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中华物理医学与康复杂志
中华物理医学与康复杂志

黄晓琳

月刊

0254-1424

cjpmr@tjh.tjmu.edu.cn

027-83662874

430030

湖北省武汉市解放大道1095号同济医院内

中华物理医学与康复杂志/Journal Chinese Journal of Physical Medicine and RehabilitationCSCD北大核心CSTPCD
查看更多>>中华医学会主办。本刊主要内容包括：贯彻党和国家的卫生工作方针政策，理论与实践相结合，提高与普及相结合，积极倡导百花齐放、百家争鸣；全面介绍物理治疗、物理医学与康复领域内领先的科研成果和新理论、新技术、新方法、新经验以及对物理因子治疗、康复临床、疗养等有指导作用，且与康复医学密切相关的基础理论研究，同时密切关注国际康复医学发展的新动向。主要栏目包括论著、综述、研究报告、经验交流、继续教育、讲座、病例报告、会议纪要、书评、国内外学术动态、学术活动预告等。
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    前颗粒蛋白在脑卒中后失语症患者外周血单核细胞中的表达

    木尼热·阿布都西库席艳玲阮仕衡
    289-296页
    查看更多>>摘要：目的 探究脑卒中后失语症(PSA)患者外周血单核细胞(PBMC)中失语相关基因前颗粒蛋白(GRN)的表达情况。 方法 将对数生长期PC12细胞进行培养，细胞密度达到30%~50%时将其分为非特异性干扰组(基因对照组)和特异性干扰组(基因沉默组)。在PC12细胞中沉默GRN的表达后采用高通量转录组测序(RNA-seq)技术分析2组基因可变剪接事件发生情况。选取PSA患者10例(患者组)和健康受试者10例(对照组)，2组受试者均于入组当天进行首次采血，并于入组12 d经皮(患者组出院当天)进行第二次采血。采用实时荧光定量聚合酶链式反应(RT-qPCR)测定2组受试者外周血单核细胞(PBMC)中GRN的mRNA表达量的变化和kappaB结合蛋白相关核因子(NFRKB)的可变剪接事件发生情况。患者组接受常规言语治疗，于首次采血和第二次采血后即刻采用汉语失语成套测试(ABC)对其言语功能进行评估，并采用Pearson法分析GRN表达量的变化与ABC各项评分变化的相关性。 结果 PC12细胞沉默GRN后，基因沉默组GRN的表达量与基因对照组GRN的表达量相比，差异有统计学意义(P<0.01)。两个样本间，发生显著差异可变剪接的基因共有237个，其中5′端发生可变剪接事件的基因数量最多。基因沉默组NFRKB可变剪接事件的发生概率与基因对照组比较，差异有统计学意义(P<0.05)；基因沉默组NFRKB可变剪接事件的发生概率与基因对照组比较，差异有统计学意义(P<0.05)。PSA患者组首次采血血样PBMC中GRN的mRNA表达水平和健康组血样比较，差异有统计学意义(P<0.001)；患者组第二次采血血样PBMC中GRN的mRNA表达水平与其首次采血血样比较，差异有统计学意义(P<0.001)。患者组首次采血血样PBMC中NFRKB基因发生可变剪接事件的概率与健康组比较，差异有统计学意义(P<0.05)。患者组第二次采血血样PBMC中NFRKB基因发生可变剪接事件的概率与首次采血比较，差异有统计学意义(P<0.01)。PSA患者第二次评估时的ABC量表口语表达得分显著优于其首次评估，差异有统计学意义(P<0.05)，且在ABC量表的口语表达部分中，PSA患者第二次评估时复述评分，显著高于其首次评估，差异有统计学意义(P<0.05)。对患者组首次血样和第二次血样PBMC中GRN表达量的差异与PSA患者ABC量表口语表达评分的差异进行相关性分析，结果发现，GRN表达量的变化与口语表达能力的恢复呈正相关。 结论 GRN可通过调控NFRKB的可变剪接来促进PSA患者言语功能的恢复。 Objective To document the expression of aphasia-related progranulin gene (GRN) in mononuclear cells in the peripheral blood (PBMC) of patients with post-stroke aphasia (PSA). Methods PC12 cells at the logarithmic-growth stage were cultured and divided into a non-specific interference group (the gene control group) and a specific interference group (the gene silencing group) when the cell density reached 30 to 50%. After the expression of GRN was knocked down in the cells, the occurrence of variable splicing events was analyzed using high-throughput transcriptome sequencing (RNA-seq). Meanwhile, 10 PSA patients were selected into a patient group and 10 healthy counterparts were chosen as a control group. Blood was collected from both groups and real-time fluorescence quantitative polymerase chain reactions (RT-qPCR) were employed to determine any changes in GRN mRNA expression and the occurrence of variable splicing events in the nuclear factor related to kappa-B-binding protein (NFRKB) in their PBMCs. The patient group received conventional speech therapy, and immediately after their first and second blood collections their speech functioning was assessed using the Chinese Aphasia Battery (ABC). Pearson correlation coefficients were then computed relating the GRN expression and ABC scores. Results After knocking down GRN in the PC12 cells, the expression of GRN in the gene knockdown group was significantly different from that in the control group. There were 237 genes with significant differences in variable splicing between the two samples. The number of genes with variable splicing events at the 5′ end was the largest. There were also significant differences between the groups in the average occurrence of NFRKB variable splicing events. And significant diffe-rences were observed in the mRNA expression of GRN between the two blood collections from the patient group, as well as between the first collection from the patient group and the controls. The average oral expression score of the PSA patients improved significantly, particularly the retelling score. The changes in the GRN expression level were positively correlated with the recovery of oral expression ability. Conclusion GRN can promote the recovery of speech function in PSA patients by regulating the variable splicing of NFRKB.

