基于本体感觉训练为主的综合干预法治疗早产儿功能性吞咽障碍的疗效观察

目的 对早产儿功能性吞咽障碍的临床干预研究，观察其近期和远期疗效，拟探索并优化其康复方法。 方法 采取随机数字表法，将符合纳入条件的70例功能性吞咽障碍早产儿分为对照组和观察组，每组35例，但最终失访8例，有30例对照组和32例观察组完成全程研究。除一般早产儿诊疗常规外，对照组采取婴儿抚触及被动操训练等常规干预措施；观察组在对照组基础上，采用基于本体感觉训练为主的综合干预法进行康复训练。2组患儿均从入院病情平稳后开始干预至出生3月龄，每日2次，每次约20 min。于出生28 d时，对2组患儿的吞咽障碍临床表现及并发症进行近期疗效评估；并于患儿3月龄时，对2组患儿的体质量及发育商(DQ)进行远期疗效对比。 结果 2组患儿均干预至出生28 d时，经口喂养后口腔奶液残留（χ2=9.255，P=0.002）和引起呛咳或口鼻返流（χ2=4.623，P=0.032）的症状发生例数对比，差异有统计学意义（P<0.05）；2组患儿吸入性肺炎（χ2=2.619，P=0.106）和喂奶后呼吸困难（Fisher精确概率法，P=0.230）并发症的发生例数对比，差异无统计学意义（P>0.05），但发生并发症的总例数对比（χ2=4.982），差异有统计学意义（P<0.05）。干预至3月龄时，2组患儿的体质量 (t=2.192,P=0.029) 和DQ值 (t=2.104,P=0.036) 组间比较，观察组明显优于对照组（P<0.05）。 结论 基于本体感觉训练为主的综合干预法治疗早产儿功能性吞咽障碍具有良好的临床疗效，可提高早产儿近远期的生活质量。     

Isokinetic, functional and proprioceptive assessment of football players two years after surgical reconstruction of the anterior cruciate ligament of the knee]

Injuries to the anterior cruciate ligament (ACL) of the knee are common in sport and are treated routinely in the world of sports medicine. In order to resume competitive sport in safety, it is important to know the actual level of performance achieved by the operated leg some time after the ligament repair. OBJECTIVES: The objective of this work was to evaluate the recovery of the operated leg in Tunisian sportsmen two years after surgery by using isokinetic testing (60 degrees s(-1)), the one-leg hop distance test (i.e. a functional activity that one often finds in sport) and proprioceptive assessment. A secondary objective was to detect any possible correlations between the various outcomes. MATERIALS AND METHOD: The ACL group was composed of 26 top-level Tunisian footballers having undergone ACL ligament repair. Two years after surgery, the following assessments were performed: an isokinetic test with an angular velocity of 60 degrees s(-1), a proprioceptive assessment in both active and passive modes and the functional one-leg hop distance test. RESULTS: Our investigations confirmed a muscle deficit of 16% in the hamstring muscles of the injured leg. In both active and passive modes, normal proprioception is observed at a flexion of 60 degrees and in total extension but not in a mid-way position. The performance level of the operated leg (in terms of distance) had an average symmetry value of 93.40+/-2.7%. CONCLUSION: Playing football appears to influence the isokinetic strength profile in sportsmen after ACL repair. The repair procedure leads to bilateral proprioceptive disruption at 15 degrees of knee flexion, on average.     

Surgical approaches to the distal radioulnar joint

For the distal radioulnar joint (DRUJ) to be stable, not only do the articulating surfaces need to be congruent and well aligned but also the capsule and ligaments need to be mechanically and sensorially competent. According to recent investigations, ligaments should not be regarded as simple static structures maintaining articular alignment but as complex arrangements of collagen fibers containing mechanoreceptors, which are able to generate neural reflexes aiming at a more efficient and a more definitive muscular stabilization. By careful planning and meticulous execution of surgical incisions to approach the DRUJ, the nerve endings innervating the capsule and DRUJ ligaments may be safeguarded, thus preserving the proprioceptive function of the joint.     

