膝关节分离运动强化训练脑卒中患者的步行能力

目的：探讨针对性的膝关节分离运动强化训练对脑卒中患者下肢运动功能及步行能力的影响。方法：45例能步行但无膝关节分离运动的脑卒中患者随机分为两组，对照组23例进行常规训练，强化组22例进行膝关节分离运动强化训练。训练前和训练2个月后评估Fugl-Meyer评价法中下肢项，6min步行距离和10m步行时间。结果：患者FMA评分(下肢项)对照组训练前为15．46分，训练后为17．51分，训练前后比较差异无显著性意义(P&;gt;0．05)，强化组训练前为16．28分，训练后为25．63分，训练前后比较差异有显著性意义(P&;lt;0．05)。步行能力强化组训练前后差异具有非常显著性意义(P&;lt;0．01)，对照组差异亦具显著性意义(P&;lt;0．05)，但训练后强化组效果优于对照组(P&;lt;0．05)。2个月后出现膝关节分离运动患者对照组为13％(3／23)，强化组为55％(12／22)，差异具有显著性意义(P&;lt;0．01)。结论：针对性的膝关节分离运动强化训练对脑卒中患者运动功能及步行能力的改善效果明显。     

减重支持训练对脑卒中偏瘫患者步行能力的影响

背景:改善患者的静态或者动态平衡,保持姿势的调节功能和肌收缩力以及肌耐力是使患者恢复步行能力的前题。减重步行训练,在减重吊带的保护下使患者站立、步行时重心分布对称,步行稳定性提高,可提高步态训练的效果。目的:探讨减重支持训练系统对脑梗死患者步行功能恢复的意义。设计:非随机同期对照观察。单位:一所市级医院的神经内科病房。对象:2000-02/2001-12沈阳市第一人民医院收治的急性脑梗死住院患者82例,纳入标准:符合贝政平《内科疾病诊断标准》中相关标准;均经头CT或M RI证实,病程<7d,患者和家属对治疗知情同意。排除标准:有意识…     

脑卒中后抗痉挛治疗对偏瘫患者步行能力的影响

选择脑卒中患者52例,随机分为两组,各26例。观察组在药物治疗的同时给予良肢位和早期康复训练,对照组只用药物治疗。经治疗3个月,观察组在下肢功能恢复和步行能力恢复方面明显优于对照组,提示早期对脑卒中患者进行抗痉挛康复治疗,有助于患者下肢功能恢复,可明显改善患者的步行能力。     

运动再学习对脑卒中患者步行功能恢复的效果

目的 探讨运动再学习方法对脑卒中患者步行功能恢复的影响。方法辽宁省友谊医院康复科1998-06／2004-06脑卒中住院患者40例，随机分为对照组和治疗组，每组20例，两组均接受常规治疗，病情平稳后治疗组开始以运动再学习、综合促通技术为主的康复治疗。1次／d，40min／次，治疗3个月。运动功能评定采用Fugl-Meyer运动功能评测法。日常生活活动能力采用Barthel指数评定。结果40例患者全部进入结果分析。两组治疗后下肢功能和平衡功能评分和Barthel指数均明显高于治疗前，治疗组治疗后各项评分明显高于对照组[(26.34&;#177;7．45)，(17．66&;#177;5．34)分；(10．07&;#177;3．45)。(4．17&;#177;2．05)分；61.03&;#177;9．14，36．05&;#177;8．16]。对照组治疗前下肢伸肌痉挛12例，足下垂内翻9例。治疗后分别为10例，8例。治疗组治疗前下肢伸肌痉挛11例，足下垂内翻8例。治疗后分别为5例，4例。结论运动再学习方法为主的综合训练明显提高脑卒中患者步行功能，减少了并发症。     