    脑卒中后失语外周血单核细胞前颗粒蛋白kappaB结合蛋白相关核因子

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    基于静息态功能性近红外光谱技术探究最小意识状态患者脑功能网络连接和区域自发神经活动的特点

    苗国富龚瑜王丝蕊陈慧...
    297-301页
    查看更多>>摘要：目的 采用静息态功能性近红外光谱技术(rs-fNIRS)探究最小意识状态(MCS)患者脑网络功能连接(FC)强度和区域自发神经活动的特点。 方法 选取10例MCS患者，纳入MCS组，同期招募12例性别、年龄与MCS组匹配的健康受试者，纳入健康对照组(HC组)。采集所有受试者5 min rs-fNIRS数据。采用NIRS-KIT工具箱计算每例受试者的53通道FC强度和比率低频振幅(fALFF)值，比较两组受试者每个通道FC值和fALFF值的差异。 结果 与HC组比较，MCS组有17条通道的功能连接强度显著下降[P<0.05，经错误发现率(FDR)校正]，异常脑区主要位于左右额极、背外侧前额叶。与HC组比较，MCS组的Broca区(通道2)、前运动皮质与辅助运动皮质(通道4、10、40)、背外侧前额叶(通道6、11、25、39)、额眼区(通道12)和额极(通道23、27、36)的fALFF值升高，额极(通道19)的fALFF值下降(P<0.05，经FDR校正)。 结论 MCS患者前额叶、部分语言和运动相关脑区的自发神经活动过度活跃，前额叶内部功能网络协同失调。 Objective To explore the characteristics of functional connectivity (FC) and regional spontaneous brain activity in patients in a minimally-conscious state (MCS). Methods Resting-state functional near-infrared spectroscopy (rs-fNIRS) was used. Ten minimally-conscious patients were studied along with 12 healthy counterparts as healthy controls (HC). Five minutes of rs-fNIRS data were recorded from each subject and FC and the fractional amplitude of low-frequency fluctuations (fALFFs) of 53 channels were computed using the NIRS-KIT toolbox. The results were compared between the two groups. Results Compared with the HC group, a significant decrease was observed in the average FC strength of seventeen channel pairs after false discovery rate (FDR) correction. Most were in the right and left frontal pole, as well as the dorsolateral prefrontal lobe. Compared with the HC group, the average fALFF values of Broca′s area (channel 2), the premotor cortex and the supplementary motor cortex (channels 4, 10, and 40), the dorsolateral prefrontal lobe (channels 6, 11, 25, 39), the eye motor area of the frontal lobe (channel 12) and the frontal pole (channels 23, 27, 36) were significantly greater in the MCS group. The fluctuations of the frontal pole (channel 19) were significantly less (after FDR correction). Conclusion In an MCS spontaneous neural activity is over-active in the prefrontal lobe and some speech- and motor-related brain regions, and coordination of the internal prefrontal functional network is disordered.