结合PNF的关节松动术(MWP)技术治疗肘关节功能障碍初探

目的:利用结合神经肌肉促进技术(PNF)的关节松动术(Mobilization with PNF,MWP)技术治疗肘关节骨折术后功能障碍,探讨其对关节主/被动活动度、疼痛、肌肉力量和本体感觉的影响。方法:取2009年8月～2012年4月本院肘关节骨折术后功能障碍患者共32例。患者术后病情稳定,视内固定牢固程度开始康复训练。分为实验组和对照组,对照组患者先常规治疗、关节松动技术、关节牵伸治疗和一般性肌力训练。实验组在以上治疗中,追加MWP治疗替换关节松动术,分别治疗8周后进行功能评价。结果:治疗前后对比,实验组、对照组在关节活动度、视觉模拟(VAS)评分、各肌群肌力方面有明显差异(P<0.01),实验组在位置觉、被动运动觉上有明显差异(P<0.01);治疗后,实验组与对照组在关节活动度、伸肌肌力和旋前肌力上有明显差异(P<0.05),尤其是在屈曲角度、主动旋前角度、VAS评分、位置觉、被动运动觉上差异明显(P<0.01)。结论:MWP对肘关节功能障碍治疗有明显疗效,对肘关节主/被动关节活动度、肌肉力量、本体感觉和疼痛缓解都有促进作用,并优于单纯使用关节松动技术的传统治疗方法。     

Evidence that the extraocular motor nuclei innervate monkey palisade endings

Palisade endings are found in the extraocular muscles (EOMs) of almost every mammalian species, including primates. These nerve specializations surrounding the muscle fiber insertion have been postulated to be the proprioceptors of the EOMs. However, it was recently demonstrated that palisade endings have a cholinergic nature, which reopened the question of whether palisade endings are motor or sensory structures. In this work, we examined whether the cell bodies of palisade endings lie in EOM motor nuclei by injecting an anterograde tracer, biotinylated dextran amine, into the abducens nucleus of a macaque monkey. Tracer visualization in the lateral rectus muscle was combined with choline acetyltransferase (ChAT) and α-bungarotoxin staining. Analysis of the samples was performed by conventional light microscopy and confocal laser scanning microscopy. About 30% of the nerve fibers innervating the muscle were tracer positive. These were ChAT positive as well. Tracer positive nerve fibers established motor contacts on singly and multiply innervated muscle fibers, which were confirmed by α-bungarotoxin staining. At the transition between muscle and distal tendon, we found palisade endings that contained tracer. Palisade endings exhibited the classic morphology: axons arising from the muscle extend onto the tendon, then turn back 180° and terminate in a cuff of terminals around an individual muscle fiber tip. This finding suggests that the cell bodies of palisade endings lie in the EOM motor nuclei, which complements prior studies demonstrating a cholinergic, and possibly motor, phenotype for palisade endings.     

前交叉韧带重建术后膝关节位置觉和运动觉的早期观察研究

目的观察关节镜下自体胭绳肌腱单双束重建前交叉韧带患者术后早期膝关节位置觉和运动觉的恢复情况,并比较有无差异。方法50例单侧前交叉韧带损伤后重建患者非随机分为两组,单束重建组26例,双束重建组24例,移植物均为自体胭绳肌腱;正常对照组12例。术后对患者进行KT2000关节测量,膝关节被动位置重现和运动感知阈值测量,同时对其IKDC2000膝关节主观功能评分和Lysholm膝关节评分进行观察;对照组进行双侧膝关节被动位置重现和运动感知闽值测量。结果比较两组病例术后膝关节的前向稳定性和功能评分以及位置觉和运动觉结果,差异均无统计学意义（P〉0．05）;两病例组与正常对照组相比较,位置觉和运动觉结果差异均有统计学意义（P〈0．05）。结论前交叉韧带重建术后早期患者膝关节的位置觉和运动觉并未恢复到正常水平;前交叉韧带单束重建术和双束重建术患者术后早期膝关节位置觉和运动觉恢复水平并无差异。     

Comparison of standing balance between female collegiate dancers and soccer players

