疏经通督推拿法治疗缺血性脑卒中恢复期患者的临床研究
|
摘要
目的：
本研究以缺血性脑卒中恢复期患者作为研究对象,运用生物力学、运动学技术及现代康复医学功能评估系统作为研究分析方法,评价疏经通督推拿对缺血性脑卒中患者运动功能的治疗作用,探讨其对脑卒中患者运动功能改善的机制。
方法：
本研究中实验对象为缺血性脑卒中恢复期患者。选自于2009年10月-2011年10月间在南京江北人民医院康复医学科和神经内科门诊及病房住院、诊断符合1995年的《脑血管疾病分类》标准并经CT或MRI检查确诊的120例患者,按照随机原则分为治疗组(疏经通督推拿法治疗)41例、对照组(普通推拿治疗)40例、康复组(康复治疗)39例。所有入组病例均根据基础疾病情况进行相应药物治疗。同时,入组时根据随机排列数据表,每组选择10名患者进行步态运动学分析测试。
研究时间为8周,观察8周治疗前后的临床疗效、神经功能缺损程度评分(neural function defect degree rating scale,NFDS)、偏瘫肢体改良Ashworth肌张力评定(modified Ashworth scale,MAS)、肢体运动功能评分(Fugl-Meyer量表评分,Fugl-Meyer assessment,FMA)、平衡功能评分(Berg评分,Berg balance scale,BBS)、功能综合量表评分(functional comprehensive assessment,FCA)、日常生活活动能力评分(改良Barthel指数,modified Barthel index,MBI)、生活质量评分(SF-36量表)以及步态时间-距离参数、下肢关节角度与步行效率等指标的变化情况。
结果：
(1)、一般情况比较：各组患者的性别、年龄、身高、病程、利手侧、偏瘫侧等一般情况比较,差异均无统计学意义；治疗前所有各组NFDS、MT、FMA、BSS、FCA、MBI、 SF-36总得分等评定无统计学意义,在步态时间-距离参数、下肢关节角度以及步行效率等各参数比较上差异均无统计学意义。因此各组间具有可比性。
(2)、与治疗前比较,治疗组、康复组患者在NFDS、MT、FMA、BSS、FCA、MBI、 SF-36总得分等评定项目上均有改善,治疗4周后、治疗8周后与治疗前比较、治疗8周后与治疗4周时比较各项目均有显著性差异。
(3)、与治疗前比较,对照组患者在NFDS、MT、FMA、BSS、FCA、MBI、SF-36总得分等评定项目上均有改善,在MT、FMA、BSS、FCA、 MBI、SF-36总得分等项目上治疗4周后、治疗8周与治疗前、治疗8周后与治疗4周时相比较差异均有显著性,但在NFDS等项目上治疗4周后与治疗前比较差异无意义。
(4)、组间比较：治疗4周后,治疗组与对照组比较,在NFDS、BSS等项目上差异有显著性,在BSS上治疗组与康复组比较也有统计学意义,在NFDS项目上康复组与对照组比较有统计学意义；治疗8周后相比较,治疗组与对照组比较,在NFDS、MT、BSS等项目上差异有显著性,在NFDS、MT、 BSS、FCA、SF-36,总得分等项目上对照组与康复组比较有统计学意义,在MT、BSS、FCA、SF-36总得分等项目上治疗组与康复组比较也有统计学意义。
(5)、治疗前后临床疗效变化比较：与治疗前比较,三组治疗后临床疗效评分均有提高,其中治疗组临床疗效提高差异有显著性意义,康复组与对照组也有明显提高。组间比较,治疗组、康复组与对照组比较差异有统计学意义,治疗组与康复组比较无差异。
(6)、三组患者治疗后NFDS、MT、FMA、BSS、FCA、MBI、SF-36总得分等评定项目上均有改善,提示积极的干预措施对缺血性脑卒中偏瘫患者有着显著功能改善作用。
(7)、与治疗前比较,治疗组、对照组患者治疗后在MT、FCA、SF-36总得分等项目评定上较康复组患者改善明显,说明推拿在身心放松、缓解肌肉张力方面有独特的治疗作用,治疗过程中,着眼于整体治疗,注重医患间沟通交流,尊重患者感受,从而乐意被患者接受,治疗的依从性较高,对脑卒中患者精神心理状态、日常生活活动能力改善明显。
(8)、治疗前后步态时间-距离参数变化比较：与治疗前比较,三组治疗后患者的步长、步幅、步频、步宽有改变,但没有统计学意义,但三组患者的步速、患肢支撑相时间与摆动相时间变化相比有显著性意义。组间两两比较,治疗组与对照组、康复组组间比较有统计学意义,对照组与康复组组间比较无差异,提示康复治疗对脑卒中偏瘫患者步态的改善有积极作用,疏经通督推拿疗效最好。
(9)、治疗前后下肢关节角度变化比较：与治疗前比较,三组治疗前后患者的患肢膝关节在支撑相时最大伸展角度和摆动相时最大屈曲角度、以及踝关节在支撑相与摆动相时最大伸展角度和在支撑相时的最大屈曲角度有改变差异有显著性意义。组间两两比较,治疗组与对照组、康复组组间比较、对照组与康复组组间比较均无统计学意义。
(10)、治疗前后步行效率变化比较：与治疗前比较,三组治疗后患者步速均有提高,而耗氧量和氧价下降,治疗组患者步行效率改善差异有显著性意义,对照组与康复组的变化也有统计学意义。组间两两比较,治疗组与对照组、康复组组间比较有统计学意义,对照组与康复组组间比较无差异。提示疏经通督推拿对改善脑卒中偏瘫患者步行效率有着极其明显的作用。
结论：
(1)、缺血性脑卒中病因病机复杂,多种因素致瘀血阻滞、痰热内蕴,或阳化风动、血随气逆,导致脑脉痹阻引起昏仆不遂,发为中风。疏经通督推拿治疗脑卒中,根据临床辩证通过调节周身经气,理顺躯干与四肢肌肤经络,使督脉气机条达,调和经络气血和恢复脏腑功能,从而达到滋阴潜阳、通腑化痰、活血通络、益气养血的目的。
(2)、由于上运动神经元损伤,下运动神经元功能过度释放,导致肌肉功能紊乱,缺血性脑卒中患者表现为运动失能,引起生活质量下降。疏经通督推拿可以改善脑卒中偏瘫的运动功能,可能的作用机制为：疏经通督推拿通过干预肌肉生物共振频率,影响外周神经元节律性运动促使肌肉功能重建,修正异常运动模式促进肌群间的相互平衡和协调,提高肌肉耐力和活动的精确性,进而改善脑卒中偏瘫运动功能。
(3)、疏经通督推拿治疗兼顾了躯干和肢体的协调运动以及充分的感觉功能的参与,通过干预肌肉生物共振频率,平衡和协调神经肌肉功能,从而可以改善脑卒中偏瘫患者肢体运动功能和步行能力,提高患者的日常生活活动能力和生存质量,具有较好的近期疗效。
(4)、疏经通督推拿对脑卒中偏瘫有良好的治疗作用,是一种疗效确切、可操作性强、适宜推广的临床治疗方法,值得进一步探讨和研究。
Objective:
Using convalescent patients after ischaemic stroke as the research model and biological mechanics, kinematics technology, modern rehabilitation function evaluation system as the research analysis method,this study evaluated the therapeutic effect of unblocking meridians and governor vessel tuina on motor function of ischemic stroke patients and discussed the mechanism to improve the function.
Methods:
This study included a total of120convalescent patients after stroke from October2009to October2011, all of whom were recruited from Rehabilitation Department and Neurology of Nanjing JiangBei Hospital. The inclusion criteria were:diagnosis according with1995cerebrovascular disease classification and approved by CT or MRI. Subjects were randomly assigned into3groups:41subjects received unblocking meridians and governor vessel tuina therapy(the treatment group),40subjects received common massage therapy (the control group),while the rest of39subjects received rehabilitation therapy (the rehabilitation group).All subjects received drug treatment corresponding with its related disease.
At the same time,10patients were chosen from each group to receive gait kinematical analysis test according to random arrangement data tables.
The research time was8-weeks.At conclusion, assessments observed before therapy and8weeks post therapy were conducted with regard to clinical effects(Clinical curative effect score), neural function (neural function defect degree rating scale, NFDS),muscular tension (modified Ashworth scale, MAS),motor function(Fugl-Meyer assessment, FMA),balance (Berg balance scale, BBS), comprehensive function (functional comprehensive assessment, FCA), activities of daily living(modified Barthel index, MBI), the quality of life (SF-36scale), gait time-space parameters, lower limb joint Angle and walk efficiency indexes.
Results:
(1)、General condition:There were no statistically significant differences in physical or demographic characteristics among three groups,such as gender,age, height, the course, the hand side, the hemiparalysis side. There were no statistically significant differences among NFDS、MT、FMA、BSS、FCA、MBI and SF-36before therapy. Also, There were no statistically significant differences among gait time-distance parameters, lower limb joint angle and walk efficiency indexes. So each group was comparable.
(2)、Compared with that before treatment, improved outcomes in the patients of the treatment and rehabilitation group have been shown respectively on the assessment items, such as the total scores of NFDS, MT, FMA, and BSS, FCA, MBI, and SF-36, etc. There were significant differences between the total scores of the assessment items when compared with that before and after4weeks and8weeks treatment, and compared with that after4weeks and8weeks treatment respectively.
(3)、Compared with that before treatment, improved outcomes in the patients of the control group have shown respectively on the assessment items, such as the total scores of NFDS, MT, FMA, and BSS, FCA, MBI, and SF-36, etc. There were significant differences between the total scores of the assessment items, such as the total scores of MT, FMA, and BSS, FCA, MBI, and SF-36when compared with that before and after4weeks and8weeks treatment, and compared with that after4weeks and8weeks treatment. But there was no significant difference on NFDS when compared with that before and after4weeks treatment.
(4)、Compared among groups:After4weeks treatment, compared between the treatment group and the control group, the difference had statistical significance on the items, such as NFDS and BSS. Compared between the treatment group and the rehabilitation group, the difference on BSS had statistical significance. Between the control group and the rehabilitation group, a statistical significance on NFDS was also shown. After8weeks treatment, compared between the treatment group and the control group, the difference had statistical significance on the items, such as NFDS、MT and BSS. Compared between the control group and the rehabilitation group, the difference on the assessment items, such as the total scores of NFDS、 MT、BSS、FCA、SF-36had statistical significance. Compared between the treatment group and the rehabilitation group, the difference on the assessment items, such as the total scores of MT, BSS, FCA, and SF-36also had statistical significance.
(5)、Compared the Clinical effects before and after treatment:Compared with that before treatment, the score of the clinical curative effect of all groups increased. Treatment group raised significantly, rehabilitation group and control group also increased obviously. The difference were significant compared the treatment group and the rehabilitation group to the control group, but no difference was revealed between the treatment group and the rehabilitation group.
(6)、After the treatment in the three groups, improved outcomes in the patients have been shown respectively on the assessment items, such as the total scores of NFDS, MT, FMA, and BSS, FCA, MBI, and SF-36, etc., which showed active prevention therapy could significantly improve the functions of the ischemic stroke patients.
(7)、Compared with that before treatment, improved outcomes in the patients of the treatment and control group have been shown respectively on the assessment items, such as the total scores of MT, FCA, and SF-36, etc., which indicates that Tuina has a special curative effect on the patients'psychosomatic state and it can decrease the muscle tone. And during the treatment it is utilized for the overall therapy and doctors pay more attention to communicate with patients and respect patients' feeling, which in turn are willing to be accepted by patients and get higher adherence. It can significantly improve stoke patients' psychosomatic state and activities of daily life.
(8)、Gait time-space parameters:The stride length, distance, frequency and width of all groups did not change obviously, whereas, the speed, limb-support time and swing time changed significantly after therapy. Compared among groups, between the treatment group and the control group or between the treatment group and the rehabilitation group, the difference had statistical significance,but there was no difference between the control group and the rehabilitation group. It indicated rehabilitation had positive function on prompting the hemiplegia gait, and the unblocking meridians and governor vessel tuina work best among the three.
(9)、Lower limb joint Angle:The maximum stretch angle in support-phase and flexion angle in swing-phase of knee-joint all changed obviously, at the same time, the maximum stretch angle in support-phase and swing-phase and flexion angle in support-phase of ankle-joint also changed obviously. Compared among groups, between the treatment group and the control group, or between the treatment group and the rehabilitation group, or between the control group and the rehabilitation group,the difference had no statistical significance.
(10)、Walk efficiency:After therapy, the stride speed of three groups increased, whereas the oxygen consumption and oxygen valence decreased, so the walk efficiency improved obviously. Compared among groups, between the treatment group and the control group or between the treatment group and the rehabilitation group, the difference had statistical significance,but there was no difference between the control group and the rehabilitation group. The result showed unblocking meridians and governor vessel tuina can obviously improve the walk efficiency of hemiplegics.
Discussion:
(1) The etiology and pathogenesis of ischemic stroke are complicated. Stroke is marked by faint and hemiplegia caused by the obstruction of the brain vessels due to various kinds of factors, such as stagnation of blood stasis, internal accumulation of phlegm-heat, or yang turning into endogenous wind, blood flowing with adverse qi. Stroke can be treated by the method of dredging the governor meridian and massage. Through regulating the general qi flow and dredging the meridians and collaterals of the trunk, limbs and muscles, smooth qi movement of governor meridian, modified qi and blood circulation of the meridians and collaterals as well as the recovery of visceral function can be achieved. And thus, the purpose of nourishing yin and suppressing yang, unblocking the fu-organs and resolving the phlegm, activating blood circulation and dredging the collaterals, invigorating qi and nourishing blood can also be achieved.
(2) The damage of upper-motor neuron and the excessive release of lower-motor neuron leads to the disorder of muscle function, which also expresses movement disability and the decline in the quality of life in ischemic stroke patients. The unblocking meridians and governor vessel tuina can improve the motor function of hemiplegics. The most likely mechanisms are that it can influence the rhythmic movement of peripheral neurons to reconstruct the muscle function by intervening muscle biological resonant frequency and, fix abnormal motor pattern to promote the balance and coordination among muscle groups and increase the muscle endurance and the accuracy of activity.
(3) By intervening muscle biological resonant frequency and balancing and coordinating nerve muscle function, the unblocking meridians and governor vessel tuina can combine the coordination of the trunk and extremities with the participation of feeling function, which leads to the improvement of the motor function and walking ability and ADL and life quality in hemiplegics. It has good short-term curative effect.
(4) The unblocking meridians and governor vessel tuina have a good therapeutic effect on hemiplegics, it is a confirmed and exercisable clinical therapy, which is proper to popularize and worthy of further discussion and study.