    静息态功能性近红外光谱技术最小意识状态功能连接比率低频振幅

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    脊髓损伤患者并发下肢深静脉血栓危险因素的回顾性研究

    孙妙巧徐沐兰吴相波梁英...
    302-306页
    查看更多>>摘要：目的 探讨脊髓损伤患者并发下肢深静脉血栓(DVT)的危险因素。 方法 回顾性分析2018年1月至2022年9月于空军军医大学第一附属医院康复医学科住院的276例脊髓损伤患者的临床资料，按入院后是否合并下肢DVT，将其分为DVT组(63例)和非DVT组(213例)。比较两组患者的性别、年龄、血型、吸烟史、手术史、入院距离脊髓损伤的时间、脊髓损伤原因、骨折情况、脊髓损伤节段、美国脊髓损伤协会(AISA)分级、合并症等相关指标，采用二分类Logistics回归分析筛选脊髓损伤患者合并下肢DVT的危险因素。 结果 276例脊髓损伤患者中，有63例(22.83%)出现下肢DVT，其中84.13%为小腿肌间静脉血栓(CMVT)。二分类Logistic回归分析结果显示，脊髓损伤患者合并下肢DVT，与贫血[OR＝2.753，95%CI(1.233，6.146)，P＝0.013]、低钠血症[OR＝5.349，95%CI(1.970，14.525)，P＝0.001]、入院距离脊髓损伤的时间[74~195 d，OR＝0.231，95%CI(0.084，0.636)，P＝0.005；≥195 d，OR＝0.124，95%CI(0.034，0.451)，P＝0.002]有关。 结论 脊髓损伤患者发生下肢DVT的风险较高，贫血、低钠血症是其独立危险因素。 Objective To explore the risk factors for lower extremity deep vein thrombosis (DVT) in patients with a spinal cord injury (SCI). Methods The medical records of 276 hospitalized SCI patients were analyzed retrospectively. They were divided into a DVT group (n=63) and a no-DVT group (n=213). Gender, age, blood type, smoking history, surgical history, the time from SCI to admission, cause of SCI, fracture, SCI segments, American Spinal Cord Injury Association grade and complications were compared between the two groups. Binomial logistic regression was used to isolate the risk factors for lower extremity DVT among such patients. Results Among 84% of the 63 with a lower extremity DVT, it was a calf muscle venous thrombosis. Anemia, hyponatremia and time from SCI to admission (which ranged from 74 to 195 days) were the most serious DVT risk factors. Conclusions SCI patients are of high risk for DVT, with anemia and hyponatremia being independent risk factors.

    脊髓损伤深静脉血栓危险因素

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    间歇性抗阻训练联合低频重复经颅磁刺激对帕金森病患者运动功能恢复的影响