膝关节分离运动强化训练改善偏瘫患者步态的作用

为提高脑卒中偏瘫患者膝关节的控制能力,克服膝过伸,改善步态,选择2004-01/2006-03长治医学院附属和平医院收治的无膝关节分离运动的脑血管意外偏瘫患者50例,随机分为治疗组30例和对照组20例。两组均接受常规运动疗法,治疗组在此基础上进行膝关节分离运动的强化训练。训练前和训练3个月后分别采用Fugl-Meyer法评定下肢运动功能和平衡,Barthel指数法评定下肢活动能力,足印法分析步态。结果显示治疗组步态较对照组明显改善(P<0.01),运动功能和活动能力显著提高(P<0.01)。提示膝关节分离运动强化训练可改善膝关节功能,克服膝过伸,改善步态,提高下肢综合能力。     

膝关节分离运动强化训练改善偏瘫患者步态的作用

为提高脑卒中偏瘫患者膝关节的控制能力，克服膝过伸，改善步态，选择2004—01／2006—03长治医学院附属和平医院收治的无膝关节分离运动的脑血管意外偏瘫患者50例，随机分为治疗组30例和对照组20例。两组均接受常规运动疗法，治疗组在此基础上进行膝关节分离运动的强化训练。训练前和训练3个月后分别采用Fugl—Meyer法评定下肢运动功能和平衡，Barthel指数法评定下肢活动能力，足印法分析步态。结果显示治疗组步态较对照组明显改善（P〈0．01），运动功能和活动能力显著提高（P〈0．01）。提示膝关节分离运动强化训练可改善膝关节功能，克服膝过伸，改善步态，提高下肢综合能力。     

急性脑卒中偏瘫患者恢复期助行器步行训练方法介绍

主要介绍关于脑卒中偏瘫患者恢复期用以康复的、有代表性的行走辅助工具以及行走辅助工具并用的辅助设备和行走训练工具,同时说明其适应证和训练要点。     

脑卒中伴心血管疾病患者减重步行训练方法及血氧含量监测

目的设计预后的、连续性的和前瞻性的观察研究,评估脑卒中后1个月内患者的运动能力。方法在一个三级甲等医院的运动测试实验室。29例脑卒中后(26±9)d患者,在减重状态下,即患者15%的体质量被支撑后的最大强度的功能训练,包括最大力量踏车和连续步行运动期间,了解其最大耗氧量情况,测定血液的氧分压峰值,同时使用开放循环呼吸测量仪测定患者肺活量峰值。结果训练过程中没有不良事件发生,平均步行速度由(0.39±0.12)m/s上升至(0.54±0.30)m/s。脑卒中1个月后的平均氧分压为久坐的健康成人平均耗氧标准值的60%,并且与年龄和性别相关。结论脑卒中后经过最大限度地锻炼1个月左右,患者的运动能力才开始恢复,后遗症的症状被缓解。     

脑卒中偏瘫患者119例介入早期康复干预后独立步行能力观察

将脑卒中患者分为两组,康复组在临床用药治疗的同时进行早期康复训练。对照组给予临床治疗及非早期康复训练。观察患者的独立步行能力恢复情况。至第15,30天时,康复治疗组独立步行人数比对照组分别增加了11.5%和20.4%。证明脑卒中患者早期康复训练有利于独立步行能力的恢复。     

距小腿关节强化训练对脑卒中患者平衡功能的影响

为探讨距小腿关节(踝关节)强化训练对脑卒中患者平衡功能的影响。将60例脑卒中患者随机分成治疗组30例和对照组30例。对照组采用常规康复治疗,治疗组在上述基础上加用距小腿关节强化训练。评定方法采用Fugl-Meyer平衡功能量表。经过两个月的康复治疗后,两组脑卒中患者平衡功能均明显改善。且治疗组改善程度明显优于对照组(P<0.01)。提示距小腿关节强化训练能明显改善脑卒中患者的平衡功能。     