本研究以缺血性脑卒中恢复期患者作为研究对象,运用生物力学、运动学技术及现代康复医学功能评估系统作为研究分析方法,评价疏经通督推拿对缺血性脑卒中患者运动功能的治疗作用,探讨其对脑卒中患者运动功能改善的机制。
方法：
本研究中实验对象为缺血性脑卒中恢复期患者。选自于2009年10月-2011年10月间在南京江北人民医院康复医学科和神经内科门诊及病房住院、诊断符合1995年的《脑血管疾病分类》标准并经CT或MRI检查确诊的120例患者,按照随机原则分为治疗组(疏经通督推拿法治疗)41例、对照组(普通推拿治疗)40例、康复组(康复治疗)39例。所有入组病例均根据基础疾病情况进行相应药物治疗。同时,入组时根据随机排列数据表,每组选择10名患者进行步态运动学分析测试。
研究时间为8周,观察8周治疗前后的临床疗效、神经功能缺损程度评分(neural function defect degree rating scale,NFDS)、偏瘫肢体改良Ashworth肌张力评定(modified Ashworth scale,MAS)、肢体运动功能评分(Fugl-Meyer量表评分,Fugl-Meyer assessment,FMA)、平衡功能评分(Berg评分,Berg balance scale,BBS)、功能综合量表评分(functional comprehensive assessment,FCA)、日常生活活动能力评分(改良Barthel指数,modified Barthel index,MBI)、生活质量评分(SF-36量表)以及步态时间-距离参数、下肢关节角度与步行效率等指标的变化情况。
结果：
(1)、一般情况比较：各组患者的性别、年龄、身高、病程、利手侧、偏瘫侧等一般情况比较,差异均无统计学意义；治疗前所有各组NFDS、MT、FMA、BSS、FCA、MBI、 SF-36总得分等评定无统计学意义,在步态时间-距离参数、下肢关节角度以及步行效率等各参数比较上差异均无统计学意义。因此各组间具有可比性。
(2)、与治疗前比较,治疗组、康复组患者在NFDS、MT、FMA、BSS、FCA、MBI、 SF-36总得分等评定项目上均有改善,治疗4周后、治疗8周后与治疗前比较、治疗8周后与治疗4周时比较各项目均有显著性差异。
(3)、与治疗前比较,对照组患者在NFDS、MT、FMA、BSS、FCA、MBI、SF-36总得分等评定项目上均有改善,在MT、FMA、BSS、FCA、 MBI、SF-36总得分等项目上治疗4周后、治疗8周与治疗前、治疗8周后与治疗4周时相比较差异均有显著性,但在NFDS等项目上治疗4周后与治疗前比较差异无意义。
(4)、组间比较：治疗4周后,治疗组与对照组比较,在NFDS、BSS等项目上差异有显著性,在BSS上治疗组与康复组比较也有统计学意义,在NFDS项目上康复组与对照组比较有统计学意义；治疗8周后相比较,治疗组与对照组比较,在NFDS、MT、BSS等项目上差异有显著性,在NFDS、MT、 BSS、FCA、SF-36,总得分等项目上对照组与康复组比较有统计学意义,在MT、BSS、FCA、SF-36总得分等项目上治疗组与康复组比较也有统计学意义。
(5)、治疗前后临床疗效变化比较：与治疗前比较,三组治疗后临床疗效评分均有提高,其中治疗组临床疗效提高差异有显著性意义,康复组与对照组也有明显提高。组间比较,治疗组、康复组与对照组比较差异有统计学意义,治疗组与康复组比较无差异。
(6)、三组患者治疗后NFDS、MT、FMA、BSS、FCA、MBI、SF-36总得分等评定项目上均有改善,提示积极的干预措施对缺血性脑卒中偏瘫患者有着显著功能改善作用。
(7)、与治疗前比较,治疗组、对照组患者治疗后在MT、FCA、SF-36总得分等项目评定上较康复组患者改善明显,说明推拿在身心放松、缓解肌肉张力方面有独特的治疗作用,治疗过程中,着眼于整体治疗,注重医患间沟通交流,尊重患者感受,从而乐意被患者接受,治疗的依从性较高,对脑卒中患者精神心理状态、日常生活活动能力改善明显。
(8)、治疗前后步态时间-距离参数变化比较：与治疗前比较,三组治疗后患者的步长、步幅、步频、步宽有改变,但没有统计学意义,但三组患者的步速、患肢支撑相时间与摆动相时间变化相比有显著性意义。组间两两比较,治疗组与对照组、康复组组间比较有统计学意义,对照组与康复组组间比较无差异,提示康复治疗对脑卒中偏瘫患者步态的改善有积极作用,疏经通督推拿疗效最好。
(9)、治疗前后下肢关节角度变化比较：与治疗前比较,三组治疗前后患者的患肢膝关节在支撑相时最大伸展角度和摆动相时最大屈曲角度、以及踝关节在支撑相与摆动相时最大伸展角度和在支撑相时的最大屈曲角度有改变差异有显著性意义。组间两两比较,治疗组与对照组、康复组组间比较、对照组与康复组组间比较均无统计学意义。
(10)、治疗前后步行效率变化比较：与治疗前比较,三组治疗后患者步速均有提高,而耗氧量和氧价下降,治疗组患者步行效率改善差异有显著性意义,对照组与康复组的变化也有统计学意义。组间两两比较,治疗组与对照组、康复组组间比较有统计学意义,对照组与康复组组间比较无差异。提示疏经通督推拿对改善脑卒中偏瘫患者步行效率有着极其明显的作用。
结论：
(1)、缺血性脑卒中病因病机复杂,多种因素致瘀血阻滞、痰热内蕴,或阳化风动、血随气逆,导致脑脉痹阻引起昏仆不遂,发为中风。疏经通督推拿治疗脑卒中,根据临床辩证通过调节周身经气,理顺躯干与四肢肌肤经络,使督脉气机条达,调和经络气血和恢复脏腑功能,从而达到滋阴潜阳、通腑化痰、活血通络、益气养血的目的。
(2)、由于上运动神经元损伤,下运动神经元功能过度释放,导致肌肉功能紊乱,缺血性脑卒中患者表现为运动失能,引起生活质量下降。疏经通督推拿可以改善脑卒中偏瘫的运动功能,可能的作用机制为：疏经通督推拿通过干预肌肉生物共振频率,影响外周神经元节律性运动促使肌肉功能重建,修正异常运动模式促进肌群间的相互平衡和协调,提高肌肉耐力和活动的精确性,进而改善脑卒中偏瘫运动功能。
(3)、疏经通督推拿治疗兼顾了躯干和肢体的协调运动以及充分的感觉功能的参与,通过干预肌肉生物共振频率,平衡和协调神经肌肉功能,从而可以改善脑卒中偏瘫患者肢体运动功能和步行能力,提高患者的日常生活活动能力和生存质量,具有较好的近期疗效。
(4)、疏经通督推拿对脑卒中偏瘫有良好的治疗作用,是一种疗效确切、可操作性强、适宜推广的临床治疗方法,值得进一步探讨和研究。
Objective:
Using convalescent patients after ischaemic stroke as the research model and biological mechanics, kinematics technology, modern rehabilitation function evaluation system as the research analysis method,this study evaluated the therapeutic effect of unblocking meridians and governor vessel tuina on motor function of ischemic stroke patients and discussed the mechanism to improve the function.
Methods:
This study included a total of120convalescent patients after stroke from October2009to October2011, all of whom were recruited from Rehabilitation Department and Neurology of Nanjing JiangBei Hospital. The inclusion criteria were:diagnosis according with1995cerebrovascular disease classification and approved by CT or MRI. Subjects were randomly assigned into3groups:41subjects received unblocking meridians and governor vessel tuina therapy(the treatment group),40subjects received common massage therapy (the control group),while the rest of39subjects received rehabilitation therapy (the rehabilitation group).All subjects received drug treatment corresponding with its related disease.
At the same time,10patients were chosen from each group to receive gait kinematical analysis test according to random arrangement data tables.
The research time was8-weeks.At conclusion, assessments observed before therapy and8weeks post therapy were conducted with regard to clinical effects(Clinical curative effect score), neural function (neural function defect degree rating scale, NFDS),muscular tension (modified Ashworth scale, MAS),motor function(Fugl-Meyer assessment, FMA),balance (Berg balance scale, BBS), comprehensive function (functional comprehensive assessment, FCA), activities of daily living(modified Barthel index, MBI), the quality of life (SF-36scale), gait time-space parameters, lower limb joint Angle and walk efficiency indexes.
Results:
(1)、General condition:There were no statistically significant differences in physical or demographic characteristics among three groups,such as gender,age, height, the course, the hand side, the hemiparalysis side. There were no statistically significant differences among NFDS、MT、FMA、BSS、FCA、MBI and SF-36before therapy. Also, There were no statistically significant differences among gait time-distance parameters, lower limb joint angle and walk efficiency indexes. So each group was comparable.
(2)、Compared with that before treatment, improved outcomes in the patients of the treatment and rehabilitation group have been shown respectively on the assessment items, such as the total scores of NFDS, MT, FMA, and BSS, FCA, MBI, and SF-36, etc. There were significant differences between the total scores of the assessment items when compared with that before and after4weeks and8weeks treatment, and compared with that after4weeks and8weeks treatment respectively.
(3)、Compared with that before treatment, improved outcomes in the patients of the control group have shown respectively on the assessment items, such as the total scores of NFDS, MT, FMA, and BSS, FCA, MBI, and SF-36, etc. There were significant differences between the total scores of the assessment items, such as the total scores of MT, FMA, and BSS, FCA, MBI, and SF-36when compared with that before and after4weeks and8weeks treatment, and compared with that after4weeks and8weeks treatment. But there was no significant difference on NFDS when compared with that before and after4weeks treatment.
(4)、Compared among groups:After4weeks treatment, compared between the treatment group and the control group, the difference had statistical significance on the items, such as NFDS and BSS. Compared between the treatment group and the rehabilitation group, the difference on BSS had statistical significance. Between the control group and the rehabilitation group, a statistical significance on NFDS was also shown. After8weeks treatment, compared between the treatment group and the control group, the difference had statistical significance on the items, such as NFDS、MT and BSS. Compared between the control group and the rehabilitation group, the difference on the assessment items, such as the total scores of NFDS、 MT、BSS、FCA、SF-36had statistical significance. Compared between the treatment group and the rehabilitation group, the difference on the assessment items, such as the total scores of MT, BSS, FCA, and SF-36also had statistical significance.
(5)、Compared the Clinical effects before and after treatment:Compared with that before treatment, the score of the clinical curative effect of all groups increased. Treatment group raised significantly, rehabilitation group and control group also increased obviously. The difference were significant compared the treatment group and the rehabilitation group to the control group, but no difference was revealed between the treatment group and the rehabilitation group.
(6)、After the treatment in the three groups, improved outcomes in the patients have been shown respectively on the assessment items, such as the total scores of NFDS, MT, FMA, and BSS, FCA, MBI, and SF-36, etc., which showed active prevention therapy could significantly improve the functions of the ischemic stroke patients.
(7)、Compared with that before treatment, improved outcomes in the patients of the treatment and control group have been shown respectively on the assessment items, such as the total scores of MT, FCA, and SF-36, etc., which indicates that Tuina has a special curative effect on the patients'psychosomatic state and it can decrease the muscle tone. And during the treatment it is utilized for the overall therapy and doctors pay more attention to communicate with patients and respect patients' feeling, which in turn are willing to be accepted by patients and get higher adherence. It can significantly improve stoke patients' psychosomatic state and activities of daily life.
(8)、Gait time-space parameters:The stride length, distance, frequency and width of all groups did not change obviously, whereas, the speed, limb-support time and swing time changed significantly after therapy. Compared among groups, between the treatment group and the control group or between the treatment group and the rehabilitation group, the difference had statistical significance,but there was no difference between the control group and the rehabilitation group. It indicated rehabilitation had positive function on prompting the hemiplegia gait, and the unblocking meridians and governor vessel tuina work best among the three.
(9)、Lower limb joint Angle:The maximum stretch angle in support-phase and flexion angle in swing-phase of knee-joint all changed obviously, at the same time, the maximum stretch angle in support-phase and swing-phase and flexion angle in support-phase of ankle-joint also changed obviously. Compared among groups, between the treatment group and the control group, or between the treatment group and the rehabilitation group, or between the control group and the rehabilitation group,the difference had no statistical significance.
(10)、Walk efficiency:After therapy, the stride speed of three groups increased, whereas the oxygen consumption and oxygen valence decreased, so the walk efficiency improved obviously. Compared among groups, between the treatment group and the control group or between the treatment group and the rehabilitation group, the difference had statistical significance,but there was no difference between the control group and the rehabilitation group. The result showed unblocking meridians and governor vessel tuina can obviously improve the walk efficiency of hemiplegics.
Discussion:
(1) The etiology and pathogenesis of ischemic stroke are complicated. Stroke is marked by faint and hemiplegia caused by the obstruction of the brain vessels due to various kinds of factors, such as stagnation of blood stasis, internal accumulation of phlegm-heat, or yang turning into endogenous wind, blood flowing with adverse qi. Stroke can be treated by the method of dredging the governor meridian and massage. Through regulating the general qi flow and dredging the meridians and collaterals of the trunk, limbs and muscles, smooth qi movement of governor meridian, modified qi and blood circulation of the meridians and collaterals as well as the recovery of visceral function can be achieved. And thus, the purpose of nourishing yin and suppressing yang, unblocking the fu-organs and resolving the phlegm, activating blood circulation and dredging the collaterals, invigorating qi and nourishing blood can also be achieved.
(2) The damage of upper-motor neuron and the excessive release of lower-motor neuron leads to the disorder of muscle function, which also expresses movement disability and the decline in the quality of life in ischemic stroke patients. The unblocking meridians and governor vessel tuina can improve the motor function of hemiplegics. The most likely mechanisms are that it can influence the rhythmic movement of peripheral neurons to reconstruct the muscle function by intervening muscle biological resonant frequency and, fix abnormal motor pattern to promote the balance and coordination among muscle groups and increase the muscle endurance and the accuracy of activity.
(3) By intervening muscle biological resonant frequency and balancing and coordinating nerve muscle function, the unblocking meridians and governor vessel tuina can combine the coordination of the trunk and extremities with the participation of feeling function, which leads to the improvement of the motor function and walking ability and ADL and life quality in hemiplegics. It has good short-term curative effect.
(4) The unblocking meridians and governor vessel tuina have a good therapeutic effect on hemiplegics, it is a confirmed and exercisable clinical therapy, which is proper to popularize and worthy of further discussion and study.
引文
[1]Sarti C,Stegmayr B,Tolonen H,et al Are changes in mortality from stroke caused by changes in stroke event rates or case fatality? [J].Stroke,2003,34:1833-1840.
[2]陈竺主编.全国第三次死因回顾抽样调查报告.中华人民共和国卫生部.北京：中国协和医科大学出版社,2008：14-17.
[3]姚滔涛,王宁华,陈卓铭.脑卒中运动功能训练的循证医学研究[J].中国康复医学杂志,2010,25(5)：565-570
[4]Dancause N,Barbay S,Frost S,et al.Extensive cortical rewiring after brain injury[J]. J Neuro-science.2005, 25:10167-10179.
[5]谢光柏,姜洪福.早期康复治疗对急性脑血管意外偏瘫患者下肢运动功能的影响[J].中华物理医学与康复杂志,2001,23(2)：102.
[6]Chan S P,Luk T C,& Hong Y.Kinematic and electromyographic analysis of the push movement in taichi[J]. Br J Sports Med,2003,37:339-344.
[7]Mccrea PH, Eng JJ, Hodgson AJ. Time and magnitude of torque generation is both arms following stroke[J].Phys Ther,2003,83(1):49-57.
[8]Christou, E. A.,Shinohara,M.,& Enoka,R.M.Fluctuations in acceleration during voluntary contractions lead to greater impairment of movement accuracy in old adults[J].J Appl Physiol,2003a,21:373-384.
[9]Margareta nordin,Victor H. Frankel肌肉骨骼系统基础生物力学[M].第二版,北京：人民卫生出版社,2008：111
[10]Mcbride JM.Porcari JP.Scheunke MD. Effect of vibration during fatigning resistance exercise on subsequent muscle activity during maximal voluntary isometric contractions[J]. J Strength Cond Res. 2004 Nov;18(4):777-81.
[11]Lssurin VB. Vibrations and their applications in sport A review[J].Sports Meded.2005,35(1):23-41.
[12]Kawahira K, Shimodozono M, Ogata A, et al. Addition of intensive repetition of facilitation exercise to multidisciplinary rehabilitation promotes motor functional recovery of the hemiplegic lower limb [J]. RehabilMed,2004,36(4):159-164.
[13]Bellew, J. W. The effect of strength training on control of ferce in older men and women[J]. Aging Clin Exp Res,2002,14:35-41.
[14]Tracy B L,Kern DS, Mehoudar PD,et al.Strength training does not improve the steadiness of muscles contractions in the knee extensors of older adults[J].Med Sci Sports Exerc,2001,33:S254
[15]Christou EA,YangY,Rosengren KS.Taiji training improves knee extensor strength and force control in older adults[J].J Gerontol:Medical Science,2003b,58A(8):763-766
[16]金栋.《内经》中风病病症名探讨[J].世界中西医结合杂志,2009,4(10)：694-695
[17]国家中医药管理局脑病急症协作组.中风病诊断与疗效评定标准[J].北京中医药大学学报,1996,19(1)：55
[18]金栋.内经中风病病因病机探讨[J].世界中西医结合杂志,2009,4(7)：458
[19]刘完素.素问玄机原病式[M].南京：江苏科学技术出版社,1985：4647,27
[20]田德禄.中医内科学[M].北京：人民卫生出版社,2002：271.
[21]包祖晓,赵国平.试论缺血性中风气虚血瘀病机学说[J],中医学研究,2001,10(17)：5
[22]宋含平.气虚与中风关系浅探[J].新中医,2004,36(7)：75-76
[23]常富业,李云.邵念方教授从痰论治中风病经验[J].山东中医药大学学报,2001,25(2)：109-111.
[24]艾华,谭素娟,肇隆起.痰瘀同治论[J].中国中医基础医学杂志.1999,5(5)：4445
[25]王新陆.试论滋补肝肾是治疗缺血性脑卒中的重要法则[J].山东中医杂志,2005,24(10)：579-582.
[26]王玉民,程广书.调理肺气法在中风病治疗中的应用[J].陕西中医,2005,26(2)：187-188
[27]张会娜,刘卫红,李萍.中医证候要素研究概况[J].北京中医药,2009,28(5)：396-397
[28]周庆博,邵念方,毕建忠.清热解毒法在中风病急性期治疗中的探讨[J].中国中西医结合杂志,2004,24(3)：263-265
[29]沈承玲,赵海滨.中风病内生热毒之内涵、演变及特性探析[J].山东中医药大学学报,2002,26(4)：242-245
[30]杨小清.补阳还五汤治疗中风病气虚血瘀证的机制探讨[J].现代中西医结合杂志,2005,14(2)：190-191
[31]叶人,单泽松.豁痰开窍法治疗大片脑梗死的临床观察[J].浙江中医学院学报,2002,26(2)：39.
[32]韦月梅.自拟活血通络汤治疗脑梗塞恢复期58例[J].广西中医药,2000,23(5)：13-14.
[33]吴泉.自拟益气化痰通络汤给疗脑梗死恢复期56例[J].中华实用中西医杂志,2003,3(16)：1201-1202.
[34]赵拥军.加减地黄饮子治疗脑血栓形成恢复期62例总结[J].湖南中医杂志,2004,20(4)：5-6.
[35]杨克勤.补肾通络法治疗缺血性中风30例[J].中医研究,2007,20(9)：25-27.
[36]贺景宏,任旭红,杨秀丽.补肾益气活血化瘀法治疗缺血性脑卒中60例疗效观察[J].中西医结合心脑血管病杂志,2003,1(2)：121-122.
[37]景军,洪文学,何瑶.针灸治疗脑血管疾病机制研究[J].北京生物医学工程,2006,25(6)：666-668.
[38]Shigekazu Sakai, Etsuro Hori, Katsumi Umeno, et al. Specific Acupuncture Sensation Correlates with EEGs and Autonomic Changes in Human Subjects[J]. Autonomic Neuroscience:Basic and Clinical,2007, 133:158-169
[39]张琳瑛.中风的针灸冶疗概况[J].针灸临床杂志,2004,20(6)：61-63
[40]Park J,Hopwood V,White AR,et al.Effectiveness of acupuncture for stroke:a systematic review[J].J Neurol,2001,248 (7):558-563.
[41]Zhang SH,LiuM,Asp lund K,et al.Acupuncture for acute stroke[CD].Cochrane Database Syst Rev,2005, 2:CD003317.
