美国华人的残疾与康复

In this article, I will discuss disability issues as a second and a half generation American of Chinese descent who has worked with persons with disabilities, has taught rehabilitation counseling as well as having been a rehabilitation psychologist for more than 35 years in the U.S. and Australia. I am pleased to be able to share some of my thoughts and experiences in this article that is a bit less formal than what you may expect in a professional journal. Though I hope that what I share will provoke some thinking and action from those who read these words.

工作作为药物及酒精滥用者有效的干预策略和治疗方法

Despite years of interventions in the United States, substance abuse continues to be a major national problem in our society. For individuals affected, it can constitute a major disability and a decrease in quality of life. Current American societal expectations are that individuals who identify they are involved in substance abuse will go to treatment, eventually recover, get off public assistance straightaway, and return to work. Most rehabilitation professionals also maintain the same expectations. The reality is that efforts of prevention do not appear to diminish the number of people with substance abuse. Traditional treatment appears to have minimal, if any, influence upon the cessation of substance abuse, and traditional vocational rehabilitation practices appear unsuited for the unique problems and types of symptoms experienced by substance abusers. Creative, yet sound, alternatives that combine effective treatment strategies and non-traditional vocational rehabilitation methods need to be explored and tested for effectiveness, and applied.

继发性残疾对康复和生活质量的影响

In this paper, we will discuss the consequences of secondary conditions and their impact on rehabilitation outcomes and quality of life for persons with disabilities. Health promotion as a preventive method for secondary conditions for persons with disabilities has not been a significant area of interest on the part of the general health care and rehabilitation services community in Western societies. In the U.S., after years of careful evaluation a shift in scientific and advocacy thinking has encouraged researchers, funding agencies, health care providers, rehabilitation professionals and persons with disabilities, as well as the consumers of health care services to prioritize future studies in this specific area and establishing quality health care and the best possible rehabilitation outcomes for millions of individuals with disabilities.

康复咨询与心理学在处理职业性慢性疼痛损伤者中的作用——美国的慢性疼痛与职业损伤

This paper addresses the topic of an interdisciplinary approach of chronic pain management from a biopsychosocial perspective. The first section provides an introduction to the definitions and theories of chronic pain and the various contributing factors (psychological, interpersonal/environmental and social support, and vocational). The second section presents the role of various health care professions (medical doctors, nurses, physical therapists, occupational therapists, psychologists and rehabilitation counselors) and the evidence of their treatment effectiveness. The third section discusses the concept of an interdisciplinary pain rehabilitation program (IPRP) and its evidence to support its effectiveness. Finally, the clinical implications of rehabilitation counseling and psychology as part of the inter-disciplinary program in treating individuals with chronic pain will be highlighted.

中国残疾与康复信息系统的建设

1 The general development of causes of disability and rehabilitationThe development status of the cause of rehabilitation of the disabled is closely related with growth of economy and the extent of civilization of a country. In China, due to historical reasons, the cause of rehabilitation of the disabled experienced a late start and had been on a rather weak foundation.

The Differential Effects of Exercise,Brace and Combined Rehabilitation Treatment in Patients with Adolescent Idiopathic Scoliosis

骨盆骨折临床与康复

骨盆骨折占全身骨折的2.3%～3.0%，大多数由高能量创伤导致，包括交通事故、挤压伤和高处坠落等[1]，表现为不稳定骨折，常伴发腹部或盆腔脏器、泌尿生殖系统、盆腔神经血管、腹膜后区损伤及下肢骨折等其它损伤。Wubben [2]报道骨盆骨折的病死率取决于骨盆骨折及盆腔外损伤的类型，范围在6.4%～30%，Heetveld等[3]认为骨盆骨折合并血流动力学不稳定时，病死率高达37%，急诊的快速评估和诊断以及病情稳定后的康复治疗对良好的预后至关重要。

全膝关节置换术后患者康复问题的研究进展

全膝关节置换术( total knee arthroplasty，TKA )可以帮助终末期膝关节疾病患者缓解疼痛、稳定关节、矫正畸形、重建关节功能[1]是矫形外科临床常见的手术之一。在西方国家，TKA 手术的患者约为15～20/100万[2-3]。近几年，随着我国人口老龄化进程发展和我国经济状况持续改善 TKA 已经成为一项安全、效价良好的成功治疗方法[1]。对TKA患者进行康复锻炼不仅是患者获得独立生活能力的关键，而且直接影响到了手术的效果，因此越来越受到临床工作者的重视[4]。近年来，TKA患者的康复受到国内外研究者的广泛关注。

