中风偏瘫所致肩关节半脱位的早期康复治疗

目的:探讨早期康复治疗对中风偏瘫所致肩关节半脱位的重要临床意义．方法:１２０例因中风偏瘫导致关节半脱位的患者按病程分为早、中、晚期三组,给予同等剂量,同样疗程的康复治疗;疗程结束后进行康复评估,观察其疗效．结果:早期组肩关节半脱位恢复较理想,治疗后与治疗前相比有显著性差异(Ｐ＜０．０１),中晚期组治疗后也有一定程度的恢复,但和早期组相比具有相当程度差异(Ｐ＜０．０５)．结论:早期康复治疗对预防中风偏瘫所致肩关节半脱位的发生和康复具有决定性意义．     

Optimal outcomes obtained with body-weight support combined with treadmill training in stroke subjects

OBJECTIVES: To identify stroke patients who are most likely to benefit from locomotor training with body-weight support (BWS), to determine the extent of carryover from treadmill training to overground locomotion, and to determine the variables that are most likely to influence the recovery of locomotion. DESIGN: A randomized clinical trial. SETTING: Inpatient rehabilitation hospital. PARTICIPANTS: Of 100 stroke subjects, 50 were randomized to receive locomotor training with BWS (BWS group), and 50 were randomized to receive locomotor training with full weight bearing (no-BWS group). The subjects were stratified according to their initial overground walking speed and endurance, initial treadmill speed and endurance, functional balance, motor recovery, side of the lesion, and age. INTERVENTION: Fifty subjects were trained to walk on a treadmill with up to 40% of their body weight supported by a BWS system with an overhead harness (BWS group), and 50 subjects were trained to walk while bearing their full weight (no-BWS group). MAIN OUTCOME MEASURES: Clinical outcome measures included overground walking speed and endurance, functional balance, and motor recovery. The effect of confounding variables such as age, comorbidity, and depression on locomotor outcome was also investigated. RESULTS: After 6 weeks of locomotor training, the BWS group scored significantly higher in all clinical outcomes. When the subjects were stratified according to their initial overground walking speed, endurance, balance, and motor recovery, a significant statistical difference in gait and balance dysfunction of all outcomes occurred in the more severely impaired subjects. An important transfer from treadmill speed to overground walking speed was observed in subjects in the BWS group. Finally, a significantly greater effect was observed in older subjects (65-85y) in the BWS group. CONCLUSIONS: Retraining gait in severely impaired stroke subjects with a percentage of their body weight supported resulted in better walking and postural abilities than did gait training in patients bearing their full weight. It appears that subjects with greater gait impairments benefited the most from training with BWS, as did the older patients with stroke. There is evidence of transfer from treadmill training to overground locomotion.     

巨刺疗法联合运动想象对卒中患者肢体功能恢复影响

目的：观察巨刺疗法联合运动想象对卒中患者肢体功能恢复的影响。方法将80例卒中后单侧肢体功能障碍患者随机分为2组。治疗组40例,予巨刺疗法联合运动想象治疗;对照组40例,单纯予巨刺疗法治疗。2组均以4周为1个疗程,连续治疗3个疗程后,采用 Fugl －Meyer 运动功能评分（FMA）评定患者运动功能,改良 Barthel 指数（MBI）评定患者日常生活活动能力,改良爱丁堡斯堪的那维亚评分（MESSS）进行神经功能缺损程度评定,并采用 MESSS 评分进行疗效比较。结果治疗组总有效率95．0％,对照组总有效率82．5％,2组总有效率比较差异有统计学意义（P ＜0．05）;2组治疗后 FMA、MBI 及 MESSS 评分与本组治疗前比较差异均有统计学意义（P ＜0．05）,FMA、MBI 评分升高,MESSS 评分降低,且治疗组改善均优于对照组（P ＜0．05）。结论巨刺疗法联合运动想象可以明显促进卒中后肢体功能障碍患者肢体功能恢复,疗效确切,二者联合相辅相成具有协同作用。     

四肢联动训练器在偏瘫患者康复治疗中的应用

目的:观察四肢联动对偏瘫患者功能恢复的疗效。方法:脑出血、脑梗死、颅脑损伤所致偏瘫患者40例,随机分为治疗组和对照组各20例,治疗组采用四肢联动康复加常规康复治疗,对照组为单纯常规康复治疗,采用Fugl-Meyer(FMA)积分法、Barthel指数(MBI)评分法、国际通用的临床神经功能缺损程度评分(CNS)评定患者肌张力、肢体运动功能、日常生活能力、临床神经功能缺损程度。结果:治疗8周后,两组CNS评分较前明显下降(P<0.01),且治疗组低于对照组(P<0.05);两组FMA及MBI评分较前明显提高,且治疗组低于对照组(P<0.05)。结论:常规康复治疗对偏瘫患者的功能恢复起了重要作用,联合四肢联动康复训练器训练对偏瘫患者运动功能的恢复起了推动作用。     