[42]王刚,庞勇,卢琰琰.不同针法治疗中风的临床应用述评[J].四川中医,2006,24(9)：101-102
[43]姜东升.推拿配合对抗阻力运动治疗偏瘫60例[J].河南中医,2006,26(2)：60-61
[44]林萍,李林,许洪伟,等.节段性按摩法改善脑卒中肢体功能障碍[J].中国临床康复,2003,7(10)：1610
[45]刘海潮,蒋惠瑜.推拿结合运动疗法缓解偏瘫痉挛40例观察[J].中国康复理论与实践,2009,15(6)：588
[46]萧蕙,张广清,王琳,等.情志护理配合穴位按摩对脑卒中后抑郁患者康复的影响[J].中华护理杂志,2008,43(1)：77-79
[47]李应昆,吴节,胡卡明,等.推按运经仪治疗脑卒中的效果：与针灸治疗的随机分组比较[J].中国临床康,2006,10(19)：4-5
[48]张金生,喻杉,王晓庆,等.中医养生在中风社区防治中的应用[J].中国民间疗法,2011,19(2)：54-55
[49]Osuga H,Hakin AM.Relevance of interstitial glutamate to selective vulnerability in focal cerebral ischemia[J].Cereb Bliood Flow Metab,1994,14(2):343
[50]Yang GY,Schielke GP,Gong C,et al. Expression of TNF-a and ICAM-1 after focal cerebral ischemia in IL-βconverting enzyme deficient mice[J]. J Cereb Blood Flow Metab,1999,19:1109.
[51]Tymianski M,Tator CH.Normal and abnormal calcium homeostasis in neurons:A basis for the pathophysiology of traumatic and ischemic central nervous sy stem injury[J].Neurosurgery,1996,38: 11-16.
[52]Zheng Z,Yenari MA.Post-ischemic inflammation:molecular mechanisms and therapeutic implications[J]. Neurol Res,2004,26(8):884-892
[53]Park TS,Gonzales ER,Giday JM. Platelet-activating factor mediates ischemia included leukocyte endothelial adherence in new-bornpig brain[J].Coreb B lood Flow Metab,1999,19:417-418
[54]Bates B,Hirt L,Thomas SS,et al.Neurotrophin-3 promotes cell death induced in cerebral ischemia, oxygen-glucose deprivation,and oxidative stress:possible involvement of oxygen free radicals[J].Neurobiol Dis, 2002,9:24-37.
[55]Huey KA,Roy RR,Zhong H,et al.Time-dependent in caspase-3 activity and heat shock protein 25 after spinal cord transection in adultrats[J]. Exp Physiol,2008,93:415-425.
[56]张微微,黄勇华,马志刚,等.北京市急性缺血性脑卒中磁共振成像分型研究[J].中国老年心脑血管病杂志,2006,8(6)：401-403.
[57]Dold Stein LB.Acute ischemic stroke treatment in 2007 [J].Circulation,2007,116(13):1504-1514.
[58]HackE W,Donnan G,Fieschic,et al.Association of outcome with early stroke treatment:pooled analysis of ATLANTIS,ECASS,and NINDS rt-PA stroke trials[J].Lancet,2004,363(9411):768-774
[59]AdamsHP,Adams R,Del Zoppo G, et al.Guidelines for the early management of patients with ischemic stroke:2005 guidelines update:a scientific statement from the Stroke Council of the American Heart Association/American Stroke Association[J].Stroke,2005,36(4):916-923
[60]Camerlingo M,Salivi P,Belloni G, et al.Intravenous heparin started within the first 3 hours after onset of symptoms as a treatment for acute nonlacunar hemispheric cerebral infarctions [J].Stroke,2005,36(11): 2415-2420
[61]张习红,李兆军,肖亮.阿司匹林对缺血性脑卒中二级预防的前瞻性分析[J].中国实用神经疾病杂志,2007,7(10)：70-71.
[62]Farres MT,Grabenwoger F,Gross CE,et al.Antithrombotic trialists collaborative meta:analysis of randomized trials of antiplatelet therapy for prevention of death myocardial infarction,and stroke in high risk patients[J]. BMJ,2002,324(1):71-86
[63]艾清龙,钟莲梅,临床神经病学讲座[M].昆明：云南人民出版社,2005：110-113.
[64]宋金森,张凤祥,姚惠风.氯吡格雷治疗急性脑梗死42例临床分析.山东医药,2007,23(47)：32-33.
[65]Fish ER M, Feuerstein G, Howells D W, et al. Update of the stroke therapy academic industry round table preclinical recomm endations[J].Stroke,2009,40(6):2244-2250.
[66]张立群,陈洁丽,程焱,等.尼莫地平对局灶性脑缺血鼠脑血浆蛋白的影响[J].中风与神经疾病杂志,2001,18(7)：300.
[67]Horn J,Limburg M,Calcium antagonists for ischemic stroke a systematic review[J].Stroke,2001,32(2):570-576
[68]Toth G, Albers G.Use of MRI to estimat the therapeutic window in acute stroke:is perfusion weighted imaging/diffusion weighted imaging mismatch and EPITHET for salvageable ischemic brain tissue? [J].Stroke,2009,40(1):333-335.
[69]韦联星.急性缺血性脑卒中的溶栓治疗[J].广西医学,2003,3(25)：403-404.
[70]Smith WS,Sung G, Starkman S,et al.Safety and efficacy of mechanical embolectomy in acute is chemic stroke:results of the MERCI trial[J].Stroke,2005,36(7):1432-1438.
[71]Levin MF, Kleim JA, Wo If SL. What do motor"recovery" and"compensation" mean in patients following stroke? Neurorehabil Neural Repair [J].2009,23(4):313-319.
[72]Levin MF,Michaelsen SM,Cirstea CM, et al.Use of the trunk for reaching targets placed within and beyond the reach in adult hemiparesis[J].Exp Bra in Res,2002,143(2):171-180.
[73]Carmichael ST. Cellular and molecular mechanisms of neural repair after stroke:making waves[J]. An.n Neurol,2006,59:735-742.
[74]刘罡,吴毅,胡永善,等.跑台训练对脑缺血大鼠脑组织超微结构及突触素表达的影响[J].中国康复医学杂志,2008,10(23)：872-874
[75]Muller HD, Hanumanthiah KM, Diederich K,et al. Brain-derived neurotrophic factor but not forced arm use improves long-term outcome after photothrombotic stroke and transiently upregulates binding densities of excitatory glutamate receptors in the rat brain[J].Stroke.2008,39:1012-1021.
[76]Nudo RJ. Post-infarct cortical plasticity and behavioral recovery[J]. Stroke.2007,38(part2):840-845.
[77]Vaynman SS, Ying Z, Yin D,et al. Exercise differentially regulates synaptic proteins associated to the function of BDNF[J]. Brain Res.2006,1070:124-130.
[78]Kleim J,Hogg T,van den Berg P,et al.Cortical synaptogenesis and motor map reorganization occur during late, but not early phase of motor skill leaming[J].J Neuroscience.2004,24:628-633.
[79]Michaelsen SM, Levin MF.Short-term effects of practice with trunk restraint on reaching movements in patients with chronic stroke:a controlled trial[J].Stroke.2004,35:1914-1919.
[80]Tanaka DH,Yamauchi K,Murakami F.Guidance mechanisms in neuronal and axonal migration [J].Brain Nerve,2008,60(4):405-413.
[81]Carmichael ST, Archibeque I, Luke L,et al. Growth associated gene expression after stroke:evidence for a growthpromoting region in periinfarct cortex [J].Exp Neurol,2005,193(13):291-311.
[82]Hobohm C,Gunther A,Grosche J, et al. Decompo sition and longlasting down regulation of extracellular matrix in perineuronalnets induced by focal cerebral ischemia in rats[J].J Neurosci Res,2005,80(4):539-548.
[83]Giger RJ,Venkatesh K,Chivatakarn O, et al. Mechanisms of CNS myelin inhibition:evidence for distinct and neuronal cell type specific receptor systems [J].Restor Neurol Neurosci,2008,26 (2-3):97-115.
[84]Leocani L,Comi G.Electrophysiological studies of brain plasticity of the motor system [J].Neurol Sci, 2006,27:S27-S29.
[85]Yun-Hee Kim,Sung H.You,Myoung-Hwan Ko,et al.Repetitive transcranial magnetic stimulation-induced corticomotor excitability and associated motor skill acquisition in chronic stroke[J]. Stroke,2006,37:1471-1476.
[86]Lee HH,Shin MS,Kim YS,et al.Early treadmill exercise decreases intrastriatal hemorrhage-induced neuronal cell death and increases cell proliferation in the dentate gyrus of streptozotocin induced hyperglycemic rats [J]. J DiabetesComplications,2005,19(6):339-346.
[87]Cramer SC. Repair ing the human brain after stroke:I.Mechanisms of spontaneous recovery [J].Ann Neuro,2008,63(3):272-287.
[88]Kim YH,You SH,Kwon YH,et al. Longitudinal fMRI study for locomotor recovery in patients with stroke[J].Neurology,2006,67:330-333.
[89]Luft AR, Macko RF, Forrester LW, et al. Treadmill exercise activates subcortical neural networks and improves walking after stroke:a randomized controlled trial [J].Stroke,2008,39(12):3341-3350.
[90]Sherrill L,Susan R.Early intervention care in the acute stroke patient[J].Arch Phys Med Rehabil,1986,67: 319-321
[91]胡永善,吴毅,朱玉连,等,规范三级康复治疗促进脑卒中偏瘫患者综合功能的临床研究[J].中华物理医学与康复杂志,2005,27(2)：105-110
[92]Teasell RW,Kalra L.What's new in stroke rehabilitation:back to basis[J].Stroke,2005,36:215-217
[93]Ardelt AA,McCullough LD,Korach KS,et al.Estradiol regulates angiopoietin-1mRNA expression through estrogen receptor-a in a rodent experimental stroke model[J].Stroke,2005,36:337-341
[94]Briones TL,Suh E,Jozsa L,et al.Changes in number of synapses and mitochondria in presynaptic terminals in the dentate gyrus following cerebral ischemia and rehabilitation training[J].Brain Res,2005,1033:51-57
[95]Kelly J,Rudda,Lewis RR,et al.Venous thromboembolism after acute ischemic stroke:a prospective study using magnetic resonance direct thrombus imaging [J].Stroke,2004,35(10):2320-2325.
[96]Smith Hammond CA, Goldstein LB.Cough and aspiration of foods and liquids due to oral-pharyngeal dysphagia:ACCP evidence-based clinical practice guidelines[J].Chest,2006,129(1Suppl):154S-168S
[97]WHO.Recommendation on stroke prevention,diagnosis end therapy[J].Stroke,1989,20(10):1407
[98]Bernhardt J, Dewey H, Thrift A, et al Inactive and alone:physical activity with in the first 14 days of acute stroke unit care[J].Stroke,2004,35:1005-1009.
[99]Sawner K,LaVigne J.Brunnstrom's movement therapy in hemiplegia:a neurophysiological approach[M]. 2nd edn.Philadelphia:JB Lippincott,1992.
[100]Mayston MJ. Raine:a response.Physiotherapy Research International.2006,11(3):183-186.
[101]潘化平,冯慧,李亚娟,等.负荷控制的本体感觉训练对脑卒中患者平衡功能及下肢运动能力的影响[J].中国康复医学杂志,2011,26(11)：1025-1028
[102]郑洁皎,俞卓伟,夏汶,等.本体感觉神经肌肉促进技术对脑卒中患者膝关节运动控制功能的影响[J].中国康复理论与实践,2010,16(2)：115-117
[103]Carr Janet H, Shepherd Roberta B中风病人的运动再学习方案[M].第1版.北京：北京医科大学出版社,1999：3-27
[104]Chan DY, Chan CC, Au DK. Motor relearning programme for stroke patients:a randomized controlled trial[J].Clin Rehabil,2006,20:191-200
[105]Winstein CJ.The best we can be is yet to come[J].Phys Ther,2009,89(11):1236-49
[106]Carr Janet H, Shepherd Roberta B脑卒中康复-优化运动技巧的指南[M].第1版.北京：北京大学医学出版社,2007：35-37.
[107]Taub E. Movement in nonhuman primates deprived of somatosensory feedback[J].Exercise and Sport Sciences Reviews.1976,4:335-374.
[108]Taub E, Crago J E. An operant approach to rehabilitation medicine:overcoming learned nonuse by shaping[J]. Journal of the Experimental Analysis of Behavior.1994,61(2):281-293.
[109]毕胜.强制性使用运动疗法的起源与进展[J].中国康复医学杂志,2006,21(8)：739-743.
[110]Wolf SL,Winstein CJ,Miller JP,et al.Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke:the EXCITE randomized clinical trial[J].JAMA,2006,296:2095-2104
[111]Grillner S,Debuc,R.Control of locomotion in vertebrates:Spinal and supraspinal mechanisms. In: Waxman SG,Advances in Neurology,Vol.47:Functional Recovery in Neurological Disease[J].Raven Press, New York.1988,425-453
[112]Grillner S, Ekeberg O, E. Manira A, et al. Intrinsic function of a neuronal network-a vertebrate central pattern generator[J] Brain Research Reviews.1998,26:184-197.
[113]Tong RK, Ng MF, Li LS. Effectiveness of gait training using an electromechanical gait trainer, with and without functional electric stimulation,in subacute stroke:a randomized controlled trial[J]. Arch Phys Med Rehabil,2006,87:1298-1304.
[114]Tveit M,Karrholm,J. Low effectiveness of prescribed partial weight bearing. J Rehabil Med[J],2001, 33(1):42-44
[115]游国清,燕铁斌.功能性电刺激及其在脑卒中后偏瘫患者中的应用[J].中华物理医学与康复杂志,2007,29(2)：142-143.
[116]Kreisel SH,Hennerici MG,Bazner HJ.Pathophysiology of stroke rehabilitation:the natural course of clinical recovery,use-dependent plasticity and rehabilitative outcome[J].Cerebrovasc Dis,2007,23:243-255
[117]Liberson W,Hohnquest H,Scot D,et al.Functional electrotherapy:stimulation of the peroneal nerve synchronized with the swing phase of the gait of hemiplegic patients[J].Arch Phys Med Rehabil,1961,42: 101-105.
[118]Magnusson M,Johansson K,JohanssonBB.Sensory stimulatiopromotes normalization of postural control after stroke[J]. Stroke,1994,25(6):1176-1180.
[119]刘忠良,宋琳,关爽,等.功能性电刺激对脑卒中偏瘫患者上肢运动功能恢复的影响[J].中国康复,2005,20(1)：52-53.
[120]Page SJ,Levine P,Sisto SA,et al.Mental practice combined with physical practice for upper-limb motor deficit in subacute stroke[J].Phys Ther,2001,81(8):1455-1462
[121]王茂斌.脑卒中的康复医疗[M].北京：中国科学技术出版社,2006：482-486.
[122]Page SJ,Levine P,Sisto SA,et al.A randomized efficacy and feasibility study of imagery in acute stroke [J].Clin Rehabil,2001,15(3):233-240.
[123]Hamel MF,Lajoie YVES.Mental imagery,effects on static balance and attentional demands of the elderly[J].Aging Clin Exp Res,2005,17(3):223-228.
[124]Jeannerod M,Decety J.Mental motor imagery:a window into the representational stages of action. Curr OpinNeurobiol[J].1995,5(6):727-732.
[125]Sharma N,Pomeroy VM,Baron JC, et al. Motor imagery:a backdoor to the motor system after stroke? [J] Stroke,2006,37(7):1941-1952.
[126]Page SJ,LevineP,LeonardA.Mental practice in chronic stroke:results of a randomized, placebocontrolled-trial[J].Strok.2007 Apr;38(4):1293-1297.
[127]Ietswaart M,Johnston M,Dijkerman HC,et al.Recovery of hand function through mental practice:a study protocol[J]. BMC Neurol.2006,26(6):39.
[128]Dickstein R, Deutsch JE. Motor imagery in physical therapist practice[J]. Physical Therapy,2007,87(7): 942-953.
[129]Rizzolatti G, Fadiga L, Gallese V, et al. Premotor cortex and the recognition ofmotor actions[J]. Cogn Brain Res,1996,3(2):131-141.
[130]PetridesM, Cadoret G,Mackey S. Orofacial somatomotor responses in the macaque monkey homologue of Broca's area [J]. Nature,2005,435 (7046):1235-1238.
[131]Calmels C,Hohmes P,Jarry G,et al. Variability of EEG synchronization prior to and during observation and execution of a sequential fingermovement[J]. Hum BrainMapp,2006,27 (3):251-266.
[132]Kwakkel G,Van PeppenR,Wagenaar RC,et al.Effects ofaugmented exercise therapy time after stroke:a meta2analysis[J]. Stroke,2004,35(11):2529-2539.
[133]Di Pellegrino G, Fadiga L, Fogassi L, et al. Understanding motor events:a neurophysiological study [J]. Exp Brain Res,1992,91(1):176-180.
[134]范振华.运动疗法基础[J].神经病学与神经康复学杂志,1996,1：60.
[135]褚海林,詹红生,侯群,等.推拿治疗早期中老年脑血管缺血性疾病(脑梗塞)的临床研究[J].浙江中医学院学报,2002,26(3)：62-63
[136]陆筱安.按摩与导引在中风康复临床上的应用[J],按摩与导引,2007,24(2)：32
[137]刘丽秋.调整督脉法对中风后遗症的康复体会[J[.针灸临床杂志,2005,21(10)：43
[138]李玉亮.再谈“按摩以脊背为纲”.[J]按摩与导引,2006,22(11)：35
[139]郭泽新,陈卫华.缓解中风偏瘫痉挛状态推拿手法及其机理探讨[J],按摩与导引,2003,19(1)：2
[140]田洪文,高欣,于洪梅.脑卒中后肩手综合症治疗36例临床体会[J].航空航天医药,2005,16(2)：25
[141]朱江.中风病人便秘的护理[J].辽宁中医杂志,2006,33(1)：116
[142]梁雯.经穴按摩法治疗老年性便秘的临床观察[J].陕西中医学院学报,2003,26(6)：45
[143]王晶,曲红岩.脑中风患者便秘的中医调护[J].新疆中医药,2006,24(4)：63
[144]程晓巍,金伟,秋红.穴位按摩在临床护理中的应用[J].针灸临床杂志,2002,18(6)：5
[145]丁世勇.论按摩治病的机理[J].按摩与导引,2006,22(6)：12-13.
