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From April to November 2019, 5 community health service centers in Shanghai Hongkou District were randomly selected for thematic group interviews to investigate the current status, problems and challenge for further development of chronic disease management. The community chronic disease management was mainly divided into growth period (typically hypertension and diabetes) and introduction period (cardiovascular and cerebrovascular diseases, respiratory diseases, dementia, osteoporosis). The management of hypertension and diabetes in the growing stage mainly faced difficulties such as refusal or non-cooperation of patients, loss of follow-up, incomplete quality control, not meeting quality control indicators, repeated management of comorbidities, insufficient information sharing, and discrepancy in assessment indicators of multiple parties. The management of cardiovascular and cerebrovascular diseases, respiratory diseases and other diseases in the introduction period mainly faced poor awareness rate of patients, loss of follow-up, difficulty in diagnosis, irregular medication, insufficient information sharing, lack of management plan, insufficient resource investment, and few variety of medicines in the community. The current management system should be refined to provide more effective and efficient chronic disease management in the community. Meanwhile, the awareness of residents, the information network and multi-center collaborative research also need to be strengthened.
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Objective:To observe the effect of observing good swallowing on the swallowing action of stroke survivors with dysphagia.Methods:Eighteen stroke survivors with dysphagia were randomly divided into a treatment group ( n=9) and a control group ( n=9). In addition to routine swallowing rehabilitation therapy, the treatment group was asked to simulate swallowing after watching a video of normal people′s swallowing action. They did so 5 times a week for 10 minutes, while the control group just watched landscape videos at the same time. The treatment lasted 8 weeks. Before and after the treatment, both groups were assessed using the eating assessment tool (EAT-10), the functional oral intake scale (FOIS) and the penetration and aspiration scale (PAS). Functional magnetic resonance imaging (fMRI) was also used to observe their swallowing action. Results:There was no significant difference between the two groups in any of the measurements before the treatment. After the 8 weeks of treatment the average EAT-10, FOIS and PAS scores of the treatment group were all significantly better than before the treatment and better than the control group′s averages at the time. fMRI showed significantly more areas activated in the precuneus, parietal lobe, posterior central gyrus, BA7, BA5, frontal lobe and paracentral lobule in the treatment group compared with before the intervention and also more than in the control group.Conclusions:Observing proper swallowing action can improve dysphagia and activation of the swallowing-related brain areas of stroke survivors.
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Objective:To observe any effect of repeated unilateral high frequency transcranial magnetic stimulation (rTMS) on the swallowing function and functional magnetic resonance images of dysphagic stroke survivors.Methods:Twenty stroke survivors with dysphagia were randomly divided into a treatment group ( n=10) and a control group ( n=10). Both groups received traditional swallowing rehabilitation training, while the treatment group was additionally provided with high frequency rTMS over the cortical area of the suprahyoid muscle group of the healthy contralateral cerebral hemisphere. The stimulation frequency was 5Hz and the stimulation intensity was 80% of the resting movement threshold. During the 20-minute treatment, there was a 20-second interval between each 2-second dose of stimulation. Before and after the treatment, both groups were evaluated using the Eating Assessment Tool-10 (EAT-10), a swallowing functional communication measurement (FCM) and the modified Mann Assessment of Swallowing Ability (MMASA). In addition, functional magnetic resonance imaging was used to observe any changes in the relevant brain regions. Results:After the treatment the average EAT-10, FCM and MMASA scores of both groups were significantly better than those before the treatment, with the treatment group′s averages significantly superior to those of the control group. After the treatment, the activation range of the parietal lobe, the superior parietal lobule, the BA7 region and the BA40 area in the treatment group was significantly larger than before the treatment and larger than the control group′s ranges.Conclusions:Repeated high-frequency transcranial magnetic stimulation of the cortical area of the suprahyoid muscles in the contralateral cerebral hemisphere can improve dysphagia and promote the activation of brain areas related to swallowing after a stroke.
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Objective:To observe the effect of applying repetitive transcranial magnetic stimulation (rTMS) on swallowing function and auditory evoked potentials in the brain-stems of stroke survivors with dysphagia.Methods:Sixty stroke survivors with dysphagia were randomly assigned to an observation group and a control group, each of 30. Both groups were given 30 minutes of routine swallowing training 6 times a week for 5 weeks, while the observation group was additionally provided with two-second bursts of rTMS on the left and right brain hemispheres alternately for 20 minutes daily. The frequency was 3.0Hz and the strength was 80% of the resting motor threshold (RMT), with an interval of 10 seconds between bursts. Before and after the treatment, both groups′ swallowing was assessed using the functional communication measure (FCM) and the modified Mann swallowing capacity evaluation scale (MMASA). Brainstem auditory evoked potentials (BAEP) were recorded to detect any changes in the peak latency (PL) and inter-peak latency (IPL). The clinical efficacy was also observed.Results:After the treatment, the average FCM results of both groups had improved significantly, but the observation group had improved significantly more. The average MMASA total scores and the average scores on all the sub-items had improved significantly more in the observation group except for the expressive speech disorder and anarthria scores. After the treatment, improvement was observed in respiration, anarthria, range of motion of the tongue muscles, strength of the tongue muscles, gag reflex and soft palate movement compared with before the intervention. Peak and inter-peak latencies had also improved significantly more in the observation than in the control group, on average.Conclusions:rTMS combined with conventional swallowing training can significantly improve the swallowing of dysphagic stroke survivors, and shorten the PL of the BAEP so as to better regulate deglutition.