    李东升古祺李学石小雪...
    307-311页
    查看更多>>摘要：目的 观察间歇性抗阻训练联合低频重复经颅磁刺激(rTMS)对帕金森病(PD)患者运动功能恢复及肌张力的影响。 方法 采用随机数字表法将104例PD患者分为观察组及对照组，每组52例。2组患者均给予常规药物及低频rTMS治疗，观察组患者在此基础上辅以间歇性抗阻训练。于治疗前、治疗8周后采用统一帕金森病综合评定量表-Ⅲ(UPDRS-Ⅲ)和Berg平衡量表(BBS)评价患者运动功能情况，采用改良Ashworth量表(MAS)评价患者肢体肌张力，采用三维动作处理系统采集、分析患者步态运动学数据，采用运动自我效能量表(ESE)、改良Barthel指数量表(MBI)评价患者运动心理状态及日常生活活动能力。 结果 治疗后2组患者UPDRS-Ⅲ、MAS、BBS、ESE、MBI评分及各步态空间参数均较治疗前有不同程度改善，并且观察组UPDRS-Ⅲ评分[(24.84±5.43)分]、MAS评分[(1.85±0.29)分]、BBS评分[(32.16±4.10)分]、ESE评分[(45.89±6.14)分]、MBI评分[(56.84±6.14)分]及各步态空间参数[步长(45.67±6.01)cm、步幅(78.35±5.12)cm、步频(113.84±15.23)步/分钟、步速(0.95±0.15)m/s]亦显著优于同期对照组水平(P<0.05)。 结论 间歇性抗阻训练联合低频rTMS可显著降低PD患者肢体肌张力，提高患者运动功能，其疗效优于单一的低频rTMS治疗。 Objective To explore any effect of supplementing low-frequency repeated transcranial magnetic stimulation (rTMS) with intermittent resistance training on muscle tone and the recovery of motor function among persons with Parkinson′s disease (PD). Methods A total of 104 PD patients were randomly divided into an observation group and a control group, each of 52. Both groups were treated with conventional drugs and low-frequency rTMS, while the observation group was additionally provided with intermittent resistance training for 8 weeks. Before and after the intervention, the motor functioning of both groups was evaluated using unified Parkinson′s disease rating scale-III (UPDRS-III) and the Berg Balance Scale (BBS). Limb muscle tension was quantified using the modified Ashworth scale (MAS). The subjects′ psychological states were quantified using the exercise self-efficacy scale (ESE), and the modified Barthel index (MBI) was applied to evaluate their ability in the activities of daily living. A 3D motion processing system collected and analyzed data describing each subject′s gait kinematics. Results After the intervention, significantly greater average improvement was observed in all of the outcome measures among the observation group compared with the control group. Conclusion Combining intermittent resistance training with low-frequency rTMS can significantly reduce muscle tone and improve the motor functioning of PD patients. The combination is more effective than low-frequency rTMS alone.

    帕金森病间歇性抗阻训练低频重复经颅磁刺激运动功能肌张力

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    重复经颅磁刺激联合心理干预治疗帕金森病抑郁患者的疗效观察

    熊莉君杨燕王芳易浩...
    312-316页
    查看更多>>摘要：目的 探讨重复经颅磁刺激(rTMS)联合心理干预对帕金森病抑郁(dPD)患者抑郁症状、神经功能及生活质量的改善作用。 方法 采用随机数字表法将120例dPD患者分为心理组、rTMS组及观察组，每组40例。所有患者均给予常规抗帕金森病及抗抑郁药物治疗，在此基础上心理组、rTMS组患者分别给予心理干预或高频(10 Hz)rTMS治疗(刺激部位为左侧背外侧皮质区)，观察组患者则辅以心理干预及高频rTMS治疗，3组患者均持续治疗8周。于治疗前、治疗8周后分别采用汉密尔顿抑郁量表(HAMD-24)、新版帕金森病综合评价量表(MDS-UPDRS)及生活质量评价量表(SF-36)对3组患者抑郁症状、神经功能受损程度和生活质量进行评估。 结果 治疗8周后3组患者HAMD评分、MDS-UPDRS评分及SF-36评分均较治疗前明显改善(P<0.05)，并且治疗后观察组HAMD评分[(13.98±2.46)分]、MDS-UPDRS评分、SF-36评分[(82.35±5.66)分]及临床缓解率(40.0%)、反应率(90.0%)等均显著优于心理组及rTMS组水平(P<0.05)。 结论 心理干预联合rTMS治疗dPD患者具有协同作用，能进一步缓解患者抑郁症状，改善受损神经功能及生活质量，该联合疗法值得临床推广、应用。 Objective To explore any effect of supplementing psychological intervention with repeated transcranial magnetic stimulation (rTMS) in the rehabilitation of depressed persons with Parkinson′s disease (dPD). Methods A total of 120 dPD patients were randomly divided into a psychological intervention group, an rTMS treatment group and an observation group, each of 40. In addition to conventional anti-Parkinson′s treatment and anti-depressant treatment, the psychological intervention group received such treatment and the rTMS group received 10Hz rTMS applied over the left dorsolateral prefrontal cortex for 8 weeks. The observation group received both interventions. Before and after the treatment, depression, neurological functioning and life quality were evaluated in all of the subjects using the 24-item Hamilton Depression Scale, the Movement Disorder Society′s unified Parkinson′s disease rating scale and the SF-36 questionnaire. Results After the intervention, significant improvement was observed in all of the quantitative evaluations as well as in the remission rate (40%) and the reaction rate (90%). On average, the observation group′s results were significantly better than those of the other two groups. Conclusion Psychological intervention and rTMS a have synergistic effect in treating dPD patients and their combination is worthy of clinical promotion and application, as it can relieve their depression and improve their neurological functioning and life quality.