STUDY DESIGN: This study was designed as a comparison study of two cohorts. OBJECTIVES: The hypothesis of this study was that soccer players and dancers have different balance abilities and that these differences could be objectively measured using center of pressure measurements. BACKGROUND: Center of pressure (COP) measurements are reproducible and have been validated in the literature for assessing standing balance. The literature does not provide sensitive enough techniques for discriminating between two groups of athletes with excellent standing balance. METHODS AND MEASURES: A Matscan pressure mat (Tekscan, Boston, MA) was used to compare COP change variability between 32 female collegiate soccer players and 32 dancers. COP was used to calculate sway index, center acquisition time, sway path length and sway velocity as measures of standing balance. RESULTS: The dancers had significantly better balance scores (p<0.05) in 5 of 20 balance tests. Results for the remaining 15 balance tests were not significantly different. CONCLUSION: These data show that standing balance characteristics of dancers and soccer players can be objectively measured using COP data. Dancers have certain standing balance abilities that are better than those of soccer players. The COP measurements in this study can be used as a tool in future studies investigating standing balance in different groups of athletes.     

Muscle stretching technique increases vital capacity and range of motion in patients with chronic obstructive pulmonary disease

Putt MT, Watson M, Seale H, Paratz JD. Muscle stretching technique increases vital capacity and range of motion in patients with chronic obstructive pulmonary disease.

Objectives

To determine if a specific hold and relax stretching technique was capable of (1) reversing the effect of tight chest wall muscles by increasing chest expansion, vital capacity, and shoulder range of motion and (2) decreasing perceived dyspnea and respiratory rate in persons with chronic obstructive pulmonary disease (COPD).

Design

Double-blind crossover trial.

Setting

A physiotherapy department at a major metropolitan hospital.

Participants

Fourteen stable patients with COPD who had recently completed a pulmonary rehabilitation program were enrolled, with 10 patients completing the study.

Intervention

A hold and relax stretching technique of the pectoralis major and a sham technique each for 2 days.

Main Outcome Measures

The primary outcome measure was vital capacity (VC), with secondary outcome measures being perceived dyspnea, axillary (ACE) and xiphisternal chest expansion (XCE), right and left shoulder horizontal extension, and respiratory rate.

Results

The hold and relax technique to the pectoralis major compared with the sham technique produced significant effects on VC (P<.01), and right (P<.01) and left (P<.05) upper-limb range of motion. There was no significant effect on ACE, XCE, perceived dyspnea, or respiratory rate. There was no order effect for either technique.

Conclusions

The hold and relax technique produces short-term benefits in patients with COPD and should be investigated further.     

Comment on "Two enigmas in proprioception: abundance and location of muscle spindles" by T. Kokkorogiannis

I present observations on the numbers and distributions of muscle spindles indicating that spindle number is an important controlled variable of muscle design, but the distribution of spindles within a muscle is not. Although our understanding of the functional correlates of spindle number is far from complete, I argue that nothing that is known about their number or distribution is inconsistent with them acting as length sensors, in contradiction to Kokkorogiannis's comment [Brain Res. Bull., this issue] on Windorst's review [U. Windhorst, Muscle proprioceptive feedback and spinal networks, Brain Res. Bull. 73 (2007) 155-202].     

Dynamic estimation of hand position is abnormal in Parkinson's disease

Parkinson's disease (PD) is widely viewed as a disorder of central motor control. However, recent studies suggest that disordered kinesthetic processing may also contribute to bradykinesia and hypometria in PD. To examine the hypothesis that abnormal kinesthesia in PD would result in impaired hand motion estimation used for motor control, we tested PD patients, elderly people, and young adults in an active, multi-joint kinesthetic-to-visual matching task. To minimize initial localization errors, visual information about the starting position was always available. The participants performed center-out drawing movements to visual targets in the absence of visual feedback of hand/pen motion at their preferred speed. Movement time (MT), end-point position error (EPE), and initial directional error (IDE) were measured. No detrimental effects of aging were observed; however, the PD group showed prolonged MTs and higher EPE scores as compared to the elderly and young groups. Principal component analysis of the end-point error distributions showed that the PD patients had larger variability in both the extent and direction axes. These results suggest that PD patients have abnormal proprioception and deficits in the central processing and integration of kinesthetic signals, resulting in the incorrect assembly of multiple sensorimotor inputs into a motor plan. It is hypothesized that altered kinesthesia in PD causes improper estimation of hand motion used for motor control due to the degraded maintenance of a dynamic internal hand representation.