早期减重平板步行训练对脑卒中偏瘫患者的影响

目的探讨早期应用减重平板步行训练对脑卒中偏瘫患者运动功能和日常生活能力的影响。方法将69例脑卒中偏瘫患者随机分为减重组(39例)和对照组(30例)。减重组除进行常规康复治疗外,另给予减重平板步行训练,每周6次,每次15~30min,起始减重量为体重的30%~60%,平板速度0.25m/s;对照组仅给予常规康复治疗。采用功能性步行分级、Fugl-Meyer量表和Barthel指数评分于治疗前、后对2组患者进行评定。结果治疗后,减重组患者Fugl-Meyer量表、Barthel指数得分较对照组提高(P<0.05),步行功能、步速均较对照组明显提高(P<0.01)。结论早期应用减重平板步行训练结合常规康复治疗可更有效提高脑卒中偏瘫患者的步行、运动、平衡功能和日常生活能力。     

膝关节外伤后运动疗法中的ROM治疗

复位、固定和康复是现代医学治疗骨折的 3个主要环节 ,及时适宜的康复 ,不仅是促进组织修复的重要手段 ,而且是功能恢复的“必经之路” ,但目前重治疗、轻康复的医疗观点仍十分常见。膝关节损伤后的康复方法很多 ,如按摩、运动疗法、作业疗法、水疗、理疗 ,传统中医药治疗等 ;在运动治疗中 ,亦可进行肌松弛训练、肌力训练、关节活动度 (ＲＯＭ )的恢复训练、耐力训练等 ,一般综合训练效果更佳 ,本文介绍ＲＯＭ的训练。1膝关节的ＲＯＭ1.1膝关节的活动范围　膝关节有屈伸和横向旋转两个活动自由度。膝关节的运动主要是绕额状轴做屈、伸运动 ,…     

等速肌力测试在膝关节损伤后康复训练中的应用

运用Ｃｙｂｅｘ３３０型等速运动仪对４５例膝关节外伤后患者进行双侧膝关节等速肌力测试，并依据慢速测试（６０°／ｓ）结果指导患者进行为期２个月的渐进抗阻练习。结果发现，患膝屈伸肌峰力矩值在训练后明显增加，屈肌与伸肌峰力矩比值接进正常。康复训练前后比较，患膝功能的差别有显著性（Ｐ＜００１），说明抗阻练习对膝关节功能恢复有明显的促进作用。     

Effect of blocked vision treadmill training on knee joint proprioception of patients with chronic stroke

[Purpose] The purpose of this study was to compare the effect of treadmill training with the eyes closed and eyes open on the joint position sense of chronic stroke patients. [Subjects and Methods] Thirty patients with chronic stroke participated in this study. Patients performed the timed up and go test and were assigned to one of two treadmill training groups with and without visual deprivation. The treadmill gait training for each group lasted 40 minutes, and sessions were held 3 times a week for 4 weeks. The knee joint proprioception was measured using the Biodex System Pro 3 before and after the intervention. [Results] The knee joint proprioception of the treadmill training with blocked vision group showed more significant improvement after the treadmill training sessions than that of the eyes open group. [Conclusion] This study demonstrated that treadmill training with blocked vision may be useful for the proprioceptive sensory rehabilitation of patients with chronic stroke.Key words: Chronic stroke, Knee joint proprioception, Visual deprivation     

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.     

Effects of isokinetic training on the rate of movement during ambulation in hemiparetic patients

The purpose of this study was to determine the effects of isokinetic training on the rate of movement during ambulation in hemiparetic patients. Ten male and 10 female subjects, aged 40 to 75 years, participated in the study. The 20 hemiparetic subjects were assigned randomly to either a control group or an experimental group. All of the subjects participated in a conventional therapeutic exercise program and gait training. The experimental group also received isokinetic training on the Kinetron exercise machine as part of their program. Functional ambulation profile tests were administered to each subject before and after the five-week experimental period. All of the subjects showed improvement in the rate of ambulation and in overall ambulation performance. The differences in ambulation times and functional ambulation profile scores between the two groups were shown to be insignificant.     

