Non-traumatic lower limb older amputees: a database survey from a geriatric centre

Purpose: The purpose of this survey was to examine the characteristic of a geriatric population admitted for amputation of a lower limb and to explore some of the factors that may affect the course of their hospital stay. Method: The study took place in the geriatric division of a tertiary general hospital and included a close geriatric-orthopaedic liaison. Two-hundred and forty-one patients were included in the final analysis. Results: Many above knee amputations were performed, which correlated with advanced age. Rates of in hospital mortality and systemic complications were 16% and 19%, respectively. Thirty-three percent of the patients were discharged back home, and only 6% were supplied with an artificial limb. The general condition of most patients remained poor. Conclusion: We conclude that despite a team approach to the care of the geriatric amputee a poor functional result was obtained. By encouraging earlier referrals from the community it is postulated that a reduction in the costly provision of antibiotics would be beneficial and that perhaps lower levels of amputation could be performed thereby enhancing the possibilities for ambulation.     

不同年龄组儿童急性偏瘫伴随症状与病因的关系

目的 探讨儿童不同年龄组急性偏瘫伴随症状和病因的关系。方法 对2007-2009年本院收治的31例急性偏瘫患儿的临床资料进行回顾性分析。结果 31例患儿中，＜1岁5例，＞1～3岁12例，＞3～6岁儿童4例，＞6岁年长儿10例。主要伴随症状：惊厥21例、发热12例、意识障碍10例。急性偏瘫的主要病因：①脑血管病10例：其中脑血管畸形4例（幼儿3例、学龄儿1例）、外伤性脑梗死2例（学龄前）、合并先天性代谢缺陷病（同型半胱氨酸血症）2例；②中枢神经系统感染9例（<1岁4例）；③先天代谢性缺陷病5例（均为年长儿）；④偏侧惊厥偏瘫综合征/偏侧惊厥偏瘫癫痫综合征（hemiconvulsion-hemiplegia/hemiconvulsion-hemiplegia-epilepsy syndrome，HH/HHE）4例；交替性偏瘫2例；⑤其他：维生素K1缺乏性颅内出血、急性播散性脑脊髓炎和脑干肿瘤各1例。结论 ①小儿急性偏瘫病因繁多，各年龄段均有发病，其中1～3岁所占比例最大；②偏瘫主要伴随症状有惊厥、发热、意识障碍；伴随症状不同其病因各异；③婴幼儿主要病因是中枢神经系统感染，幼儿和学龄前期儿童中外伤性脑梗死和脑血管畸形并不少见；先天性代谢缺陷病是年长儿偏瘫的病因之一。     

针刺配合康复训练对脑卒中后运动功能恢复的影响

目的 观察"醒脑开窍"针刺法配合康复训练对脑卒中后运动功能及日常生活能力(ADL)改善的影响.方法 90例脑卒中后偏瘫患者随机分为治疗组、对照组Ⅰ、对照组Ⅱ,每组各30例,对照组I采用"醒脑开窍"针刺法,对照组Ⅱ采用康复训练疗法,治疗组为两种方法联合使用,比较三组临床治疗效果.结果 治疗组总有效率90.0%,对照组Ⅰ总有效率66.7%,对照组Ⅱ总有效率63.3%,治疗组与对照组Ⅰ、Ⅱ比较差异有统计学意义(P<0.01);治疗组运动功能及日常生活能力的改善情况与对照组Ⅰ、Ⅱ比较,差异有统计学意义(P<0.01).结论 "醒脑开窍"针刺法配合康复训练对脑卒中后偏瘫的运动功能改善及日常能力的改善疗效显著.     

Treatment of 30 Cases of Apoplectic Language Disorders by Electroacupuncture

Objective: To discuss the therapeutic method of apoplectic patients with language disorders.Methods: Sixty cases of apoplexy were classified into electroacupuncture group of 30 cases and acupuncture group of 30 cases. In electroacupuncture group, acupoints Lianquan (CV 23), Tongli (HT 5) and lower 2/5 part of motor area and sensory area were selected. In acupunc -ture group, acupoints Lianquan (CV 23) and Tongli (HT 5) were selected. Results and conclusions: After 2 courses of treatment, the total effective rate in electroacu -puncture group was 93.3% and that in acupuncture group was 76.6%. There was a significant difference in the therapeutic effect between the two groups (P＜0.05).     

