运动想象疗法联合PNF躯干模式训练对脑卒中偏瘫患者上肢功能、步行功能和躯干控制能力的影响

摘要 目的：探讨运动想象疗法（MI）联合神经肌肉本体感觉促进术(PNF)躯干模式训练对脑卒中偏瘫患者上肢功能、步行功能和躯干控制能力的影响。方法：选取2015年1月-2019年6月期间中国人民解放军第九八三医院及中国中医科学院望京医院康复治疗中心收治的112例脑卒中偏瘫患者。根据按入院顺序编号的奇、偶数分为对照组（n=56）和研究组（n=56）,对照组给予常规康复训练联合MI训练,研究组在对照组基础上联合PNF躯干模式训练,两组均干预8周。对比两组干预前、干预4周后、干预8周后的Carroll手功能评定(UEFT)、Fugl-Meyer运动功能评定(FMA)、改良的Barthel指数（mBI）、功能性步行分级(FAC)、Tinetti步态评估量表(TGA)、躯干控制能力测试(TCT)、Berg平衡功能量表(BBS)、坐-站-坐时间以及躯干前倾距离。结果：两组干预4周后、干预8周后UEFT、FMA、mBI评分逐渐升高,且研究组高于对照组（P<0.05）。两组干预4周后、干预8周后FAC、TGA评分逐渐升高,且研究组高于对照组（P<0.05）。两组干预4周后、干预8周后TCT、BBS评分逐渐升高,且研究组高于对照组（P<0.05）。两组干预4周后、干预8周后坐-站-坐时间逐渐降低,且研究组低于对照组（P<0.05）,躯干前倾距离逐渐升高,且研究组高于对照组（P<0.05）。结论：MI联合PNF躯干模式训练治疗脑卒中偏瘫患者,可有效改善患者步行功能、上肢功能和躯干控制能力。     

三维旋进式振动疗法联合运动想象训练对脑卒中偏瘫患者上肢功能、平衡能力及日常生活活动能力的影响

摘要 目的：研究运动想象训练联合三维旋进式振动疗法对脑卒中偏瘫患者平衡能力、上肢功能及日常生活活动能力的影响。方法：研究对象来源于苏州市立医院康复医学科2019年4月~2022年4月期间收治的80例脑卒中偏瘫患者。入院后按照计算机产生随机数进行随机分配为对照组和研究组,每组各40例。对照组患者接受运动想象训练,研究组患者接受三维旋进式振动疗法联合运动想象训练。对比两组疗效、上肢功能、平衡能力及日常生活活动能力。结果：两组患者干预2周后、干预4周后Fugl-Meyer上肢运动功能量表（FM-uL）、上肢动作研究量表（ARAT）评分均升高,且研究组均高于对照组同期;改良Ashworth痉挛量表（MAS）评分均下降,且研究组低于对照组同期（P<0.05）。两组患者干预2周后、干预4周后Berg平衡量表（BBS）评分均升高,且研究组高于对照组同期（P<0.05）。两组患者干预2周后、干预4周后Barthel指数（BI）评分均升高,且研究组高于对照组同期（P<0.05）。结论：运动想象训练联合三维旋进式振动疗法干预脑卒中偏瘫患者,可有效改善患者的平衡能力、上肢功能及日常生活活动能力。     

肌电生物反馈对急性期脑卒中偏瘫患者上肢功能的影响

目的:评价肌电生物反馈联合常规康复训练对急性期脑卒中偏瘫患者上肢功能的影响,为脑卒中后急性期上肢运动功能障碍的康复治疗探寻更有效的方法.方法:将35例生命体征平稳、无意识障碍的急性期脑卒中偏瘫患者分为观察组18例和对照组17例.两组患者均给予神经内科药物治疗和常规康复训练,观察组患者偏瘫侧上肢加以肌电生物反馈治疗.两组均于治疗前和治疗2个月后对偏瘫侧上肢进行Bmnnstrom运动功能分级、简式Fugl-Meyer(FMA)上肢运动功能评定和腕背伸时肌肉最大收缩时肌电(EMG)幅值的测定.结果:经2个月治疗后,两组患者偏瘫侧上肢的Bnnnstrom分级、FMA及EMG幅值较治疗前均有提高(P＜0.05),且观察组各项评分均优于对照组(P＜0.05).结论:本文中观察组和对照组的患者经康复治疗后,偏瘫侧上肢的运动功能均较治疗前提高.但在脑卒中患者的急性期应用肌电生物反馈治疗联合常规康复训练,较单独使用常规运动疗法和作业疗法治疗,能更好地改善急性期脑卒中偏瘫患者上肢的功能,更显著地促进偏瘫上肢的运动功能恢复及分离运动的产生,同时对促进腕关节背伸肌力的恢复方面提供了电生理学依据.总之,在常规康复训练的基础上加用肌电生物反馈治疗,可更显著地促进急性期脑卒中偏瘫患者的上肢功能,为脑卒中急性期肢体运动障碍的康复治疗提供了更有效的方法.     

