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排序方式： 共有114条查询结果，搜索用时 15 毫秒
1.
目的:探讨磁共振弥散张量成像(DTI)在脑卒中早期患者下肢康复疗效中应用价值。方法:收集广东省江门市中心医院神经内科2012年8月至2013年9月符合入选标准的患者17例,入院后均给以相同药物治疗和综合康复治疗。分别于康复治疗前和康复治疗3周后完成DTI检查,测量最大病灶侧及对侧相应部位的部分各向异性值(FA),计算FA比值(r FA)、FA不对称性(FAasy)及健患侧FA差值。同时完成Fugl-Meyer下肢运动功能评估(FMA)。观察治疗前后患侧FA、健侧FA、r FA、FAasy及健患侧FA差值的变化值与FMA变化值的相关性。结果:康复治疗3周后,患侧FA、r FA、FAasy、健患侧FA差值及FMA评分与治疗前比较,差异均有显著性意义(P0.05);健侧FA值与治疗前比较,差异无显著性意义(P0.05)。康复治疗前后患侧FA和r FA的变化值与FMA变化值呈线性正相关(r=0.579,P=0.015;r=0.560,P=0.020);FAasy和健患侧FA差值的变化值与FMA变化值呈线性负相关(r=-0.530,P=0.029;r=-0.557,P=0.020);健侧FA变化值与FMA变化值不相关(r=-0.300,P=0.242)。结论:DTI中各参数的改变与下肢运动损伤程度存在关联性,可用于评估脑卒中后皮质脊髓束的损伤程度和运动功能障碍。  相似文献   
2.
目的 探讨预警护理在神经外科重症患者治疗中的临床效果.方法 选取我院2012年4月至2013年10月收治的神经外科重症患者100例为研究对象.将患者随机分为观察组和对照组,各50例.观察组予以预警护理模式,对照组则予以常规护理模式.观察比较两组患者的Barthel指数评分和Fugl-Meyer评分、护理满意度以及术后出血、尿崩症、压疮等并发症发生率等.结果 观察组Barthel指数评分与Fugl-Meyer评分明显高于对照组,差异具有统计学意义(P＜0.05).观察组护理满意率为88.0％,对照组为70.0％,差异有统计学意义(x 2=4.882,P＜0.05).住院期间,对照组术后出血及压疮发生率显著高于观察组(P＜0.05).两组尿崩症发生率差异无统计学意义(P＞0.05).结论 相比于常规护理,预警护理能有效提高患者身体恢复程度,降低疾病风险,增加护理满意度,具有良好的应用前景和临床价值,值得临床推广.  相似文献   
3.

Objective

To compare the efficacy of neuromuscular electrical stimulation (NMES) and transcutaneous nerve stimulation (TENS) on hemiplegic shoulder pain (HSP).

Design

This is a prospective randomized controlled trial.

Setting

A rehabilitation hospital.

Participants

Participants (N=90) were randomized into NMES (n=36), TENS (n=36), or control groups (n=18).

Interventions

NMES (15Hz, pulse width 200μs) was applied to supraspinatus and deltoids (medial and posterior parts), whereas TENS (100Hz, pulse width 100μs) was used on the same areas. The surface electrodes were placed near the motor points of the supraspinatus and medial or posterior bundle of deltoids. The 4-week treatment consisted of 20 sessions, each session composed of 1 hour of stimulation per day. Routine rehabilitation program without any stimulation was administered to the control and the NMES/TENS groups. Numerical rating scale (NRS), active/passive range of motion (AROM/PROM) of shoulder, upper extremity Fugl-Meyer Assessment (FMA), modified Ashworth scale (MAS), Barthel Index (BI), and stroke-specific quality of life scale (SSQOLS) were assessed in a blinded manner at baseline, 2, 4, and 8 weeks after treatment, respectively.

Main Outcome Measures

The primary endpoint was the improvement from baseline in NRS for HSP at 4 weeks.

Results

NRS scores in NMES, TENS, and control groups had decreased by 2.03, 1.44, and 0.61 points, respectively after 4 weeks of treatment, with statistically significant differences among the 3 groups (P<.001). The efficacy of the NMES group was significantly better than that of the TENS group (P=.043). Moreover, the efficacy of NMES and TENS groups was superior to that of the control group (P<.001, P=.044, respectively). The differences in the therapeutic efficacy on shoulder AROM/PROM, FMA, MAS, BI, and SSQOLS scores were not significant among the 3 groups.

Conclusions

TENS and NMES can effectively improve HSP, the efficacy of NMES being distinctly superior to that of TENS in maintaining long-term analgesia. However, NMES was not more efficacious than the TENS or control group in improving the shoulder joint mobility, upper limb function, spasticity, the ability of daily life activity, and stroke-specific quality of life in HSP patients.  相似文献   
4.

