基底节钙化与急性偏瘫综合征的关系

目的 探讨基底节钙化(BGC)与小儿急性偏瘫综合征(AHS)发病的关系。方法 对34例AHS病例有关，临床资料进行回顾性分析、总结。结果 39．4％AHS患儿有BGC，其中79．8％发病前10d内有明确轻微头部外伤史。临床表现为不同程度的一侧急性偏瘫，部分有惊厥发作，但无意识障碍，颅内压增高不明显。CT扫描显示在一侧或双侧基底节区点或片状钙化，其附近存在类圆形点或片状低密度灶。结论 BGC与外伤后AHS的发生有一定关系，故对年龄小于3岁、外伤后近期有偏瘫或惊厥发作患儿，应注意有BGC的可能。     

抗抑郁治疗对卒中后抑郁及神经功能康复的影响

目的探讨氟西汀抗抑郁治疗对卒中后抑郁(PSD)患者的抑郁症状和神经功能康复的影响及其安全性。方法将91例PSD患者随机分为治疗组46例和对照组45例,两组同时应用脑血管病治疗药物,治疗组加用氟西汀治疗。采用汉密尔顿抑郁量表(HAMD)、日常生活自理能力量表(Barthel指数记分)和神经功能缺损程度评定疗效和功能改善状况。结果治疗后治疗组HAMD量表减分率与对照组比较,差异有高度显著性(P<0.01),神经功能缺损程度积分值降低与Barthel评分提高,治疗组优于对照组(P<0.05和P<0.01)。治疗组抑郁症状改善的显效率和神经功能缺损改善的总有效率均显著高于对照组(P<0.001和P<0.05)。氟西汀的主要副反应为失眠、焦虑和恶心。结论氟西汀抗抑郁治疗能明显改善PSD患者的抑郁症状和神经功能,且副反应轻。     

1例偏瘫患者健侧C7神经移位术的护理并文献复习

目的:探讨健侧C₇神经根经食管后椎前路神经桥接移位术修复偏瘫患者上肢运动功能障碍的护理方法。方法:术前注重心理护理干预及常规护理,术后重点做好患侧、健侧肢体康复功能锻炼指导、健康宣教,观察术后效果。结果:患者手术顺利,无并发症发生,患者手部屈肌痉挛情况有一定改善,肌张力较前有所下降。结论:做好健侧C₇神经根经食管后椎前路神经桥接移位患者的护理,是保证患者手术成功的关键,可促进患者早日康复。     

Interfacing a haptic robotic system with complex virtual environments to treat impaired upper extremity motor function in children with cerebral palsy

Objective: To investigate the ability of the New Jersey Institute of Technology Robot Assisted Virtual Rehabilitation (NJIT-RAVR) system training to elicit changes in upper extremity (UE) function in children with hemiplegia secondary to cerebral palsy.

Methods: Nine children (mean age 9 years, three males) participated in three pilots. Subjects trained 1 hour, 3 days a week for 3 weeks. Two groups performed this protocol as their only intervention. The third group also performed 5–6 hours of constraint-induced movement therapy.

Results: All subjects participated in a short programme of nine, 60-minute training sessions without adverse effects. As a group, subjects demonstrated statistically significant improvements in Melbourne Assessment of Unilateral Upper Limb Function Test, a composite of three timed UE tasks and several measurements of reaching kinematics. Several subjects demonstrated clinically significant improvements in active shoulder abduction and flexion as well as forearm supination.

Conclusion: Three small pilots of NJIT-RAVR training demonstrated measurable benefit with no complications, warranting further examination.     

Remind to move – A novel treatment on hemiplegic arm functions in children with unilateral cerebral palsy: A randomized cross-over study

Objective: To investigate the effects of ‘remind to move’ treatment on hemiplegic arm function in children with unilateral cerebral palsy (CP). Methodology: Twelve students with unilateral CP aged 6–18 were recruited from a special school and randomly assigned into two groups. Participants in the experimental group underwent a 3-week sensory cueing treatment followed by a 3-week sham treatment. Participants in the waitlist group completed the sham treatment first followed by the sensory-cueing treatment. There was a 4-week washout period between treatments. Results: Both functional hand use and arm impairment level significantxly improved after the 3-week sensory cueing treatment for the combined sample between groups. However, no significant carryover effects were found for either treatment. Conclusion: Three weeks of ‘remind to move’ treatment is useful in improving hemiplegic arm function and quantity of hand use in children with unilateral CP but the long-term carryover effect requires further investigation.     

How clerks understand the requests of people living with aphasia in service encounters

ABSTRACT

Aphasia often restricts participation. People living with aphasia (PLWA) engage in fewer activities, which leads to fewer interactions than before aphasia. Analyses of interactions with non-familiar people in activities of daily life could provide knowledge about how to integrate these situations in rehabilitation and facilitate ongoing PLWA participation post-rehabilitation. This qualitative study is the first to examine how PLWA make their requests understood in service encounters despite aphasia. Six people living with moderate or severe aphasia were video-recorded in situations of service encounters, e.g., pharmacies, specialised shops, restaurants, and others. We identified fifty-nine occurrences with one or several difficulties in the formulation of the request. They were examined, including the clerks’ responses and ensuing interaction using multimodal conversation analysis. Results showed that PLWA used nonverbal communication within the physical environment and the context of the interaction to support verbal production. In the majority of situations, the clerks understood the request promptly. In other situations, they both collaborated to achieve a clear understanding of the request. Moreover, the findings attest to the competence of people living with moderate or severe aphasia in engaging in service encounters and add to the knowledge base about interaction and social participation in aphasia.     