    重复经颅磁刺激心理干预帕金森病抑郁神经功能生活质量

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    高频重复经颅磁刺激联合电针治疗脑卒中后偏瘫肩痛的疗效观察

    李占标吕运良张振燕刘方铭...
    317-319页
    查看更多>>摘要：目的 观察高频重复经颅磁刺激(HF-rTMS)联合电针治疗脑卒中后偏瘫肩痛的临床疗效。 方法 采用随机数字表法将75例脑卒中后偏瘫肩痛患者分为HF-rTMS组、电针组及联合组，每组25例患者。3组患者均给予对症药物及良肢位摆放、肌力训练、关节活动度训练等常规干预，在此基础上HF-rTMS组针对病灶侧脑半球M1区辅以10 Hz rTMS刺激，电针组则针对偏瘫侧肢体辅以电针治疗，联合组则辅以HF-rTMS及电针治疗。于治疗前、治疗4周后分别采用视觉模拟评分法(VAS)、肩痛和残疾指数(SPADI)、Constant-Murley量表(CMS)及改良Barthel指数(MBI)量表对3组患者疼痛程度、肩关节功能及日常生活自理能力进行评定。 结果 治疗后3组患者疼痛VAS、SPADI、CMS及MBI评分均较治疗前明显改善(P<0.05)；HF-rTMS组疼痛VAS、SPADI、CMS及MBI评分与电针组间差异无统计学意义(P>0.05)；联合组患者疼痛VAS评分[(2.6±0.8)分]、SPADI评分[(57.5±16.2)分]、CMS评分[(47.4±9.8)分]及MBI评分[(76.4±10.8)分]均显著优于HF-rTMS组及电针组水平(P<0.05)。 结论 HF-rTMS联合电针治疗能显著改善脑卒中后偏瘫肩痛患者疼痛程度，提高肩关节功能及日常生活自理能力，其疗效优于单一rTMS或电针治疗，该联合疗法值得临床推广、应用。

    高频重复经颅磁刺激电针脑卒中偏瘫肩痛

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    虚拟现实训练对养老机构主观认知下降患者认知功能和功能性体适能的影响

