. Two tetraplegics and three paraplegics participated in this study. A repeated measure design was used in which subjects underwent two graded-tilt table (0 degrees, 15 degrees, 30 degrees, 45 degrees, 60 degrees) orthostatic stress tests with and without FNS (randomized treatment order) of the knee extensors and foot plantar flexors. Successive one-minute digital readings of heart rate (HR) and blood pressure were obtained with an electronic pulse oximeter and automated blood pressure monitor, respectively. Analysis of covariance (ANCOVA) revealed significant test position (tilt angle) and treatment condition (with or without FNS) main effects, but no significant interactions. Between-treatment pairwise contrasts showed that systolic blood pressure was lower without FNS for 15 degrees, 30 degrees, 45 degrees g, and 60 degrees of tilt, while diastolic blood pressure was lower without FNS at 30 degrees and 45 degrees of tilt. In contrast, HR showed a progressive rise with increasing tilt angle. Functional neuromuscular stimulation may be an important treatment adjunct to minimize cardiovascular changes during postural orthostatic stress in individuals with acute spinal cord injury.     

Upper limb exercise effect on tilt tolerance during orthostatic training of patients with spinal cord injury

Twelve male patients with traumatic spinal cord injury were randomly divided into a group of six experimental and six control subjects. All subjects were tilted from 0 degree to 70 degrees by 10 degrees increments at five-minute intervals until blood pressure dropped below 70/40, hypotensive symptoms appeared, or 70 degrees of tilt was achieved. The experimental subjects performed 60 active bilateral full-range forearm flexion and extension movements per minute during the first and third minute of each tilt angle. The control patients did not perform upper limb exercises during the same orthostatic training procedure. Blood pressure and pulse rate of all subjects were recorded prior to orthostatic training, during the training at specified intervals and posttraining on each day of testing and training. Total group response was quantitated by indicating the tilting protocol step at which subjects experienced orthostatic hypotension requiring termination of the test. All subjects significantly increased their tolerance of higher tilt angles by using this protocol, but there was no significant difference between the exercise group and nonexercise group with reference to tolerance to progressive vertical tilt (Mann-Whitney U test).     

Employment satisfaction of individuals with spinal cord injury

OBJECTIVES: Community reentry after a spinal cord injury is a long-term integrative process, because individuals must adjust to an extraordinary new set of circumstances. In this study, quality-of-life and work satisfaction variables associated with employed or unemployed individuals with spinal cord injury were examined. METHODS: Quality-of-life and work satisfaction variables associated with 109 employed or unemployed individuals with spinal cord injury were examined by using an employment satisfaction survey. RESULTS: Most of those employed indicated that they would either change jobs or some employment variable such as duties, supervisor, or hours worked. Participants who were not working attributed unemployment to an array of factors including ongoing health problems, lack of transportation, and impact of and/or lost disability benefits. Both groups offered feedback related to information provided to them by medical professionals about return-to-work resources. CONCLUSIONS: The following three themes emerged from this analysis: (1) more comprehensive provider training about spinal cord injury is needed; (2) increased communication between consumer and family would be beneficial; and (3) an increase in the flexibility and availability of services would help to ensure access to essential care.     

Exploration of quality-of-life goals in individuals with spinal cord injury

The aim of the study is to investigate the applicability of structured interviews for exploration of quality-of-life goals using an established instrument. Structured interviews were performed using WHOQOL-BREF and Disabilities Module as guideline with 35 clients admitted for first rehabilitation intervention after spinal cord injury. Although participants found some questions difficult to answer or psychologically stressful, most of them have appreciated the interviews' help considering their position in life at an early phase of rehabilitation. WHOQOL-BREF and Disabilities Module is an appropriate tool as an interview guideline for exploring quality-of-life goals.     

