脑卒中肩部并发症的评价

脑卒中的肩关节并发症主要有肩手综合征和肩关节脱位，正确的评价这些并发症对脑卒中的综合评价、治疗和预后起重要的作用，章重点介绍脑卒中肩关节并发症的评价。     

脑卒中后肩部并发症的康复预防

脑卒中后上肢功能恢复的程度,关系到患者今后生活质量的高低。影响上肢功能恢复的因素很多,其中肩部并发症是上肢功能恢复的阻碍因素之一,常在病后３个月内发生,因明显的疼痛,造成肩关节活动范围受限,导致患侧上肢的功能恢复缓慢。近年我们对偏瘫患者进行早期康复综合治疗,观察偏瘫后肩部并发症的发生率及类型,探讨有效的防治措施。１临床资料１２０例偏瘫患者均为住院病人,男性７４例,女性４６例;年龄５１～７９岁,平均６１岁;其中脑溢血４５例,脑血栓７５例。发病至住院时间３ｈ～７ｄ,发病至康复时间８ｄ～１７ｄ。全部患者均有偏瘫,右侧…     

脑卒中患者的肩部问题

肩部问题是脑卒中患常见的并发症,主要表现有肩痛、肩关节半脱位和肩－手综合征。肩部问题的存在有碍于脑卒中患上肢功能的恢复,早期预防和治疗肩痛有助于改善上肢的功能活动能力。     

脑卒中后肩关节半脱位的康复治疗进展

肩关节半脱位作为脑卒中常见的并发症,多于卒中后3月内发生。肩关节半脱位可引起肩痛等并发症,如不进行积极有效的治疗,将严重影响上肢运动功能的恢复。本文就近几年肩关节半脱位的康复治疗方法进行综述,为卒中后肩关节半脱位的预防和康复治疗提供新思路。     

脑卒中后肩关节半脱位患者74例的康复护理

目的 研究脑卒中后肩关节半脱位的康复护理及其效果。方法 74例脑卒中肩关节半脱位患通过肢位摆放、矫正肩胛骨位置、按摩肩关节周围稳定肌、维持肩关节的活动等措施进行康复护理。结果 74例患肩关节半脱位明显减轻，上肢功能明显改善。结论 恰当的康复护理措施对脑卒中后肩关节半脱位患上肢功能的恢复有着重要的意义。     

脑卒中病人应用矫形器的康复护理

目的了解脑卒中病人应用矫形器的康复护理方法。方法对68例应用矫形器的脑卒中病人,在各期进行矫形器穿戴前后康复护理,重视早期介入。结果68例病人无1例压疮发生,病人肌张力和痉挛症状得到缓解,生活自理能力(ADL)有显著提高。结论脑卒中病人应用矫形器,同时加强康复护理,特别是早期介入,能预防并发症的发生,促进运动功能恢复,提高病人的生活质量。     

脑卒中病人应用矫形器的康复护理

目的了解脑卒中病人应用矫形器的康复护理方法.方法对68例应用矫形器的脑卒中病人,在各期进行矫形器穿戴前后康复护理,重视早期介入.结果68例病人无1例压疮发生,病人肌张力和痉挛症状得到缓解,生活自理能力(ADL)有显著提高.结论脑卒中病人应用矫形器,同时加强康复护理,特别是早期介入,能预防并发症的发生,促进运动功能恢复,提高病人的生活质量.     

交互式步态矫形器在脊髓损伤患者康复中的应用

目的采用自行研制的交互式步态矫形器（RGO）帮助脊髓损伤截瘫患者重建站立和行走功能，促进其全面康复并尽早回归社会。方法先后为18例C6～T12节段完全性脊髓损伤患者装配交互式步态矫形器，并于安装前对其进行关节活动度、肌肉力量、平衡转移、站立等综合康复训练，装配后则继续进行步行功能等训练。经3个月训练后．对患者步行功能进行评定。结果本研究18例完全性脊髓损伤患者中，共有12例达到功能性家庭内步行水平（其中3例达到功能性社区内步行水平），其余6例则达到治疗性步行水平。结论完全性脊髓损伤患者可应用交互式步态矫形器重建站立及步行功能；交互式步态矫形器能帮助T4以下完全性脊髓损伤截瘫患者实现功能性步行。     

脑卒中后肩关节半脱位的康复治疗与护理

[目的]探讨康复治疗与护理对脑卒中病人肩关节半脱位的影响.[方法]60例脑卒中后肩关节半脱位病人,通过心理干预、良肢位摆放、悬吊固定、纠正肩胛骨位置、促进肩周稳定肌肌力和维持肩关节活动等措施进行康复治疗及护理,在治疗后进行肩关节半脱位的测定.[结果]60例脑卒中病人治疗后肩关节半脱位情况明显改善.[结论]恰当的康复治疗及护理措施能促进脑卒中后肩关节半脱位病人上肢功能的恢复.     