    孙志成王彤顾晓美马金霖...
    320-325页
    查看更多>>摘要：目的 观察虚拟现实(VR)训练对养老机构主观认知下降(SCD)患者认知功能和功能性体适能的影响。 方法 选取养老机构SCD患者56例，按随机数字表法分为观察组和对照组，每组患者28例。2组患者均给予阶段性的健康教育和养老机构常规养老护理服务，观察组在此基础上增加VR训练干预，VR训练包括八段锦、变魔术、鸟儿飞翔、超市购物、引力球、健身房共6项，每周3次，每次共训练45 min，连续训练6个月。于干预前和干预6个月后(干预后)分别对2组患者进行认知功能评估[包括主观认知下降量表(SCD-Q)、蒙特利尔认知评估量表(MoCA)、Rivermead行为记忆测验第2版(RBMT-Ⅱ)、数字符号转换测验(DSST)、动物词语流畅性测验(AFT)和连线测验A-B(TMT A-B)]和功能性体适能评估[包括8英尺起立行走测试(8UGT)、30 s手臂弯曲试验(30sACT)、30 s坐椅站立试验(30sCST)、双手背勾测试(BST)、坐椅前伸试验(CSRT)和2 min踏步试验(2MST)]。 结果 干预后，观察组的SCD-Q、MoCA、RBMT-Ⅱ、DSST、TMT-A和TMT-B测试结果与组内干预前比较，均明显改善，差异均有统计学意义(P<0.05)，且观察组上述认知功能评定指标干预后均显著优于对照组干预后，差异均有统计学意义(P<0.05)。干预后，观察组患者的8UGT、30sACT、30sCST、CSRT和2MST测试结果分别为(6.70±1.87)s、(19.23±5.02)次、(18.21±4.36)次、(－0.21±2.48)cm、(103.75±6.38)次，与组内干预前比较，均明显改善，差异均有统计学意义(P<0.05)，且观察组上述功能性体适能评定指标干预后均优于对照组干预后，差异均有统计学意义(P<0.05)。 结论 VR训练可有效地改善养老机构SCD患者的认知功能和功能性体适能，适用于养老机构内推广、实践。 Objective To observe any effect of virtual reality (VR) training on the cognitive functioning and functional fitness of nursing home residents with subjective cognitive decline (SCD). Methods Fifty-six of such residents were randomly divided into an observation group and a control group, each of 28. Both groups received health education and routine care, but the observation group was additionally provided with 45 minutes of VR training three times a week for 6 months. The training included Baduanjin, magic, flying bird, supermarket shopping, gravity ball and gym episodes. Both groups′ cognition was evaluated using the subjective cognitive decline questionnaire (SCD-Q), the Montreal cognitive assessment (MoCA), the Rivermead Behavioural Memory Test (second edition) (RBMT-Ⅱ), a digit symbol substitution test (DSST), an animal fluency test (AFT) and trail-making test A-B (TMT A-B). Functional fitness was quantified using the 8-foot up-and-go test (8UGT), a 30-second arm curl test (30sACT), a 30-second chair stand test (30sCST), a back scratching test (BST), the sit-and-reach test (CSRT) and a 2-minute step test (2MST) before and after the 6-month intervention. Results After the intervention, the average SCD-Q, MoCA, RBMT-Ⅱ, DSST, TMT-A, and TMT-B scores of the observation group were significantly better than before the intervention, and significantly better than the control group′s averages. And except for the back scratching their functional results were also significantly better, on average, than those of the control group. Conclusions VR training can effectively improve the cognition and functional fitness of nur-sing home residents with SCD. Such training is worthy of promotion and wider application in nursing homes.

    虚拟现实训练养老机构主观认知下降认知功能功能性体适能医养结合

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    声门下滞留物吸引联合间歇经口管饲在颅脑损伤患者中的临床应用效果

    方明珠赵顺杰白莎郭君...
    326-329页
    查看更多>>摘要：目的 探讨声门下滞留物吸引联合间歇经口管饲在颅脑损伤患者中的临床应用效果。 方法 选取符合纳入条件的颅脑损伤合并气管切开且佩戴声门下吸引患者90例，按随机数字表法分为对照组、持续吸引组、间歇吸引组三组，每组30例。3组患者均给予常规康复治疗、药物治疗和间歇经口管饲法的肠内营养支持，持续吸引组在常规治疗的基础上给予持续声门下吸引抽取气囊上滞留物，间歇吸引组在常规治疗的基础上给予每日4 h一次的间歇声门下吸引抽取气囊上滞留物，每组均治疗4周。分别比较3组患者治疗期间拔除气管套管的拔管时间及拔管率，并对比3组患者的吸入性肺炎、呼吸道黏膜破损、胃食管反流、消化道出血并发症的发生率。 结果 ①间歇吸引组的气管套管拔管时间低于对照组(P<0.05)，3组气管套管拔管率差异无统计学意义(P>0.05)；②持续吸引组的呼吸道黏膜破损率高于对照组和间歇吸引组，对照组的吸入性肺炎发生率分别高于持续吸引组和间歇吸引组，且组间差异有统计学意义(P<0.05)；③3组患者胃食管反流及消化道出血的发生率组间比较，差异均无统计学意义(P>0.05)。 结论 声门下吸引联合间歇经口管饲可降低颅脑损伤患者吸入性肺炎的发生率，有利于缩短患者的气管套管拔管时间，具有较高的安全性。

