ObjectiveTo investigate the effect of virtual scene simulation training combined with midium frequency impulse electrotherapy on upper limb function and daily living ability of hemiplegia patients.MethodsFrom March to October 2019, 50 hemiplegic patients were recruited and randomly assigned to the trial group and the control group, with 25 patients in each group. The control group was given routine rehabilitation training, while the trial group was given virtual scene simulation training and medium frequency impulse electrotherapy on the basis of routine rehabilitation training. The Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Simple Test for Evaluating Hand Function (STEF), and Modified Barthel Index (MBI) were used to assess patients’ upper limb function and daily living ability before treatment and after 8 weeks of treatment.ResultsBefore treatment, the FMA-UE, STEF, and MBI scores of the trial group vs. the control group were 22.88±5.18 vs. 23.44±6.26, 40.12±4.82 vs. 41.44±4.54, and 51.40±7.29 vs. 48.60±7.00, respectively, and none of the between-group differences was statistically significant (P>0.05); after 8 weeks of treatment, the FMA-UE, STEF, and MBI scores of the two groups were 39.48±6.35 vs. 33.52±6.53, 59.08±7.54 vs. 52.52±5.83, and 71.00±8.78 vs. 62.40±9.37, respectively, and all of the between-group differences were statistically significant (P<0.05). After 8 weeks of treatment, the FMA-UE, STEF and MBI scores of the two groups of patients were significantly improved compared with those before treatment (P<0.05), and the improvement of each score of the trial group was significantlybetter than that of the control group (P<0.05). No stroke recurrence, electric burn, or other adverse reactions occurred in the two groups after treatment. ConclusionVirtual scene simulation training combined with midium frequency impulse electrotherapy can effectively improve the upper limb function of patients with hemiplegia and improve their quality of life.
ObjectiveTo systematically review the efficacy of Kinesio taping on upper limb function recovery in stroke patients.MethodsPubMed, The Cochrane Library, Web of Science, WanFang Data, CNKI and VIP databases were electronically searched to collect randomized controlled trials (RCTs) of the efficacy of Kinesio taping on upper limb function recovery in stroke patients from inception to December 20th, 2020. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed by using RevMan 5.3 software.ResultsA total of 13 RCTs involving 589 patients were included. The results of meta-analysis showed that compared with the control group, Kinesio taping significantly improved the FMA-UE score (MD=6.21, 95%CI 3.68 to 8.74, P<0.000 01), VAS score (MD=1.76, 95%CI 1.30 to 2.23, P<0.000 01), and MBI score (MD=10.28, 95%CI 8.43 to 12.13, P<0.000 01) of patients.ConclusionsCurrent evidence shows that the Kinesio taping can significantly improve the upper limb motor function, pain, and daily living ability of stroke patients. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusions.
ObjectivesTo investigate the influence of the abduction angle of the upper extremities on the image quality of non-enhanced CT scan and clinical value of the patients who cannot lift with double upper limbs by vehicle accident.Methods60 patients with double upper limbs that could not lift by vehicle accidents were required to receive liver non-enhanced CT scan, the patients were divided into 3 groups according to the abduction angle (group A, B, C), 20 cases in each group, another 20 cases with standard pose as the control group (group D). The CT value and standard deviation of the liver region of interest, the erector and the background air were measured, and the contrast to noise ratio of liver images, image noise value were calculated, together with the assessment of image quality and statistic analysis.ResultsThe liver non-enhanced CT scan were completed successfully. The image quality of group D was significantly better than A, B, C (Z=–10.753, P<0.05;Z=–11.645, P<0.05;Z=–12.281, P<0.05), respectively. Group C was better than A and B (Z=–8.502, P<0.05;Z=–4.068, P<0.05), respectively. Group B was better than A (Z=–5.885, P<0.05). The CNR of the four groups of images increased gradually, group A (0.09±0.77), group B (1.56±0.83), group C (2.51±0.87), group D (2.59±0.97), respectively. There were significant differences between four groups (F=36.323, P<0.05). The image noise decreased systematically, group A (14.84±2.94), group B (13.04±1.59), group C (11.60±1.72), group D (10.44±1.13), respectively. There were significant differences between four groups (H=426.755, P<0.05).ConclusionOn the premise of safety inspection, with the enlargement of angle of the upper limbs of patients who cannot lift with double upper limbs by vehicle accidents, the image noise decreased and image quality is improved with the increase of signal noise ratio.