[146]熊周清.推拿结合针刺治疗中风偏瘫[J].按摩与导引,1993,3：17.
[147]李成永,吴嘉容,沈国权,等.推拿、针刺对急性脑缺血大鼠的脑保护作用[J].中医药信息,2003,20(6)： 44-45.
[148]Mcbride JM.Porcari JP.Scheunke MD. Effect of vibration during fatigning resistance exercise on subsequent muscle activity during maximal voluntary isometric contractions [J]. J Strength Cond Res. 2004,18(4):777-81.
[149]Lssurin VB. Vibrations and their applications in sport A review [J]. Sports Meded.2005,35(1):23-41.
[150]Kawahira K, Shimodozono M, Ogata A, et al. Addition of intensive repetition of facilitation exercise to multidisciplinary rehabilitation promotes motor functional recovery of the hemiplegic lower limb[J]. Rehabil Med,2004,36(4):159-164.
[151]各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6)：379
[152]张仕年,张宏如.金宏柱教授疏经通督学术思想浅析[J].贵阳中医学院学报,2010,3(1)：12-14
[153]范炳华,韩明舫,赵毅.推拿学-普通高等教育十一五国家及规划教材[M].中国中医药出版社,2008：227-228
[154]于国才.推拿手法学[M].北京：中国中医药出版社,2003
[155]Scandinavian Stroke Study Group.Multicenter trial of hermodilution in ischernic stroke-background and study protocol[J].Stroke,1985,16:885-890
[156]陶子荣.我国脑卒中患者临床神经功能缺损评分标准信度、效度及敏感度的评价[J].第二军医大学学报.2009,30(3)：283-285
[157]Fugl-Meyer AR, Jaasko L, Leyman I, Olsson S, Steglind S. The post-stroke hemiplegic patient:a method for evaluation of physical performance[J]. Scand J Rehabil Med 1975,7:13-31.
[158]Fugl-Meyer AR. Post-stroke hemiplegia assessment of physical properties [J]. Scand J Rehabil Med 1980, Suppl 7:85-93.
[159]Duncan PW, Propst M, Nelson SG, Duncan PW, Propst M, Nelson SGReliability of the Fugl-Meyer assessment of sensorimotor recovery following cerebrovascular accident[J]. Phys Ther 1983,63:1606-1610.
[160]Berg KO, Wood-Dauphinee SL, Williams JI, et al. Measuring balance in the elderly:validation of an instrument[J]. Can J Public Health 1992,83 Suppl 2:S7-11
[161]Berg KO, Wood-Dauphinee SL, Williams JI, et al. Measuring balance in the elderly:preliminary development of an instrument[J]. Physiother Can,1989,41:304-311.
[162]Lajoie Y, Gallagher SP. Predicting falls within the elderly community:comparison of postural sway, reaction time, the Berg Balance Scale and the Activities-specific Balance Confidence(ABC) Scale for comparing fallers and non-fallers [J]. Arch Gerontol Geriatr,2004,38:11-26.
[163]Bogle Thorbahn LD, Newton RA. Use of the Berg BalanceTest to predict falls in elderly persons [J]. Phys Ther,1996,76:576-583; discussion 584-585.
[164]Berg KO,Wood-Dauphinee S, WilliamsJI. The Balance Scale:Reliability assessment with elderly residents and patients with acute stroke[J], Scand J Rehabil Med 1995,27:27-36.
[165]燕铁斌,金冬梅.平衡功能的评定及平衡功能训练[J].中华物理医学与康复杂志,2007,29(11)：787-789
[166]瓮长水,王军,王刚,等.Berg平衡量表在脑卒中患者中的内在信度和同时效度[J].中国康复医学杂志,2007,22(8)：688-690
[167]胡永善,吴毅,范文可,等.FCA量表与FIM量表的比较研究[J].中国康复医学杂志,2004,19(3)：228-229
[168]范文可,胡永善,吴毅,等.功能综合评定量表用于脑卒中的信度、效度及敏感度再次评价[J].中华物理医学与康复杂志,2007,29(7)：453-457
[169]王涛,倪朝民,范文祥,等.社区康复对脑卒中患者功能和生存质量的远期疗效观察[J].中国康复医学杂志,2009,24(10)：934-937
[170]孟兆祥,倪朝民,李厥,等.应用功能综合评定量表评估早期康复对脑卒中患者功能结局的影响[J].中国临床康复,2005,9(5)：1-3
[171]燕铁斌.现代康复治疗技术[M].合肥：安徽科学技术出版社,1994：300
[172]Mahoney FI, Barthel D. Functional evaluation:The Barthel Index[J]. Maryland State Medical Journal, 1965,14(2):56-61.
[173]Leung SO,Chan CC,Shah S.Development of a Chinese version of the Modified Barthel Index-validity and reliability[J].Clin Rehabil,2007,21(10):912-922
[174]Shah S, Vanclay F, Cooper B. Predicting discharge status at commencement of stroke rehabilitation[J]. Stroke,1989,20(6):766-769.
[175]Leung SO, Chan CC, Shah S. Development of a Chinese version of the Modified Barthel Index-validity and reliability[J]. Clinical Rehabilitation,2007,21(10):912-922.
[176]闵瑜,吴媛嫒,燕铁斌,等.改良Barthel指数(简体中文版)量表评定脑卒中患者日常生活活动能力的效度和信度研究[J].中华物理医学与康复杂志,2008,30(3)：16-18
[177]黄晓琳,陆敏,喻澜,等Barthel指数对脑卒中患者住院康复效果的预测[J].中国康复,2003,18(3)：139-141
[178]Hackett ML,Duncan JR,Anderson CS,et al.Health2related quality of life among longterm survivors of stroke:results from the Auckland Stroke Study,1991-1992[J].Stroke,2000,31 (2):440-447.
[179]Ware J E, Sherbourne CD. The MOS-36-item short term health survey (SF-36)1:conceptual framework and item selection [J].Med Care,1992,30:473-483.
[180]袁洪江,张俊,孙敏,等.脑卒中后6-9月于两年的生存质量比较[J].老年医学与保健,2002,8(1)：17-20.
[181]HackettML, DuncanJR, Anderson CS, et al. Health related quality of life among long term survivors of stroke[J]. Stroke,2000,312(2):440-447.
[182]Javer CA. Quality of life among stroke survivors evaluated 1 year after stroke [J]. Stroke,2000,31 (12): 2995.
[183]郭铁成,陈小红.急性期脑卒中患者生活质量及SF-36适用性的研究[J].中华物理医学与康复杂志,2007,29(12)：822-824
[184]李青青,吴宗耀.步行中胫前后肌群的表面肌电图[J].神经损伤与功能重建,2007,2(2)：116-118.
[185]江晓峰,胡雪艳.偏瘫步态膝关节角度分析[J].中国康复医学杂志,2007,22(10)：918-920.
[186]徐光青,毛玉瑢,兰月,等.脑卒中患者躯体运动偏瘫模式的三维运动学评价[J].中国康复医学杂志,2009,24(10)：893-895.
[187]荣湘江,姚鸿恩,王卫强,等.偏瘫步态中时相与周期的定量研究[J].天津体育学院院报,2004,19(2)： 56-58
[188]王桂茂,严隽陶,刘玉超,等.三维运动解析系统测试脑卒中偏瘫步态的运动学定量评价[J].中国组织工程研究与临床康复,2010,14(52)：9816-9818
[189]许光旭,顾绍钦,孟殿怀,等.下肢痉挛偏瘫患者的步行效率[J].中国组织工程研究与临床康复,2009,13(11)：2166-2169
[190]Utter AC, Robertson RJ, Green JM, et al. Validation of the Adult OMNI Scale of Perceived Exertion for Walking/Running Exercise[J].Med SCI Sports Exerc.2004,36(10):1776-1780.
[191]励建安.神经疾病的步态分析[J].中国康复医学杂志,2005,20(4)：304-306
[192]Bowen TR, Cooley SR, Castagno PW,et al. A method for normalization of oxygen cost and consumption in normal children while walking[J]. J Pediatr Orthop.1998,18(5):589-593.
[193]Jankovic J, Brin MF. Botulinum toxin:historical perspective and potential new indications [J]. Muscle Nerve,1997,6:S129-S145.
[194]贾耿.督脉、足太阳、任脉、肾精实质试探[J].湖南中医学院学报,2000,20(4)：47-49
[195]邱继华.从《内经》论“筋”看经筋[J].浙江中医学院学报,1994,18(4)：3
[196]梁启军.经络和穴位的结构本义及针刺基本机理[J].长春中医药大学学报,2008,24(3)：239-240
[197]费伦,承焕生,蔡德亨.经络物质基础及其功能性特征的实验探索和研究展望[J].科学通报,1998,43(6)：658-672
[198]郭明霞.经络的物质基础、循经感传及其作用机制研究与进展[J].中国临床康复,2004,8(25)：5353-5355
[199]张保真.经脉线的构造和机能[M].西安：陕西科学技术出版社,1991：85
[200]Colloca CJ,Keller'IS,Harrison DE,et al.Spinal manipulation force and duration afect vertebral movement and neuromuscular responses[J].Clinical Biomeehanie,2006,21(3):254-262
[201]谢益宽,李惠清,肖文华.经络和循经感传的神经生物学性质研究[J].中国科学B辑,1995,25(7)：721-731
[202]杨志新,石学敏.醒脑开窍针刺法治疗中风疗效与安全性的系统评价[J].中国针灸,2007,27(8)：601-608
[203]焦顺发,焦青峰.督脉是脊髓浅识[J].中国针灸,2006,26(10)：761
[204]Lappin AK, Monroy JA, Pilarski JQ, et al. Storage and recovery of elastic potential energy powers ballistic prey capture in toads [J]. J Exp Biol.2006,209:2535-2553.
[205]Deliagina TG, Orlovsky GN, Zelenin PV, et al. Neural Bases of Postural Control. Physiology.2006,21: 216-225
[206]Moorhouse KM, Granata, KP. Role of reflex dynamics in spinal stability:intrinsic muscle stiffness alone is insufficient for stability[J]. J Biomech,2007,40(5):1058-1065.
[207]Winter D A. Biomechanics and motor control of human movement [M]. New York:John Wiley Sons, 2009.
[208]Dickstein R, Sheffi S, Markovici E.Anticipatory postural adjustment in selected trunk muscles in poststroke hemiparetic patients[J]. Archives of Physical Medicine and Rehabilitation.2004,85:261-267.
[209]Wildr DG, Aleksiev AR, Magnusson ML, et al. Muscular response to sudden load. A tool to evaluate fatigue and rehabilitation[J]. Spine,1996,21(22):2628-2639.
[210]Arashanapalli M, Wilson SE. Paraspinal muscle vibration alters dynamic motion of the trunk[J]. J Biomech Eng,2008,130(2):1-7.
[211]Brown SH, Haumann ML, Potvin JR. The responses of leg and trunk muscles to sudden unloading of the hands:implications for balance and spine stability[J]. Clin Biomech (Bristol,Avon),2003,18(9):812-820.
[212]Brown SH, McGill SM. The intrinsic stiffness of the in vivolumbar spine in response to quick releases: implications for reflexive requirements[J]. JElectromyogr Kinesiol,2009,19(5):727-736.
[213]Andersen TB, Essendrop M, Schibye B. Movement of the upper body and muscle activity patterns following a rapidly applied load:the influence of pre-load alterations[J]. Eur J Appl Physiol,2004,91(4): 488-492.
[214]Alexandra Handley, Pippa Medcalf, Kate Hellier, et al.Movement disorders after stroke[J].Age Ageing. 2009,38(4):260-266.
[215]Spencer JD, Hayes KC, Alexander IJ. Knee joint effusion and quadriceps inhibition in man[J].Archive of physical medicine and rehabilitation,1984,65(4):171-177.
[216]Delahunt E. Neuromuscular contributions to functional instability of the ankle joint[J]. Journal of Bodywork and Movement Therapies,2007,11(3):203-213.
[217]Lephart SM, Henry TJ. Functional rehabilitation for the upper and lower extremity[J]. Orthop clin North Am,1995,26(3):579-592.
[218]Nudo RJ. Post-infarct cortical plasticity and behavioral recovery[J]. Stroke.2007,38(part2):840-845.
[219]Dillman CJ, Murray TA, Hint ermeister RA.Biomechanical Differences of open and closed chain exercise w ith respect to the shoulder [J]. J Sport Rehabil,1994,3:228-238.
[220]Forestier N, Teasdale N, Nougier V. Alteration of the position sense at the ankle induced by muscular fatigue in humans[J]. Med Sci Sports Exerc,2002,34(1):117-122.
[221]Riemann BL, Lephart SM. The sensorimotor system, part ii:The role of proprioception in motor control and functional joint stability[J]. J Athl Train,2002,37(1):80-84.
[222]Kiehn O,T resch M C.Gap junctions and motor behavior[J].Trends Neurosci,2002,25(2):108-115.
[223]Harris Warri ck RM. Voltagesensiti veion channels in rhythmic motor systems[J].Curr Opin Neu robiol, 2002,12(6):646-651.
[224]Utter AC, Robertson RJ, Green JM, et al. Validation of the Adult OMNI Scale of Perceived Exertion for Walking/Running Exercise[J].Med SCI Sports Exerc.2004,36(10):1776-1780.
[225]Dobkin B, Harkema S, Requejo P, et al. Modulation of locomot or-1 ike EMG activit y in subjects with complete and incomplete spinal cord injury[J]. J Neuro Rehab,1995,9:183-190.
[226]Fox EL,Hatthews DK.The physiological basis of physical education and athletics Philadelphia [J].Sau Nders College Publishers,1981,49:123-128.
[227]Svendsen B. Treatment of the hemiplegic patient:new strat egies for gait training[J]. Physical Therapy Products,1996,3:32-34.
[228]马超,郑政,谢益宽.背最长肌反射性肌电活动的循经感传特性[J].科学通报,2000,45(18)：1982-1988
[229]Emken J.L.,Reinkensmeyer D.J.Robot-Enhanced Motor Learning:Accelerating Internal Model Formation During Locomotion by Transient Dynamic Amplification[J].IEEE transactions on neural systems and rehabilitation engineering,2005,13(1):33-39.
[230]Yun SJ,Park HJ,Yeom MJ,et al.Effect of electroacupuncture on the stress induced changes in brain-derived neurotrophic factor expression in rat hippocampus[J].Neuroscience Letters,2002,318:85-88
[231]Wu MT,Sheen JM,Chuang KH,et al.Neuronal specificity of acupuncture response:A fMRI study with electroacupuncture[J].NeuroImage,2002,16:1028-1037
[232]张建华编著.推拿手法用力技巧(第一版)[M].合肥：安徽科学技术出版社,2005年：12-81
[233]陈景藻.次声的存在及其基本生物效应和研究意义[J].中华物理医学与康复杂志,1999,21(3)：131-133
[234]Akira Okada, Mari Nari, Makoto Ariizumi. Experimental studies on the effects of vibration and noise sympathetic nerve activity in skin[J]. Europe Journal of Applied Physiology,1991,62:324-331
[235]Hiroyuki N,Takashi M,Hirofumi N.Changes of cerebral vasoactive intestinal polypeptide and somatostatin-like immunoreactivity induced by noise and whole-body vibration in the rat [J]. Europe Journal of Applied physiology,1994,68:62-67
[236]D. Mealing. Vibration recording from human muscles with known fiber composition different[J]. British Journal Sports,1996,30:27-31.
[237]Footnote:What's new in the literature[M].Physical Therapists,2005,1:63.
[238]Stephan Turbanski Effects of random WBV on postural control in Pakinsons' Disease[J]. Research in Sports Med icine,2005,3:243-256.
[239]Hsu A L,Tang PF,JanM H.Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients aftermild to moderate stroke [J].Arch Phys Med Rehabil,2003,8:1185-1193.
[240]Dillman CJ, Murray TA, Hint ermeister RA.Biomechanical Differences of open and closed chain exercise with respect to the shoulder [J].J Sport Rehabil,1994,3:228-238.
[241]辛喜艳,高颖,马斌,等.中风病气虚证与神经功能缺损程度及远期预后的关系研究[J].中国中西医结合杂志,2011,31(12)：1627-1631
[242]Siegfried Mense,David G.Simons,I.Jon Russell,著.郭传友译.肌痛[M].北京：人民卫生出版社,2005：85
[243]Walsh EG Muscles, Masses and Motion. The Physiology of Normality, Hypotonieity, Spasticity and Rigidity[M]. London:Mac Keith Press,1992:101.
[244]Karatas M, Cetin N, Bayramoqlu M. Trunk muscle strength in relation to balance and functional disability in unihemispheric stroke patients [J]. Am J Phys Med Rehabil,2004,83(2):81-87.
[245]Verheyden G, Vereeck L, Truijen S. Trunk performance after stroke and the relationship with balance, gait and functional ability[J]. Clin Rehabil,2006,20(5):451-458.
[246]Hsieh CL, Hsueh IP1Trunk control as an early p redictor of comp rehensive activities of daily living function in stroke patients[J].Stroke,2002,33 (11):2626-2630
[247]Au-Yeung SS, Hui-Chan CW, Tang JC. Short-form Tai Chi improves standing balance of people with chronic stroke [J]. Neurorehabil Neural Repair,2009,23(5):515-522.