    持续声门下吸引间歇声门下吸引间歇经口管饲颅脑损伤

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    单任务平板训练与双任务平板训练对痉挛型双瘫脑瘫儿童运动功能影响的比较

    罗光金张璇罗慧李小平...
    330-334页
    查看更多>>摘要：目的 比较单任务平板训练与双任务平板训练对痉挛型双瘫脑瘫儿童运动功能的影响。 方法 选取具备独立行走能力的痉挛型双瘫脑瘫患儿50例，按照随机数字表法将其分为单任务训练组(对照组)和双任务训练组(观察组)，每组25例，治疗期间分别脱落2例和3例，最终纳入对照组23例，观察组22例。2组患儿在常规康复训练基础上，对照组进行单任务平板训练，观察组进行双任务平板训练。治疗前、治疗2个月后(治疗后)，采用粗大运动功能评定量表(GMFM-88)D功能区(站立)和E功能区(走跑跳)、儿童平衡量表(PBS)、1 min步行试验(1MWT)评价2组患儿的粗大运动功能、平衡功能和步行移动能力，采用改良起立-行走计时(mTUG)测试、双任务mTUG测试、双任务成本(DTE)评估2组患儿在双任务条件下的表现。 结果 治疗前，2组患儿GMFM-88 D区和E区、PBS、1MWT、单任务mTUG、双任务mTUG、DTE比较，差异无统计学意义(P>0.05)。治疗后，2组患儿上述指标均较组内治疗前改善(P<0.05)。2组患儿治疗后GMFM-88 D区和E区、PBS、1MWT评估结果比较，差异无统计学意义(P>0.05)。观察组患儿治疗后双任务mTUG[(16.95±3.44)s]和DTE[(－18.79±12.25)%]改善程度优于对照组，差异有统计学意义(P<0.05)。 结论 在常规康复训练基础上进行单任务平板训练或双任务平板训练，均能改善痉挛型双瘫脑瘫患儿的运动功能，其中以双任务平板训练的疗效更优。 Objective To explore any effect of the single- and dual-task treadmill training on the functioning of children with bilateral spastic cerebral palsy. Methods Fifty children with bilateral spastic cerebral palsy were randomly divided into a single-task treadmill training group (the control group, n=25) and a dual-task treadmill training group (the observation group, n=25). All of the children also received routine rehabilitation training, and the control and observation groups also conducted single- and dual-task treadmill training in addition to the routine rehabilitation training, respectively. Before and after 2 months of treatment, each child′s gross motor functioning was quantified using sections D (standing) and E (walking, running and jumping) of the Gross Motor Function Measurement-88 (GMFM-88) instrument. Balance was quantified using the Pediatric Balance Scale (PBS) and walking mobility was quantified using a 1 minute walking test (1MWT). Modified and dual task Timed Up and Go (mTUG) tests and dual-task effects (DTE) tests were also administered. Results There were no significant differences in average test scores between the two groups before the treatment. After the treatment significant improvement was observed in both groups. There was no significant difference between the two groups in terms of average GMFM-88, PBS and 1MWT scores, but significantly greater improvement was observed in the average dual-task mTUG and DTE results of the observation group. Conclusion Both single- and dual-task treadmill training are effective supplements to routine rehabilitation training for children with bilateral spastic cerebral palsy. Dual-task treadmill training is more effective than the single-task version.

