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11.
Jayme S. Knutson Amy S. Friedl Kristine M. Hansen Terri Z. Hisel Mary Y. Harley 《Archives of physical medicine and rehabilitation》2019,100(1):140-143.e1
Objective
To evaluate the convergent validity and responsiveness of the Stroke Upper Limb Capacity Scale (SULCS) in comparison to the Arm Motor Ability Test (AMAT), the Box and Blocks Test (BBT), and the upper limb Fugl-Meyer Assessment (FMA). The SULCS is a relatively new measure that was designed to be easier to score and less time consuming than some existing measures.Design
Prospective repeated-measures design.Setting
Clinical research laboratory of a large public hospital.Participants
Patients (N=61) <2 years poststroke with moderate to severe upper limb hemiparesis.Intervention
Participants received 12 weeks of therapy that included neuromuscular electrical stimulation of the paretic finger and thumb extensors. The SULCS, AMAT, BBT, and FMA were administered at weeks 0, 6, 12 (end of therapy), 20, 28, and 36 (6mo post-therapy).Main Outcome Measures
Convergent validity was evaluated with Spearman’s correlation coefficients between pairs of measures at each time point. Responsiveness from 0 to 12 weeks and 0 to 36 weeks was evaluated with the standardized response mean (SRM).Results
The SULCS demonstrated strong correlation with the AMAT (ρ=0.81-0.93), BBT (ρ=0.73-0.92), and FMA (ρ=0.78-0.92), at all 6 time points. All 4 measures had moderate to large SRMs (SULCS, 0.71-0.77; AMAT, 0.83-0.97; BBT, 0.73-0.82; FMA, 0.75-0.76). There was no significant difference in responsiveness among the 4 measures.Conclusions
The results support the use of the SULCS to measure upper limb capacity in patients who are less than 2 years poststroke with moderate to severe hemiplegia. 相似文献12.
目的:评定运用肌内效贴技术结合针刀治疗卒中后肩痛的临床疗效及安全性。方法:选取2018年1月~2019年9月东莞市滨海湾中心医院中医康复科和神经内科的脑卒中后肩痛患者120例,随机分为治疗组和对照组各60例。对照组运用常规康复治疗训练,治疗组在此基础上配合运用肌内效贴技术及针刀治疗。分别记录两组患者在治疗前、治疗2周后及治疗4周后的肩痛VAS评分、上肢简化Fugl-Meyer运动功能评分及Constant-murley评分,并分析其疗效。结果:治疗2周、4周后,两组患者的VAS评分、FAM评分、CMS评分均较治疗前显著改善(P<0.05),且治疗组组治疗后的各评分显著优于对照组(P<0.05)。结论:运用肌内效贴结合针刀治疗卒中后肩痛临床疗效满意,安全性高。 相似文献
13.
Xuqiang Wei Liyun He Jia Liu Yanke Ai Yali Liu Yi Yang Baoyan Liu 《Journal of stroke and cerebrovascular diseases》2019,28(5):1388-1399
Background: Reflex sympathetic dystrophy (RSD) is the common complication among stroke and cerebral injury patients, which is lack of safe and effective treatment. Electroacupuncture (EA) may potentially be a reliably therapy, but the evidence is insufficiency. Methods: Cochrane Library, MEDLINE, Embase, Chinese National Knowledge Infrastructure, Wan Fang Data, the Chinese Biology Medicine disc, etc., were searched, until July 20, 2018. We included random control trials that contrast EA with conventional rehabilitation therapy for the treatment of RSD. Main outcomes were visual analog scale score and Fugl-Meyer upper limb motor function scoring scale, other outcomes such as Barthel index, and hand swelling score were also collected. Data in included studies were extracted into an excel and pooled by Stata/MP 14.1. Results: We incorporated 13 studies involving 1040 RSD patients and outcomes were from 2 to 6 weeks' follow-up. The analgesic effect between 2 groups had statistically significant difference (weighted mean difference [WMD] = ?1.122, 95% confidence interval [CI] [?1.682 to ?.562], P?=?.000], a statistical difference existed in improving dysfunction between 2 groups: (WMD?=?6.039, 95% CI [2.231?.916], P?=?.000). EA groups had a better effect on improving activities of daily life abilities (WMD?=?12.170, 95% CI [6.657?17.682], P < .00011] and better detumescence effect (WMD = ?.800, 95% CI [?1.972 to ?.212], P = .000] contrast to conventional rehabilitation therapy. Conclusions: This meta-analysis supports that EA has a positive effect on alleviating pain, improving limb dysfunction, and promoting activities of daily living. On account of moderate-quality random control trials and high heterogeneity, further high-quality studies are imperative to optimize the EA treatment program. 相似文献
14.