[248]吴毅,胡永善,杨晓冰,等.功能综合评定量表信度和效度的研究[J].中国临床康复杂志,2002,64(14)：2036-2037
[249]胡永善,吴毅,朱玉连,等.规范三级康复治疗促进脑卒中偏瘫患者综合功能康复的临床研究[J].中国康复医学杂志,2004,19(6)：418-421
[250]范文可,胡永善,吴毅,等.规范三级康复治疗对脑卒中偏瘫患者运动功能康复的影响[J].中国康复医学杂志,2006,21(6)：484-487
[251]朱玉连,胡永善,吴毅,等.规范三级康复治疗中不同时期卒中患者运动功能改善规律的分析[J].中国运动医学杂志,2004,23(4)：377-380
[252]张惠,吴毅,胡永善.影响脑卒中患者日常生活活动能力预后的相关因素分析[J].中国康复医学杂志,2008,23(2)：130-131
[253]Freeman CT, Hughes AM, Burridge JH et al. A robotic workstation for stroke rehabilitation of the upper extremity using FES[J]. Medical engineering & physics,2009,31(3):364-373
[254]白玉龙,胡永善,陈文华等.规范三级康复治疗对缺血性脑卒中患者功能独立性的影响[J].中国运动医学杂志,2007,26(5)：552-559
[255]Dai DC, Fang M, Yan JT, Liu KP. Tuina intervention and sleep and emotional disordersdue to chronic fatigue syndrome[J].J Acupunct Tuina Sci.2009,7(3):147-151
[256]Tueblood PR.Partial body weight treadmill training in persons with chronic stroke [J].Neuro Rehabilita-tion,2001,16(3):141-153
[257]Guralnik JM,Ferrucci L,Balfour JL,et al.Progressive versus catast rophicloss of the ability to walk: implications the prevention of mobilityloss [J].J Am Geriatr Soc,2001,49 (11):1463-1470
[258]Neckel N D, Blonien N, Nichols D, et al. Abnormal joint torque patterns exhibited by chronic stroke subjects while walking with a prescribed physiological gait pattern[J].J Neuroeng Rehabil,2008,5:19.
[259]Duncan PW, Sullivan KJ, Behrman AL, et al. Protocol for the Locomotor Experience Applied Post-stroke (LEAPS) trial:a randomized controlled trial[J].BMC Neurol,2007,7(39):1471.
[260]Kavanagh JJ. Lower trunk motion and speed-dependence during walking[J].J Neuroeng Rehabil,2009, 6(9):1186.
[261]Brach JS, Berlin JE, VanSwearingen JM, et al. Too much or too little step width variability is associated with a fall history in older persons who walk at or near normal gait speed[J].Journal of NeuroEngineering and Rehabilitation,2005,2(21):1743.
[262]金道鹏,徐俊,赵吉忠,等.推拿功法易筋经对骨骼肌减少症患者日常活动能力及体质的影响[J].中国中医药信息杂志,2011,18(1)：14-16
[263]O' Byrne JM, Jenkinson A, O'Brien TM. Quantitative analysis and classification of gait patterns in cerebral palsy using a three-dimensional motion analyzer [J].J Child Neurol,1998,13 (3):101-108.
[264]Tiebin Yan,ChristinaWY,Leonard SW.Functional electrical stimulation improvesmotor recovery of the lower extremity and walking ability of subjectswith first acute stroke [J]. Stroke,2005,36:80-85
[265]王瑞华.步态分析[J].中级医刊,1994,29(4)：9-10
[266]胡雪艳,恽晓平,张通.基于数字视频和数字图像处理的步态分析在卒中康复训练中的应用[J].中国脑血管病杂志,2009,6(9)：456-460.
[267]荣湘江,姚鸿恩,王卫强,等.偏瘫步态中时相与周期的定量研究[J].天津体育学院院报.2004,19(2)：56-58.
[268]胡雪艳,恽晓平,王广志,等偏瘫步态髋关节角度研究[J].中国康复理论与实践,2007,13(10)：924-925.
[269]Cauraugh J H,Summers J J.Neural plasticity and bilateral movements:A rehabilitation approach for chronic stroke [J].ProgNeurobiol,2005,75:30-320.
[270]Mudie MH, Matyas TA. Can simultaneous bilateral movement involve the undamaged hemisphere in reconstruction of neural networks damaged by stroke [J]. Disabil Rehabil,2000,22:23-37.
[271]Whitall J, McCombe Waller S, Silver KH, et al. Repetitive bilateral arm training with rhythmic auditory cueing improves motor function in chronic hemiparetic stroke [J]. Stroke,2000,31:2390-2395.
[272]Kerrigan,D C,Guest editorial aesthetics of walking[J]. Journal Rehabilitation Research and Development, 2001,38:9-10
[273]Sibley KM,Tang A,Brooks D,et al. Effects of extended effortful activity on spatio-temporal parameters of gait in individuals with stroke[J].Gait Posture,2008,27(3):387-392.
[274]Mccrea PH, Eng JJ, Hodgson AJ. Time and magnitude of torque generation is both arms following stroke [J]. Phys Ther,2003,83(1):49-57.
[275]高霞,李京平,陈刚.偏瘫患者行走能量消耗与速度的相关性[J].中国临床康复,2006,10(16)：110-111
[276]Olney SJ,Griffin MP,Monga TN,et al.Work and power in gait of stroke[J].Arch phys Med Rehabil,1991, 72:309-314.
[277]Utter AC, Robertson RJ, Green JM, et al. Validation of the Adult OMNI Scale of Perceived Exertion for Walking/Running Exercise[J].Med SCI Sports Exerc.2004,36(10):1776-1780.
[278]Bereket S.Effects of anthropometric parameters and stride frequency on estimation of energy cost of walking[J].J Sports Med Phys Fitness.2005,45:152-161.
1、陈竺主编.全国第三次死因回顾抽样调查报告[M].中华人民共和国卫生部.北京：中国协和医科大学出版社,2008：14-17.
2、姚滔涛,王宁华,陈卓铭.脑卒中运动功能训练的循证医学研究[J].中国康复医学杂志,2010,25(5)：565-570
3、Dickstein R, Sheffi S, Markovici E.Anticipatory postural adjustment in selected trunk muscles in poststroke hemiparetic patients[J]. Archives of Physical Medicine and Rehabilitation.2004,85:261-267.
4、Liu CJ, Latham NK. Progressive resistance strength training for improving physical function in older adults[J]. Cochrane Database Syst Rev.2009,3:CD002759.
5、Alexandra Handley, Pippa Medcalf, Kate Hellier, et al.Movement disorders after stroke[J].Age Ageing. 2009,38(4):260-266.
6、Dickstein R,Sheffi S,Markovici E. Anticipatory posturaladjustment in selected trunk muscles in poststroke hemiparetic patients[J]. Archives of Physical Medicine and Rehabilitation.2004,85:261-267.
7、Leroux A.Exercise training to improve motor performance inchronic stroke:effects of a community-based exercise programme[J].International Journal of Rehabilitation Research.2005,28:17-23.
8、Spencer JD, Hayes KC, Alexander IJ. Knee joint effusion and quadriceps inhibition in man[J].Archive of physical medicine and rehabilitation,1984,65(4):171-177.
9、Wildr DG, Aleksiev AR, Magnusson ML, et al. Muscular response to sudden load. A tool to evaluate fatigue and rehabilitation[J]. Spine,1996,21(22):2628-2639.
10、Arashanapalli M, Wilson SE. Paraspinal muscle vibration alters dynamic motion of the trunk[J]. J Biomech Eng,2008,130(2):1-7.
11、Brown SH, Haumann ML, Potvin JR. The responses of leg and trunk muscles to sudden unloading of the hands:implications for balance and spine stability[J]. Clin Biomech (Bristol,Avon),2003,18(9):812-820.
12、Brown SH, McGill SM. The intrinsic stiffness of the in vivolumbar spine in response to quick releases: implications for reflexive requirements[J]. JElectromyogr Kinesiol,2009,19(5):727-736.
13、Andersen TB, Essendrop M, Schibye B. Movement of the upper body and muscle activity patterns following a rapidly applied load:the influence of pre-load alterations[J].Eur J Appl Physiol, 2004,91(4):488-492.
14、Delahunt E.Neuromuscular contributions to functional instability of the ankle joint[J].Journal of Bodywork and Movement Therapies,2007,11 (3):203-213.
15、Lephart SM, Henry TJ. Functional rehabilitation for the upper and lower extremity[J]. Orthop clin North Am,1995,26(3):579-592.
16、Nudo RJ. Post-infarct cortical plasticity and behavioral recovery. Stroke.2007,38(part2),840-845
17、Dillman CJ,Murray TA, Hint ermeister RA.Biomechanical Differences of open and closed chain exercise w ith respect to the shoulder [J].J Sport Rehabil,1994,3:228-238.
18、Forestier N, Teasdale N, Nougier V. Alteration of the position sense at the ankle induced by muscular fatigue in humans[J]. Med Sci Sports Exerc,2002,34(1):117-122.
19、Riemann BL, Lephart SM. The sensorimotor system, part ii:The role of proprioception in motor control and functional joint stability[J]. J Athl Train,2002,37(1):80-84.
20、Kiehn O, T resch M C. Gap juncti on s an d mot or b ehavior [J].Trends Neu ros ci,2002,25(2):108-115.
21、HarrisWarri ck RM. Voltagesensiti veion channels in rhythmic motor systems[J]. Curr Opin Neu robiol, 2002,12(6):646-651.
22、Margareta nordin,Victor H.Frankel肌肉骨骼系统基础生物力学[M].第二版,北京：人民卫生出版社,2008：111
23、Kiehn O,T resch M C.Gap juncti on s an d mot or b ehavior [J].Trends Neu ros ci,2002,25(2):108-115.
24、HarrisWarri ck RM.Voltagesensiti veion channels in rhythmic motor systems[J].Curr Opin Neu robiol, 2002,12(6):646-651.
25、费伦,承焕生,蔡德亨.经络物质基础及其功能性特征的实验探索和研究展望[J].科学通报,1998,43(6)：658-672
26、郭明霞.经络的物质基础、循经感传及其作用机制研究与进展[J].中国临床康复,2004,8(25)：5353-5355
27、张保真.经脉线的构造和机能[M].西安：陕西科学技术出版社,1991：85
28、谢益宽,李惠清,肖文华.经络和循经感传的神经生物学性质研究[J].中国科学B辑,1995,25(7)：721-731
29、Utter AC, Robertson RJ, Green JM, et al. Validation of the Adult OMNI Scale of Perceived Exertion for Walking/Running Exercise[J].Med SCI Sports Exerc.2004,36(10):1776-1780.
30、Dobkin B, Harkema S, Requejo P, et al. Modulation of locomot or-1 ike EMG activit y in subjects with complete and incomplete spinal cord injury[J]. J Neuro Rehab,1995,9:183-190.
31、Fox EL,Hatthews DK.The physiological basis of physical education and athletics Philadelphia [J].Sau Nders College Publishers,1981,49:123-128.
32、Colloca CJ,Keller'IS,Harrison DE,et al.Spinal manipulation force and duration afect vertebral movement and neuromuscular responses[J].Clinical Biomeehanie,2006,21(3):254-262
33、Svendsen B. Treatment of the hemiplegic patient:new strat egies for gait training[J]. Physical Therapy Products,1996, March:32-34.
34、Bellew, J. W. The effect of strength training on control of force in older men and women[J]. Aging Clin Exp Res,2002,14:35-41.
35、Tracy B L,Kern D S,Mehoudar P D,et al. Strength training does not improve the steadiness of muscles contractions in the knee extensors of older adults[J].Med Sci Sports Exerc,2001,33:S254
36、Christou E A,Yang Y, Rosengren K S.Taiji training improves knee extensor strength and force control in older adults[J]. J Gerontol:Medical Science,2003b,58A(8):763-766
37、马超,郑政,谢益宽.背最长肌反射性肌电活动的循经感传特性[J].科学通报,2000,45(18)：1982-1988
38、Emken J L,Reinkensmeyer D J.Robot-Enhanced Motor Learning:Accelerating Internal Model Formation During Locomotion by Transient Dynamic Amplification[J].IEEE transactions on neural systems and rehabilitation engineering,2005,13(1):33-39
39、Yun SJ,Park HJ,Yeom MJ,et al.Effect of electroacupuncture on the stress induced changes in brain-derived neurotrophic factor expression in rat hippocampus[J].Neuroscience Letters,2002,318:85-88
40、Wu MT,Sheen JM,Chuang KH,et al.Neuronal specificity of acupuncture response:A fMRI study with electroa cupuncture[J].NeuroImage,2002,16:1028-1037
41、张建华编著.推拿手法用力技巧[M]第一版.合肥：安徽科学技术出版社,2005年：12-81
42、陈景藻.次声的存在及其基本生物效应和研究意义[J].中华物理医学与康复杂志,1999,21(3)：131-133.
43、Akira Okada, Mari Nari, Makoto Ariizumi. Experimental studies on the effects of vibration and noise sympathetic nerve activity in skin[J]. Europe Journal of Applied Physiology,1991,62:324-331
44、Hiroyuki Nakamura, Takashi Moroji, Hirofumi Nagase. Changes of cerebral vasoactive intestinal polypeptide and somatostatin-like immunoreactivity induced by noise and whole-body vibration in the rat [J]. Europe Journal of Applied physiology,1994,68:62-67
45、Fox EL, Hatthews DK. The physiological basis of physical education and athletics Philadelphia[J]. Sau Nders College Publishers,1981,49:123-128
46、D Mealing. Vibration recording from human muscles with known fiber composition different[J]. British Journal Sports,1996,30:27-31.
47、obkin B, Harkema S, Requejo P, et al. Modulation of locomot or-1 ike EMG activit y in subjects with complete and incomplete spinal cord injury. J Neuro Rehab,1995,9:183-190.
48、Colloca CJ,Keller'IS,Harrison DE,et al.Spinal manipulation force and duration afect vertebral movement and neuromuscular responses[J].Clinical Biomeehanie,2006,21(3):254-262
49、Footnote:What's new in the literature[M]. Physical Therapists,2005,1:63.
50、Stephan Turbanski. Effects of random WBV on postural control in Pakinson's Disease[J]. Research in Sports Med icine,2005,3:243-256.
51、Hsu AL,Tang PF,JanMH.Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients aftermild to moderate stroke [J]. Arch Phys Med Rehabil,2003,8:1185-1193
52、Kawahira K, Shimodozono M, Ogata A, et al. Addition of intensive repetition of facilitation exercise to multidisciplinary rehabilitation promotes motor functional recovery of the hemiplegic lower limb.. RehabilMed,2004,36(4):159-164.
[2]陈竺主编.全国第三次死因回顾抽样调查报告.中华人民共和国卫生部.北京：中国协和医科大学出版社,2008：14-17.
[3]姚滔涛,王宁华,陈卓铭.脑卒中运动功能训练的循证医学研究[J].中国康复医学杂志,2010,25(5)：565-570
[4]Dancause N,Barbay S,Frost S,et al.Extensive cortical rewiring after brain injury[J]. J Neuro-science.2005, 25:10167-10179.
[5]谢光柏,姜洪福.早期康复治疗对急性脑血管意外偏瘫患者下肢运动功能的影响[J].中华物理医学与康复杂志,2001,23(2)：102.
[6]Chan S P,Luk T C,& Hong Y.Kinematic and electromyographic analysis of the push movement in taichi[J]. Br J Sports Med,2003,37:339-344.
[7]Mccrea PH, Eng JJ, Hodgson AJ. Time and magnitude of torque generation is both arms following stroke[J].Phys Ther,2003,83(1):49-57.
[8]Christou, E. A.,Shinohara,M.,& Enoka,R.M.Fluctuations in acceleration during voluntary contractions lead to greater impairment of movement accuracy in old adults[J].J Appl Physiol,2003a,21:373-384.
[9]Margareta nordin,Victor H. Frankel肌肉骨骼系统基础生物力学[M].第二版,北京：人民卫生出版社,2008：111
[10]Mcbride JM.Porcari JP.Scheunke MD. Effect of vibration during fatigning resistance exercise on subsequent muscle activity during maximal voluntary isometric contractions[J]. J Strength Cond Res. 2004 Nov;18(4):777-81.
[11]Lssurin VB. Vibrations and their applications in sport A review[J].Sports Meded.2005,35(1):23-41.
[12]Kawahira K, Shimodozono M, Ogata A, et al. Addition of intensive repetition of facilitation exercise to multidisciplinary rehabilitation promotes motor functional recovery of the hemiplegic lower limb [J]. RehabilMed,2004,36(4):159-164.
[13]Bellew, J. W. The effect of strength training on control of ferce in older men and women[J]. Aging Clin Exp Res,2002,14:35-41.
[14]Tracy B L,Kern DS, Mehoudar PD,et al.Strength training does not improve the steadiness of muscles contractions in the knee extensors of older adults[J].Med Sci Sports Exerc,2001,33:S254
[15]Christou EA,YangY,Rosengren KS.Taiji training improves knee extensor strength and force control in older adults[J].J Gerontol:Medical Science,2003b,58A(8):763-766
[16]金栋.《内经》中风病病症名探讨[J].世界中西医结合杂志,2009,4(10)：694-695
[17]国家中医药管理局脑病急症协作组.中风病诊断与疗效评定标准[J].北京中医药大学学报,1996,19(1)：55
[18]金栋.内经中风病病因病机探讨[J].世界中西医结合杂志,2009,4(7)：458
[19]刘完素.素问玄机原病式[M].南京：江苏科学技术出版社,1985：4647,27
[20]田德禄.中医内科学[M].北京：人民卫生出版社,2002：271.