Functional electrical stimulation effect on orthostatic hypotension after spinal cord injury

OBJECTIVE: To investigate the possibility of using functional electrical stimulation (FES) to control orthostatic hypotension in patients with spinal cord injury (SCI) and to clarify the mechanism of the response. DESIGN: Subjects were tilted by 10 degree increments with varying intensities of lower-extremity FES. Stimulation over muscles was compared to stimulation over noncontractile sites. SETTING: Physical therapy department of a major rehabilitation center. PATIENTS: Six patients with SCI above T6 (3 with recent injury recruited consecutively from an inpatient spinal cord rehabilitation unit, and 3 from the community with longstanding injury, recruited as volunteers). MAIN OUTCOME MEASURES: Blood pressure, heart rate, and perceived presyncope score recorded at each tilt angle and analyzed using a multivariate analysis of variance statistical methodology. RESULTS: Systolic and diastolic blood pressure increased with increasing stimulation intensities (systolic, p = .001; diastolic, p = .0019) and decreased with increasing angle of tilt (p < .001) regardless of the site of stimulation. Subjects tolerated higher angles of incline with electrical stimulation than without (p = .03). CONCLUSIONS: FES causes a dose-dependent increase in blood pressure independent of stimulation site that may be useful in treating orthostatic hypotension.     

全身振动对绝经后妇女平衡能力的影响

目的：通过对绝经后妇女进行16周的振动训练,研究振动刺激对绝经后妇女平衡能力的影响。方法：21例50—63岁绝经后妇女随机分为实验组和对照组,采用Postural Equa平衡分析系统测量平衡能力等各项指标。实验组采用振动干预,对照组不接受任何干预。振动方案为：频率30—45Hz、20min/次,3次/周,连续16周。结果：组内对比,实验组在实验后,在闭眼状态下,压力中心（COP）指标中的Y值、最大摆幅（ML）值、线形图面积（AREA）值都明显低于实验前,分别下降7.33mm、8.33mm、16.67mm（P<0.05）;在睁眼状态下,其他各指标差异不明显。组间对比,实验组与对照组在实验前后,在睁眼和闭眼状态下静态平衡指标COP、TL、ML和AREA也未见有明显改变（P>0.05)。结论：16周的全身振动训练方案可以明显改善绝经期妇女的静态平衡功能。     

Balance and ambulation improvements in individuals with chronic incomplete spinal cord injury using locomotor training-based rehabilitation

Harkema SJ, Schmidt-Read M, Lorenz DJ, Edgerton VR, Behrman AL. Balance and ambulation improvements in individuals with chronic incomplete spinal cord injury using locomotor training–based rehabilitation.ObjectiveTo evaluate the effects of intensive locomotor training on balance and ambulatory function at enrollment and discharge during outpatient rehabilitation after incomplete SCI.DesignProspective observational cohort.SettingSeven outpatient rehabilitation centers from the Christopher and Dana Reeve Foundation NeuroRecovery Network (NRN).ParticipantsPatients (N=196) with American Spinal Injury Association Impairment Scale (AIS) grade C or D SCI who received at least 20 locomotor training treatment sessions in the NRN.InterventionsIntensive locomotor training, including step training using body-weight support and manual facilitation on a treadmill followed by overground assessment and community integration.Main Outcome MeasuresBerg Balance Scale; Six-Minute Walk Test; 10-Meter Walk Test.ResultsOutcome measures at enrollment showed high variability between patients with AIS grades C and D. Significant improvement from enrollment to final evaluation was observed in balance and walking measures for patients with AIS grades C and D. The magnitude of improvement significantly differed between AIS groups for all measures. Time since SCI was not associated significantly with outcome measures at enrollment, but was related inversely to levels of improvement.ConclusionsSignificant variability in baseline values of functional outcome measures is evident after SCI in individuals with AIS grades C and D and significant functional recovery can continue to occur even years after injury when provided with locomotor training. These results indicate that rehabilitation, which provides intensive activity-based therapy, can result in functional improvements in individuals with chronic incomplete SCI.