目的：探讨辨证施护对脑出血患者肢体功能的临床效果。方法：选择我院脑出血偏瘫患者154例,随机分为对照组及治疗组,对照组给予一般常规护理,治疗组在对照组的基础上给予中医辨证护理,观察护理后15 d、30 d患者肌力变化、FMA评分、Barthel指数的变化情况。结果：（1）两组患者肌力比较：与护理前相比较,治疗组经辨证护理后30 d肌力明显优于对照组,差异有统计学意义（P＜0.05）;（2）FMA评分比较：治疗组在15 d、30 d FMA评分明显高于护理前,差异有统计学意义（P＜0.05）,与对照组比较,差异有统计学意义（P＜0.05）;（3）Barthel指数比较：经护理后治疗组Barthel指数明显高于护理前,差异有统计学意义（P＜0.05）,组间比较,差异亦有统计学意义（P＜0.05）。结论：辨证施护对脑出血患者肢体功能有较好恢复作用。 相似文献
15.
目的观察腹针联合运动疗法治疗中风后痉挛性偏瘫的疗效。方法将120例中风后痉挛性偏瘫患者随机分为观察组、对照组,每组各60例。治疗组以腹针加运动疗法治疗,腹针穴取中脘、下脘、气海、关元、商曲、气旁、滑肉门、外陵。针刺完毕配合运动疗法。治疗隔日1次,每周3次,共24次。对照组以单纯运动疗法治疗,运动疗法的手法及疗程同观察组。结果通过两组治疗前后临床疗效及四肢FMA评分比较,发现两组治疗后总有效率差异有统计学意义(P0.01),治疗后两组FMA评分比较有显著差异(P0.05),观察组与对照组治疗后FMA评分治疗前比较,有非常显著差异(P0.01)。结论腹针联合运动疗法治疗中风后痉挛性偏瘫的疗效优于单纯运动疗法。 相似文献
16.
目的观察电子生物反馈疗法对偏瘫患者运动功能障碍的临床疗效。方法随机选择治疗组、对照组各40例,对照组用常规药物治疗配合早期康复治疗,治疗组同时配合电子生物反馈治疗。观察两组治疗前后临床神经功能缺损程度评分、肢体运动功能Fugl-Meyer评分(FMA),日常生活活动能力按Barthel指数积分(MBI)评定。结果治疗组治疗后临床神经功能缺损程度评分、MBI、FMA与对照组相比,差异有统计学意义(P0.05)。结论常规药物治疗配合早期康复治疗可改善偏瘫患者的运动障碍,但配合电子生物反馈疗法的疗效更显著。 相似文献
17.