ObjectiveTo evaluate the effectiveness of the upper limb free flap for repair of severe contracture of thumb web, and one stage reconstruction of the index finger abduction. MethodsBetween March 2007 and June 2011, 16 cases of severe contracture of thumb web and index finger abduction dysfunction were treated. There were 14 males and 2 females with an average age of 29 years (range, 16-42 years). All injuries were caused by machine crush. The time between injury and admission was 6-24 months (mean, 10 months). The angle of thumb web was 10-25° (mean, 20°), and the width of thumb web was 15-24 mm (mean, 22 mm). After scar relax of the thumb web, the defect size ranged from 6 cm × 4 cm to 8 cm × 6 cm; the upper limb free flap from 7 cm × 5 cm to 9 cm × 7 cm was used to repair the defect, index finger abduction was simultaneously reconstructed by extensor indicis proprius tendon transfer. The donor site was repaired with skin grafting. ResultsAll the flaps and skin graftings survived after operation and incisions healed by first intention. Fourteen patients were followed up 6-12 months (mean, 9 months). The flap appearance was satisfactory. The two-point discrimination was 6-9 mm (mean, 7 mm) after 6 months. The angle of thumb web was 85-90° (mean, 88°). The width of thumb web was 34-52 mm (mean, 40 mm). The abduction and opposing functions of thumb and abduction function of index finger were both recovered. Conclusion A combination of the upper limb free flap for severe contracture of thumb web and one stage reconstruction of the index finger abduction for index finger abduction dysfunction can achieve good results in function and appearance.
【Abstract】 Objective To research the method and effectiveness of V-Y advancement of skin flap pedicled with the upper limb lateral branch in the treatment of small skin defect in the dorsal elbow. Methods Between March 2008 and August 2010, 6 cases of skin defect in the dorsal elbow were treated by V-Y advancement of skin flap pedicled with the upper limb lateral branch, including 4 males and 2 females with a mean age of 53 years (range, 16-76 years). Defects were caused by crushing in 3 cases, by punching in 2 cases, and the disease duration was 4 hours 30 minutes to 7 days (mean, 29.5 hours); and by chronic infection in 1 case, and the disease duration was 12 months. The defect size ranged from 4.0 cm × 2.5 cm to 9.5 cm × 3.5 cm, all complicating by bone or tendon exposure. The flap size ranged from 6.0 cm × 4.0 cm to 12.5 cm × 9.5 cm; the donor sites were sutured directly. Results All flaps survived completely, wounds and incisions at donor sites healed by first intention. Six cases were followed up 6-12 months after operation. The flaps had good texture and color. Two-point discrimination of the skin flap was 12-16 mm. The function of limb was normal, and elbow flexion and extension activity averaged 105° (range, 95-125°). Conclusion It is ideal to treat small skin defect in the dorsal elbow with V-Y advancement of skin flap pedicled with the upper limb lateral branch because of easier operation and less injury at donor site.
To solve the safety problems caused by the restriction of interaction space and the singular configuration of rehabilitation robot in terminal traction upper limb rehabilitation training, a trajectory planning and tracking control scheme for rehabilitation training is proposed. The human-robot safe interaction space was obtained based on kinematics modeling and rehabilitation theory, and the training trajectory was planned based on the occupational therapy in rehabilitation medicine. The singular configuration of the rehabilitation robot in the interaction space was avoided by exponential adaptive damped least square method. Then, a nonlinear controller for the upper limb rehabilitation robot was designed based on the backstepping control method. Radial basis function neural network was used to approximate the robot model information online to achieve model-free control. The stability of the controller was proved by Lyapunov stability theory. Experimental results demonstrate the effectiveness and superiority of the proposed singular avoidance control scheme.
At present, upper limb motor rehabilitation relies on specific rehabilitation aids, ignoring the initiative of upper limb motor of patients in the middle and late stages of rehabilitation. This paper proposes a fuzzy evaluation method for active participation based on trajectory error and surface electromyography (sEMG) for patients who gradually have the ability to generate active force. First, the level of motor participation was evaluated using trajectory error signals represented by computer vision. Then, the level of physiological participation was quantified based on muscle activation (MA) characterized by sEMG. Finally, the motor performance and physiological response parameters were input into the fuzzy inference system (FIS). This system was then used to construct the fuzzy decision tree (FDT), which ultimately outputs the active participation level. A controlled experiment of upper limb flexion and extension exercise in 16 healthy subjects demonstrated that the method presented in this paper was effective in quantifying difference in the active participation level of the upper limb in different force-generating states. The calculation results of this method and the active participation assessment method based on sEMG during the task cycle showed that the active participation evaluation values of both methods peaked in the initial cycle: (82.34 ± 9.3) % for this paper’s method and (78.44 ± 7.31) % for the sEMG method. In the subsequent cycles, the values of both showed a dynamic change trend of rising first and then falling. Trend consistency verifies the effectiveness of the active participation assessment strategy in this paper, providing a new idea for quantifying the participation level of patients in middle and late stages of upper limb rehabilitation without special equipment mediation.