髋臼骨折常见并发症的产生机制及治疗进展

伴随经济的飞速发展及交通运输业的日渐发达，由车祸、高空坠落及工业意外导致的高能量损伤越来越多，髋臼骨折的发生率也在逐年增加。由于髋臼解剖结构的特殊性及其生理功能的复杂性，骨折后手术难度大，并发症多，对患者的预后产生重要的影响。现对髋臼骨折常见并发症的产生机制及治疗进展作如下综述。

中国骨与关节临床的康复之梦

康复医学的诞生与骨科密切相关。骨科的英文单词 Orthopedics就是治疗19世纪小儿麻痹后遗症患者的手术与康复两位专家智慧的结合，由矫形( ortho-)和儿童( pedics )而构成。国际上骨科学的发展与康复医学的发展一直有着密切的关系。中国骨科发展迅速，康复医学紧随其后。我们都怀有骨科康复之梦，解析面临的挑战和希望，推进学科共同发展。

中国骨与关节临床的康复之梦

康复医学的诞生与骨科密切相关。骨科的英文单词 Orthopedics就是治疗19世纪小儿麻痹后遗症患者的手术与康复两位专家智慧的结合，由矫形( ortho-)和儿童( pedics )而构成。国际上骨科学的发展与康复医学的发展一直有着密切的关系。中国骨科发展迅速，康复医学紧随其后。我们都怀有骨科康复之梦，解析面临的挑战和希望，推进学科共同发展。

2012年版“脊髓损伤后残存自主神经功能国际记录标准”简要介绍

美国脊柱损伤协会( the american spinal injury associ-ation，ASIA )和世界脊髓协会( the international spinal cord society，ISCoS )，2012年发表的关于脊髓损伤后残存自主神经功能的国际记录标准已出版面世。现基于我们在过去半年使用过程中的一些问题作一个解读与说明，希望对从事脊髓损伤诊治工作的同仁给予一些参考与借鉴。

To investigate the effect of early rehabilitation on neurofunctional outcome after surgery in chil-dren with spinal tumors, this study reviewed the medical charts and radiographic records of 70 pediatric patients (1-17 years old) who received spinal tumor surgical removal. The peddiatric patients received rahabilitation treatment at 4 (range, 2-7) days after surgery for 10 (range, 7-23) days. Results from the Modiifed McCormick Scale, Functional Independence Measure for Chil-dren, American Spinal Injury Association Impairment Scale and Karnofsky Performance Status Scale demonstrated that the sensory function, motor function and activity of daily living of pedi-atric children who received early rehabilitation were signiifcantly improved. Results also showed that tumor setting and level localization as well as patients’s clinical symptoms have no inlfuences on neurofunctional outcomes.

This is an expert consensus on the evaluation and treatment of thoracolumbar spinal injury, estab-lished from February 2009 to July 2010. The expert consensus consists mainly of six parts with a total of 54 recommendations including the overview (one item);pre-hospital care (one item);evalu-ation and diagnosis (13 items);treatment (23 items); prevention and treatment of major complica-tions (12 items);and rehabilitation (four items). This is the first time that Chinese experts have pub-lished a consensus on spine and spinal cord injury. The expert consensus was established based on Delphi methods, literature analysis, and clinical experiences. Each recommendation is supported by and was interpreted using multi-level evidences. The level of agreement with the recommenda-tion among the panel members was assessed as either low, moderate, or strong. Each panel member was asked to indicate his or her level of agreement on a 5-point scale, with “1” corre-sponding to neutrality and“5”representing maximum agreement. Scores were aggregated across the panel members and an arithmetic mean was calculated. This mean score was then translated into low, moderate, or strong. After al of the votes were col ected and calculated, the results showed no low-level recommendations, 10 moderate-level recommendations, and 44 strong-level recom-mendations. An expert consensus was reached and was recognized by Chinese spine surgeons. Wide-scale adoption of these recommendations is urgent in the management of acute thoracol-umbar spine and spinal cord injury in a broader attempt to create a standard evaluation and treat-ment strategy for acute thoracolumbar spine and spinal cord injury in China.