    脑性瘫痪痉挛型双瘫平板训练单任务双任务

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    右侧低频rTMS对老年抑郁症患者抑郁症状及认知功能的影响

    周雪莹张盛徐德毅王黔艳...
    335-340页
    查看更多>>摘要：目的 探讨右侧低频重复经颅磁刺激(rTMS)对老年抑郁症患者抑郁症状及认知功能的影响。 方法 采用随机数字表法将86例老年抑郁症患者分为低频组(43例)和对照组(43例)。2组在抗抑郁药物治疗的基础上，低频组给予1.0 Hz的rTMS治疗，刺激部位为右侧背外侧前额叶皮质区，每日治疗1次，每次20 min，每周5次，治疗4周，共20次；对照组给予相同时间和频次的伪刺激治疗。分别于治疗前及治疗第1、2、3、4、6、8周末，采用汉密尔顿抑郁量表(HAMD-24)评估2组患者的抑郁情况，采用威斯康星卡片分类测验(WCST)、连线测试A(TMT-A)评估患者治疗前及治疗4、8周末的认知功能，治疗期间记录患者的不良反应。 结果 治疗前，2组患者的HAMD评分及WCST评分组间差异均无统计学意义(P>0.05)。治疗第1、2、3、4、6、8周时，2组患者的HAMD评分均较组内治疗前明显下降(P<0.05)；治疗3、4、6、8周后，各时间点低频组的HAMD评分均低于对照组，且组间差异均有统计学意义(P<0.05)。治疗4、8周后，2组患者WCST评分中的完成分类数和正确应答数评分均增加，而错误应答数和持续错误数评分均较组内治疗前明显减少(P<0.05)；治疗4、8周后，各时点低频组较对照组患者WCST中完成分类数、正确应答数均增加，错误应答数、持续错误数均减少，且组间差异有统计学意义(P<0.05)。治疗4、8周后，2组的TMT-A总时间与组内治疗前比较，差异有统计学意义(P<0.05)，但治疗前后组间各时间点TMT-A总时间差异无统计学意义(P>0.05)。2组患者治疗后的不良反应发生率组间差异无统计学意义(P>0.05)。 结论 抗抑郁药物治疗基础上，右侧低频rTMS可更快改善老年抑郁症患者的抑郁症状和认知功能，且不良反应少、耐受性好。 Objective To explore any effect of repeated application of low-frequency transcranial magnetic stimulation (rTMS) on depression and the cognition of depressed elderly persons. Methods Eighty-six elderly persons with depression were randomly divided into an rTMS group and a control group, each of 43. In addition to anti-depressant treatment, the rTMS group was given 20 minutes of 1Hz rTMS daily applied over the right dorsolateral prefrontal cortex, five times a week for 4 weeks. The control group was given sham treatment on the same schedule. Before the experiment and after 1, 2, 3, 4, 6 and 8 weeks of the treatment, depression in both groups was evaluated using the Hamilton Depression Scale (HAMD-24). At the 4- and 8-week evaluations the Wisconsin Card Sorting Test (WCST) and the Trail Making Test Part A (TMT-A) were also administered. Results Before the treatment there were no significant differences in the 2 groups′ average HAMD or WCST scores. At each subsequent evaluation both groups′ average HAMD score had decreased significantly. After 3 weeks the average HAMD score of the rTMS group consistently remained significantly lower than the control group′s average. At the 4- and 8-week evaluations both groups′ WCST and TMT-A scores had improved significantly compared with before the treatment, with significantly greater improvement in the rTMS group′s average WCST result, though not in their TPT-A result. There was no signi-ficant difference in the incidence of adverse reactions between the 2 groups. Conclusion As a supplement to antidepressant treatment, right-side low-frequency rTMS can relieve depressive symptoms and improve the cognitive functioning of depressed elderly persons. It is well tolerated with few adverse reactions.

    重复经颅磁刺激抑郁症认知功能

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