目的:探讨针刺配合康复训练对脑卒中上肢功能障碍患者神经功能特异性烯醇化酶(NSE)、硫化氢(H_2S)、神经营养因子(NGF)与脑血管动力学的影响。方法:选取2016年5月至2017年10月空军军医大学唐都医院收治的脑卒中上肢功能障碍患者198例进行回顾性分析。将患者分为针刺配合康复训练治疗观察组100例,单纯依靠康复训练治疗对照组98例。比较与分析2组治疗前后的NSE、H_2S、NGF与脑血管动力学等。结果:观察组治疗后NSE(12. 36±6. 35)μg/L,H_2S(52. 19±3. 77)μmol/L,NGF(152. 94±32. 67) pg/m L。对照组治疗后NSE (16. 28±7. 45)μg/L,H_2S (36. 67±6. 95)μmol/L,NGF(129. 81±33. 02) pg/m L。观察组治疗后颈动脉血流速度平均值(V_(mean))(26. 45±3. 79) cm/s,血流量(Q_(mean))(18. 52±3. 32) cm~3/s,外周阻力(RV)(82. 37±22. 39) k Pa·s/m,舒张压与临界压差值(DP)(0. 45±0. 08) k Pa. s/m,动态阻力(DR)(32. 36±10. 08) k Pa。对照组治疗后V_(mean)(19. 86±3. 73) cm/s,Q_(mean)(14. 79±2. 72) cm3/s,RV(95. 31±30. 45)k Pa·s/m,DP(0. 63±0. 14) k Pa·s/m,DR(42. 37±9. 67) k Pa。观察组治疗前FMA评分为(38. 41±7. 52)分,治疗后FMA评分为(54. 61±5. 34)分,改善值(16. 22±6. 46)分。MBI指数治疗前为(36. 75±6. 87),治疗后为(60. 33±12. 73),改善值为(23. 58±9. 34)。观察组中医证候积分治疗前(16. 52±0. 68)和治疗后(4. 60±0. 22)。对照组中医证候积分治疗前(16. 95±0. 83)分和治疗后(8. 72±0. 27)分。结论:针刺配合康复训练能够有效的帮助脑卒中上肢功能障碍患者的恢复神经功能,加速脑血管血流速度,减少压强阻力,从而达到治疗患者上肢及手功能,恢复日常生活活动能力的效果。 相似文献
18.
Juan Wen Shu Liu Xiao Ye Xiaoqiu Xie Jialing Li Huang Li Li Mei 《Journal of the American Dental Association (1939)》2017,148(12):913-921
Background
The authors conducted a study to compare 2-dimensional (2D) lateral cephalometric radiography (LCR), 2D cone-beam computer tomographic (CBCT)–generated cephalogram and 3-dimensional (3D) CBCT for assessing cephalometric measurements.Methods
The authors took 2D LCR, 2D CBCT-generated cephalogram, and 3D CBCT images involving 60 participants. They obtained 11 angular and 11 linear measurements for all images. They used 1-way analysis of variance and the Fisher least significant difference test for statistical comparisons. The authors used Pearson correlation and Pearson χ2 test to assess the relationship of these imaging modalities for vertical cephalometric analyses.Results
Significant differences existed between the 2D cephalograms (LCR and CBCT-generated cephalogram) and the 3D CBCT in 2 angular measurements (maxillary first incisor-nasion (N) point A [A] and mandibular first incisor-N point B (B) (P = .027 and P < .001, respectively) and 5 linear measurements (N menton[Me]/sella gonion [Go], condylion [Co]A, Co gnathion, Go-Me and anterior nasal spine-posterior nasal spine) (P < .004). These measurement values with significant differences were generally greater (approximately 5° for angular measurements and 10 millimeters for linear measurements) on the 3D CBCT scans than on the 2D cephalograms. No significant difference was found between the 2 2D cephalograms (P > .164). No significant difference was found among the 3 imaging modalities for the vertical cephalometric analyses (P > .466).Conclusions
Significant differences existed between the 2D cephalograms (LCR and CBCT-generated cephalogram) and the 3D CBCT scans in 2 angular and 5 linear measurements. The 2 2D cephalograms were similar for cephalometric measurements. The 3 imaging modalities had no significant difference for the vertical cephalometric analyses. CBCT might not add value for every orthodontic situation.Practical Implications
These results find the values of cephalometric measurements on 3D CBCT scans may be greater than on the conventional LCR for some parameters. The 2D CBCT-generated cephalogram could be an alternative to the conventional LCR for patients whose large-field-of-view CBCT images are already available. 相似文献19.