[21]包祖晓,赵国平.试论缺血性中风气虚血瘀病机学说[J],中医学研究,2001,10(17)：5
[22]宋含平.气虚与中风关系浅探[J].新中医,2004,36(7)：75-76
[23]常富业,李云.邵念方教授从痰论治中风病经验[J].山东中医药大学学报,2001,25(2)：109-111.
[24]艾华,谭素娟,肇隆起.痰瘀同治论[J].中国中医基础医学杂志.1999,5(5)：4445
[25]王新陆.试论滋补肝肾是治疗缺血性脑卒中的重要法则[J].山东中医杂志,2005,24(10)：579-582.
[26]王玉民,程广书.调理肺气法在中风病治疗中的应用[J].陕西中医,2005,26(2)：187-188
[27]张会娜,刘卫红,李萍.中医证候要素研究概况[J].北京中医药,2009,28(5)：396-397
[28]周庆博,邵念方,毕建忠.清热解毒法在中风病急性期治疗中的探讨[J].中国中西医结合杂志,2004,24(3)：263-265
[29]沈承玲,赵海滨.中风病内生热毒之内涵、演变及特性探析[J].山东中医药大学学报,2002,26(4)：242-245
[30]杨小清.补阳还五汤治疗中风病气虚血瘀证的机制探讨[J].现代中西医结合杂志,2005,14(2)：190-191
[31]叶人,单泽松.豁痰开窍法治疗大片脑梗死的临床观察[J].浙江中医学院学报,2002,26(2)：39.
[32]韦月梅.自拟活血通络汤治疗脑梗塞恢复期58例[J].广西中医药,2000,23(5)：13-14.
[33]吴泉.自拟益气化痰通络汤给疗脑梗死恢复期56例[J].中华实用中西医杂志,2003,3(16)：1201-1202.
[34]赵拥军.加减地黄饮子治疗脑血栓形成恢复期62例总结[J].湖南中医杂志,2004,20(4)：5-6.
[35]杨克勤.补肾通络法治疗缺血性中风30例[J].中医研究,2007,20(9)：25-27.
[36]贺景宏,任旭红,杨秀丽.补肾益气活血化瘀法治疗缺血性脑卒中60例疗效观察[J].中西医结合心脑血管病杂志,2003,1(2)：121-122.
[37]景军,洪文学,何瑶.针灸治疗脑血管疾病机制研究[J].北京生物医学工程,2006,25(6)：666-668.
[38]Shigekazu Sakai, Etsuro Hori, Katsumi Umeno, et al. Specific Acupuncture Sensation Correlates with EEGs and Autonomic Changes in Human Subjects[J]. Autonomic Neuroscience:Basic and Clinical,2007, 133:158-169
[39]张琳瑛.中风的针灸冶疗概况[J].针灸临床杂志,2004,20(6)：61-63
[40]Park J,Hopwood V,White AR,et al.Effectiveness of acupuncture for stroke:a systematic review[J].J Neurol,2001,248 (7):558-563.
[41]Zhang SH,LiuM,Asp lund K,et al.Acupuncture for acute stroke[CD].Cochrane Database Syst Rev,2005, 2:CD003317.
[42]王刚,庞勇,卢琰琰.不同针法治疗中风的临床应用述评[J].四川中医,2006,24(9)：101-102
[43]姜东升.推拿配合对抗阻力运动治疗偏瘫60例[J].河南中医,2006,26(2)：60-61
[44]林萍,李林,许洪伟,等.节段性按摩法改善脑卒中肢体功能障碍[J].中国临床康复,2003,7(10)：1610
[45]刘海潮,蒋惠瑜.推拿结合运动疗法缓解偏瘫痉挛40例观察[J].中国康复理论与实践,2009,15(6)：588
[46]萧蕙,张广清,王琳,等.情志护理配合穴位按摩对脑卒中后抑郁患者康复的影响[J].中华护理杂志,2008,43(1)：77-79
[47]李应昆,吴节,胡卡明,等.推按运经仪治疗脑卒中的效果：与针灸治疗的随机分组比较[J].中国临床康,2006,10(19)：4-5
[48]张金生,喻杉,王晓庆,等.中医养生在中风社区防治中的应用[J].中国民间疗法,2011,19(2)：54-55
[49]Osuga H,Hakin AM.Relevance of interstitial glutamate to selective vulnerability in focal cerebral ischemia[J].Cereb Bliood Flow Metab,1994,14(2):343
[50]Yang GY,Schielke GP,Gong C,et al. Expression of TNF-a and ICAM-1 after focal cerebral ischemia in IL-βconverting enzyme deficient mice[J]. J Cereb Blood Flow Metab,1999,19:1109.
[51]Tymianski M,Tator CH.Normal and abnormal calcium homeostasis in neurons:A basis for the pathophysiology of traumatic and ischemic central nervous sy stem injury[J].Neurosurgery,1996,38: 11-16.
[52]Zheng Z,Yenari MA.Post-ischemic inflammation:molecular mechanisms and therapeutic implications[J]. Neurol Res,2004,26(8):884-892
[53]Park TS,Gonzales ER,Giday JM. Platelet-activating factor mediates ischemia included leukocyte endothelial adherence in new-bornpig brain[J].Coreb B lood Flow Metab,1999,19:417-418
[54]Bates B,Hirt L,Thomas SS,et al.Neurotrophin-3 promotes cell death induced in cerebral ischemia, oxygen-glucose deprivation,and oxidative stress:possible involvement of oxygen free radicals[J].Neurobiol Dis, 2002,9:24-37.
[55]Huey KA,Roy RR,Zhong H,et al.Time-dependent in caspase-3 activity and heat shock protein 25 after spinal cord transection in adultrats[J]. Exp Physiol,2008,93:415-425.
[56]张微微,黄勇华,马志刚,等.北京市急性缺血性脑卒中磁共振成像分型研究[J].中国老年心脑血管病杂志,2006,8(6)：401-403.
[57]Dold Stein LB.Acute ischemic stroke treatment in 2007 [J].Circulation,2007,116(13):1504-1514.
[58]HackE W,Donnan G,Fieschic,et al.Association of outcome with early stroke treatment:pooled analysis of ATLANTIS,ECASS,and NINDS rt-PA stroke trials[J].Lancet,2004,363(9411):768-774
[59]AdamsHP,Adams R,Del Zoppo G, et al.Guidelines for the early management of patients with ischemic stroke:2005 guidelines update:a scientific statement from the Stroke Council of the American Heart Association/American Stroke Association[J].Stroke,2005,36(4):916-923
[60]Camerlingo M,Salivi P,Belloni G, et al.Intravenous heparin started within the first 3 hours after onset of symptoms as a treatment for acute nonlacunar hemispheric cerebral infarctions [J].Stroke,2005,36(11): 2415-2420
[61]张习红,李兆军,肖亮.阿司匹林对缺血性脑卒中二级预防的前瞻性分析[J].中国实用神经疾病杂志,2007,7(10)：70-71.
[62]Farres MT,Grabenwoger F,Gross CE,et al.Antithrombotic trialists collaborative meta:analysis of randomized trials of antiplatelet therapy for prevention of death myocardial infarction,and stroke in high risk patients[J]. BMJ,2002,324(1):71-86
[63]艾清龙,钟莲梅,临床神经病学讲座[M].昆明：云南人民出版社,2005：110-113.
[64]宋金森,张凤祥,姚惠风.氯吡格雷治疗急性脑梗死42例临床分析.山东医药,2007,23(47)：32-33.
[65]Fish ER M, Feuerstein G, Howells D W, et al. Update of the stroke therapy academic industry round table preclinical recomm endations[J].Stroke,2009,40(6):2244-2250.
[66]张立群,陈洁丽,程焱,等.尼莫地平对局灶性脑缺血鼠脑血浆蛋白的影响[J].中风与神经疾病杂志,2001,18(7)：300.
[67]Horn J,Limburg M,Calcium antagonists for ischemic stroke a systematic review[J].Stroke,2001,32(2):570-576
[68]Toth G, Albers G.Use of MRI to estimat the therapeutic window in acute stroke:is perfusion weighted imaging/diffusion weighted imaging mismatch and EPITHET for salvageable ischemic brain tissue? [J].Stroke,2009,40(1):333-335.
[69]韦联星.急性缺血性脑卒中的溶栓治疗[J].广西医学,2003,3(25)：403-404.
[70]Smith WS,Sung G, Starkman S,et al.Safety and efficacy of mechanical embolectomy in acute is chemic stroke:results of the MERCI trial[J].Stroke,2005,36(7):1432-1438.
[71]Levin MF, Kleim JA, Wo If SL. What do motor"recovery" and"compensation" mean in patients following stroke? Neurorehabil Neural Repair [J].2009,23(4):313-319.
[72]Levin MF,Michaelsen SM,Cirstea CM, et al.Use of the trunk for reaching targets placed within and beyond the reach in adult hemiparesis[J].Exp Bra in Res,2002,143(2):171-180.
[73]Carmichael ST. Cellular and molecular mechanisms of neural repair after stroke:making waves[J]. An.n Neurol,2006,59:735-742.
[74]刘罡,吴毅,胡永善,等.跑台训练对脑缺血大鼠脑组织超微结构及突触素表达的影响[J].中国康复医学杂志,2008,10(23)：872-874
[75]Muller HD, Hanumanthiah KM, Diederich K,et al. Brain-derived neurotrophic factor but not forced arm use improves long-term outcome after photothrombotic stroke and transiently upregulates binding densities of excitatory glutamate receptors in the rat brain[J].Stroke.2008,39:1012-1021.
[76]Nudo RJ. Post-infarct cortical plasticity and behavioral recovery[J]. Stroke.2007,38(part2):840-845.
[77]Vaynman SS, Ying Z, Yin D,et al. Exercise differentially regulates synaptic proteins associated to the function of BDNF[J]. Brain Res.2006,1070:124-130.
[78]Kleim J,Hogg T,van den Berg P,et al.Cortical synaptogenesis and motor map reorganization occur during late, but not early phase of motor skill leaming[J].J Neuroscience.2004,24:628-633.
[79]Michaelsen SM, Levin MF.Short-term effects of practice with trunk restraint on reaching movements in patients with chronic stroke:a controlled trial[J].Stroke.2004,35:1914-1919.
[80]Tanaka DH,Yamauchi K,Murakami F.Guidance mechanisms in neuronal and axonal migration [J].Brain Nerve,2008,60(4):405-413.
[81]Carmichael ST, Archibeque I, Luke L,et al. Growth associated gene expression after stroke:evidence for a growthpromoting region in periinfarct cortex [J].Exp Neurol,2005,193(13):291-311.
[82]Hobohm C,Gunther A,Grosche J, et al. Decompo sition and longlasting down regulation of extracellular matrix in perineuronalnets induced by focal cerebral ischemia in rats[J].J Neurosci Res,2005,80(4):539-548.
[83]Giger RJ,Venkatesh K,Chivatakarn O, et al. Mechanisms of CNS myelin inhibition:evidence for distinct and neuronal cell type specific receptor systems [J].Restor Neurol Neurosci,2008,26 (2-3):97-115.
[84]Leocani L,Comi G.Electrophysiological studies of brain plasticity of the motor system [J].Neurol Sci, 2006,27:S27-S29.
[85]Yun-Hee Kim,Sung H.You,Myoung-Hwan Ko,et al.Repetitive transcranial magnetic stimulation-induced corticomotor excitability and associated motor skill acquisition in chronic stroke[J]. Stroke,2006,37:1471-1476.
[86]Lee HH,Shin MS,Kim YS,et al.Early treadmill exercise decreases intrastriatal hemorrhage-induced neuronal cell death and increases cell proliferation in the dentate gyrus of streptozotocin induced hyperglycemic rats [J]. J DiabetesComplications,2005,19(6):339-346.
[87]Cramer SC. Repair ing the human brain after stroke:I.Mechanisms of spontaneous recovery [J].Ann Neuro,2008,63(3):272-287.
[88]Kim YH,You SH,Kwon YH,et al. Longitudinal fMRI study for locomotor recovery in patients with stroke[J].Neurology,2006,67:330-333.
[89]Luft AR, Macko RF, Forrester LW, et al. Treadmill exercise activates subcortical neural networks and improves walking after stroke:a randomized controlled trial [J].Stroke,2008,39(12):3341-3350.
[90]Sherrill L,Susan R.Early intervention care in the acute stroke patient[J].Arch Phys Med Rehabil,1986,67: 319-321
[91]胡永善,吴毅,朱玉连,等,规范三级康复治疗促进脑卒中偏瘫患者综合功能的临床研究[J].中华物理医学与康复杂志,2005,27(2)：105-110
[92]Teasell RW,Kalra L.What's new in stroke rehabilitation:back to basis[J].Stroke,2005,36:215-217
[93]Ardelt AA,McCullough LD,Korach KS,et al.Estradiol regulates angiopoietin-1mRNA expression through estrogen receptor-a in a rodent experimental stroke model[J].Stroke,2005,36:337-341
[94]Briones TL,Suh E,Jozsa L,et al.Changes in number of synapses and mitochondria in presynaptic terminals in the dentate gyrus following cerebral ischemia and rehabilitation training[J].Brain Res,2005,1033:51-57
[95]Kelly J,Rudda,Lewis RR,et al.Venous thromboembolism after acute ischemic stroke:a prospective study using magnetic resonance direct thrombus imaging [J].Stroke,2004,35(10):2320-2325.
[96]Smith Hammond CA, Goldstein LB.Cough and aspiration of foods and liquids due to oral-pharyngeal dysphagia:ACCP evidence-based clinical practice guidelines[J].Chest,2006,129(1Suppl):154S-168S
[97]WHO.Recommendation on stroke prevention,diagnosis end therapy[J].Stroke,1989,20(10):1407
[98]Bernhardt J, Dewey H, Thrift A, et al Inactive and alone:physical activity with in the first 14 days of acute stroke unit care[J].Stroke,2004,35:1005-1009.
[99]Sawner K,LaVigne J.Brunnstrom's movement therapy in hemiplegia:a neurophysiological approach[M]. 2nd edn.Philadelphia:JB Lippincott,1992.
[100]Mayston MJ. Raine:a response.Physiotherapy Research International.2006,11(3):183-186.
[101]潘化平,冯慧,李亚娟,等.负荷控制的本体感觉训练对脑卒中患者平衡功能及下肢运动能力的影响[J].中国康复医学杂志,2011,26(11)：1025-1028
[102]郑洁皎,俞卓伟,夏汶,等.本体感觉神经肌肉促进技术对脑卒中患者膝关节运动控制功能的影响[J].中国康复理论与实践,2010,16(2)：115-117
[103]Carr Janet H, Shepherd Roberta B中风病人的运动再学习方案[M].第1版.北京：北京医科大学出版社,1999：3-27
[104]Chan DY, Chan CC, Au DK. Motor relearning programme for stroke patients:a randomized controlled trial[J].Clin Rehabil,2006,20:191-200
[105]Winstein CJ.The best we can be is yet to come[J].Phys Ther,2009,89(11):1236-49
[106]Carr Janet H, Shepherd Roberta B脑卒中康复-优化运动技巧的指南[M].第1版.北京：北京大学医学出版社,2007：35-37.
[107]Taub E. Movement in nonhuman primates deprived of somatosensory feedback[J].Exercise and Sport Sciences Reviews.1976,4:335-374.
[108]Taub E, Crago J E. An operant approach to rehabilitation medicine:overcoming learned nonuse by shaping[J]. Journal of the Experimental Analysis of Behavior.1994,61(2):281-293.
[109]毕胜.强制性使用运动疗法的起源与进展[J].中国康复医学杂志,2006,21(8)：739-743.
[110]Wolf SL,Winstein CJ,Miller JP,et al.Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke:the EXCITE randomized clinical trial[J].JAMA,2006,296:2095-2104
[111]Grillner S,Debuc,R.Control of locomotion in vertebrates:Spinal and supraspinal mechanisms. In: Waxman SG,Advances in Neurology,Vol.47:Functional Recovery in Neurological Disease[J].Raven Press, New York.1988,425-453
[112]Grillner S, Ekeberg O, E. Manira A, et al. Intrinsic function of a neuronal network-a vertebrate central pattern generator[J] Brain Research Reviews.1998,26:184-197.
[113]Tong RK, Ng MF, Li LS. Effectiveness of gait training using an electromechanical gait trainer, with and without functional electric stimulation,in subacute stroke:a randomized controlled trial[J]. Arch Phys Med Rehabil,2006,87:1298-1304.
[114]Tveit M,Karrholm,J. Low effectiveness of prescribed partial weight bearing. J Rehabil Med[J],2001, 33(1):42-44
[115]游国清,燕铁斌.功能性电刺激及其在脑卒中后偏瘫患者中的应用[J].中华物理医学与康复杂志,2007,29(2)：142-143.
[116]Kreisel SH,Hennerici MG,Bazner HJ.Pathophysiology of stroke rehabilitation:the natural course of clinical recovery,use-dependent plasticity and rehabilitative outcome[J].Cerebrovasc Dis,2007,23:243-255
[117]Liberson W,Hohnquest H,Scot D,et al.Functional electrotherapy:stimulation of the peroneal nerve synchronized with the swing phase of the gait of hemiplegic patients[J].Arch Phys Med Rehabil,1961,42: 101-105.
[118]Magnusson M,Johansson K,JohanssonBB.Sensory stimulatiopromotes normalization of postural control after stroke[J]. Stroke,1994,25(6):1176-1180.
[119]刘忠良,宋琳,关爽,等.功能性电刺激对脑卒中偏瘫患者上肢运动功能恢复的影响[J].中国康复,2005,20(1)：52-53.
[120]Page SJ,Levine P,Sisto SA,et al.Mental practice combined with physical practice for upper-limb motor deficit in subacute stroke[J].Phys Ther,2001,81(8):1455-1462
[121]王茂斌.脑卒中的康复医疗[M].北京：中国科学技术出版社,2006：482-486.
