痉挛型双瘫与正常儿童下肢肌力对照分析

目的:比较痉挛型双瘫儿童与正常儿童下肢差异,并且分析不同年龄双瘫儿童的肌力表现。方法:纳入痉挛型双瘫儿童和同龄正常儿童各25例为研究对象,其中痉挛型双瘫儿童男性14例,女性11例,平均(8.8±1.8)岁,正常组儿童男性12例,女性13例,平均(8.2±1.4)岁。采用手持式肌力测定仪(hand-held dynamometry,HHD)测定儿童下肢髋、膝、踝等部位肌群的肌力,比较双瘫儿童与正常儿童下肢肌群间肌力差异及不同年龄儿童的肌力表现。结果:痉挛型双瘫儿童下肢伸肌和屈肌肌群肌力除髋伸展肌群以外都明显弱于正常儿童(P0.01),双瘫组中5—8岁组和9—11岁组除双侧髋伸展肌群以外,其余各肌群的肌力都比较接近,差异没有显著性。结论:对痉挛型双瘫儿童进行力量训练时,应该注意提高下肢所有肌群的肌力,同时应该随着年龄的增长而持续训练。     

偏瘫患者膝屈伸肌力等速测试的研究

目的　探讨对偏瘫患者是否需要进行下肢肌力训练。方法　运用Cybex 60 0 0型等速肌力测试系统对3 1例病程大于 6个月和能独立行走的偏瘫患者的两侧膝关节伸肌和屈肌进行肌力测试。结果　 (1)患膝屈、伸肌的峰力矩在不同的运动速度下 (60°/s ,12 0°/s ,180°/s)均较健侧明显下降 ;(2 )患膝屈、伸肌的峰力矩出现的时间与健侧相比有提前趋势 ;(3 )虽然患膝的屈肌和伸肌肌力同时下降 ,但屈肌的肌力较伸肌下降明显 ,患膝屈肌和伸肌的峰力矩比值较健侧有明显差异。结论　偏瘫患者的下肢肌力、肌耐力、爆发力明显下降 ,因此 ,应加强患侧下肢屈肌和伸肌的肌力训练 ,尤应加强屈肌的肌力训练     

肌电生物反馈电刺激治疗偏瘫型脑瘫下肢运动功能障碍的疗效观察

目的观察肌电生物反馈电刺激疗法治疗痉挛型偏瘫型脑瘫患儿下肢运动功能障碍的疗效。方法 60例痉挛型偏瘫型脑瘫患儿按照监护人的治疗意愿分为治疗组和对照组各30例,两组均进行运动训练、物理疗法及配戴矫形器等,治疗组在此基础上应用肌电生物反馈电刺激治疗仪对偏瘫侧下肢进行肌电生物反馈刺激。在治疗前与治疗12周后,分别用综合痉挛评分量表(CSS)评定患侧下肢肌张力、关节量角器法测量患侧下肢踝关节被动背屈角度、粗大运动功能量表(GMFM-88)之D区(站立)、E区(走跑跳)分值以比较观察疗效。结果治疗后两组上述指标均较治疗前有改善(P<0.05)。治疗组12周后下肢CSS评分及踝关节被动背屈角度、GMFM之D区和E区评分均比对照组改善(P<0.05)。结论肌电生物反馈电刺激疗法配合康复功能训练能降低痉挛型偏瘫型脑瘫患儿的下肢肌张力,改善踝关节活动范围,提高下肢运动功能。     

MOTOmed训练系统用于痉挛型偏瘫患儿下肢运动功能恢复的研究

目的:研究常规康复治疗联合MOTOmed训练系统对痉挛型偏瘫患儿下肢功能的影响。方法:将40例痉挛型偏瘫患儿随机分为MOTOmed训练组(给予常规康复治疗及MOTOmed训练)及常规治疗组(给予常规康复治疗)。于治疗前及治疗12周时,同时对两组患儿改良的Ashworth分值(腘绳肌)综合痉挛量表(CSS)、粗大运动功能88项量表(GMFM)中的D、E两功能区及步态参数(健侧及患侧步长、步速)。所有患儿共接受为期12周的康复治疗。结果:两组患儿治疗前指数评分组间差异均无显著性意义(均P>0.05),治疗12周时上述各项指标均较治疗前明显改善(P<0.05),且以MOTOmed训练组的改善幅度较显著,与对照组比较,组间差异具有显著性意义(P<0.05)。结论:MOTOmed训练结合常规康复治疗能进一步提高痉挛型偏瘫患儿下肢运动功能。     