Pierre Nicolo Cécile Magnin Elena Pedrazzini Gijs Plomp Anaïs Mottaz Armin Schnider Adrian G. Guggisberg 《Archives of physical medicine and rehabilitation》2018,99(5):862-872.e1
Objective
To investigate the effects of cathodal transcranial direct current stimulation (tDCS) and continuous theta burst stimulation (cTBS) on neural network connectivity and motor recovery in individuals with subacute stroke.Design
Double-blinded, randomized, placebo-controlled study.Setting
University hospital rehabilitation unit.Participants
Inpatients with stroke (N=41; mean age, 65y; range, 28–85y; mean weeks poststroke, 5; range, 2–10) with resultant paresis in the upper extremity (mean Fugl-Meyer score, 14; range, 3–48).Interventions
Subjects with stroke were randomly assigned to neuronavigated cTBS (n=14), cathodal tDCS (n=14), or sham transcranial magnetic stimulation/sham tDCS (n=13) over the contralesional primary motor cortex (M1). Each subject completed 9 stimulation sessions over 3 weeks, combined with physical therapy.Main Outcome Measures
Brain function was assessed with directed and nondirected functional connectivity based on high-density electroencephalography before and after stimulation sessions. Primary clinical end point was the change in slope of the multifaceted motor score composed of the upper extremity Fugl-Meyer Assessment score, Box and Block test score, 9-Hole Peg Test score, and Jamar dynamometer results between the baseline period and the treatment time.Results
Neither stimulation treatment enhanced clinical motor gains. Cathodal tDCS and cTBS induced different neural effects. Only cTBS was able to reduce transcallosal influences from the contralesional to the ipsilesional M1 during rest. Conversely, tDCS enhanced perilesional beta-band oscillation coherence compared with cTBS and sham groups. Correlation analyses indicated that the modulation of interhemispheric driving and perilesional beta-band connectivity were not independent mediators for functional recovery across all patients. However, exploratory subgroup analyses suggest that the enhancement of perilesional beta-band connectivity through tDCS might have more robust clinical gains if started within the first 4 weeks after stroke.Conclusions
The inhibition of the contralesional M1 or the reduction of interhemispheric interactions was not clinically useful in the heterogeneous group of subjects with subacute stroke. An early modulation of perilesional oscillation coherence seems to be a more promising strategy for brain stimulation interventions. 相似文献20.
目的 分析注射用己酮可可碱联合奥扎格雷钠治疗急性脑梗死的临床疗效。方法 选取2015年3月—2020年10月北京市丰台中西医结合医院收治的112例急性脑梗死患者,按随机数字表法将患者分为对照组和治疗组,每组各56例。对照组静脉滴注注射用奥扎格雷钠,80 mg/次,溶于500 mL生理盐水中,2次/d。治疗组在对照组治疗基础上静脉滴注注射用己酮可可碱,0.2 g/次,溶于250 mL生理盐水中,1次/d,输注过程中患者平卧,2～3 h内滴注完成。两组疗程均为14 d。观察两组的临床疗效,比较两组治疗前后美国国立卫生研究院卒中量表（NIHSS）评分、简式Fugl-Meyer评定量表（FMA）评分、脑卒中专门化生存质量量表（SS-QOL）评分及血小板压积（PCT）、血小板聚集率（PAgT）、纤维蛋白原（FIB）和炎症相关指标[中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）]的变化。结果 治疗后,治疗组总有效率是94.64%,显著高于对照组的82.14%（P＜0.05）。治疗3、7、14 d后,两组NIHSS评分均较同组治疗前显著降低（P＜0.05）;治疗后,治疗组患者NIHSS评分显著低于对照组（P＜0.05）。治疗后,两组FMA、SS-QOL评分均较治疗前显著增加（P＜0.05）;治疗后,治疗组FMA、SS-QOL评分高于对照组（P＜0.05）。治疗后,两组PCT、PAgT、FIB、NLR、PLR均显著下降（P＜0.05）;治疗后,治疗组凝血及炎症相关指标显著低于对照组（P＜0.05）。结论 注射用己酮可可碱联合奥扎格雷钠治疗急性脑梗死的效果确切,能在较佳的安全性基础上,有效促进患者神经功能、运动功能恢复,改善凝血功能紊乱和机体炎症损害,利于患者生存状态提升。 相似文献