[122]Page SJ,Levine P,Sisto SA,et al.A randomized efficacy and feasibility study of imagery in acute stroke [J].Clin Rehabil,2001,15(3):233-240.
[123]Hamel MF,Lajoie YVES.Mental imagery,effects on static balance and attentional demands of the elderly[J].Aging Clin Exp Res,2005,17(3):223-228.
[124]Jeannerod M,Decety J.Mental motor imagery:a window into the representational stages of action. Curr OpinNeurobiol[J].1995,5(6):727-732.
[125]Sharma N,Pomeroy VM,Baron JC, et al. Motor imagery:a backdoor to the motor system after stroke? [J] Stroke,2006,37(7):1941-1952.
[126]Page SJ,LevineP,LeonardA.Mental practice in chronic stroke:results of a randomized, placebocontrolled-trial[J].Strok.2007 Apr;38(4):1293-1297.
[127]Ietswaart M,Johnston M,Dijkerman HC,et al.Recovery of hand function through mental practice:a study protocol[J]. BMC Neurol.2006,26(6):39.
[128]Dickstein R, Deutsch JE. Motor imagery in physical therapist practice[J]. Physical Therapy,2007,87(7): 942-953.
[129]Rizzolatti G, Fadiga L, Gallese V, et al. Premotor cortex and the recognition ofmotor actions[J]. Cogn Brain Res,1996,3(2):131-141.
[130]PetridesM, Cadoret G,Mackey S. Orofacial somatomotor responses in the macaque monkey homologue of Broca's area [J]. Nature,2005,435 (7046):1235-1238.
[131]Calmels C,Hohmes P,Jarry G,et al. Variability of EEG synchronization prior to and during observation and execution of a sequential fingermovement[J]. Hum BrainMapp,2006,27 (3):251-266.
[132]Kwakkel G,Van PeppenR,Wagenaar RC,et al.Effects ofaugmented exercise therapy time after stroke:a meta2analysis[J]. Stroke,2004,35(11):2529-2539.
[133]Di Pellegrino G, Fadiga L, Fogassi L, et al. Understanding motor events:a neurophysiological study [J]. Exp Brain Res,1992,91(1):176-180.
[134]范振华.运动疗法基础[J].神经病学与神经康复学杂志,1996,1：60.
[135]褚海林,詹红生,侯群,等.推拿治疗早期中老年脑血管缺血性疾病(脑梗塞)的临床研究[J].浙江中医学院学报,2002,26(3)：62-63
[136]陆筱安.按摩与导引在中风康复临床上的应用[J],按摩与导引,2007,24(2)：32
[137]刘丽秋.调整督脉法对中风后遗症的康复体会[J[.针灸临床杂志,2005,21(10)：43
[138]李玉亮.再谈“按摩以脊背为纲”.[J]按摩与导引,2006,22(11)：35
[139]郭泽新,陈卫华.缓解中风偏瘫痉挛状态推拿手法及其机理探讨[J],按摩与导引,2003,19(1)：2
[140]田洪文,高欣,于洪梅.脑卒中后肩手综合症治疗36例临床体会[J].航空航天医药,2005,16(2)：25
[141]朱江.中风病人便秘的护理[J].辽宁中医杂志,2006,33(1)：116
[142]梁雯.经穴按摩法治疗老年性便秘的临床观察[J].陕西中医学院学报,2003,26(6)：45
[143]王晶,曲红岩.脑中风患者便秘的中医调护[J].新疆中医药,2006,24(4)：63
[144]程晓巍,金伟,秋红.穴位按摩在临床护理中的应用[J].针灸临床杂志,2002,18(6)：5
[145]丁世勇.论按摩治病的机理[J].按摩与导引,2006,22(6)：12-13.
[146]熊周清.推拿结合针刺治疗中风偏瘫[J].按摩与导引,1993,3：17.
[147]李成永,吴嘉容,沈国权,等.推拿、针刺对急性脑缺血大鼠的脑保护作用[J].中医药信息,2003,20(6)： 44-45.
[148]Mcbride JM.Porcari JP.Scheunke MD. Effect of vibration during fatigning resistance exercise on subsequent muscle activity during maximal voluntary isometric contractions [J]. J Strength Cond Res. 2004,18(4):777-81.
[149]Lssurin VB. Vibrations and their applications in sport A review [J]. Sports Meded.2005,35(1):23-41.
[150]Kawahira K, Shimodozono M, Ogata A, et al. Addition of intensive repetition of facilitation exercise to multidisciplinary rehabilitation promotes motor functional recovery of the hemiplegic lower limb[J]. Rehabil Med,2004,36(4):159-164.
[151]各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6)：379
[152]张仕年,张宏如.金宏柱教授疏经通督学术思想浅析[J].贵阳中医学院学报,2010,3(1)：12-14
[153]范炳华,韩明舫,赵毅.推拿学-普通高等教育十一五国家及规划教材[M].中国中医药出版社,2008：227-228
[154]于国才.推拿手法学[M].北京：中国中医药出版社,2003
[155]Scandinavian Stroke Study Group.Multicenter trial of hermodilution in ischernic stroke-background and study protocol[J].Stroke,1985,16:885-890
[156]陶子荣.我国脑卒中患者临床神经功能缺损评分标准信度、效度及敏感度的评价[J].第二军医大学学报.2009,30(3)：283-285
[157]Fugl-Meyer AR, Jaasko L, Leyman I, Olsson S, Steglind S. The post-stroke hemiplegic patient:a method for evaluation of physical performance[J]. Scand J Rehabil Med 1975,7:13-31.
[158]Fugl-Meyer AR. Post-stroke hemiplegia assessment of physical properties [J]. Scand J Rehabil Med 1980, Suppl 7:85-93.
[159]Duncan PW, Propst M, Nelson SG, Duncan PW, Propst M, Nelson SGReliability of the Fugl-Meyer assessment of sensorimotor recovery following cerebrovascular accident[J]. Phys Ther 1983,63:1606-1610.
[160]Berg KO, Wood-Dauphinee SL, Williams JI, et al. Measuring balance in the elderly:validation of an instrument[J]. Can J Public Health 1992,83 Suppl 2:S7-11
[161]Berg KO, Wood-Dauphinee SL, Williams JI, et al. Measuring balance in the elderly:preliminary development of an instrument[J]. Physiother Can,1989,41:304-311.
[162]Lajoie Y, Gallagher SP. Predicting falls within the elderly community:comparison of postural sway, reaction time, the Berg Balance Scale and the Activities-specific Balance Confidence(ABC) Scale for comparing fallers and non-fallers [J]. Arch Gerontol Geriatr,2004,38:11-26.
[163]Bogle Thorbahn LD, Newton RA. Use of the Berg BalanceTest to predict falls in elderly persons [J]. Phys Ther,1996,76:576-583; discussion 584-585.
[164]Berg KO,Wood-Dauphinee S, WilliamsJI. The Balance Scale:Reliability assessment with elderly residents and patients with acute stroke[J], Scand J Rehabil Med 1995,27:27-36.
[165]燕铁斌,金冬梅.平衡功能的评定及平衡功能训练[J].中华物理医学与康复杂志,2007,29(11)：787-789
[166]瓮长水,王军,王刚,等.Berg平衡量表在脑卒中患者中的内在信度和同时效度[J].中国康复医学杂志,2007,22(8)：688-690
[167]胡永善,吴毅,范文可,等.FCA量表与FIM量表的比较研究[J].中国康复医学杂志,2004,19(3)：228-229
[168]范文可,胡永善,吴毅,等.功能综合评定量表用于脑卒中的信度、效度及敏感度再次评价[J].中华物理医学与康复杂志,2007,29(7)：453-457
[169]王涛,倪朝民,范文祥,等.社区康复对脑卒中患者功能和生存质量的远期疗效观察[J].中国康复医学杂志,2009,24(10)：934-937
[170]孟兆祥,倪朝民,李厥,等.应用功能综合评定量表评估早期康复对脑卒中患者功能结局的影响[J].中国临床康复,2005,9(5)：1-3
[171]燕铁斌.现代康复治疗技术[M].合肥：安徽科学技术出版社,1994：300
[172]Mahoney FI, Barthel D. Functional evaluation:The Barthel Index[J]. Maryland State Medical Journal, 1965,14(2):56-61.
[173]Leung SO,Chan CC,Shah S.Development of a Chinese version of the Modified Barthel Index-validity and reliability[J].Clin Rehabil,2007,21(10):912-922
[174]Shah S, Vanclay F, Cooper B. Predicting discharge status at commencement of stroke rehabilitation[J]. Stroke,1989,20(6):766-769.
[175]Leung SO, Chan CC, Shah S. Development of a Chinese version of the Modified Barthel Index-validity and reliability[J]. Clinical Rehabilitation,2007,21(10):912-922.
[176]闵瑜,吴媛嫒,燕铁斌,等.改良Barthel指数(简体中文版)量表评定脑卒中患者日常生活活动能力的效度和信度研究[J].中华物理医学与康复杂志,2008,30(3)：16-18
[177]黄晓琳,陆敏,喻澜,等Barthel指数对脑卒中患者住院康复效果的预测[J].中国康复,2003,18(3)：139-141
[178]Hackett ML,Duncan JR,Anderson CS,et al.Health2related quality of life among longterm survivors of stroke:results from the Auckland Stroke Study,1991-1992[J].Stroke,2000,31 (2):440-447.
[179]Ware J E, Sherbourne CD. The MOS-36-item short term health survey (SF-36)1:conceptual framework and item selection [J].Med Care,1992,30:473-483.
[180]袁洪江,张俊,孙敏,等.脑卒中后6-9月于两年的生存质量比较[J].老年医学与保健,2002,8(1)：17-20.
[181]HackettML, DuncanJR, Anderson CS, et al. Health related quality of life among long term survivors of stroke[J]. Stroke,2000,312(2):440-447.
[182]Javer CA. Quality of life among stroke survivors evaluated 1 year after stroke [J]. Stroke,2000,31 (12): 2995.
[183]郭铁成,陈小红.急性期脑卒中患者生活质量及SF-36适用性的研究[J].中华物理医学与康复杂志,2007,29(12)：822-824
[184]李青青,吴宗耀.步行中胫前后肌群的表面肌电图[J].神经损伤与功能重建,2007,2(2)：116-118.
[185]江晓峰,胡雪艳.偏瘫步态膝关节角度分析[J].中国康复医学杂志,2007,22(10)：918-920.
[186]徐光青,毛玉瑢,兰月,等.脑卒中患者躯体运动偏瘫模式的三维运动学评价[J].中国康复医学杂志,2009,24(10)：893-895.
[187]荣湘江,姚鸿恩,王卫强,等.偏瘫步态中时相与周期的定量研究[J].天津体育学院院报,2004,19(2)： 56-58
[188]王桂茂,严隽陶,刘玉超,等.三维运动解析系统测试脑卒中偏瘫步态的运动学定量评价[J].中国组织工程研究与临床康复,2010,14(52)：9816-9818
[189]许光旭,顾绍钦,孟殿怀,等.下肢痉挛偏瘫患者的步行效率[J].中国组织工程研究与临床康复,2009,13(11)：2166-2169
[190]Utter AC, Robertson RJ, Green JM, et al. Validation of the Adult OMNI Scale of Perceived Exertion for Walking/Running Exercise[J].Med SCI Sports Exerc.2004,36(10):1776-1780.
[191]励建安.神经疾病的步态分析[J].中国康复医学杂志,2005,20(4)：304-306
[192]Bowen TR, Cooley SR, Castagno PW,et al. A method for normalization of oxygen cost and consumption in normal children while walking[J]. J Pediatr Orthop.1998,18(5):589-593.
[193]Jankovic J, Brin MF. Botulinum toxin:historical perspective and potential new indications [J]. Muscle Nerve,1997,6:S129-S145.
[194]贾耿.督脉、足太阳、任脉、肾精实质试探[J].湖南中医学院学报,2000,20(4)：47-49
[195]邱继华.从《内经》论“筋”看经筋[J].浙江中医学院学报,1994,18(4)：3
[196]梁启军.经络和穴位的结构本义及针刺基本机理[J].长春中医药大学学报,2008,24(3)：239-240
[197]费伦,承焕生,蔡德亨.经络物质基础及其功能性特征的实验探索和研究展望[J].科学通报,1998,43(6)：658-672
[198]郭明霞.经络的物质基础、循经感传及其作用机制研究与进展[J].中国临床康复,2004,8(25)：5353-5355
[199]张保真.经脉线的构造和机能[M].西安：陕西科学技术出版社,1991：85
[200]Colloca CJ,Keller'IS,Harrison DE,et al.Spinal manipulation force and duration afect vertebral movement and neuromuscular responses[J].Clinical Biomeehanie,2006,21(3):254-262
[201]谢益宽,李惠清,肖文华.经络和循经感传的神经生物学性质研究[J].中国科学B辑,1995,25(7)：721-731
[202]杨志新,石学敏.醒脑开窍针刺法治疗中风疗效与安全性的系统评价[J].中国针灸,2007,27(8)：601-608
[203]焦顺发,焦青峰.督脉是脊髓浅识[J].中国针灸,2006,26(10)：761
[204]Lappin AK, Monroy JA, Pilarski JQ, et al. Storage and recovery of elastic potential energy powers ballistic prey capture in toads [J]. J Exp Biol.2006,209:2535-2553.
[205]Deliagina TG, Orlovsky GN, Zelenin PV, et al. Neural Bases of Postural Control. Physiology.2006,21: 216-225
[206]Moorhouse KM, Granata, KP. Role of reflex dynamics in spinal stability:intrinsic muscle stiffness alone is insufficient for stability[J]. J Biomech,2007,40(5):1058-1065.
[207]Winter D A. Biomechanics and motor control of human movement [M]. New York:John Wiley Sons, 2009.
[208]Dickstein R, Sheffi S, Markovici E.Anticipatory postural adjustment in selected trunk muscles in poststroke hemiparetic patients[J]. Archives of Physical Medicine and Rehabilitation.2004,85:261-267.
[209]Wildr DG, Aleksiev AR, Magnusson ML, et al. Muscular response to sudden load. A tool to evaluate fatigue and rehabilitation[J]. Spine,1996,21(22):2628-2639.
[210]Arashanapalli M, Wilson SE. Paraspinal muscle vibration alters dynamic motion of the trunk[J]. J Biomech Eng,2008,130(2):1-7.
[211]Brown SH, Haumann ML, Potvin JR. The responses of leg and trunk muscles to sudden unloading of the hands:implications for balance and spine stability[J]. Clin Biomech (Bristol,Avon),2003,18(9):812-820.
[212]Brown SH, McGill SM. The intrinsic stiffness of the in vivolumbar spine in response to quick releases: implications for reflexive requirements[J]. JElectromyogr Kinesiol,2009,19(5):727-736.
[213]Andersen TB, Essendrop M, Schibye B. Movement of the upper body and muscle activity patterns following a rapidly applied load:the influence of pre-load alterations[J]. Eur J Appl Physiol,2004,91(4): 488-492.
[214]Alexandra Handley, Pippa Medcalf, Kate Hellier, et al.Movement disorders after stroke[J].Age Ageing. 2009,38(4):260-266.
[215]Spencer JD, Hayes KC, Alexander IJ. Knee joint effusion and quadriceps inhibition in man[J].Archive of physical medicine and rehabilitation,1984,65(4):171-177.
[216]Delahunt E. Neuromuscular contributions to functional instability of the ankle joint[J]. Journal of Bodywork and Movement Therapies,2007,11(3):203-213.
[217]Lephart SM, Henry TJ. Functional rehabilitation for the upper and lower extremity[J]. Orthop clin North Am,1995,26(3):579-592.
[218]Nudo RJ. Post-infarct cortical plasticity and behavioral recovery[J]. Stroke.2007,38(part2):840-845.
[219]Dillman CJ, Murray TA, Hint ermeister RA.Biomechanical Differences of open and closed chain exercise w ith respect to the shoulder [J]. J Sport Rehabil,1994,3:228-238.
[220]Forestier N, Teasdale N, Nougier V. Alteration of the position sense at the ankle induced by muscular fatigue in humans[J]. Med Sci Sports Exerc,2002,34(1):117-122.
[221]Riemann BL, Lephart SM. The sensorimotor system, part ii:The role of proprioception in motor control and functional joint stability[J]. J Athl Train,2002,37(1):80-84.
[222]Kiehn O,T resch M C.Gap junctions and motor behavior[J].Trends Neurosci,2002,25(2):108-115.
[223]Harris Warri ck RM. Voltagesensiti veion channels in rhythmic motor systems[J].Curr Opin Neu robiol, 2002,12(6):646-651.
[224]Utter AC, Robertson RJ, Green JM, et al. Validation of the Adult OMNI Scale of Perceived Exertion for Walking/Running Exercise[J].Med SCI Sports Exerc.2004,36(10):1776-1780.
[225]Dobkin B, Harkema S, Requejo P, et al. Modulation of locomot or-1 ike EMG activit y in subjects with complete and incomplete spinal cord injury[J]. J Neuro Rehab,1995,9:183-190.
[226]Fox EL,Hatthews DK.The physiological basis of physical education and athletics Philadelphia [J].Sau Nders College Publishers,1981,49:123-128.
[227]Svendsen B. Treatment of the hemiplegic patient:new strat egies for gait training[J]. Physical Therapy Products,1996,3:32-34.
[228]马超,郑政,谢益宽.背最长肌反射性肌电活动的循经感传特性[J].科学通报,2000,45(18)：1982-1988
[229]Emken J.L.,Reinkensmeyer D.J.Robot-Enhanced Motor Learning:Accelerating Internal Model Formation During Locomotion by Transient Dynamic Amplification[J].IEEE transactions on neural systems and rehabilitation engineering,2005,13(1):33-39.
