功能训练配合针灸治疗对脑卒中偏瘫患者运动功能及日常生活活动能力的影响

目的 研究功能训练配合针灸治疗对脑卒中偏瘫患者运动功能及日常生活活动能力的影响。方法 对32例住院的脑卒中患者进行运动疗法、作业训练及针灸等综合康复治疗，采用Brunnstrom法和香港版活动分析法评定治疗前后运动功能及日常生活自理能力。结果 平均治疗(40.0&;#177;7．0)d，偏瘫侧上下肢体运动功能Brunnstorm分级治疗前后差异有显著性意义(P&;lt;0.05)，治疗前、后患者的整体功能活动、自理活动得分差异有非常显著性意义(P&;lt;0．001)。结论 功能训练配合针灸治疗可改善脑卒中偏瘫患者的运动功能及日常生活活动能力。     

活动分析法在脑卒中偏瘫患者日常生活活动能力训练中的应用

目的:探讨如何通过活动分析法系统地进行日常生活活动能力训练,使脑卒中后日常生活活动能力障碍患者的自理能力得到最大程度的恢复。方法:选择2002-02/2004-08中山大学附属第三医院康复医学科脑卒中后偏瘫患者82例,随机分成两组:①治疗组41例,男24例,女17例;脑出血13例,脑梗死28例;平均年龄(58±9)岁。②对照组41例,男23例,女18例;脑出血15例,脑梗死26例;平均年龄(57±9)岁。使用偏瘫患者日常生活活动分析表对两组患者进行评估。治疗组采用活动分析法,治疗程序为:入院时第1次评估,针对性制订治疗方案进行日常生活活动训练,先由作业治疗师对患者在日常生活活动治疗室进行日常生活活动训练,再逐渐过渡到病房进行真实环境的日常生活活动,30min/次,1次/d,治疗1个月后再次评估。对照组治疗程序为:入院时做第1次评估,治疗师给予日常生活活动指导,30min/次、1次/周,1个月后再次评估。结果:82例患者均进入结果分析。①治疗组41例,总有效率98%(40/41),15例达到日常生活活动能力完全自理(64分),13例达到日常生活活动能力大部分自理(51～63分),12例日常生活活动能力部分自理(31～50分),1例没有明显进步(0～30分);对照组41例,总有效率76%(31/41),8例达到完全自理,10例达到大部分自理,14例部分自理,9例日常生活活动能力评分没有明显进步。②两组患者治疗前后功能活动、自理活动、日常生活活动总分比较,差异有显著性意义(P<0.05);治疗后治疗组与对照组功能活动、自理活动、日常生活活动总分比较犤(7.13±5.58,4.16±3.38);(13.35±7.93,6.65±5.09);(19.90±8.18,10.81±7.10)犦,差异有统计学意义(P<0.01)。结论:选择和使用适合偏瘫患者的活动分析法并针对性地制订治疗方案更加有利于偏瘫患者日常生活活动能力的恢复。     

功能训练配合针灸治疗对脑卒中偏瘫患者运动功能及日常生活活动能力的影响

目的研究功能训练配合针灸治疗对脑卒中偏瘫患者运动功能及日常生活活动能力的影响。方法对32例住院的脑卒中患者进行运动疗法、作业训练及针灸等综合康复治疗,采用Brunnstrom法和香港版活动分析法评定治疗前后运动功能及日常生活自理能力。结果平均治疗(40.0±7.0)d,偏瘫侧上下肢体运动功能Brunnstorm分级治疗前后差异有显著性意义(P<0.05),治疗前、后患者的整体功能活动、自理活动得分差异有非常显著性意义(P<0.001)。结论功能训练配合针灸治疗可改善脑卒中偏瘫患者的运动功能及日常生活活动能力。     