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Objective To explore the effects of action observation therapy on upper-extremity motor function and ability in the activities of daily living after cerebral infarction.Methods Forty-one cerebral infarction survivors were randomly assigned to an observation group (n =21) or a control group (n =20).Both groups were given the conventional rehabilitation treatment,while the observation group additionally received action observation therapy 20 mins per day,6 times per week for 8 weeks.Before and after the 8 weeks of treatment,both groups were assessed using the Fugl-Meyer assessment (FMA),Wolf's motor function test (WMFT) and the modified Barthel index (MBI).Results Before the intervention there was no significant difference between the groups in any of the measurements.After the 8 weeks of treatment,all of the results in the treatment group were significantly better,on average,than those of the control group.Conclusions Action observation therapy can improve upper-extremity motor function and ability in the activities of daily living after stroke.
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Objective To explore the effectiveness of a respiratory function training instrument with stable chronic obstructive pulmonary disease (COPD) patients.Methods Sixty-seven COPD patients in the stable period were randomly divided into a treatment group of 36 and a control group of 31 using a random number table.Both groups were given conventional pulmonary rehabilitation,including half-closed lip respiration,abdominal respiration and upper limb training.The treatment group was additionally provided with 30 minutes of respiratory training using a respiration function training instrument 5 times per week for 6 months.Both groups were assessed for their mobility,life quality and pulmonary function using the 6-minute walk test (6 MWT),a COPD assessment test (CAT),the BODE index,forced vital capacity (FVC),forced expiratory volume in one second (FEV1) and surface electromyography (SEMG) of the respiratory muscles before and after the 6-month intervention.Results Before the treatment there were no significant differences between the two groups in terms of any of the measurements.After the treatment,significant improvement was observed in the average 6 MWT,CAT,BODE index and SEMG results in both groups,but with significantly greater improvement in the treatment group.The average FVC and FEV1 results did not improve significantly,so after the intervention there was still no significant difference between the groups.Conclusions Respiratory training using the pulmonary function training instrument can improve the mobility,life quality and the functioning of the respiratory muscles of COPD patients in the stable period.
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Objective To explore any effect of combining urodynamic analysis with individualized bladder training in rehabilitating neurogenic bladder dysfunction after spinal cord injury.Methods Urology patients who had suffered a spinal cord injury were randomly divided into an experimental group and a control group.Both groups were given routine drugs and intermittent catheterization based on a urodynamics analysis using the Laborie urodynamic analyzer.The experimental group also received individualized bladder training for eight weeks.The bladder balance time and urinary infection rate of both groups were recorded 2,4,6 and 8 weeks after the intervention.Results After treatment,all of the patients wcrc able to achieve bladder balance,but the average bladder balance time of the experimental group was significantly shorter than that of the patients in the control group with similar injuries.After 2,4,6 and 8 weeks the incidence of urinary infection in the experimental group was significantly lower than in the control group.Moreover,after the treatment the average bladder storage volume (VH2O),bladder compliance (BC),bladder pressure (Pves) and detrusor pressure (Pdet) of both groups were significantly better than before the treatment,but the results of the experimental group were,on average,significantly better than those in the control group.Conclusion Individualized bladder training can effectively promote bladder balance and reduce the risk of urinary infection after spinal cord injury.
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Objective To explore the effects of action observation therapy on upper-extremity motor function after ischemic stroke and on the motor cortex using functional magnetic resonance imaging (fMRI).Methods Forty patients with ischemic stroke were randomly assigned to an observational group (n =20) or a control group (n =20).Both groups received conventional rehabilitation,while the observational group was additionally provided with action observation therapy for 8 weeks.Both groups were assessed using the Fugl-Meyer assessment (FMA) and the Barthel index (BI) before and after the 8 weeks of treatment and functional magnetic resonance imaging was performed before treatment.Two months after the treatment,nine patients of the experimental group and 8 of the control group who continued to receive their respective treatments after discharge were again assessed using functional magnetic resonance imaging.Results After the treatment the average FMA score and BI score of both the observational group and the control group had increased significantly.The increase in the average FMA score of the observational group was significantly greater than that of the control group.However,there was no significant difference between the two groups in the increases in BI score after 8 weeks of treatment.The fMRI results showed that there was a significantly greater rise in activity in the bilateral precentral gyrus,parietal lobe and the supplementary motor area of the patients in the observational group after the treatment compared with the control group.Conclusion Action observation therapy can improve upper extremity motor function and performance in the activities of daily living after ischemic stroke and induce changes in the excitability of the cerebral motor cortex.