MOTOmed下肢智能运动训练联合运动想象疗法对脑卒中偏瘫患者下肢功能、步行能力和躯干屈伸肌群肌力的影响

摘要 目的：探讨MOTOmed下肢智能运动训练联合运动想象疗法对脑卒中偏瘫患者下肢功能、步行能力和躯干屈伸肌群肌力的影响。方法：148例脑卒中偏瘫患者来源于我院2019年5月~2021年5月期间我院接收的患者,根据随机数字表法分为对照组（n=74,常规康复训练的基础上结合MOTOmed下肢智能运动训练）和研究组（n=74,对照组的基础上结合运动想象疗法）。两组均干预12周。对比两组下肢功能、步行能力和躯干屈伸肌群肌力变化。结果：两组干预12周后Fugl-Meyer运动功能量表（FMA）、Barthel指数（BI）、功能性步行能力分级量表（FAC）评分升高,且研究组高于对照组（P<0.05）。两组干预12周后步频、步速、跨步长比率升高,且研究组高于对照组（P<0.05）。两组干预12周后健侧腹直肌、竖脊肌表面肌电信号的均方根值未见明显变化,且组间同时点对比无差异（P>0.05）。两组干预12周后患侧腹直肌、竖脊肌表面肌电信号的均方根值升高,且研究组高于对照组（P<0.05）。结论：脑卒中偏瘫患者在MOTOmed下肢智能运动训练的基础上进行运动想象疗法,可促进下肢功能改善,提高步行能力,同时还可改善患侧躯干屈伸肌群肌力。     

针灸结合康复训练对脑卒中患者恢复阶段的临床分析

目的:探讨针灸结合康复训练对脑卒中患者恢复阶段的疗效。方法:选取了240例脑卒中患者,按随机数字表法分为两组,对照组(108例)给予针灸疗法观察组(132例)给予针灸结合康复训练疗法。通过观察并记录治疗后3个月的疗效治疗前治疗后3个月的NIHSS评分、Fugl-Meyer评分、SF-36量表评分,评价针灸结合康复训练对脑卒中患者恢复阶段的疗效。结果:经治疗,观察组患者有效率93.9%,对照组患者有效率81.5%观察组有效率明显高于对照组(P0.05),治疗前,两组NIHSS和Fugl-Meyer评分无统计学差异(P0.05)治疗后3个月,两组NIHSS评分均明显下降且观察组下降较多,Fugl-Meyer评分明显升高且观察组升高较多(P0.05),治疗前,两组SF-36各项评分无统计学差异,治疗后3个月,两组SF-36评分均明显增加(P0.05)。观察组在活力、情感职能和精神健康3项评分明显高于对照组(P0.05),其余5项评分相比无统计学差异(P0.05)。结论:采用针灸结合康复训练对脑卒中患者的恢复具有促进作用有效改善患者神经功能缺损和运动功能情况,提高患者生活质量。     

强制性运动疗法在脑卒中偏瘫康复治疗中的应用效果研究

目的:研究强制性运动疗法(CIMT)在脑卒中偏瘫康复治疗中的应用效果。方法:将100例脑卒中偏瘫患者随机分为两组,对照组50例予常规运动疗法,实验组50例予CIMT。治疗后,比较两组患者的临床总有效率、步行速度评分、日常生活活动能力评分、运动功能评分及患者满意度。结果:治疗后,试验组的总有效率显著高于对照组(90%vs.68%),步行速度评分[(61.25±7.94)vs.46.12±8.56]、日常生活活动能力评分[(58.76±8.92)vs.47.95 9.16]、运动功能评分[(85.14±4.68)vs.52.39 9.64]、患者满意度(94%vs.78%)较对照组均明显升高(94%vs.78%),差异具有统计学意义(P0.05)。结论:强制性运动疗法用于脑卒中偏瘫患者康复治疗的临床效果明显提升,可有效改善患者的运动功能。     