对称负重式坐站-站坐训练对脑卒中偏瘫患者平衡功能以及ADL的影响

目的：探讨对称负重式坐站-站坐训练对脑卒中偏瘫患者平衡功能以及ADL的影响。方法：48例脑卒中偏瘫患者随机分为2组各24例,生命体征平稳后均接受常规康复治疗,对照组给予常规的双足平行位进行坐站-站坐训练;观察组患者采用患足置后下坐站-站坐训练;2组患者均接受4周,每周5次,每次30min的坐站-站坐训练。训练前后分别采用Berg平衡量表(BBS)评分、改良Barthel指数评定量表 (MBI)评定平衡能力、日常生活活动能力,使用平衡评估系统测试2组患者训练前后坐位静态下压力中心点的轨迹长及轨迹面积（COP-SL、COP-SA）、训练后独立完成坐站及站坐的时间、双下肢负重对称性（WBasym）。结果：训练后,2组患者CoP-SL较训练前明显降低（P<0.01）,2组患者CoP-SA、BBS及MBI较训练前明显提高（P<0.01）;观察组的BBS及MBI评分更高于对照组（P<0.01）,2组的坐位平衡比较差异无统计学意义。训练4周后,观察组完成坐-站转移所需的时间、健侧下肢负重、WBasym均明显低于对照组（P<0.01）,患足负重明显高于对照组（P<0.01）。观察组完成站-坐转移所需的时间、健/患侧下肢负重、WBasym与对照组相比较,差异无统计学意义。结论：对称负重式坐站-站坐训练能更好地促进脑卒中偏瘫患者平衡功能以及ADL提高。     

活动分析法在脑卒中偏瘫患者日常生活活动能力训练中的应用

目的：探讨如何通过活动分析法系统地进行日常生活活动能力训练，使脑卒中后日常生活活动能力障碍患者的自理能力得到最大程度的恢复、方法：选择2002-02／2004-08中山大学附属第三医院康复医学科脑卒中后偏瘫患者82例．随机分成两组：①治疗组41例，男24例，女17例；脑出血13例．脑梗死28例；平均年龄（58&;#177;9）岁。②对照组41例，男23例，女18例；脑出血15例，脑梗死26例；平均年龄（57&;#177;9）岁。使用偏瘫患者日常生活活动分析表对两组患者进行评估。治疗组采用活动分析法，治疗程序为：入院时第1次评估，针对性制订治疗方案进行日常生活活动训练，先由作业治疗师对患者在日常生活活动治疗室进行日常生活活动训练，再逐渐过渡到病房进行真实环境的日常生活活动，30min／次，1次／d，治疗1个月后再次评估。对照组治疗程序为：入院时做第1次评估，治疗师给予日常生活活动指导，30min／次、1次／周．1个月后再次评估： 结果：82例患者均进入结果分析。①治疗组41例，总有效率98％（40／41），15例达到日常生活活动能力完全自理（64分），13例达到日常生活活动能力大部分自理（51-63分），12例日常生活活动能力部分自理（31～50分），1例没有明显进步（0-30分）；对照组41例，总有效率76％（31／41），8例达到完全自理，10例达到大部分自理，14例部分自理，9例日常生活活动能力评分没有明显进步。②两组患者治疗前后功能活动、自理活动、日常生活活动总分比较，差异有显著性意义（P〈0．05）；治疗后治疗组与对照组功能活动、自理活动、日常生活活动总分比较[（7．13&;#177;5．58．4．16&;#177;3．38）；（13．35&;#177;7．93，6．65&;#177;5．09）；（19．90&;#177;8．18，lO．81&;#177;7．10）]，差异有统计学意义（P〈0．01）。 结论：选择和使用适合偏瘫患者的活动分析法并针对性地制订治疗方案更加有利于偏瘫患者日常生活活动能力的恢复。     

矫形器结合功能训练改善患者步行能力

目的探讨矫形器结合功能训练对患者步行能力的影响。方法对 3 6例步行困难患者 (腰膨大脊髓损伤 11例、脑血管意外及脑外伤 2 5例 )于不同康复训练阶段配合踝足矫形器 (AFO)进行强化训练 6周 ,分别在患者入院时、AFO训练前和AFO训练 6周后进行ASIA、FMA运动评分评定和限时的步行功能检查 (包括 6min步行评定和 10米步行时间评定 )。结果AFO训练 6周后 ,患者的步行功能评分与AFO训练前的差异具有非常显著性意义 (P <0 .0 1) ;脊髓损伤患者的ASIA运动评分与入院时的差异无显著性意义 (P >0 .0 5 ) ;脑损伤患者的运动评分与入院时的差异具有非常显著性意义 (P <0 .0 1) ,脑损伤患者的运动评分与AFO训练前的差异有显著性意义 (P <0 .0 5 )。结论AFO结合功能训练可显著改善腰膨大脊髓损伤及部分脑损伤患者的步行能力。     