Objective

To compare sitting posture and movement strategies between chronic hemiparetic and healthy subjects while performing a drinking task, using statistical parametric mapping (SPM) and feature analysis.

Design

Cross-sectional study.

Setting

A university physical therapy department.

Participants

Participants (N=26) consisted of chronic hemiparetic (n=13) and healthy individuals (n=13) matched for sex and age.

Interventions

Not applicable.

Main Outcome Measures

The drinking task was divided into phases: reaching, transporting the glass to mouth, transporting the glass to table, and returning to initial position. An SPM 2-sample t test was used to compare the entire kinematic waveforms of different joint angles (trunk, scapulothoracic, humerothoracic, elbow). Joint angles at the beginning and end of the motion, movement time, peak velocity timing, trajectory deviation, normalized integrated jerk, and range of motion were extracted from the motion data. Group differences for these parameters were analyzed using independent t tests.

Results

At the static posture and beginning of the reaching phase, patients showed a shoulder position more deviated from the midline and externally rotated with increased scapula protraction, medial rotation, anterior tilting, trunk anterior flexion and inclination to the paretic side. Altered spatiotemporal variables throughout the task were found in all phases, except for the returning phase. Patients returned to a similar posture as the task onset, except for the scapula, which was normalized after the reaching phase.

Conclusions

Chronic hemiparetic subjects showed more deviations in the proximal joints during seated posture and reaching. However, the scapular movement drew nearer to the healthy individuals' patterns after the first phase, showing an interesting point to consider in rehabilitation programs.  相似文献   
5.

Objective

To critically evaluate the rehabilitative effects of mindful exercises for poststroke patients.

Data Sources

Six databases (PubMed, Physiotherapy Evidence Database, Cochrane Library, Web of Science, Wanfang, Chinese National Knowledge Infrastructure) and reference lists of relevant articles were searched.

Study Selection

Randomized controlled trials on the effects of mindful exercises on rehabilitative outcomes such as sensorimotor function, gait speed, leg strength, aerobic endurance, cognitive function, and overall motor function.

Data Extraction

Two investigators independently screened eligible studies according to the eligible criteria, extracted data, and assessed risk of bias.

Data Synthesis

A total of 20 studies that satisfied the eligibility criteria were finally included. The sum scores of 5-9 points in the adapted Physiotherapy Evidence Database scale indicates low-to-medium risk of bias. The study results of meta-analysis indicate that mindful exercise intervention was significantly associated with improved sensorimotor function on both lower limb (standardized mean difference=0.79; 95% confidence interval, 0.43-1.15; P<.001; I2=62.67%) and upper limb (standardized mean difference=0.7; 95% confidence interval, 0.39-1.01; P<.001; I2=32.36%).

Conclusions

This review suggests that mindful exercises are effective in improving sensorimotor function of lower and upper limbs in poststroke patients. The effects on gait speed, leg strength, aerobic endurance, overall motor function, and other outcomes (eg, cognitive function, gait parameters) require further investigation for allowing evidence-based conclusions.  相似文献   
6.

Objective

To compare virtual reality (VR) combined with functional electrical stimulation (FES) with cyclic FES for improving upper extremity function and health-related quality of life in patients with chronic stroke.

Design

A pilot, randomized, single-blind, controlled trial.

Setting

Stroke rehabilitation inpatient unit.

Participants

Participants (N=48) with hemiplegia secondary to a unilateral stroke for >3 months and with a hemiplegic wrist extensor Medical Research Council scale score ranging from 1 to 3.

Interventions

FES was applied to the wrist extensors and finger extensors. A VR-based wearable rehabilitation device was used combined with FES and virtual activity–based training for the intervention group. The control group received cyclic FES only. Both groups completed 20 sessions over a 4-week period.

Main Outcome Measures

Primary outcome measures were changes in Fugl-Meyer Assessment–Upper Extremity and Wolf Motor Function Test scores. Secondary outcome measures were changes in Box and Block Test, Jebsen-Taylor Hand Function Test, and Stroke Impact Scale scores. Assessments were performed at baseline (t0) and at 2 weeks (t1), 4 weeks (t4), and 8 weeks (t8). Between-group comparisons were evaluated using a repeated-measures analysis of variance.

Results

Forty-one participants were included in the analysis. Compared with FES alone, VR-FES produced a substantial increase in Fugl-Meyer Assessment–distal score (P=.011) and marginal improvement in Jebsen-Taylor Hand Function Test–gross score (P=.057). VR-FES produced greater, although nonsignificant, improvements in all other outcome measures, except in the Stroke Impact Scale–activities of daily living/instrumental activities of daily living score.