上肢康复机器人联合等速肌力训练对脑卒中恢复期偏瘫患者的康复效果研究

摘要 目的：探讨等速肌力训练联合上肢康复机器人在脑卒中恢复期偏瘫患者中的应用效果。方法：根据随机数字表法,将2020年1月-2022年12月期间合肥市第二人民医院收治的136例脑卒中恢复期偏瘫患者分为对照组（n=68,等速肌力训练）与观察组（n=68,等速肌力训练联合上肢康复机器人干预）。两组均干预3周,观察两组Fugl-Meyer上肢运动功能量表（FMA-UL）评分、改良Barthel指数（MBI）评分、偏瘫Brunnstrom分级、表面肌电图相关指标和生活质量评分变化情况。结果：观察组干预3周后FMA-UL、MBI评分高于对照组（P<0.05）。观察组干预3周后IV级患者例数多于对照组（P<0.05）。观察组干预3周后肱二头肌、肱三头肌、三角肌前束、三角肌中束的均方根值（RMS）和积分肌电值（iEMG）高于对照组（P<0.05）。观察组干预3周后生理职能、躯体疼痛、生理功能、总体健康、精神健康、活力、情感职能、社会功能各维度评分高于对照组（P<0.05）。结论：脑卒中恢复期偏瘫患者经等速肌力训练、上肢康复机器人联合干预,可促进偏瘫上肢肌肉激活和运动单位募集同步化,改善上肢肌力,提高患者的生活质量。     

智能化人机交互和场景模拟对脑卒中患者上肢运动功能的影响

摘要 目的：研究智能化人机交互和场景模拟对脑卒中患者上肢运动功能的影响,探索其在康复训练中的作用,为脑卒中患者康复提供新的治疗方法和方向。方法：选取2019年1月-2022年12月在我院接收治疗的80例脑卒中患者,按随机数字表法分为对照组和实验,每组40人,对照组接受常规康复治疗,实验组在常规康复治疗基础上增加智能化人机交互和场景模拟训练。比较两组Fugl-Meyer上肢运动功能量表评分（UE-FMA）、患者的生活自理能力Barthel指数、上肢功能测试（UEFT）,患侧上肢腕背伸肌的改良Ashworh评分（MAS）以及徒手肌力评估（MMT）。比较两组患者满意度评分。结果：治疗后,两组患者UE-FMA评分与治疗前相比均提高,且实验组显著高于对照组（P<0.05）;治疗后,两组患者MBI评分与治疗前相比均提高,且实验组显著高于对照组（P<0.05）;治疗后,两组患者UEFT评分与治疗前相比均提高,且实验组显著高于对照组（P<0.05）;治疗后,两组患者MMT评分与治疗前相比均提高,且实验组显著高于对照组（P<0.05）治疗后,两组患者MAS评分与治疗前相比均降低,且实验组显著低于对照组（P<0.05）;与对照组相比,实验组满意度95%,高于对照组80%（P<0.05）。结论：智能化人机交互和场景模拟训练对脑卒中患者的上肢运动功能有积极的影响,可以有效改善患者的康复效果。     

低频电刺激联合康复训练治疗脑卒中偏瘫患者效果及运动功能、自我效能的影响

摘要 目的：分析低频电刺激联合康复训练治疗脑卒中偏瘫患者效果及运动功能、自我效能的影响。方法：选择我院自2019年5月至2022年1月收治的156例脑卒中偏瘫患者作为研究对象,随机分为对照组和观察组,每组各78例。对照组予以常规对症支持治疗,加用康复训练;观察组在对照组的基础上,加用低频电刺激治疗,持续治疗8周后评估疗效。根据患者的下肢Brunnstrom分级改善幅度,评价治疗效果;比较两组治疗前后的下肢Fugl-Meyer运动功能量表（FMA）、Berg平衡量表（BBS）、改良Barthel指数（MBI）和一般自我效能感量表（GSES）评分。结果：观察组治疗总有效率为96.15 %,高于对照组的84.62 %（P＜0.05）;对比对照组,观察组治疗后下肢FMA评分、BBS评分均更高（P＜0.05）;对比对照组,观察组治疗后MBI评分、GSES评分均更高（P＜0.05）。结论：低频电刺激联合康复训练治疗脑卒中偏瘫患者的效果明显,能够有效改善运动功能和生活质量,提高自我效能,值得进一步研究应用。     

