In order to realize an individualized and specialized rehabilitation assessment of remoteness and intelligence, we set up a remote intelligent assessment system of upper limb movement function of post-stroke patients during rehabilitation. By using the remote rehabilitation training sensors and client data sampling software, we collected and uploaded the gesture data from a patient's forearm and upper arm during rehabilitation training to database of the server. Then a remote intelligent assessment system, which had been developed based on the extreme learning machine (ELM) algorithm and Brunnstrom stage assessment standard, was used to evaluate the gesture data. To evaluate the reliability of the proposed method, a group of 23 stroke patients, whose upper limb movement functions were in different recovery stages, and 4 healthy people, whose upper limb movement functions were normal, were recruited to finish the same training task. The results showed that, compared to that of the experienced rehabilitation expert who used the Brunnstrom stage standard table, the accuracy of the proposed remote Brunnstrom intelligent assessment system can reach a higher level, as 92.1%. The practical effects of surgery have proved that the proposed system could realize the intelligent assessment of upper limb movement function of post-stroke patients remotely, and it could also make the rehabilitation of the post-stroke patients at home or in a community care center possible.
Objective To evaluate the effect of Otago exercise program (OEP) on fear of falling in central hemiplegia patients in communities. Methods We collected the clinical data of 61 central hemiplegia patients in the Department of Neurology of Pangang General Hospital from January to June 2014. They were randomly divided into treatment group (n=30) and control group (n=31) after discharge. The treatment group had OEP, while the control group had not. After 20 weeks of follow-up, we evaluated fall self-efficacy, balance and mobility of patients in the two groups. Results The OEP adherence rate was 73.3% for the treatment group. In the treatment group, modified fall efficacy scale (MFES) score and Berg balance scale (BBS) score were significantly higher than those before intervention (P<0.05); time up and go test (TUGT) score was significantly lower than that before intervention (P<0.05). In the control group, MFES score, BBS score and TUGT score were not significantly changed (P>0.05). After intervention, MFES score and BBS score of the treatment group were significantly higher than those of the control group (P<0.05), but TUGT score was not significantly different (P>0.05). Conclusion OEP for central hemiplegia patients after discharge can reduce fall self-efficacy and increase balance ability of the patients.
Objective To investigate the difference in the effectiveness between proximal femoral nail anti-rotation (PFNA) and proximal femoral locking compression plate (PFLCP) for intertrochanteric fracture in elderly patients combined with hemiplegia due to cerebral infarction. Methods The clinical data of 67 cases of intertrochanteric femoral fractures combined with hemiplegia due to cerebral infarction between October 2013 and January 2017 were retrospectively analyzed. Among them, 32 cases were treated with PFNA internal fixation (PFNA group), and 35 cases were treated with PFLCP internal fixation (PFLCP group). There was no significant difference in gender, age, injury side, modified Evans classification of fracture, preoperative medical disease, and interval from injury to operation between 2 groups (P>0.05). The operation time, intraoperative blood loss, postoperative bed time, incidence of perioperative complications, time of fracture healing, and hip Harris score at 6 months and 1 year after operation were recorded and compared. Results Both groups were followed up 12-24 months with an average of 14 months. Compared with the PFLCP group, the PFNA group had shorter operation time, less intraoperative blood loss, and shorter bed time, and the differences were significant (P<0.05). X-ray films showed that the fractures healed in both groups. The fracture healing time of the PFNA group was shorter than that of the PFLCP group, but the difference was not significant (t=0.743, P=0.460). During hospitalization, there were 3 cases of pulmonary infection, 2 cases of deep venous thrombosis of lower limbs, and 1 case of urinary tract infection in the PFNA group; and the incidence of perioperative complications was 18.8% (6/32). There were 4 cases of pulmonary infection, 6 cases of deep venous thrombosis of lower limbs, 1 case of recurrent cerebral infarction, and 1 case of stress ulcer in the PFLCP group; and the incidence of perioperative complications was 34.3% (12/35). There was no significant difference in the incidence of perioperative complications between 2 groups (χ2=2.053, P=0.152). At 6 months after operation, the Harris total score and individual scores in the PFNA group were higher than those in the PFLCP group (P<0.05). At 1 year after operation, there was no significant difference in the Harris total score and pain score, life ability score, and walking ability score between the PFNA group and the PFLCP group (P>0.05); However, the joint deformity and activity score of the PFNA group was significantly better than that of the PFLCP group (t=4.112, P=0.000). Conclusion For intertrochanteric fracture in elderly patients with cerebral infarction hemiplegia, the PFNA has shorter operative time, less intraoperative blood loss, shorter bed time after operation, and better short-term hip function when compared with the PFLCP.