对脑卒中偏瘫本质的认识及其在针灸治疗中的指导作用

脑卒中偏瘫是中枢性瘫痪的一种，它的本质是运动模式质的改变，因此它的康复过程也就是运动模式质变的过程。本文将偏瘫康复过程分为3期，探讨了各期针灸治疗的目的及原则，并指出传统的肌力练习并不适合于痉挛期，而应以抑制痉挛、促进正常运动模式的发展、促进分离运动的形成为主要原则。     

COMPARATIVE ANALYSIS ON THERAPEUTIC EFFECTS OF APOPLEXY TREATED BY XINGNAO KAIQIAO ACUPUNCTURE METHOD AND WESTERN MEDICINE

The therapeutic effects of Xingnao Kaiqiao (醒脑开窍) acupuncture method and West-ern medicine treating apoplexy were compared in this paper. The results show that the total effectiverate is over 90. 00% in acupuncture group for treating motor dysfunction of limbs and main clinicalsymptotns, especially for treating paralysis of extremities, the total effective rate is up to 97. 72%,which is obviously better than that of Western medicine; moreover, the acupuncture has a special ef-fectiveness for restoring the function of cerebral tissue, and treating aphasia and central facial palsy.The characteristics of Xingnao Kaiqiao acupuncture method were described too.     

Conditioning and recovery of functions lost by brain damage

The muscle spindle is a receptor apparatus in striated muscle that is necessary for voluntary muscle movement. Paralysis victims lose the feedback of this receptor and cannot initiate motor responses. Four hemiplegic patients were trained to use auditory feedback from electromyographic recordings to initiate activity in paretic limbs. With the addition of visual feedback and the use of the auditory signal as a reinforcing stimulus, the patients' muscle activity was then shaped to approximate normal movement.     

改进的大脑半球切除术治疗婴儿性偏瘫伴顽固性癫痫疗效观察

目的探讨大脑半球切除术治疗婴儿性偏瘫伴顽固性癫痫的疗效。方法采用改进的大脑半球切除术治疗婴儿性偏瘫伴顽固性癫痫18例,随访临床疗效并分析原因。结果16例患者癫痫发作停止,2例基本控制,行为异常改善,神经功能障碍无加重。患者健侧大脑脚明显增粗,与患侧及正常人比较差异有统计学意义（t=58．32,P〈0．001;t=14．63,P〈0．001）;患侧大脑脚萎缩,与正常人比较差异有统计学意义（t=51．27,P〈0．001）。结论改进的大脑半球切除术去除了含铁血黄素沉积症发生的原因,是治疗婴儿性偏瘫伴顽固性癫痫的有效方法。     

Methods of constraint-induced movement therapy for children with hemiplegic cerebral palsy: development of a child-friendly intervention for improving upper-extremity function

We delineate the methodology for constraint-induced movement therapy (CIMT) modified for children with hemiplegic cerebral palsy (CP) and describe important considerations that need to be made when testing this intervention in children. The resulting intervention evolved from piloting and testing it with 38 children with hemiplegic CP who were between the ages of 4 and 14 years. Thirty-seven successfully completed the treatment protocol. The intervention retains the 2 major elements of the adult CIMT (repetitive practice, shaping) and was constructed to be as child-friendly as possible. It involves restraining the noninvolved extremity with a sling and having the child engage in unimanual activities with the involved extremity 6 hours a day for 10 days (60 h). Specific activities are selected by considering joint movements with pronounced deficits and improvement of which interventionists believe have greatest potential. The activities are chosen to elicit repetitive practice and shaping. The intervention is conducted in groups of 2 to 3 children to provide social interaction, modeling, and encouragement. Each child is assigned to an interventionist to maintain at least a 1:1 ratio. CIMT can be modified to be child-friendly while maintaining all practice elements of the adult CIMT. The modified therapy is tolerated by most children. Further modifications will likely be required to hone in on the specific components of the intervention that are most effective before applying them to children who are most likely to benefit.