步行矫形器在截瘫患者康复中的应用

目的：改善截瘫患者的转移能力，促进早日回归社会。方法：先后有4例T10-L1节段脊髓损伤患者，经过转移平衡训练后，配戴步行矫形器（Walkabout），再进行步行训练。结果：4例完全性损伤患者均达到功能性步行。结论：步行矫形器能帮助T10以下完全性截瘫患者完成功能性步行，值得临床推广应用。     

新型互动式截瘫行走器在截瘫患者中的应用

目的 探讨新型互动式截瘫行走器(walkabout orthosis，WO)对截瘫患者的作用。方法 针对截瘫患者个体差异，制作并装配WO，对患者进行康复治疗及步态训练。结果 患者经过康复治疗及训练后，其Barthel指数明显提高，患者站立及步行能力明显改善，能够达到治疗性步行及家庭性步行。结论 康复治疗可以有效地改善患者的独立生活能力，WO能明显提高截瘫患者的行走能力，是较好的行走器之一。     

偏瘫患者早期使用下肢矫形器步行训练

下肢矫形器治疗在早期康复中使用的目的是支持体重、促进功能恢复和矫正步态.并介绍了下肢矫形器在早期康复中使用的原则和方法.     

Understanding gait control in post-stroke: implications for management

The role of the brain in post-stroke gait is not understood properly, although the ability to walk becomes impaired in more than 80% of post-stroke patients. Most, however, regain some ability to walk with either limited mobility or inefficient, asymmetrical or unsafe gait. Conventional intervention focuses on support of weak muscles or body part by use of foot orthosis and walking aids. This review provides an overview of available evidence of neuro-kinesiology & neurophysiology of normal and post-stroke gait. The role of the spinal cord has been explored, more in animals than humans. Mammalian locomotion is based on a rhythmic, "pacemaker" activity of the spinal stepping generators. Bipedal human locomotion is different from quadripedal animal locomotion. However, knowledge derived from the spinal cord investigation of animals, is being applied for management of human gait dysfunction. The potential role of the brain is now recognized in the independent activation of muscles during walking. The brain modifies the gait pattern during the complex demands of daily activities. Though the exact role of the motor cortex in control of gait is unclear, available evidence may be applied to gait rehabilitation of post-stroke patients.     

Preservation of the first rocker is related to increases in gait speed in individuals with hemiplegia and AFO

Background

Changes in impulse during the first rocker (braking force) and third rocker (propulsion force) may affect changes in gait speed after orthotic intervention. The purpose of this investigation was to objectively measure changes in impulse during double support and correlate those findings to changes in gait speed with and without ankle foot orthosis in individuals with hemiplegia.

Methods

Fifteen adults with stroke-related hemiplegia walked with and without ankle foot orthosis while foot pressure data was collected bilaterally. Outcome measures included: gait cycle time (s), mean force (N), and impulse (Ns) in the wholefoot, hindfoot, forefoot, and toe box during initial double support and terminal double support.

Findings

Time significantly decreased during the entire gait cycle, initial double support, and terminal double support, with the ankle foot orthosis. During initial double support, affected limb impulse significantly decreased with the ankle foot orthosis in the wholefoot (P = 0.016), and hindfoot (P = 0.006), and hindfoot impulse % change and gait speed % change were significantly correlated (P = 0.007). During terminal double support, affected limb impulse was not significantly different in the wholefoot or forefoot and these changes were not significantly correlated to gait speed.

Interpretation

Previous research found that orthotics increase gait speed in individuals with hemiplegia. This research suggests that the increase in speed is not due to increased propulsive forces at the end of terminal double support, but due to decreased braking forces during initial double support. Therefore, the orthosis preserved the first ankle rocker and provided a more efficient weight acceptance which positively affected gait speed.     

Decrease in post-stroke spasticity and shoulder pain prevalence over the last 15 years

ObjectivesThe usual complications after recent stroke such as disabling spasticity and shoulder pain seemed less frequent in recent years. This study examined the frequency of spasticity and shoulder pain in recent post-stroke patients over time in our physical and rehabilitation medicine department.MethodsThis was a retrospective study of post-stroke inpatients over the last 15 years. Spasticity and shoulder pain prevalence were analyzed, as were demographic, clinical and stroke characteristics.ResultsWe reviewed medical records for 786 patients (506 men); mean age 58.1 years (SD 13.2); 530 (68%) with ischemic stroke and 256 (32.36%) hemorrhagic stroke. After a first increase from 2000 to 2006, the prevalence of disabling spasticity decreased from 2006 to 2015 (31%–10%; P < 0.001). Shoulder pain at admission and during hospitalization also decreased (13% of patients in 2000 to 8% in 2015, P < 0.001). Disabling spasticity was associated with shoulder pain (26% of patients with disabling spasticity presented shoulder pain at admission vs 7% with hyperreflexia of the deep tendon reflexes, P < 0.05). Characteristics of stroke, time of admission after stroke and length of stay did not change over the years. We observed an increase in number of walking patients at admission and number with a functional paretic arm at admission and discharge (P < 0.05), which may explain the increase in functional independence measure scores at admission and discharge (both P < 0.05). Prevalence of cognitive disorders increased over the same period (24% in 2000 vs 63% in 2015, P < 0.05).ConclusionsDisabling spasticity and shoulder pain frequency in recent post-stroke patients decreased over the last 15 years, and functional abilities both at admission and discharge improved. Confirmation of these results in a multicentric study may be important evidence of an improvement in stroke healthcare both in stroke and physical and rehabilitation medicine units in the last 10 years in France and could affect future estimations of the need for rehabilitation care after stroke.     