品管圈活动在卒中偏瘫患者肢体功能锻炼中的应用效果分析

目的:研究观察品管圈活动应用于卒中偏瘫患者肢体功能锻炼的实施效果。方法:回顾性分析行肢体功能锻炼的卒中偏瘫患者60例,随机分为品管圈组与常规锻炼组,所有患者均进行肢体功能锻炼治疗,品管圈组按照品管圈原则设计锻炼方案并进行治疗,常规锻炼组按传统的肢体功能锻炼流程进行治疗,比较两组患者肌力指标恢复情况、肢体运动能力等指标之间的差异。结果:品管圈组患者肌力恢复情况、肢体运动能力等指标明显优于常规锻炼组,差异有统计学意义(P<0.05)。结论:品管圈活动应用于卒中偏瘫患者可以有效提高其肢体功能锻炼的治疗效果,加快运动功能的改善和恢复。     

脑卒中术后偏瘫患者康复治疗临床观察

目的：探究与分析康复治疗对脑卒中偏瘫患者术后恢复的重要性。方法：选取2011年5月至2012年5月在我院行手术治疗的神经内科偏瘫患者100例,分成A、B两组,将其作为临床研究对象。 A组患者作为对照组,B组患者作为观察组,每组各50例。对照组只接受常规神经内科药物治疗,观察组在对照组基础上进行综合性康复治疗。观察两组患者术后恢复的情况。结果：观察组患者康复治疗后焦虑抑郁、神经功能缺损评分明显低于对照组;观察组患者并发症的发生率为6．00％,明显低于对照组,P＜0．05,具有统计学意义。结论：康复治疗对神经内科偏瘫患者术后恢复具有很重要的价值,康复效果显著,值得在临床上广泛应用。     

以急性脑病为主要表现的儿童偏瘫型偏头痛五例临床及遗传学分析

目的总结分析以急性脑病为主要表现的偏瘫型偏头痛的临床特征、遗传学特点及诊疗,提高对该病的认识。方法回顾性分析2018年8月至2020年6月在首都医科大学附属北京儿童医院住院治疗的5例以急性脑病为主要表现的偏瘫型偏头痛患儿的临床病例及随访资料。结果 5例患儿中男3例、女2例,年龄9.7(3.9~12.7)岁,发病年龄7.0(2.1~12.7)岁。5例患儿高峰期症状均有嗜睡、昏迷等脑病表现,其他临床表现包括头痛、视觉异常、偏瘫、失语、抽搐和发热等,高峰出现时间在病程第2~6天。发病前2例有轻度头外伤,2例有既往类似病史。5例患儿头颅磁共振成像表现为半侧或部分大脑皮层肿胀及皮层下白质弥散受限,3例合并小脑萎缩。5例患儿均经对症治疗,其中2例使用小剂量糖皮质激素,均恢复到基线水平,1例头颅磁共振成像示遗留病灶区萎缩改变。5例患儿全外显子组基因测序提示均为CACNA1A基因变异,1例为新生变异,1例遗传自无先兆偏头痛的母亲。诊断明确后5例患儿均长期口服氟桂利嗪,通过电话及门诊随访22(7~29)个月,至末次随访5例患儿均未再发肢体无力或脑病表现。1例仍有间断头痛,偶有一过性右侧肢体麻木。结论偏瘫型偏头痛重度发作除表现为头痛、偏瘫、失语、视觉异常等,常伴随意识障碍。多数短期内完全恢复,极少数恢复缓慢,遗留脑萎缩、认知障碍甚至死亡。以CACNA1A基因变异为最常见。氟桂利嗪可预防复发。     

轻度偏瘫患者的髋部骨密度探讨

目的 临床所见大量的偏瘫患者发生瘫侧髋部骨折,笔者通过髋部骨密度测定,研究骨折与髋部骨量之间的关系,探讨瘫侧骨折发生率高的原因。方法 我们选择脑卒中患者60例,男性35例,48-78岁,平均年龄67岁,女性25例,48-70岁,平均年龄61岁。病史0.5-17年,平均6年。按其步行能力进行运动分级。另取正常对照60例,男性30例,女性30例,平均年龄64岁。分别用DEXA测定其双侧髋部骨密度值。结果 轻瘫患者中,不论患者有无跛行,其瘫侧髋部骨密度较健侧相比无显著性差异(P>0.05),与同年龄对照组相比亦无显著性差异(P>0.05)。结论 偏瘫患者瘫侧骨折发生率高与瘫侧髋部骨量无关。可能与患者瘫侧运动功能障碍,重心倾向瘫侧,瘫侧肌力减弱,易向瘫侧跌倒有关。     

低血糖性偏瘫（附三例报告）

低血糖偶尔仅仅表现为轻偏瘫．临床上常常认识不足；本文报告三例这种病人．其中二例为糖尿病及高血压病．山于其他疾病而未能正常进食，但仍继续口服降糖药物。另一例为非糖尿病病人，困误服降糖药而致病。低血糖偏瘫易误诊为急性脑血管病。本文三例病人均初诊为脑梗塞或TIA，认识到低血糖是偏瘫的病因之一十分重要．迅速纠正低血糖可以改善这种病人的预后。     

‘Disposal’ of Post Acute Cerebral Vascular Accident Patients: Discussion of a Statistical Comparative Study

The methods of decision making of the disposal of the post acute cerebral vascular accident patients are investigated as well as the ultimate destination or placement of these patients. Four large general hospitals were selected for inclusion in the survey and all medical records on cerebral vascular accident patients admitted during 1977 were studied. The data were analysed and questions posed to highlight areas of concern to personnel currently employed in treatment programmes directed at this patient group.