西方脊柱手法医学的进展与镜鉴

脊柱手法在东西方治疗脊柱退变性疾病都有数千年的历史。近半个世纪以来,西方国家的脊柱手法治疗的发展已经形成了现代科学研究的框架和体系。许多基础研究和手法机制的研究已经得到现代医学科学的认可。以经验医学为主导的脊柱手法治疗能够在一个以现代实验医学占主导的欧美国家生存和发展实属不易。本文就此进行了综述和剖析。分析了当代脊柱手...     

Imagination after neurological losses of movement and sensation: The experience of spinal cord injury

To what extent is imagination dependent on embodied experience? In attempting to answer such questions I consider the experiences of those who have to come to terms with altered neurological function, namely those with spinal cord injury at the neck. These people have each lost all sensation and movement below the neck. How might these new ways of living affect their imagination?     

Teaching preschoolers with disabilities to seek adult assistance in response to simulated injuries

Four preschool-aged children with disabilities received training to seek adult assistance in response to simulated injuries. The children first watched while the instructor modeled and verbalized a first-aid procedure for obtaining adult assistance when injured, and then they practiced the skill with instructor praise or correction. Following this practice with feedback, the children demonstrated their skill without instructor feedback. Generalization probes were conducted before and after training on the school playground and at the children's homes. A multiple baseline design across children was used to evaluate the effects of the program. Rapid increases in the children 's performances of this skill was demonstrated. Further, the posttraining generalization data indicated that the children's performance had generalized across the two settings (school playground and children's homes). More importantly, this skill maintained at 100% at a 1-month follow-up generalization probe.     

胸椎管狭窄症的临床分型与术式选择

为探讨胸椎管狭窄症的临床分型与术式选择,对35例患者行后路椎管减压术,所有患者术后12个月时ASIA分级均有1级或1级以上的恢复;按Epstein标准：优良率：85．7％;影像学检查示脊髓减压充分,植骨患者术后6个月均达骨性融合。据不同的临床类型选择不同的术式,可取得满意的临床疗效。     

脊柱疾患临床诊断的辩证思维

脊柱外科是骨科学的一个亚专科,也是外科学领域中发展最为迅速的一个分支学科。脊柱外科疾患的正确诊断有赖于诊断过程中的正确辩证思维。在临床诊断思维中,从疾病学角度和症状学角度,需要正确处理几个辨证关系,同时要避免临床思维常见误区,才能提高诊断正确性。     

SKy椎体后凸成形术治疗骨质疏松胸腰椎压缩性骨折

为了探讨SKy椎体后凸成形术（SKy-PKP）治疗骨质疏松胸腰椎压缩性骨折的临床疗效,应用SKy椎体后凸成形术治疗骨质疏松胸腰椎椎体压缩性骨折。手术全部采用经皮椎弓根入路。SKy骨扩张后,形成一个空腔。注入骨水泥。观察患者的临床症状、椎体高度及脊柱后凸畸形的改善情况。结果显示,患者术后1-3d均可下床活动,患者腰背部疼痛明显减轻或消失,术后VAS评分降至1.5分,Cobb角平均18°,椎体中线高度丢失为6.3mm,随访3-12个月,患者对疗效满意,无椎体的高度丢失。提示SKy椎体后凸成形术是治疗骨质疏松腰椎压缩性骨折的一种有效治疗方法。关键词：脊柱骨折,胸椎,腰椎,经皮椎体后凸成形术     

Assessment of Biopsychosocial Risk Factors for Medical Treatment: A Collaborative Approach

There is a growing body of evidence that psychosocial variables have a significant ability to predict the outcome of medical treatment procedures, especially when the procedure is performed to reduce pain. The study described in this paper serves as an illustration of the valuable role psychologists can play in dealing with the challenges of biopsychosocial assessment of patients who are candidates for medical treatments, especially elective, invasive procedures. Based on a convergent model of risk factors that can potentially influence outcomes from spinal surgery and spinal cord stimulation, exclusionary and cautionary risk factors were identified, and the BHI 2 and BBHI 2 tests were used to assess them. An estimate of the prevalence of these risk factors was calculated using data obtained from 1,254 patient and community subjects gathered from 106 sites in 36 US states. Standardized Cautionary Risk and Exclusionary Risk scores demonstrated a test-retest reliability of .85 to .91. Evidence of validity of these scores was also provided based on subjective and objective criteria, using multiple groups of patients and community subjects. Recommendations are made regarding how biopsychosocial assessments could be used in collaborative settings for presurgical candidates to identify risks that could compromise a patient’s ability to benefit from other medical treatments as well. Once identified, appropriate interventions could ameliorate these risks, or lead to the consideration of other treatments that are more likely to be effective. Methods of refining this approach for specific clinical applications are also discussed.     