轻度阿尔采默氏病病人智力竞技休闲型活动训练研究

目的　探讨轻度阿尔采默氏病 (AD)人智力竞技休闲型活动训练的效果。方法　 5 6例轻度AD病人分为智力活动组 (30例 )和非智力活动组 (2 6例 ) ,智力活动组给予 1年的智力竞技休闲型活动训练 ;采用痴呆严重程度临床评定量表 (CDR)、简易精神状态检查量表 (MMSE)、成人韦氏记忆量表 (WMS)、日常生活能力量表 (ADL)在入组时和 1年后评定其认知功能及日常生活能力。结果　通过有目的的智力竞技休闲型活动训练 ,1年后 2组病人MMSE评分、ADL评分、WMS评分差异均有显著性 (均P <0 .0 5 ) ,痴呆程度的演变 ,差异也有显著性 (P <0 .0 5 )。结论　智力竞技休闲型活动训练可以延缓病情发展 ,智力活动可为AD的保护性因素。     

截瘫患者装配行走器后的训练与日常生活活动能力分析

目的　观察截瘫患者装配互动式行走器 (Walkabout)后行走训练的意义及日常生活活动能力的改变。方法　为 6例脊髓完全性损伤后截瘫患者配戴行走器后 ,逐步进行站立平衡训练、行走训练、助行架及拐杖训练 ;训练前、后应用Barthel指数评定日常生活活动 (ADL)能力 ,并进行分析。结果　 6例患者基本达到功能性步态 ,训练后ADL能力明显提高 ,训练前、后比较 ,差异有显著性 (P <0 .0 5 )。结论　截瘫患者装配行走器后的训练十分必要 ,它可使患者恢复较有实际意义的行走功能 ,并可提高患者的ADL能力     

早期坐-站转移训练对亚急性脑卒中偏瘫患者平衡功能的影响

目的：探讨早期坐-站训练对亚急性脑卒中偏瘫患者平衡功能的影响。方法：44例亚急性不能独立完成坐-站转移的脑卒中偏瘫患者随机分为2组各22例,均接受常规康复治疗,对照组给予常规辅助下坐-站转移训练;观察组患者采用患足置后下辅助坐-站转移训练。训练前后采用Berg平衡量表(BBS)评估2组患者的平衡功能、AL-080平衡功能评估系统测试2组患者训练前后坐位静态下压力中心点的轨迹长（SLsi）、坐位稳定极限下压力中心点的最大面积（SAsi）、训练后独立完成坐-站转移时间（T）、双下肢负重差异（ALD）、足底压力峰值（Fmax）以及站立静态下压力中心点的轨迹长（SLst）、站立稳定极限下压力中心点的最大面积（SAst）。结果：训练2周后,2组SLsi评分均较训练前明显下降(P<0.01),且观察组更低于对照组(P<0.05);2组SAsi及BBS评分均较训练前明显提高(P<0.01),且观察组更高于对照组(P<0.05)。训练后, 观察组完成坐-站转移所需的时间、健侧下肢负重及ALD评分均明显低于对照组(P<0.05),观察组患侧下肢负重、Fmax及动态SAst评分均明显高于对照组(P<0.05);2组SLst评分比较差异无统计学意义。结论：早期坐-站转移训练能更好地促进脑卒中偏瘫患者平衡功能提高,且采用患足置后下坐-站转移训练效果更佳。     

姿势对脑卒中偏瘫患者站-坐转移下肢负重及稳定性的影响

目的:探讨不同的四肢体位对脑卒中偏瘫患者站-坐转移下肢负重及稳定性的影响。方法:选取30例脑卒中偏瘫患者为实验组,30例正常人为对照组,两组受试者均在4种肢位下完成站-坐转移,对受试者完成站-坐转移的时间、双下肢负重、人体重心点在冠状面上的最大摆动幅度(COGX)进行比较。结果:不同上肢体位下脑卒中偏瘫患者站-坐转移的所需时间、下肢负重及COGX的差异不显著(0.05P0.1)。不同足位下脑卒中偏瘫患者站-坐转移的时间、下肢负重及COGX有差异,差异具有显著性意义(P0.05);患足置后,脑卒中偏瘫患者完成站-坐转移时双下肢负重的不对称性要明显小于健足置后(P0.05);而当健足置后时,脑卒中偏瘫患者完成站-坐转移的稳定性要明显优于患足置后(P0.05)。正常人在不同四肢体位下其站-坐转移的时间、下肢负重及COGX均无显著性意义(P0.05)。结论:不同上肢体位对脑卒中偏瘫患者站-坐转移的稳定性及下肢负重无明显影响;不同足位能显著影响脑卒中偏瘫患者站-坐转移时稳定性及下肢负重,患足置后可视为一种潜在提高患侧下肢功能的训练方法。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.