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Objective To observe the effects of action observation therapy based on mirror neuron theory on upper-extremity motor function and performance in activities of daily living(ADL) after stroke.Methods Eightyone stroke patients were randomly assigned to an observational group (41 cases) or a control group (40cases).Both groups received conventional rehabilitation,and the observational group also received action observation therapy for 16 weeks,10 times per week.Upper-extremity motor function and ADL performance were assessed before treatment using the Fugl-Meyer assessment (FMA) and the Barthel index (BI) and then again after 4,8 and 16 weeks of treatment.Results The average FMA scores and BI scores in the observational group at the 4th week (32.50 ± 9.32 and 67.41 ± 16.81),the 8th week (36.35 ± 8.32 and 78.74 ± 15.63) and the 16 th week (41.32 ± 13.45 and 93.85 ± 13.45) had increased significantly compared with the pre-treatment assessment and were significantly better than at the same time point for the control group (P ＜ 0.05).Conclusion Action observation therapy based on mirror neuron theory can promote the recovery of upper-extremity motor function and ADL performance after stroke.
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Objective To explore the effects of virtual reality (VR) combined with motor imagery therapy on the upper limb function of hemiplegic stroke survivors.Methods Thirty-nine hemiplegic stroke patients were divided randomly into a treatment group (n =20) and a control group (n =19).Both groups were treated with motor imagery therapy,but the treatment group also received VR training lasting 20 min/day,6 days/week for 8 weeks.All of the patients were assessed with the Fugl-Meyer (FMA) upper limb assessment,the modified Barthel index (MBI) and electromyography at the beginning and after eight weeks of treatment.Results Before the intervention there was no significant difference between the groups in any of the assessments.After eight weeks of treatment,all the assessment results in the treatment group were significantly better than those in the control group.Conclusion Virtual reality combined with motor imagery therapy can distinctly improve the upper limb motor function of hemiplegic stroke survivors and their ability in the activities of daily living.
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Objective To evaluate and analyze the clinical effect of comprehensive rehabilitation therapy after arthroscopic rotator cuff repair using suture-bridge technique for full-thickness rotator cuff tears.Methods Forty-one patients (20 males,21 females; mean age 52.2 years) with full-thickness rotator cuff tears were treated with arthroscopic rotator cuff repair using suture-bridge technique between June 2010 and January 2012 in our hospital.After arthroscopic rotator cuff repair,the patients were randomly assigned to a treatment group (21 patients) or a control group (20 patients).The treatment group received systematic rehabilitation therapy including rehabilitation education,physical modalities treatment and rehabilitative training additionally,while the control group only accepted the routine rehabilitation therapy including stretching and muscle strength training.The outcome was evaluated at 6 months after surgery,by employing visual analogae scale (VAS),the range of motion (ROM) testing of shoulder joint flexion and rotation,the rating scale of University of California at Los Angeles (UCLA),and the shoulder index of American shoulder and elbow surgeons (ASES).Results The mean follow-up period was 15.6 months (8-24 months).Prior to intervention,there was no significant difference in any parameter between the two groups (P ＞ 0.05).Six months later,all scores of assessments changed:in treatment group VAS (1.7 ± 1.5),ROM [flexion (168.3±31.3)°,rotation (47.2±11.2)°],UCLA(30.7 ±4.13) and ASES (85.1 ±15.67); in control group VAS(3.8±2.2),ROM[flexion (121.2 ±53.6)°,rotation (32.9 ±14.9)°],UCLA(18.3 ±4.94) and ASES (36.4 ± 17.70).Significant changes occurred in both groups in all the parameters after treatment when compare to baseline (P ＜ 0.05).Conclusions Comprehensive rehabilitation therapy is an effective approach for improving motor ability of the shoulder in patients after arthroscopic rotator cuff repair with suture-bridge technique for their full-thickness rotator cuff tears.
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@#Objective To explore the nursing after free great toe fibular flap transplant to repair finger pulp defects. Methods 12 cases with finger pulp defect accepted the free great toe fibular flap were reviewed. Results All flaps survived and no vascular crisis occurred. The flap shaped well, and the skin sweated and the two point discrimination was 4-6 mm. Conclusion Close monitoring and appropriate is important after free great toe fibular flap transplant to repair finger pulp defects.