Parental ratings of daily behavior and child cognitive test performance after pediatric mild traumatic brain injury

This study aimed to evaluate the degree to which the Behavior Rating Inventory of Executive Function (BRIEF) and Child Behavior Checklist (CBCL) measure overlapping vs. distinct constructs in pediatric patients with mild traumatic brain injury (TBI), and to examine the demographic and injury correlates of such constructs as well as those of cognitive test performance. A total of 100 parents completed the BRIEF and the CBCL within 1 to 12 months after the injury of their child. Groups were contrasted based on the presence vs. absence of impairment on, respectively, the BRIEF and the CBCL. Exploratory maximum likelihood factor analysis was used to evaluate latent constructs. Correlates of the various factor scores were evaluated through regression analysis and contrasted with those of a test of verbal learning and memory.The results revealed that the BRIEF and the CBCL disagree about the presence vs. absence of impairment in about one quarter of cases. A prior history of attention deficit/hyperactivity disorder (ADHD) was associated with an increased likelihood of impairment on both the BRIEF and the CBCL, whereas prior outpatient psychiatric treatment was associated with the increased likelihood of selective impairment on the CBCL. Latent constructs manifested themselves along cognitive regulation, emotional adjustment and behavioral regulation factors. Whereas premorbid characteristics were the exclusive correlates of these factors, performance on a test of verbal learning and memory was negatively affected by intracranial lesions on neuroimaging.It is concluded that the BRIEF and the CBCL offer complementary and non-redundant information about daily functioning after pediatric mild TBI. The correlates of cognitive test performance and parental behavior ratings after such injuries are different and reflect a divergence between premorbid and injury-related influences.     

Motor imagery in spinal cord injured people is modulated by somatotopic coding,perspective taking,and post‐lesional chronic pain

Motor imagery (MI) allows one to mentally represent an action without necessarily performing it. Importantly, however, MI is profoundly influenced by the ability to actually execute actions, as demonstrated by the impairment of this ability as a consequence of lesions in motor cortices, limb amputations, movement limiting chronic pain, and spinal cord injury. Understanding MI and its deficits in patients with motor limitations is fundamentally important as development of some brain–computer interfaces and daily life strategies for coping with motor disorders are based on this ability. We explored MI in a large sample of patients with spinal cord injury (SCI) using a comprehensive battery of questionnaires to assess the ability to imagine actions from a first‐person or a third‐person perspective and also imagine the proprioceptive components of actions. Moreover, we correlated MI skills with personality measures and clinical variables such as the level and completeness of the lesion and the presence of chronic pain. We found that the MI deficits (1) concerned the body parts affected by deafferentation and deefferentation, (2) were present in first‐ but not in third‐person perspectives, and (3) were more altered in the presence of chronic pain. MI is thus closely related to bodily perceptions and representations. Every attempt to devise tools and trainings aimed at improving autonomy needs to consider the cognitive changes due to the body–brain disconnection.     

Problem-solving training via videoconferencing for family caregivers of persons with spinal cord injuries: a randomized controlled trial

Objective

To examine the effectiveness of an individualized problem-solving intervention delivered in videoconferencing sessions with family caregivers of persons living with a spinal cord injury (SCI) and possible contagion effects on care recipients.

Design

Family caregivers were randomly assigned to an education-only control group or an intervention group in which participants received problem-solving training (PST) in monthly videoconference session for a year.

Participants

Sixty-one caregivers (54 women, 7 men) and their care recipients (40 men, 21 women) consented to participate.

Main outcome measures

The Social Problem-Solving Inventory-Revised was administered to caregivers. Caregivers and care recipients completed the Inventory to Diagnose Depression, the SF-36 and the Satisfaction with Life scale at pre-treatment, 6 months and 12 months.

Results

Twenty-eight caregivers discontinued the study and their follow-up data were unavailable at the final assessment. Older caregivers were more likely than younger caregivers to remain in the study. Intent-to-treat analyses projected a significant decrease in depression among caregivers receiving PST; efficacy analyses indicated this effect was pronounced at the 6th month assessment. ITT analyses and efficacy analyses revealed that care recipients of caregivers receiving PST reported gains in social functioning over time.

Conclusions

Community-based, telehealth interventions may benefit family caregivers and their care recipients, but the mechanisms of these effects are unclear. Attrition and sample issues should be considered in future studies with these populations.