Outcomes of a Clinic-Based Pediatric Constraint-Induced Movement Therapy Program

ABSTRACT

A single-group pre- and post-test design was used to evaluate functional outcomes of a constraint-induced movement therapy (CIMT) protocol implemented in an outpatient therapy center. The participants were 29 children with hemiplegia, ages 1.6–19.1 years old. The less-involved upper limb was placed in a cast that was worn 24 hr a day, 7 days a week. Individual therapy sessions took place 5 days/week. Children received 3 or 6 hr therapy sessions for 16–19 days followed by 2–5 days in which bimanual tasks were performed. Outcomes were assessed at baseline and following CIMT. Statistically significant gains were made on the Melbourne Assessment of Unilateral Upper Limb Function, Quality of Upper Extremity Skills Test (except the Protective Extension subtest), Assisting Hand Assessment, and the Canadian Occupational Performance Measure. The effect sizes varied from 0.46 to 0.70 indicating a moderate effect size. The results support the effectiveness of CIMT provided through a center-based program.     

Quantitative Ultrasound Imaging to Assess the Biceps Brachii Muscle in Chronic Post-Stroke Spasticity: Preliminary Observation

We prospectively investigated the feasibility of using quantitative ultrasound imaging (QUI) to assess the biceps brachii muscle (BBM) in individuals with chronic post-stroke spasticity. To quantify muscle echogenicity and stiffness, we measured QUI parameters (gray-scale pixel value and shear wave velocity [SWV, m/s]) of the BBM in three groups: 16 healthy BBMs; 12 post-stroke, non-spastic BBMs; and 12 post-stroke, spastic BBMs. The QUI results were compared with the Modified Ashworth Scale and Tardieu Scale. A total of 20 SWVs were measured in each BBM, once at elbow in 90° flexion and again at maximally achievable extension using acoustic radiation force impulse imaging. BBM pixel value was measured in gray-scale images captured at 90° elbow flexion using ImageJ software. Statistical analyses included analysis of variance for examining the difference in SWV and pixel values among the three groups; Bonferroni correction for testing the difference in SWV and pixel values in a paired group; t-test for examining the difference in SWV values measured at two elbow angles; and Pearson correlation coefficient for analyzing the correlation of QUI to Modified Ashworth Scale and Tardieu Scale. SWV significantly differed between spastic BBMs and non-spastic or healthy BBMs. For pixel values, each of the three groups significantly differed from the others at elbow 90° flexion. The difference in SWV measured between the two elbow angles was also significant (p?<0.01). A strong negative correlation was found between SWV and passive range of motion (R²?=??0.88, p?<0.0001) in spastic upper limbs. These results suggest that the use of QUI is feasible in quantitative assessment of spastic BBM.     

运动灸配合反射抑制模式治疗脑卒中后痉挛性瘫痪疗效评价

目的评价运动灸配合反射抑制模式对脑卒中后痉挛性瘫痪患者肌张力的改善作用。方法纳入合格受试者90例,采用随机数字表法,随机分成3组,试验组(A组,30例)采用运动灸配合反射抑制模式治疗;对照组(B组,30例)采用运动灸治疗;对照组(C组,30例)采用反射抑制模式治疗。观察指标为改良Ashworth评分、临床神经功能缺损评分(NDS)及日常生活能力量表(ADL)。结果 3组治疗结束后及随访期间,组间NDS评分、ADL评分比较差异均有统计学意义(P0.05);3组治疗后各关节均有所改善,但是A组肘关节、膝关节改善均优于B组和C组。各组急性期总有效例数最高,其次为恢复期,后遗症期;A组急性期总有效例数远高于B组、C组,恢复期和后遗症期例数差别不大。结论运动灸配合反射抑制模式对改善脑卒中痉挛性瘫痪的神经功能缺损程度、日常生活能力方面均优于单一疗法,而且对急性期患者效果更为明显。     

益气温阳—养阴解痉中药治疗中风偏瘫肢体痉挛随机平行对照研究

[目的]观察益气温阳,养阴解痉中药治疗中风偏瘫肢体痉挛疗效。[方法]使用随机平行对照方法,将30例住院及门诊患者按诊顺序号方法分为两组。对照组15例巴氯芬,5mg/次,1次/d,口服。治疗组15例益气温阳,养阴解痉(黄芪、党参、白芍、石斛、桂枝、桑枝、地龙、甘草等),1剂/d,水煎400m L,早晚温服。两组均连续治疗28d为1疗程。观测临床症状、血液生化指标、《Barthel氏ADL指数法》评分、不良反应。治疗1疗程,判定疗效。[结果]治疗组痉挛疗效显效4例,有效9例,无效2例,总有效率86.70%。对照组显效3例,有效8例,无效4例,总有效率73.33%。治疗组疗效优于对照组(P0.05)。Bathel指数变化治疗组优于对照组(P0.01)[结论]益气温阳,养阴解痉中药治疗中风偏瘫肢体痉挛效果显著,值得推广。