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@#Objective To observe the effect of psychological intervention on dysphagia after stroke complicated with depression. Methods 60 cases with dysphagia complicated with depression were divided into treatment and control groups. Based on the nountine nursing and swallowing function training, the treatment group received psychological intervention. They were assessed with multimodel approach to diagnosis of post stroke depression (MMADD) and drinking test before and after treatments. Results The scores of drinking test and MMADD inside symptom in treatment group were lower than that of control （P＜0.05）. Conclusion The psychological intervention at early stage can facilitate the recovery of swallowing dysfunction and depresson after stroke.
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OBJECTIVE To investigate the influence of intermittent catheterization methods and indwelling catheterization methods on the urinary tract infection in patients with spinal cord injury.METHODS After eighty cases of spinal cord injury,the urine retention patients caused by bladder dysfunction were respectively used intermittent catheterization and indwelling catheterization.The urinary tract infection rates of regucally urine culture were compared.By use of intermittent catheterization,the bladder function was trained.Bacteria culture and identification of the urine from the patients were conducted after 15 or 30 days of intermittent catheterization and indwelling catheterization respectively.RESULTS The rates of urinary tract infection(colony count≥1?10 CFU/ml) after 15 or 30 days of intermittent catheterization were 32.6% and 31.5%,respectively.Which were significantly lower than those of indwelling catheterization(100%)(P
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Objective To observe the iffectiveness of comprehensive rehabilitationinterventions on stroke patients with unilateral spatial neglect (USN). Methods A total of 245 cases if strijd were examined to diagnose USN. Of the 245 patients,86 cases were diagnosed as being with USN, and divided into a control group(n=43 cases) and a treatment group (n=43 cases) randomly. The control group was treated with Bobath and Rood techniques in addition to routine clinical medical interventions, while the treatment group was treated with a comprehensive rehabilitation protocol for USN in addition to the same interventions for the control group. Both groups were assessed with regard to motor, balance function, walking performance, and USN severity as well as the activities of daily living (ADL) performance. Results After 8 weeks of treatment,both groups improved, but there showed a significantly statistical difference between the 2 groups in terms of Fugl-Meyer motor function scores (P＜0.01), balance function scores (P＜0.01) Holden walding function classifications (P＜0.01), Barthel index(P＜0.001) and USN severity scores(P＜0.01). Conclusion Comprehensive USN rehabilitation intervention could improve motor, balance, walking functions and ADL performance and alleviate the USN severity in stroke patients with USN.
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@#Objective To explore the effect of rehabilitation training combined with rational-emotive therapy on post-stroke depression (PSD).Methods 51 PSD patients were randomly divided into the treatment group (n=25) and control group (n=26). All patients received routine rehabilitation training, simultaneously took 20 mg of fluoxetine hydrochloride dispersible tablets per day. Based on above, the treatment group was given physiological rehabilitation treatment with rational-emotive therapy in early stage, 30 min each time, continuously 6 weeks. The two groups were assessed with Zung Self-rating Depression Scale and Fugl-Meyer Motor Scale before and after treatment.Results Afer treatment, the scoers of Zung Self-rating Depression Scale and Fugl-Meyer Motor Scale of the treatment group was higher than that of the control group ( P<0.05).Conclusion The rational-emotive therapy might improve the depression condition of post-stroke, enhance patients' motor function.
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Objective To observe the effect of early occupational therapy intervention on unilateral spatial neglect caused by stroke.Methods A total of 92 patients with unilateral spatial neglect caused by stroke were ran- domly divided into a treatment group(46 cases)and a control group(46 cases).The cases of the control group were treated by routine clinical treatment plus positioning on the bed,passive joint motion,bridging movement,facilitation techniques,balance training in sitting and standing positions,gait training immediately after the patients' conditions got stable.The patients in the treatment group were treated with activities of daily living(ADL)training in addition to the interventions employed in the control group.Results Effect of the treatment group are superior to that of the control group as reflected by the scores with Fug1-Meyer scale and Barthel Index(P
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@#目的探讨加强康复指导对提高患者运动功能和日常生活能力(ADL)的意义。方法选择脊髓损伤患者59例,随机分两组,1组在康复治疗过程中开展康复指导(以下简称康复指导组) ;1组常规康复治疗(以下简称对照组)。康复指导组由专人负责制订实施康复训练,并对患者及家属、陪护人员进行指导。对照组不设专人,由主管医师负责康复训练并提供随机指导。治疗前及治疗后两组患者均采用Barthel指数进行评定。结果康复指导组在患者运动功能、ADL方面明显优于对照组,差异有显著性(P<0.01)。结论脊髓损伤康复中加强康复指导,有助于提高患者运动功能和生活自理能力。