针灸联合十八段锦治疗对中风偏瘫患者运动功能影响

目的:研究针灸联合十八段锦治疗对中风偏瘫患者运动功能的影响.方法:选择2017年1月～2019年12月我院中医科针灸门诊针灸治疗的201例中风偏瘫患者,随机分为两组.对照组采用常规治疗,观察组采用针灸联合十八段锦治疗.治疗前后,比较两组的血清基质金属蛋白酶-9 (Matrix metalloproteinases-9,...     

Effects of Kinect-based virtual reality game training on upper extremity motor recovery in chronic stroke

Background: Therapeutic benefits of Kinect-based virtual reality (VR) game training in rehabilitation encourage its use to improve motor function.

Objective: To assess the effects of Kinect-based VR training on motor recovery of the upper extremity and functional outcomes in patients with chronic stroke.

Methods: In this randomized controlled trial, group A received 20 sessions of physical therapy (PT)?+?20 sessions of Kinect-based VR training and group B received only 20 sessions of PT. Clinical outcome measures were assessed at baseline and at the end of the treatments. Primary outcome measures that assess stroke patients’ motor function included upper extremity (UE) Fugl-Meyer Assessment (FMA). Secondary outcome measures were Brunnstrom Recovery Stages (BRS), Modified Ashworth Scale (MAS), Box and Block test (BBT), Motricity index (MI), and active range of motion (AROM) measurement.

Results: Statistically significant improvements in game scores (p?p?Conclusions: To conclude, our results suggest that the adjunct use of Kinect-based VR training may contribute to the improvement of UE motor function and AROM in chronic stroke patients. Further studies with a larger number of subjects with longer follow-up periods are needed to establish its effectiveness in neurorehabilitation.     

Motor unit number estimation and quantitative needle electromyography in stroke patients

ObjectiveTo evaluate the effect of upper motor neuron damage upon motor units’ function by means of two separate and supplementary electrophysiological methods.MethodsThe abductor digiti minimi muscle of the non-paretic and the paretic side was studied in forty-six stroke patients with (a) motor unit number estimation (MUNE) – adapted multiple point stimulation method and (b) computerized quantitative needle electromyography (EMG) assessing the configuration of voluntary recruited motor unit potentials. Main outcome comparisons were focused on differences between non-paretic and paretic side.ResultsOn the affected hands mean MUNE value was significantly lower and mean area of the surface recorded single motor unit potentials was significantly larger than the corresponding ones on the non-paretic hands. EMG findings did not reveal remarkable differences between the two sides. Neither severity nor chronicity of stroke was related to MUNE or EMG parameters.DiscussionMUNE results, which suggested reduced motor unit numbers in stroke patients, in conjunction with the normal EMG features in these same muscles has given rise to different interpretations. In a clinical setting, reinnervation type changes in the EMG similar to that occurring in neuronopathies or axonal neuropathies should not be expected in muscles with central neurogenic lesion.     

Mean muscle activation comparison between fastballs and curveballs with respect to the upper and lower extremity

Baseball research on muscle activity (upper and lower extremity) during the throwing motion is important to understanding pitching mechanics for the future. Therefore, it is the purpose of this research study to compare the lower extremity muscle and upper extremity muscle activation patterns associated with the curveball pitch and the fastball pitch from the stretch position. Twelve skilled (NCAA collegiate level) pitchers volunteered to be in this study, with a mean age of 22.3 ± 4.53 years, mean height of 1.74 ± 0.13 m, and mean mass of 89.0 k ± 10.97 kg. The pitchers were fitted with six surface electromyography (EMG) bipolar electrodes on the stride leg biceps femoris, medial gastrocnemius, ipsilateral side lower trapezius, upper trapezius, triceps brachii and biceps brachii. Each pitcher underwent maximum voluntary isometric contraction (MVIC) testing and then performed the fastball & curveball pitching sequence. All EMG variables of interest were normalized using MVIC data and compared between pitching type. A repeated measures ANOVA was conducted for all muscle activity as well. If significance was found a pairwise analysis (Bonferroni) was performed between pitch type, using SPSS (p 0.05). Significant differences in the mean muscle activity for the fastball and curveball pitched from the stretch were observed. A higher level of muscle activity was found for the stretch fastball when compared to the stretch curveball. This study was able to provide a baseline measurement of muscle activity; however, kinematics and kinetics should be measured in future studies.     