Virtual reality is a new technology that simulates a three-dimensional virtual world on a com-puter and enables the generation of visual, audio, and haptic feedback for the full immersion of users. Users can interact with and observe objects in three-dimensional visual space without limitation. At present, virtual reality training has been widely used in rehabilitation therapy for balance dysfunction. This paper summarizes related articles and other articles suggesting that virtual reality training can improve balance dysfunction in patients after neurological diseases. When patients perform virtual reality training, the prefrontal, parietal cortical areas and other motor cortical networks are activated. These activations may be involved in the reconstruction of neurons in the cerebral cortex. Growing evidence from clinical studies reveals that virtual reality training improves the neurological function of patients with spinal cord injury, cerebral palsy and other neurological impairments. These ifndings suggest that virtual reality training can acti-vate the cerebral cortex and improve the spatial orientation capacity of patients, thus facilitating the cortex to control balance and increase motion function.

Hemiparesis is one of the most common consequences of stroke. Advanced rehabilitation tech-niques are essential for restoring motor function in hemiplegic patients. Functional electrical stimulation applied to the affected limb based on myoelectric signal from the unaffected limb is a promising therapy for hemiplegia. In this study, we developed a prototype system for evaluating this novel functional electrical stimulation-control strategy. Based on surface electromyography and a vector machine model, a self-administered, multi-movement, force-modulation functional electrical stimulation-prototype system for hemiplegia was implemented. This paper discusses the hardware design, the algorithm of the system, and key points of the self-oscillation-prone system. The experimental results demonstrate the feasibility of the prototype system for further clinical trials, which is being conducted to evaluate the efifcacy of the proposed rehabilitation technique.

Two key characteristics of all virtual reality applications are interaction and immersion. Systemic interaction is achieved through a variety of multisensory channels (hearing, sight, touch, and smell), permitting the user to interact with the virtual world in real time. Immersion is the degree to which a person can feel wrapped in the virtual world through a deifned interface. Virtual real-ity interface devices such as the Nintendo? Wii and its peripheral nunchuks-balance board, head mounted displays and joystick allow interaction and immersion in unreal environments created from computer software. Virtual environments are highly interactive, generating great activation of visual, vestibular and proprioceptive systems during the execution of a video game. In addi-tion, they are entertaining and safe for the user. Recently, incorporating therapeutic purposes in virtual reality interface devices has allowed them to be used for the rehabilitation of neurological patients, e.g., balance training in older adults and dynamic stability in healthy participants. The improvements observed in neurological diseases (chronic stroke and cerebral palsy) have been shown by changes in the reorganization of neural networks in patients’ brain, along with better hand function and other skills, contributing to their quality of life. The data generated by such studies could substantially contribute to physical rehabilitation strategies.

Objective. To undertake the pilot experiments of prevention of disability (POD) in 14 different geographical areas to serve as examples for future development of rehabilitation work in China and in Asia. Methods. According to the principles and national criterion, 27 000 people aflected by leprosy were selected and assessed using disability record forms at beginning and followed up regularly for observing changes of different indica-tors. Results. A total of 197 neuritis cases were detected and treated with prednisolone out of 1 407 new or active cas-es. Self-care training of eyes, hands and feet were conducted for 10 500 disabled people affected by leprosy. Compre-hensive therapy was given to 1 804 cases having complicated ulcers of which 1 055 cases have got their ulcers healed.Out of 706 prostheses, 613 were given to patients with satisfactory results. Surgical treatment was given to 269 cases and 251 have shown good progress. Conclusion. Most of patients have got benefit from the project in function or appearance which is very helpful for their going back to the society and agreed by foreign experts during the final evaluation. The experiences from the pro-ject can be implemented in the whole country.

Walking training after stroke:improvements keeping our feet on the ground

慢性精神分裂症患者院内职业康复社会功能疗效评估

AIM:To evaluate the effectiveness of hospitalized occupational rehabilitation for chronic schizophrenic patients in social functioning.METHODS:79 qualified cases were selected from chronic psychiatric inpatient departments,divided into two groups randomly,of which 45 cases of treatment group accepted hospitalized occupational rehabilitation,another 34 cases of control group accepted ordinary treatment.Social functioning was evaluated by the Scale of Social Skills of Chronic Schizophrenic In patients(SSSI). RESULTS:6 month course of research figured out that the rank of improvement of the total disability degree of the treatment was significantly larger than that of the control group(P< 0.05).Items of which rank of improvement of the treatment was significantly larger than those of the control group are participating in the occupational rehabilitation,social withdraw and concern and care about others (P< 0.01- 0.05).The level of disability of 55.6% of the treatment decreased more than that of the control (26.5% ) (P< 0.05) evaluated by SSSI.CONCLUSION:Hospitalized occupational rehabilitation is effective in improving social functioning of chronic schizophrenic patients,especially in improving items like participating in the occupational rehabilitation, social withdraw and concern and care about others.