ObjectiveTo observe the effects of upper limb rehabilitation robot-assisted training combined with mirror therapy on unilateral spatial neglect (USN) in stroke patients.MethodsA total of 40 patients with USN admitted to the Department of Rehabilitation Medicine of the Second Affiliated Hospital of Nantong University from January 2017 to December 2018 were selected and randomly divided into the trial group and the control group, with 20 cases in each group. The trial group used upper limb rehabilitation robot-assisted training combined with mirror therapy and USN comprehensive rehabilitation treatment. The control group patients only received USN comprehensive rehabilitation treatment. All patients continued treatment for 4 weeks. Before treatment and after 4 weeks of treatment, the modified Barthel index (MBI) was used to assess the activities of daily living, the Fugl-Meyer assessment (FMA) was used to assess motor function, and the Catherine-Bergego scale was used to assess the degree of USN.ResultsThere was no statistically significant difference in general information between the two groups of patients (P>0.05). There was no significant difference in MBI, FMA or USN degree scores between the two groups before treatment (P>0.05). After 4 weeks of treatment, the MBI, FMA and USN degree scores of the two groups were improved compared with those before treatment (P<0.05). The improvements in MBI, FMA and USN degree scores of the trial group were 14.75±1.97, 17.05±3.93 and 5.25±2.29, respectively, and those of the control group were 9.75±4.44, 8.30±2.06 and 3.10±0.72, respectively, and the differences were statistically significant (P<0.05).ConclusionsUpper limb rehabilitation robot-assisted training combined with mirror therapy can effectively improve the spatial neglect of USN patients, and improve the ability of daily living and motor functions.
ObjectiveTo explore the clinical effect of the end-traction upper limb rehabilitation training system on patients with upper limb motor dysfunction after stroke.MethodsPatients with upper limb motor dysfunction who were admitted to the Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanchang University from September to November 2019 were selected. According to the software, the patients were randomly divided into the experimental group and the control group. Both groups received conventional medical treatment, basic rehabilitation, and activities of daily living training. In addition, the control group received traditional occupational therapy, while the experimental group received end-traction upper limb rehabilitation training. The training time of both groups was 30 min/ (times ·d) and 5 days per week. Rehabilitation evaluation and recording were performed before and after the four-week treatment in both groups using the simplified upper extremity Fugl-Meyer assessment (FMA) and the modified Barthel index (MBI).ResultsA total of 36 patients were enrolled, with 18 in each group. All patients completed the experiment, and no special discomfort was observed. Before the treatment, there was no statistically significant difference in FMA and MBI between the experimental group [(13.22±3.13) and (49.66±6.81) points] and the control group [(14.78±1.70) and (51.67±6.65) points] (t=1.858, 0.896; P=0.072, 0.377). After four-week treatment, FMA and MBI in both groups improved significantly (P<0.05); the difference between the experimental group [(27.56±15.68) and (73.55±8.72) points] and the control group [(17.67±6.73) and (65.33±9.20) points] was statistically significant (t=2.459, 2.751; P=0.019, 0.009).ConclusionsThe end-traction upper limb rehabilitation training system can significantly improve the upper limb motor function of patients with upper limb motor dysfunction after stroke and improve the patients’ daily life ability. It is worthy of clinical promotion and application.
At present, fatigue state monitoring of upper limb movement generally relies solely on surface electromyographic signal (sEMG) to identify and classify fatigue, resulting in unstable results and certain limitations. This paper introduces the sEMG signal recognition and motion capture technology into the fatigue state monitoring process and proposes a fatigue analysis method combining an improved EMG fatigue threshold algorithm and biomechanical analysis. In this study, the right upper limb load elbow flexion test was used to simultaneously collect the biceps brachii sEMG signal and upper limb motion capture data, and at the same time the Borg Fatigue Subjective and Self-awareness Scale were used to record the fatigue feelings of the subjects. Then, the fatigue analysis method combining the EMG fatigue threshold algorithm and the biomechanical analysis was combined with four single types: mean power frequency (MPF), spectral moments ratio (SMR), fuzzy approximate entropy (fApEn) and Lempel-Ziv complexity (LZC). The test results of the evaluation index fatigue evaluation method were compared. The test results show that the method in this paper has a recognition rate of 98.6% for the overall fatigue state and 97%, 100%, and 99% for the three states of ease, transition and fatigue, which are more advantageous than other methods. The research results of this paper prove that the method in this paper can effectively prevent secondary injury caused by overtraining during upper limb exercises, and is of great significance for fatigue monitoring.