Combining muscle synergies and biomechanical analysis to assess gait in stroke patients

The understanding of biomechanical deficits and impaired neural control of gait after stroke is crucial to prescribe effective customized treatments aimed at improving walking function. Instrumented gait analysis has been increasingly integrated into the clinical practice to enhance precision and inter-rater reliability for the assessment of pathological gait. On the other hand, the analysis of muscle synergies has gained relevance as a novel tool to describe the neural control of walking. Since muscle synergies and gait analysis capture different but equally important aspects of walking, we hypothesized that their combination can improve the current clinical tools for the assessment of walking performance.To test this hypothesis, we performed a complete bilateral, lower limb biomechanical and muscle synergies analysis on nine poststroke hemiparetic patients during overground walking. Using stepwise multiple regression, we identified a number of kinematic, kinetic, spatiotemporal and synergy-related features from the paretic and non-paretic side that, combined together, allow to predict impaired walking function better than the Fugl-Meyer Assessment score. These variables were time of peak knee flexion, VAF_total values, duration of stance phase, peak of paretic propulsion and range of hip flexion. Since these five variables describe important biomechanical and neural control features underlying walking deficits poststroke, they may be feasible to drive customized rehabilitation therapies aimed to improve walking function.This paper demonstrates the feasibility of combining biomechanical and neural-related measures to assess locomotion performance in neurologically injured individuals.     

Robot-assisted rehabilitation of hand function after stroke: Development of prediction models for reference to therapy

BackgroundRecovery of hand function after stroke represents the hardest target for clinicians. Robot-assisted therapy has been proved to be effective for hand recovery. Nevertheless, studies aimed to refer patients to the best therapy are missing.MethodsWith the aim to identify which clinical features are predictive for referring to robot-assisted hand therapy, 174 stroke patients were assessed with: Fugl-Meyer Assessment (FMA), Functional Independence Measure (FIM), Reaching Performance Scale (RPS), Box and Block Test (BBT), Modified Ashworth Scale (MAS), Nine Hole Pegboard Test (NHPT). Moreover, patients ability to control the robot with residual force and surface EMG (sEMG) independently, was checked. ROC curves were calculated to determine which of the measures were the predictors of the event.ResultssEMG control (AUC = 0.925) was significantly determined by FMA upper extremity (FMUE) (>24/66) and sensation (>23/24) sections, MAS at Flexor Carpi (<3/4) and total MAS (>4/20). Force control (AUC = 0.928) was correlated only with FMUE (>24/66).ConclusionsFMUE and MAS were the best predictors of preserved ability to control the device by two different modalities. This finding opens the possibility to plan specific therapies aimed at maximizing the highest functional outcome achievable after stroke.     

Somatosensory cortex excitability changes due to differences in instruction conditions of motor imagery

Purpose Vivid motor imagery appears to be associated with improved motor learning efficiency. However, the practical difficulties in measuring vivid motor imagery warrant new analytical approaches. The present study aimed to determine the instruction conditions for which vividness in motor imagery could be more easily seen and the excitability of the sensory cortex as it relates to the motor image. Materials and methods In total, 15 healthy, right-handed volunteers were instructed to imagine grasping a rubber ball under a verbal-only instruction condition (verbal condition), a verbal?+?visual instruction condition (visual condition), and a verbal?+?execution (physically grasping a real ball) condition (execution condition). We analyzed motor imagery-related changes in somatosensory cortical excitability by comparing somatosensory-evoked potentials in each condition with the rest (control) condition. We also used a visual analogue scale to measure subject-reported vividness of imagery. Results We found the N33 component was significantly lower in the execution condition than in the rest condition (p?Conclusions These data suggest that experiencing a movement through actual motor execution immediately prior to performing mental imagery of that movement enhances the excitability of motor-related cortical areas. It is suggested that the excitability of the motor-related region increased as a result of the motor imagery in the execution condition acting on the corresponding somatosensory cortex.     