A comparison of regular rehabilitation and regular rehabilitation with supported treadmill ambulation training for acute stroke patients

The purpose of this pilot study was to compare differences in motor recovery between regular rehabilitation (REG), and regular rehabilitation with supported treadmill ambulation training (STAT) using the performance on a bicycle exercise test and the locomotor scale of the Functional Independence Measure (FIM-L). Twelve patients with acute strokes were randomly assigned to either REG or STAT for 2 to 3 weeks. The STAT group received daily gait training utilizing a treadmill with partial support of body weight. After intervention, the STAT group had higher oxygen consumption (11.34+/-0.88 vs 8.32+/-0.88 ml/kg/min, p=0.039), total workload (58.75+/-7.09 vs 45.42+/-7.09 watts, p=ns), and total time pedaling the bike (288.91+/-30.61 vs 211.42+/-30.61 s, p=ns) compared to the REG group. The FIM-L scores were not different for the two groups. This pilot study suggests that the STAT intervention is a promising technique for acute stroke rehabilitation, and that future studies with larger sample sizes are warranted to establish the effectiveness of this intervention.     

Constraint-induced movement therapy after stroke: efficacy for patients with minimal upper-extremity motor ability

OBJECTIVE: To examine the effects of constraint-induced movement therapy (CIMT) on chronic moderate-to-severe upper-extremity motor impairment after stroke. DESIGN: Within-subjects design; pre- and posttesting as well as 1-month follow-up. SETTING: Outpatient clinic within a rehabilitation hospital. PARTICIPANTS: Twenty participants, each greater than 12 months poststroke. INTERVENTION: Three weeks of CIMT including restraint of the nonparetic upper extremity and 6 hours of training a day. MAIN OUTCOME MEASURES: Fugl-Meyer Assessment (FMA), Graded Wolf Motor Function Test (GWMFT), and Motor Activity Log (MAL). RESULTS: There was a statistically significant effect of treatment on upper-extremity motor impairment as assessed by the FMA, the MAL, and the functional ability scale of the GWMFT. There was a trend toward an effect of CIMT on mean speed of performance on the GWMFT. Post hoc analysis showed significant differences between motor impairment scores between pretreatment and posttreatment assessments, and improvements in motor impairment scores remained stable 1 month after completion of formal treatment. Improvements appeared to be mostly in the use of the involved upper extremity for bimanual activities. CONCLUSIONS: CIMT conferred significant changes in objective measures in subjects with chronic moderate-to-severe impairments after stroke. Additional studies of long-term benefits of this treatment on poststroke motor impairments and related functional disabilities are warranted.     

肌电生物反馈联合膝关节控制训练对脑卒中偏瘫患者下肢运动功能的临床疗效

目的：探讨肌电生物反馈联合膝关节控制训练对脑卒中偏瘫患者下肢运动功能的临床疗效。方法：选取符合标准的脑卒中偏瘫患者60例随机分为观察组和对照组,各30例。2组患者均接受常规康复治疗,观察组在对照组的基础上,另行肌电生物反馈联合膝关节控制训练,每日1次,每周5次,治疗4周。于治疗前和治疗4周后分别采用简化Fugl-Meyer量表评定患者下肢运动功能,Berg平衡量表（BBS）评定平衡功能,Holden步行功能分级（FAC）评估步行能力。结果：治疗4周后,2组患者的Fugl-Meyer、BBS、FAC评分较治疗前比较均显著提高（P＜0.05）,观察组上述评分均显著高于对照组（P＜0.05）。结论：肌电生物反馈联合膝关节控制训练能够改善脑卒中患者的下肢运动功能,提高平衡能力和步行能力。     

Short-term effects of mobilisation with movement in patients with post-traumatic stiffness of the knee joint

Background

Mobilisation with movement treatment techniques have been used to increase the range of motion following pathologies associated with shoulder, elbow and ankle joints. Lack of posterior tibial glide and reflex muscle inhibition are common physical impairments in individuals with post-traumatic stiffness of the knee joint. Current evidence is lacking for the benefits of mobilisation with movement treatment techniques for the knee joint disorders.