Conclusions

FES with VR-based rehabilitation may be more effective than cyclic FES in improving distal upper extremity gross motor performance poststroke.  相似文献   
7.
目的观察穴位埋线治疗卒中后肩关节半脱位临床疗效及对血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)因子水平的影响,探讨抑制炎症反应的相关机制。方法将92例卒中后肩关节半脱位患者按1:1:1随机分3组,共剔除2例,最终每组30例。埋康组采用康复训练加穴位埋线;针康组采用康复训练加针刺治疗;康复组采用单纯康复治疗。分别于治疗前后采用Fugl-Meyer(FMA)上肢运动能力、视觉模拟评分(VAS)及血清TNF-α、IL-6炎性因子水平进行评价。结果治疗后3组患者Fugl-Meyer及VAS评分比较差异有统计学意义(P<0.05);血清TNF-α、IL-6炎性因子水平降低(P<0.05);3组中埋康组疗效最优;且3组治疗前后组内比较差异均有统计学意义(P<0.05)。结论穴位埋线能改善卒中肩关节半脱位患者上肢肩痛及运动功能,降低机体炎症性应激反应。  相似文献   
8.

Objective

To investigate the effects of various rehabilitative interventions aimed at enhancing poststroke motor recovery by assessing their effectiveness when compared with no treatment or placebo and their superiority when compared with conventional training program (CTP).

Data Source

A literature search was based on 19 Cochrane reviews and 26 other reviews. We also updated the searches in PubMed up to September 30, 2017.

Study Selection

Randomized controlled trials associated with 18 experimented training programs (ETP) were included if they evaluated the effects of the programs on either upper extremity (UE) or lower extremity (LE) motor recovery among adults within 6 months poststroke; included ≥10 participants in each arm; and had an intervention duration of ≥10 consecutive weekdays.

Data Extraction

Four reviewers evaluated the eligibility and quality of literature. Methodological quality was assessed using the PEDro scale.

Data Synthesis

Among the 178 included studies, 129 including 7450 participants were analyzed in this meta-analysis. Six ETPs were significantly effective in enhancing UE motor recovery, with the standard mean differences (SMDs) and 95% confidence intervals outlined as follow: constraint-induced movement therapy (0.82, 0.45-1.19), electrostimulation (ES)-motor (0.42, 0.22-0.63), mirror therapy (0.71, 0.22-1.20), mixed approach (0.21, 0.01-0.41), robot-assisted training (0.51, 0.22-0.80), and task-oriented training (0.57, 0.16-0.99). Six ETPs were significantly effective in enhancing LE motor recovery: body-weight-supported treadmill training (0.27, 0.01-0.52), caregiver-mediated training (0.64, 0.20-1.08), ES-motor (0.55, 0.27-0.83), mixed approach (0.35, 0.15-0.54), mirror therapy (0.56, 0.13-1.00), and virtual reality (0.60, 0.15-1.05). However, compared with CTPs, almost none of the ETPs exhibited significant SMDs for superiority.

Conclusions

Certain experimented interventions were effective in enhancing poststroke motor recovery, but little evidence supported the superiority of experimented interventions over conventional rehabilitation.  相似文献   
9.
早期康复治疗对脑梗死偏瘫患者脑血流的影响   总被引：4，自引：1，他引：4  
目的:探讨早期康复治疗对脑梗死偏瘫患者脑血流的影响,评价早期康复治疗的效果及指标.方法:脑梗死偏瘫患者87例,按人院顺序分为观察组48例和常规组39例,并选择46例同期体检的健康人(健康组)作为健康对照,观察组和常规组均在神经内科按脑梗死常规处理,以药物治疗为主.观察组在此基础上配合Bobath疗法.治疗前后和健康组均应用TCD检测双侧大脑中动脉(MCA)的平均血流速度(Vm),同时应用Fugl-Meyer法(FMA)评价瘫痪肢体的功能.结果:治疗30 d后FMA评分与治疗前比较,观察组和常规组均有显著提高(P＜0.01).治疗前观察组和常规组MCA健患侧Vm均低于健康组(P＜0.01或0.05);治疗后观察组有明显提高,与健康组比较差异无显著性意义;常规组患侧较治疗前明显提高.但仍低于观察组和健康组(P＜0.05).结论:早期康复治疗可以增加脑梗死偏瘫患者的脑血流量,促进功能恢复,TCD可以作为评价其早期疗效的指标,优于FMA评分.  相似文献   
10.
目的：研究机器人辅助训练严重脑损伤患者．Fugl—Meyer上肢运动功能评分（FMA）与上肢运动功能状态评分（MSS）的响应性。方法：训练前4周，训练开始前1天和训练结束后l天分别进行评价。采用Bland—Alttman方法来计算量表的一致性限度。响应性由治疗后超过一致性限度上限的患者比例和响应率来说明。结果：经治疗后超过一致性限度上限的患者在FMA为17例（77．3％）．MSS为18例（81．8％）。FMA的响应率为8．2，MSS的响应率为5．2。结论：FMA和MSS用于评价严重脑损伤患者上肢机器人辅助训练效果均有很高的响应性。  相似文献   
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