Effect of aging on properties of motor unit action potentials in the rat medial gastrocnemius muscle

The purpose of this study was to investigate whether age-related changes in motor unit (MU) contractile properties are reflected in parameters of motor unit action potentials (MUAPs). MUs of the medial gastrocnemius muscle were functionally isolated in anaesthetized Wistar rats. A control group of young animals (5–10 mo) was compared to two groups of old rats (24–25 mo and 28–30 mo). The basic contractile properties of MUs as well as the amplitude, total duration, peak-to-peak time, and number of turns within MUAPs were measured. Effects of aging were mainly observed for fast fatigable MUs (a prolongation of MUAPs and increased number of turns). The MUAP amplitude did not change significantly with aging in either MU type, but it correlated to the twitch or tetanic forces, which tended to increase with age, especially for slow MUs. We concluded that the prolongation of MUAPs and the greater incidence of signal turns was probably a result of a decrease in muscle fiber conduction velocity and/or an increase in their dispersion, and enlargement of MU territories – presumably caused by axonal sprouting of surviving motoneurons. The latter might also be responsible for the observed age-related tendency for a increase in MUAP amplitudes in slow MUs.     

低频重复经颅磁刺激联合益生菌对脑卒中后抑郁患者认知和运动功能及肠道菌群的影响

目的 分析低频重复经颅磁刺激联合益生菌对脑卒中后抑郁患者认知、运动功能及肠道菌群的影响。 方法 选取我院2016年12月至2019年2月收治的110例脑卒中后抑郁患者进行研究,按随机数字表法分为观察组与对照组,各55例。两组患者均给予低频重复经颅磁刺激治疗,观察组患者进一步联合益生菌治疗。治疗4周后比较两组患者抑郁、认知功能、运动功能、肠道菌群及不良反应发生情况。 结果 治疗后观察组患者肠道双歧杆菌数量[(9.59±0.73)lg copies/g vs(7.56±0.54)lg copies/g]和乳杆菌数量[(9.53±0.68)lg copies/g vs(7.84±0.56)lg copies/g]高于对照组,而肠球菌数量[(7.86±0.63)lg copies/g vs(9.81±0.52)lg copies/g]与大肠埃希菌数量[(7.64±0.37)lg copies/g vs(9.16±0.48)lg copies/g]低于对照组,差异有统计学意义(均P0.05)。 结论 低频重复经颅磁刺激联合益生菌治疗可有效改善脑卒中后抑郁患者认知、运动功能及其肠道菌群和抑郁状态,安全性较高。     

电针对脑卒中患者的疗效及其对肠道菌群的影响

探讨电针对脑卒中患者的疗效及对患者肠道菌群丰度的影响,为该类患者的治疗提供参考。

选取我院40例脑卒中患者在中风常规针刺基础上,予以电针治疗（双侧天枢穴、双侧足三里穴、双侧曲池穴）,最后纳入30例患者为观察组,同时另选取30例健康者作为对照组。观察治疗前后患者的神经功能恢复状态（mRS评分）,同时收集患者新鲜粪便标本,用16S rDNA高通量测序技术检测肠道菌群结构。

经电针治疗,30例患者mRS评分显著改善,其中显效26例,治愈2例,无效2例,临床总有效率为93.3%。与对照组比较,脑卒中患者治疗前粪便中拟杆菌门丰度减少,厚壁菌门丰度增加,拟杆菌门/厚壁菌门（B/F）比例显著减少（均P＜0.05）;且梭菌纲作为厚壁菌门下的主要细菌纲其丰度显著增加（P＜0.05）。治疗后观察组患者粪便中拟杆菌门丰度较对照组和同组治疗前均显著增加（均P＜0.05）,厚壁菌门丰度较对照组显著增加,但较治疗前显著减少（均P＜0.05）;B/F比例较对照组减少,而较治疗前显著增加（均P＜0.05）。

电针可有效治疗脑卒中,同时可通过调节肠道B/F比例,增加有益菌,减少炎症相关致病菌,改善肠道菌群结构。