In this paper, the research has been conducted by the Microsoft kinect for windows v2 for obtaining the walking trajectory data from hemiplegic patients, based on which we achieved automatic identification of the hemiplegic gait and sorted the significance of identified features. First of all, the experimental group and two control groups were set up in the study. The three groups of subjects respectively completed the prescribed standard movements according to the requirements. The walking track data of the subjects were obtained straightaway by Kinect, from which the gait identification features were extracted: the moving range of pace, stride and center of mass (up and down/left and right). Then, the bayesian classification algorithm was utilized to classify the sample set of these features so as to automatically recognize the hemiplegia gait. Finally, the random forest algorithm was used to identify the significance of each feature, providing references for the diagnose of disease by ranking the importance of each feature. This thesis states that the accuracy of classification approach based on bayesian algorithm reaches 96%; the sequence of significance based on the random forest algorithm is step speed, stride, left-right moving distance of the center of mass, and up-down moving distance of the center of mass. The combination of step speed and stride, and the combination of step speed and center of mass moving distance are important reference for analyzing and diagnosing of the hemiplegia gait. The results may provide creative mind and new references for the intelligent diagnosis of hemiplegia gait.
Objective To explore the effect of foot spacing on multi-directional reach test in the normal elderly and elderly patients with hemiplegia. Methods From October 2019 to December 2020, 50 eligible elderly hemiplegic cases and 50 normal elderly cases were randomly collected. The multi-directional reach tests with foot spacings of 1.0A, 1.5A and 2.0A (A=horizontal distance between bilateral anterior superior iliac spines) were carried out, and the differences and correlations of the maximum horizontal extension distances in the same direction with the three foot spacings were analyzed. Results The statistical results of the normal elderly group (n=50), the left hemiplegic elderly group (n=28), and the right hemiplegic elderly group (n=22) could be described as follows: the maximum horizontal stretching distances in the same direction of left or right were significantly different among the tests with three foot spacings (P<0.05), and the horizontal stretching distance was the largest when the foot spacing was 1.5A; there was no statistically significant difference in the maximum horizontal extension distances in the same direction of forward or backward among the tests with three foot spacings (P>0.05). In the normal elderly, the Pearson correlation coefficients between the maximum horizontal extension distances with the three foot spacings in the left direction were 0.64-0.71 (P<0.05), and those in the right direction were 0.68-0.75 (P<0.05). In the left hemiplegic elderly, the Pearson correlation coefficients between the maximum horizontal extension distances with the three foot spacings in the left direction were 0.72-0.77 (P<0.05), and those in the right direction were 0.78-0.82 (P<0.05). In the right hemiplegic elderly, the Pearson correlation coefficients between the maximum horizontal extension distances with the three foot spacings in the left direction were 0.62-0.77 (P<0.05), and those in the right direction were 0.72-0.88 (P<0.05). Conclusions The results of the study on the normal elderly, left hemiplegic elderly and right hemiplegic elderly are the same. When the normal elderly and hemiplegic elderly are tested in the community and clinic, the fixed foot spacing should be chosen, and the maximal horizontal extension distance on the coronal plane is significantly affected by different foot spacings.
Objective To systematically evaluate the effect of arm sling on shoulder subluxation in stroke patients with hemiplegia. METHODS CNKI, Wanfang, VIP, PubMed, Web of Science, Embase, Cochrane Library, OVID, EBM Reviews, Best Practice, ACP Journal Club, and Practice Guidline were searched from establishment to March 2023. The literature on randomized controlled trials of arm sling on gait or balance in post-stroke patients with hemiplegia were included. RevMan 5.4.1 software was used for meta-analysis. Results A total of 13 articles were included, including 691 subjects, 343 in the experimental group, and 348 in the control group. The meta-analysis results showed that patients wearing the boom arm were effective in improving the recovery of upper extremity function [mean difference (MD)=8.12, 95% confidence interval (CI) (2.39, 11.60), P＜0.000 01], relieving pain due to shoulder subluxation [MD=−1.13, 95%CI (−1.70, −0.56), P=0.000 1], and enhancement of patients’ quality of life in daily activities [MD=15.07, 95%CI (3.24, 26.90), P=0.01], all of which were superior to the control group. However, there was no statistically significant difference between the two groups in terms of Apnea-Hypopnea Index [MD=−1.86, 95%CI (−3.79, 0.06), P=0.06], 6 min walking test [MD=−0.51, 95%CI (−18.52, 17.49), P=0.96], 10 meter walk time [MD=0.00, 95%CI (−0.06, 0.06), P=0.91], heart rate [MD=−0.22, 95%CI (−5.10, 4.27), P=0.93], and Berg balance scale [MD=−2.53, 95%CI (−8.17, 3.10), P=0.38]. Conclusion The use of arm sling can effectively improve patients’ quality of life, functional recovery of the upper limbs and reduce pain, providing an evidence-based basis for healthcare professionals to treat patients with proven treatment modalities.