Decreased energy cost and improved gait pattern using a new orthosis in persons with long-term stroke

OBJECTIVE: To measure energy cost and gait analysis in persons with stroke with and without a newly developed orthosis. DESIGN: Immediate and long-term (3wk) intervention (before-after trial). SETTING: University medical center. PARTICIPANTS: Volunteer sample of 27 persons with long-term (range, 0.6-19y) hemiparetic stroke. INTERVENTION: Three-week familiarization to the new walking aid. MAIN OUTCOME MEASURES: Energy cost (per distance walked), preferred walking speed (PWS), and step length. Energy cost was examined in all subjects while walking on a treadmill at 3 different velocities (PWS, PWS+30%, PWS-30%) during 3 different situations (without orthosis, with orthosis, after 3-wk orthosis familiarization). Spatiotemporal aspects of the gait pattern were examined using a 6-m instrumented walkway system. RESULTS: Using the orthosis immediately decreased energy cost in persons with stroke during walking at the PWS (P<.001) and significantly increased walking speed (P<.005) and step length (P<.001). After 3 weeks of familiarization to the orthosis, energy cost at the PWS and at PWS+30% showed further improvement in energy cost (P<.05). CONCLUSIONS: The newly developed orthosis immediately decreases energy cost and improves walking speed and step length in persons with long-term stroke. After only 3 weeks of orthosis familiarization, energy cost shows additional improvement.     

Robotic gait trainer in water: Development of an underwater gait-training orthosis

Purpose.?To develop a robotic gait trainer that can be used in water (RGTW) and achieve repetitive physiological gait patterns to improve the movement dysfunctions.

Method.?The RGTW is a hip-knee-ankle-foot orthosis with pneumatic actuators; the control software was developed on the basis of the angular motions of the hip and knee joint of a healthy subject as he walked in water. Three-dimensional motions and electromyographic (EMG) activities were recorded in nine healthy subjects to evaluate the efficacy of using the RGTW while walking on a treadmill in water.

Results.?The device could preserve the angular displacement patterns of the hip and knee and foot trajectories under all experimental conditions. The tibialis anterior EMG activities in the late swing phase and the biceps femoris throughout the stance phase were reduced whose joint torques were assisted by the RGTW while walking on a treadmill in water.

Conclusion.?Using the RGTW could expect not only the effect of the hydrotherapy but also the standard treadmill gait training, in particular, and may be particularly effective for treating individuals with hip joint movement dysfunction.     

Robotic gait trainer in water: development of an underwater gait-training orthosis

Purpose. To develop a robotic gait trainer that can be used in water (RGTW) and achieve repetitive physiological gait patterns to improve the movement dysfunctions.

Method. The RGTW is a hip-knee-ankle-foot orthosis with pneumatic actuators; the control software was developed on the basis of the angular motions of the hip and knee joint of a healthy subject as he walked in water. Three-dimensional motions and electromyographic (EMG) activities were recorded in nine healthy subjects to evaluate the efficacy of using the RGTW while walking on a treadmill in water.

Results. The device could preserve the angular displacement patterns of the hip and knee and foot trajectories under all experimental conditions. The tibialis anterior EMG activities in the late swing phase and the biceps femoris throughout the stance phase were reduced whose joint torques were assisted by the RGTW while walking on a treadmill in water.

Conclusion. Using the RGTW could expect not only the effect of the hydrotherapy but also the standard treadmill gait training, in particular, and may be particularly effective for treating individuals with hip joint movement dysfunction.     

Kinematic effects on gait of a newly designed ankle-foot orthosis with oil damper resistance: a case series of 2 patients with hemiplegia

The ankle joint of ankle-foot orthoses (AFOs) should restrict plantarflexion to prevent foot drop during the swing phase. However, excessive plantarflexion resistance causes excessive knee flexion during the stance phase. Plantarflexion resistive moment should be easily adjustable according to the gait ability of patients with hemiplegia. Because it is difficult to adjust plantarflexion resistive moment exactly, we developed an AFO with an oil damper. It is a small shock absorber that utilizes hydraulic resistance. The oil damper generates a resistive moment to the plantarflexion rotation of the ankle joint at the initial stance phase. The magnitude of the plantarflexion resistive moment at the heel strike can be easily adjusted to accommodate each patient's condition by simply turning an adjustment screw. We used a gait analysis system to compare the gait of 2 hemiplegic patients while they were wearing either the AFO with the oil damper or the AFO with the plantarflexion stop. The AFO with the oil damper achieved sufficient plantarflexion of the ankle and mild flexion of the knee by adjusting a proper plantarflexion resistive moment during initial stance phase, and provided a more comfortable gait than did the AFOs with a plantarflexion stop.