骨科
词汇介绍
拓展阅读
解析
Tetraplegia /,tetrə'pli:dʒiə/
释义 n. 四肢瘫痪,四肢麻痹(等于 quadriplegia)
例句 Spinal cord injury may cause tetraplegia or paraplegia, which is a great damage to the abilities of people' daily living. 脊髓损伤往往造成不同程度的四肢瘫或截瘫,是一种严重致残性的创伤。
概述
概述
随着社会现代化程度的提高,特别是交通工具的发展,脊髓损伤的发病率逐年升高。 全球统计脊髓损伤发生率是223 ~755 例/百万人,各地区患病率和发病率的数据相差很大,与当地人口和社会经济因素有关,50%患者诊断是科学完整的,其中 1/3 为四肢瘫痪患者。我国发病率也有明显上升,据有关资料表明,我国脊柱损伤发病率25 ~35 例/10万人,其中1/7 ~1/6 伴有脊髓损伤,多以青壮年为主。
病因及病理机制
颈髓损伤是 SCI中最常见损伤类型,占 SCI损伤 55% ~75%,病死率可高达26%,胥少汀发现,上脊髓损伤绝大多数为不完全脊髓损伤,如为完全性脊髓损伤,因呼吸肌肉全麻痹,鲜有生存较久者。存活患者多伴有四肢瘫痪,严重影响患者的活动能力,生活依赖于他人。
临床表现
出现双下肢无力,骑自行车抬腿困难,上楼梯、蹲下站起时费力,于数月后出现双上、下肢无力,持物抬举、行走困难。
鉴别诊断
一、大脑病变所致的四肢瘫 脑血管病所致四肢瘫为老年人多见,呈隐袭性进行四肢不全性痉挛性瘫痪,同时伴有构音障碍、咽下困难等假性球麻痹症状。多发性硬化反复发作可致双侧偏瘫,常伴有假性延髓麻痹,两侧大脑半球病损,如脑水肿等可有四肢瘫及去脑强直。
二、脑干病变所致的四肢瘫 脑干病变发展至两侧时可引起四肢瘫,其瘫痪呈四肢不全性痉挛性瘫痪,伴有颅神经损害。
三、颈髓病变所致的四肢瘫 颈髓病变时常见四肢瘫。枕骨大孔附近的肿瘤可出现四肢瘫,其特点是瘫痪顺序是先从一侧上肢开始,以后波及同侧下肢,再次为另一侧上肢及下肢。颈髓上部和中部的肿瘤,瘫痪呈隐袭进行性、痉挛性四肢瘫。颈膨大肿瘤上肢呈弛缓性,下肢呈痉挛性四肢瘫痪,上肢因相应的脊髓前角和前根的损害而出现弛缓性瘫痪,下肢因锥体束损害而出现痉挛性瘫痪。肌萎缩侧束硬化的四肢瘫是开始出现上肢肌萎缩,经后出现下肢瘫痪。颈髓出血、外伤引起的四肢瘫,其特点是起病突然,开始呈四肢弛缓性瘫痪,以后逐渐向痉挛瘫痪移行,并伴有各种类型的感觉障碍。
治疗方式
徒手运动疗法:
(1)提高肌力和耐力训练,主要针对背阔肌,上下肢肌群和躯干肌训练。
(2)平衡训练:床上半坐位或端坐位平衡训练,同时进行斜板床站立训练等。 (3)体位变换及电动站立床训练:可在别人帮助下完成卧位到坐位、翻身等转移动作。
(4)轮椅训练。
(5)步行训练。作业疗法:进行日常生活能力训练,如穿衣、进食、转移、入 厕等,并训练利用支具辅助日常活动。
四肢瘫患者使用植入的脑机接口和前臂经皮肌肉刺激在熟练掌握协调方面有临床意义
发表时间:2019-07-01
影响指数:2.7
作者: Bockbrader M
期刊:Arch Phys Med Rehabil
Generalizability can also refer to the number of grip types that a user can switch between using the same decoder. A limitation of training minimal-class decoders for individual test items is that additional setup time is needed to switch grips, resulting in standardized testing that stretches across days. This can confound effects specific to objects (eg, weight, shape) with time effects (eg, learning) and limit opportunities for reassessing performance over time. It also fails to address user priorities of spontaneity, decreased setup times, and number of functions available per decoder. For this reason, multiclass GRT decoders were implemented that allowed assessment of all objects without retraining. Performance with the multiclass decoder (see fig 5D) was similar to the single-class decoder for some objects (peg, weight, fork, video tape) but not others (can, block). For block and can, the participant required more time to select the appropriate grip decoder-calibration, reducing transfer rate in multiclass conditions compared to simpler 1 to 2 class decoders. The additional selection time for block was likely related to observed overlap in cortical representation with other GRT object or grips.
译文