偏瘫肢体功能锻炼对脑卒中后患者康复评定分析

目的：探讨早期功能锻练对脑卒中后偏瘫患者肢体功能恢复的疗效。方法：选取2006年1月至2008年1月间在我院住院的脑卒中偏瘫患者84例,随机分为康复组和对照组,康复组给予早期肢体功能锻炼,对照组给予常规的医护措施。结果：两组治疗后神经功能缺损程度评分均优于入院时,两者比较差异均具有统计学意义（P〈0．05）;康复组入院2周、4周及出院时神经功能缺损程度评分均优于对照组,两者比较差异具有统计学意义（P〈0．05）;治疗后康复组患者Brunnstrom分级上下肢I级例数明显少于对照组,两者比较差异具有统计学意义（P〈0．05）。结论：早期肢体功能锻炼能明显地改善脑卒中偏瘫患者的肢体功能,并能提高日常生活能力,值得应用。     

神经发育疗法配合改进的运动再学习疗法对脑卒中后偏瘫患者功能恢复的影响

目的探讨神经发育疗法（NDT）配合改进的运动再学习疗法（MRP）对脑卒中后偏瘫患者功能恢复的影响。方法选择本院神经内科和康复医学科住院的脑卒中后偏瘫患者132例,随机分为观察组与对照组各66例,对照组采用NDT进行治疗;观察组在应用DNT治疗基础上加用MRP治疗。2组均于治疗前1周及治疗2个月后采用脑卒中病损评估量表（SIAS）和巴塞尔指数（BI）进行评定。结果2组患者治疗后的SIAS、BI评分均较治疗前有所提高,差异有统计学意义（P〈0.05）;观察组较对照组提高更为明显,2组差异有统计学意义（P〈0.05）。结论DNT配合改进的MRP能更有效地促进脑卒中后偏瘫患者的功能恢复。     

早期康复治疗在急性脑梗塞患者中的应用研究

目的:探讨早期康复治疗急性脑梗塞的疗效和可行性,以及对血清中脑源性神经营养因子水平的影响.方法:70例急性脑梗塞患者随机分为康复组和对照组各35例,于治疗前和治疗后1个月、3个月,对两组患者进行运动功能评定,采用简式Fugl-Meyer运动功能评分法;日常生活活动能力评定,采用Barthel指数;观察记录肩手综合征发生...     

神经功能重建康复仪治疗对脑卒中后偏瘫肢体运动功能的影响

①目的探讨神经功能重建康复仪治疗对脑卒中后运动功能障碍的影响。②方法将60例脑卒中后偏瘫患者随机分为观察组和对照组,每组各30例。观察组采用神经功能重建康复仪治疗结合康复运动训练,对照组仅单纯使用康复运动训练。两组患者常规神经内科治疗及护理。治疗前后均采用Lovett徒手肌力测定和改良巴氏指数（BI）评定日常生活能力。③结果治疗1个月和3个月后观察组偏瘫肢体肌力和BI指数明显改善,与对照组比较差别有显著性意义。④结论神经功能重建康复仪治疗对脑卒中后偏瘫肢体的康复效果优于单纯康复训练。     

Modular structure of awareness for sensorimotor disorders: evidence from anosognosia for hemiplegia and anosognosia for hemianaesthesia

In the present paper, we shall review clinical evidence and theoretical models related to anosognosia for sensorimotor impairments that may help in understanding the normal processing underlying conscious self-awareness. The dissociations between anosognosia for hemiplegia and anosognosia for hemianaesthesia are considered to give important clinical evidence supporting the hypothesis that awareness of sensory and motor deficits depends on the functioning of discrete self-monitoring processes. We shall also present clinical and anatomical data on four single case reports of patients selectively affected by anosognosia for hemianaesthesia. The differences in the anatomical localization of lesions causing anosognosia for hemiplegia and anosognosia for hemianaesthesia are taken as evidence that cerebral circuits subserving these monitoring processes are located in separate brain areas, which may be involved both in the execution of primary functions and the emergence of awareness related to the monitoring of the same functions. The implications of these findings for the structure of conscious processes shall be also discussed.     

基于Orem自理理论康复护理联合情志干预对脑梗死偏瘫患者神经功能、自护能力及生活质量的影响

目的:探究基于Orem自理理论康复护理联合情志干预对脑梗死偏瘫患者神经功能、自护能力及生活质量的影响。方法:选取2018年6月至2019年2月在雅安市中医医院进行脑梗死治疗的100例患者,根据患者入院时间将其分为常规组及研究组,对常规组患者行常规护理,对研究组患者行基于Orem自理理论康复护理联合情志干预,比较两组患者干预前后神经功能、自护能力及生活质量。结果:干预前,两组患者NIHSS评分、Barthel指数评分及SF36量表评分比较差异均无统计学意义(均P>0.05),干预后,研究组患者NIHSS评分及Barthel指数评分分别为(3.08±1.12)分及(79.28±6.41)分,均显著优于常规组及干预前,差异有统计学意义(均P<0.05),且研究组患者各项活质量评分均显著优于常规组及干预前(P<0.05)。结论:对脑梗死偏瘫患者实施脑梗死偏瘫患者,能够有效改善其神经功能,且对提高患者自护能力及生活质量具有重要意义。     

偏瘫患者肩痛的多因素分析

本文对71例偏瘫患者发生肩痛送行了回顾性分析，旨在了解中风肩痛的发生率以及肩痛的相关因素，结果显示偏瘫患者中肩痛的发生率达49．3％，多元回归分析表明：肌腱粘连、肌张力异常、肩手综合征与肩痛显著相关（P值分别为0．001，0．001，0．004），为了减轻肩痛的发生率，中风后努力改善异常肌张力，预防肌胜粘连等措施是至关重要的。     

人工股骨头置换术治疗偏瘫侧股骨颈骨折分析

目的探讨采用骨水泥型人工股骨头置换术治疗偏瘫下肢股骨颈骨折的利弊。方法对接受人工股骨头置换的14例偏瘫下肢股骨颈骨折病例进行回顾性分析。结果全部病例均得到随访,时间最短18个月,最长10年,术后发生非中心性关节脱位5例,其中2例反复脱位;下肢深静脉血栓(DVT)5例;假肢松动3例;伤前能行走的13例病人术后有8例伤肢功能较伤前差。结论①偏瘫下肢伤前肌力越好,术后效果越佳,反之越差;②偏瘫侧股骨颈骨折采用人工股骨头置换术治疗,优点明显,但并发症多见,风险高。     

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.