[230]Yun SJ,Park HJ,Yeom MJ,et al.Effect of electroacupuncture on the stress induced changes in brain-derived neurotrophic factor expression in rat hippocampus[J].Neuroscience Letters,2002,318:85-88
[231]Wu MT,Sheen JM,Chuang KH,et al.Neuronal specificity of acupuncture response:A fMRI study with electroacupuncture[J].NeuroImage,2002,16:1028-1037
[232]张建华编著.推拿手法用力技巧(第一版)[M].合肥：安徽科学技术出版社,2005年：12-81
[233]陈景藻.次声的存在及其基本生物效应和研究意义[J].中华物理医学与康复杂志,1999,21(3)：131-133
[234]Akira Okada, Mari Nari, Makoto Ariizumi. Experimental studies on the effects of vibration and noise sympathetic nerve activity in skin[J]. Europe Journal of Applied Physiology,1991,62:324-331
[235]Hiroyuki N,Takashi M,Hirofumi N.Changes of cerebral vasoactive intestinal polypeptide and somatostatin-like immunoreactivity induced by noise and whole-body vibration in the rat [J]. Europe Journal of Applied physiology,1994,68:62-67
[236]D. Mealing. Vibration recording from human muscles with known fiber composition different[J]. British Journal Sports,1996,30:27-31.
[237]Footnote:What's new in the literature[M].Physical Therapists,2005,1:63.
[238]Stephan Turbanski Effects of random WBV on postural control in Pakinsons' Disease[J]. Research in Sports Med icine,2005,3:243-256.
[239]Hsu A L,Tang PF,JanM H.Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients aftermild to moderate stroke [J].Arch Phys Med Rehabil,2003,8:1185-1193.
[240]Dillman CJ, Murray TA, Hint ermeister RA.Biomechanical Differences of open and closed chain exercise with respect to the shoulder [J].J Sport Rehabil,1994,3:228-238.
[241]辛喜艳,高颖,马斌,等.中风病气虚证与神经功能缺损程度及远期预后的关系研究[J].中国中西医结合杂志,2011,31(12)：1627-1631
[242]Siegfried Mense,David G.Simons,I.Jon Russell,著.郭传友译.肌痛[M].北京：人民卫生出版社,2005：85
[243]Walsh EG Muscles, Masses and Motion. The Physiology of Normality, Hypotonieity, Spasticity and Rigidity[M]. London:Mac Keith Press,1992:101.
[244]Karatas M, Cetin N, Bayramoqlu M. Trunk muscle strength in relation to balance and functional disability in unihemispheric stroke patients [J]. Am J Phys Med Rehabil,2004,83(2):81-87.
[245]Verheyden G, Vereeck L, Truijen S. Trunk performance after stroke and the relationship with balance, gait and functional ability[J]. Clin Rehabil,2006,20(5):451-458.
[246]Hsieh CL, Hsueh IP1Trunk control as an early p redictor of comp rehensive activities of daily living function in stroke patients[J].Stroke,2002,33 (11):2626-2630
[247]Au-Yeung SS, Hui-Chan CW, Tang JC. Short-form Tai Chi improves standing balance of people with chronic stroke [J]. Neurorehabil Neural Repair,2009,23(5):515-522.
[248]吴毅,胡永善,杨晓冰,等.功能综合评定量表信度和效度的研究[J].中国临床康复杂志,2002,64(14)：2036-2037
[249]胡永善,吴毅,朱玉连,等.规范三级康复治疗促进脑卒中偏瘫患者综合功能康复的临床研究[J].中国康复医学杂志,2004,19(6)：418-421
[250]范文可,胡永善,吴毅,等.规范三级康复治疗对脑卒中偏瘫患者运动功能康复的影响[J].中国康复医学杂志,2006,21(6)：484-487
[251]朱玉连,胡永善,吴毅,等.规范三级康复治疗中不同时期卒中患者运动功能改善规律的分析[J].中国运动医学杂志,2004,23(4)：377-380
[252]张惠,吴毅,胡永善.影响脑卒中患者日常生活活动能力预后的相关因素分析[J].中国康复医学杂志,2008,23(2)：130-131
[253]Freeman CT, Hughes AM, Burridge JH et al. A robotic workstation for stroke rehabilitation of the upper extremity using FES[J]. Medical engineering & physics,2009,31(3):364-373
[254]白玉龙,胡永善,陈文华等.规范三级康复治疗对缺血性脑卒中患者功能独立性的影响[J].中国运动医学杂志,2007,26(5)：552-559
[255]Dai DC, Fang M, Yan JT, Liu KP. Tuina intervention and sleep and emotional disordersdue to chronic fatigue syndrome[J].J Acupunct Tuina Sci.2009,7(3):147-151
[256]Tueblood PR.Partial body weight treadmill training in persons with chronic stroke [J].Neuro Rehabilita-tion,2001,16(3):141-153
[257]Guralnik JM,Ferrucci L,Balfour JL,et al.Progressive versus catast rophicloss of the ability to walk: implications the prevention of mobilityloss [J].J Am Geriatr Soc,2001,49 (11):1463-1470
[258]Neckel N D, Blonien N, Nichols D, et al. Abnormal joint torque patterns exhibited by chronic stroke subjects while walking with a prescribed physiological gait pattern[J].J Neuroeng Rehabil,2008,5:19.
[259]Duncan PW, Sullivan KJ, Behrman AL, et al. Protocol for the Locomotor Experience Applied Post-stroke (LEAPS) trial:a randomized controlled trial[J].BMC Neurol,2007,7(39):1471.
[260]Kavanagh JJ. Lower trunk motion and speed-dependence during walking[J].J Neuroeng Rehabil,2009, 6(9):1186.
[261]Brach JS, Berlin JE, VanSwearingen JM, et al. Too much or too little step width variability is associated with a fall history in older persons who walk at or near normal gait speed[J].Journal of NeuroEngineering and Rehabilitation,2005,2(21):1743.
[262]金道鹏,徐俊,赵吉忠,等.推拿功法易筋经对骨骼肌减少症患者日常活动能力及体质的影响[J].中国中医药信息杂志,2011,18(1)：14-16
[263]O' Byrne JM, Jenkinson A, O'Brien TM. Quantitative analysis and classification of gait patterns in cerebral palsy using a three-dimensional motion analyzer [J].J Child Neurol,1998,13 (3):101-108.
[264]Tiebin Yan,ChristinaWY,Leonard SW.Functional electrical stimulation improvesmotor recovery of the lower extremity and walking ability of subjectswith first acute stroke [J]. Stroke,2005,36:80-85
[265]王瑞华.步态分析[J].中级医刊,1994,29(4)：9-10
[266]胡雪艳,恽晓平,张通.基于数字视频和数字图像处理的步态分析在卒中康复训练中的应用[J].中国脑血管病杂志,2009,6(9)：456-460.
[267]荣湘江,姚鸿恩,王卫强,等.偏瘫步态中时相与周期的定量研究[J].天津体育学院院报.2004,19(2)：56-58.
[268]胡雪艳,恽晓平,王广志,等偏瘫步态髋关节角度研究[J].中国康复理论与实践,2007,13(10)：924-925.
[269]Cauraugh J H,Summers J J.Neural plasticity and bilateral movements:A rehabilitation approach for chronic stroke [J].ProgNeurobiol,2005,75:30-320.
[270]Mudie MH, Matyas TA. Can simultaneous bilateral movement involve the undamaged hemisphere in reconstruction of neural networks damaged by stroke [J]. Disabil Rehabil,2000,22:23-37.
[271]Whitall J, McCombe Waller S, Silver KH, et al. Repetitive bilateral arm training with rhythmic auditory cueing improves motor function in chronic hemiparetic stroke [J]. Stroke,2000,31:2390-2395.
[272]Kerrigan,D C,Guest editorial aesthetics of walking[J]. Journal Rehabilitation Research and Development, 2001,38:9-10
[273]Sibley KM,Tang A,Brooks D,et al. Effects of extended effortful activity on spatio-temporal parameters of gait in individuals with stroke[J].Gait Posture,2008,27(3):387-392.
[274]Mccrea PH, Eng JJ, Hodgson AJ. Time and magnitude of torque generation is both arms following stroke [J]. Phys Ther,2003,83(1):49-57.
[275]高霞,李京平,陈刚.偏瘫患者行走能量消耗与速度的相关性[J].中国临床康复,2006,10(16)：110-111
[276]Olney SJ,Griffin MP,Monga TN,et al.Work and power in gait of stroke[J].Arch phys Med Rehabil,1991, 72:309-314.
[277]Utter AC, Robertson RJ, Green JM, et al. Validation of the Adult OMNI Scale of Perceived Exertion for Walking/Running Exercise[J].Med SCI Sports Exerc.2004,36(10):1776-1780.
[278]Bereket S.Effects of anthropometric parameters and stride frequency on estimation of energy cost of walking[J].J Sports Med Phys Fitness.2005,45:152-161.
1、陈竺主编.全国第三次死因回顾抽样调查报告[M].中华人民共和国卫生部.北京：中国协和医科大学出版社,2008：14-17.
2、姚滔涛,王宁华,陈卓铭.脑卒中运动功能训练的循证医学研究[J].中国康复医学杂志,2010,25(5)：565-570
3、Dickstein R, Sheffi S, Markovici E.Anticipatory postural adjustment in selected trunk muscles in poststroke hemiparetic patients[J]. Archives of Physical Medicine and Rehabilitation.2004,85:261-267.
4、Liu CJ, Latham NK. Progressive resistance strength training for improving physical function in older adults[J]. Cochrane Database Syst Rev.2009,3:CD002759.
5、Alexandra Handley, Pippa Medcalf, Kate Hellier, et al.Movement disorders after stroke[J].Age Ageing. 2009,38(4):260-266.
6、Dickstein R,Sheffi S,Markovici E. Anticipatory posturaladjustment in selected trunk muscles in poststroke hemiparetic patients[J]. Archives of Physical Medicine and Rehabilitation.2004,85:261-267.
7、Leroux A.Exercise training to improve motor performance inchronic stroke:effects of a community-based exercise programme[J].International Journal of Rehabilitation Research.2005,28:17-23.
8、Spencer JD, Hayes KC, Alexander IJ. Knee joint effusion and quadriceps inhibition in man[J].Archive of physical medicine and rehabilitation,1984,65(4):171-177.
9、Wildr DG, Aleksiev AR, Magnusson ML, et al. Muscular response to sudden load. A tool to evaluate fatigue and rehabilitation[J]. Spine,1996,21(22):2628-2639.
10、Arashanapalli M, Wilson SE. Paraspinal muscle vibration alters dynamic motion of the trunk[J]. J Biomech Eng,2008,130(2):1-7.
11、Brown SH, Haumann ML, Potvin JR. The responses of leg and trunk muscles to sudden unloading of the hands:implications for balance and spine stability[J]. Clin Biomech (Bristol,Avon),2003,18(9):812-820.
12、Brown SH, McGill SM. The intrinsic stiffness of the in vivolumbar spine in response to quick releases: implications for reflexive requirements[J]. JElectromyogr Kinesiol,2009,19(5):727-736.
13、Andersen TB, Essendrop M, Schibye B. Movement of the upper body and muscle activity patterns following a rapidly applied load:the influence of pre-load alterations[J].Eur J Appl Physiol, 2004,91(4):488-492.
14、Delahunt E.Neuromuscular contributions to functional instability of the ankle joint[J].Journal of Bodywork and Movement Therapies,2007,11 (3):203-213.
15、Lephart SM, Henry TJ. Functional rehabilitation for the upper and lower extremity[J]. Orthop clin North Am,1995,26(3):579-592.
16、Nudo RJ. Post-infarct cortical plasticity and behavioral recovery. Stroke.2007,38(part2),840-845
17、Dillman CJ,Murray TA, Hint ermeister RA.Biomechanical Differences of open and closed chain exercise w ith respect to the shoulder [J].J Sport Rehabil,1994,3:228-238.
18、Forestier N, Teasdale N, Nougier V. Alteration of the position sense at the ankle induced by muscular fatigue in humans[J]. Med Sci Sports Exerc,2002,34(1):117-122.
19、Riemann BL, Lephart SM. The sensorimotor system, part ii:The role of proprioception in motor control and functional joint stability[J]. J Athl Train,2002,37(1):80-84.
20、Kiehn O, T resch M C. Gap juncti on s an d mot or b ehavior [J].Trends Neu ros ci,2002,25(2):108-115.
21、HarrisWarri ck RM. Voltagesensiti veion channels in rhythmic motor systems[J]. Curr Opin Neu robiol, 2002,12(6):646-651.
22、Margareta nordin,Victor H.Frankel肌肉骨骼系统基础生物力学[M].第二版,北京：人民卫生出版社,2008：111
23、Kiehn O,T resch M C.Gap juncti on s an d mot or b ehavior [J].Trends Neu ros ci,2002,25(2):108-115.
24、HarrisWarri ck RM.Voltagesensiti veion channels in rhythmic motor systems[J].Curr Opin Neu robiol, 2002,12(6):646-651.
25、费伦,承焕生,蔡德亨.经络物质基础及其功能性特征的实验探索和研究展望[J].科学通报,1998,43(6)：658-672
26、郭明霞.经络的物质基础、循经感传及其作用机制研究与进展[J].中国临床康复,2004,8(25)：5353-5355
27、张保真.经脉线的构造和机能[M].西安：陕西科学技术出版社,1991：85
28、谢益宽,李惠清,肖文华.经络和循经感传的神经生物学性质研究[J].中国科学B辑,1995,25(7)：721-731
29、Utter AC, Robertson RJ, Green JM, et al. Validation of the Adult OMNI Scale of Perceived Exertion for Walking/Running Exercise[J].Med SCI Sports Exerc.2004,36(10):1776-1780.
30、Dobkin B, Harkema S, Requejo P, et al. Modulation of locomot or-1 ike EMG activit y in subjects with complete and incomplete spinal cord injury[J]. J Neuro Rehab,1995,9:183-190.
31、Fox EL,Hatthews DK.The physiological basis of physical education and athletics Philadelphia [J].Sau Nders College Publishers,1981,49:123-128.
32、Colloca CJ,Keller'IS,Harrison DE,et al.Spinal manipulation force and duration afect vertebral movement and neuromuscular responses[J].Clinical Biomeehanie,2006,21(3):254-262
33、Svendsen B. Treatment of the hemiplegic patient:new strat egies for gait training[J]. Physical Therapy Products,1996, March:32-34.
34、Bellew, J. W. The effect of strength training on control of force in older men and women[J]. Aging Clin Exp Res,2002,14:35-41.
35、Tracy B L,Kern D S,Mehoudar P D,et al. Strength training does not improve the steadiness of muscles contractions in the knee extensors of older adults[J].Med Sci Sports Exerc,2001,33:S254
36、Christou E A,Yang Y, Rosengren K S.Taiji training improves knee extensor strength and force control in older adults[J]. J Gerontol:Medical Science,2003b,58A(8):763-766
37、马超,郑政,谢益宽.背最长肌反射性肌电活动的循经感传特性[J].科学通报,2000,45(18)：1982-1988
38、Emken J L,Reinkensmeyer D J.Robot-Enhanced Motor Learning:Accelerating Internal Model Formation During Locomotion by Transient Dynamic Amplification[J].IEEE transactions on neural systems and rehabilitation engineering,2005,13(1):33-39
39、Yun SJ,Park HJ,Yeom MJ,et al.Effect of electroacupuncture on the stress induced changes in brain-derived neurotrophic factor expression in rat hippocampus[J].Neuroscience Letters,2002,318:85-88
40、Wu MT,Sheen JM,Chuang KH,et al.Neuronal specificity of acupuncture response:A fMRI study with electroa cupuncture[J].NeuroImage,2002,16:1028-1037
41、张建华编著.推拿手法用力技巧[M]第一版.合肥：安徽科学技术出版社,2005年：12-81
42、陈景藻.次声的存在及其基本生物效应和研究意义[J].中华物理医学与康复杂志,1999,21(3)：131-133.
43、Akira Okada, Mari Nari, Makoto Ariizumi. Experimental studies on the effects of vibration and noise sympathetic nerve activity in skin[J]. Europe Journal of Applied Physiology,1991,62:324-331
44、Hiroyuki Nakamura, Takashi Moroji, Hirofumi Nagase. Changes of cerebral vasoactive intestinal polypeptide and somatostatin-like immunoreactivity induced by noise and whole-body vibration in the rat [J]. Europe Journal of Applied physiology,1994,68:62-67
45、Fox EL, Hatthews DK. The physiological basis of physical education and athletics Philadelphia[J]. Sau Nders College Publishers,1981,49:123-128
46、D Mealing. Vibration recording from human muscles with known fiber composition different[J]. British Journal Sports,1996,30:27-31.
47、obkin B, Harkema S, Requejo P, et al. Modulation of locomot or-1 ike EMG activit y in subjects with complete and incomplete spinal cord injury. J Neuro Rehab,1995,9:183-190.
48、Colloca CJ,Keller'IS,Harrison DE,et al.Spinal manipulation force and duration afect vertebral movement and neuromuscular responses[J].Clinical Biomeehanie,2006,21(3):254-262
49、Footnote:What's new in the literature[M]. Physical Therapists,2005,1:63.
50、Stephan Turbanski. Effects of random WBV on postural control in Pakinson's Disease[J]. Research in Sports Med icine,2005,3:243-256.
51、Hsu AL,Tang PF,JanMH.Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients aftermild to moderate stroke [J]. Arch Phys Med Rehabil,2003,8:1185-1193
52、Kawahira K, Shimodozono M, Ogata A, et al. Addition of intensive repetition of facilitation exercise to multidisciplinary rehabilitation promotes motor functional recovery of the hemiplegic lower limb.. RehabilMed,2004,36(4):159-164.