颅脑外伤后肢体功能恢复的康复训练

1对象与方法从1998年6月～2001年6月收治颅脑外伤患者986例,男696例,女290例。年龄平均43.6岁,左侧偏瘫625例,右侧偏瘫361例。方法:(1)改善肌力的训练:在肌力训练中,可着重进行健侧肢体练习,通过健侧抗阻力促发引起的联合反射,诱发患侧无力肌群的收缩。应有针对性地进行上、下肢的肌力训练,并以多轴位、多关节、多组肌群的收缩。应有针对性地进行上、下肢的肌力训练,并以多轴位、多关节、多组肌群参与多综合肌力练习,取代单轴位、单关节、单肌群参与的肌力练习,也可做坐站练习,上下楼练习等。肌力练习时间不宜过长,一旦出现肌痉挛应立即停止…     

A型肉毒毒素注射配合康复功能训练对痉挛型偏瘫脑瘫患儿上肢运动功能疗效观察

目的观察A型肉毒毒素(BTX-A)注射治疗配合康复功能训练对痉挛型偏瘫脑瘫患儿上肢功能障碍的疗效。方法 60例痉挛型偏瘫型脑瘫患儿均接受BTX-A注射治疗,治疗后进行强制性诱导运动训练、物理疗法、肌电生物反馈治疗、作业治疗及家庭训练。在治疗前与治疗3个月后,分别用改良Ashworth痉挛量表(MAS)评定患侧上肢肌张力、关节量角器法测量患侧腕关节主动背伸角度、Peabody运动发育量表(PDMS-II)进行患侧手精细运动商(FMQ)的评估、日常生活活动能力(ADL)量表评估ADL能力以比较观察疗效。结果治疗后患儿上述指标均较治疗前显著改善(P<0.001)。结论 BTX-A注射治疗配合康复功能训练能明显降低痉挛型偏瘫型脑瘫患儿的上肢肌张力,改善关节活动范围,明显提高上肢运动功能。     

偏瘫患者下肢肌力与站立功能的相关性研究

对30例偏瘫患者的站立功能及双下肢的7组肌群的肌力,进行了评定和分析,结果表明:最终评定的站立功能与最初评定的瘫痪侧下肢肌力及非瘫痪侧下肢肌力之间有显著的相关性;年龄、性别、瘫痪侧别及病程时间与站立功能之间无显著相关性.提示对偏瘫患者进行增强下肢肌力训练或进行下肢肌力不足的代偿处理,均有助于改善站立功能.     

简易促通装置对痉挛型偏瘫患儿手功能康复的作用

目的:研制简易手功能训练装置,并探讨此装置对痉挛型偏瘫患儿手功能康复的效果。方法:选取4—16岁痉挛型偏瘫患儿17例,按随机数表法分为实验组(9例)和对照组(8例)。试验组进行简易促通装置和常规康复训练,各1次/天;对照组进行常规康复训练2次/天。治疗前和治疗8周后,采用简易上肢功能评价(STEF)、改良Ashworth分级(MAS)、残疾儿童综合功能评定(ADL)及表面肌电图(s EMG)分别对两组患儿患手的运动功能、大鱼际肌群的肌张力、日常生活活动能力和大鱼际肌群的耐力进行评定。结果:治疗后,试验组STEF评分、ADL评分、MAS分级和患手大鱼际肌群表面肌电的均方根值(RMS)、平均频率(MEF)与治疗前比较,差异均具有显著性意义(P0.05);且两组间治疗后MEF比较,及治疗前、后MEF差值比较,差异具有显著性意义(P0.05)。结论:简易促通装置可降低痉挛型偏瘫患儿患手大鱼际肌群的肌张力,提高肌肉的耐力,提高运动功能和ADL能力。     

不同体位下肢被动踏踩训练对脑卒中下肢痉挛的影响

目的:观察不同体位下肢被动踏踩训练对脑卒中患者患侧下肢痉挛的疗效。方法:脑卒中患者66例,随机分为直立组35例和坐位组31例,2组在接受常规康复训练的基础上分别进行直立位和坐位的下肢被动踏踩训练。分别在训练前、训练30min及4周后对患侧小腿三头肌、股四头肌、腘绳肌进行改良Ashworth痉挛评定。结果:治疗30min后,2组患者仅患侧小腿三头肌的Ashworth痉挛评分较治疗前明显降低(P<0.05),2组间比较差异无统计学意义;治疗4周后,2组患者除坐位组患侧股四头肌外其余各肌肉痉挛评分均较治疗前明显降低(P<0.05),直立组患侧小腿三头肌痉挛评分分值降低较坐位组更显著(P<0.05)。结论:直立和坐位下肢被动踩踏训练均能降低脑卒中患者偏瘫侧下肢的痉挛,其中直立下肢被动踏踩训练对缓解患侧小腿三头肌的痉挛效果更好。     

功能性运动训练对脑卒中偏瘫患者下肢肌力和肌张力的影响

目的:观察功能性运动训练在脑卒中偏瘫患者下肢肌力康复中的疗效和对肌力、肌张力的影响。方法:将脑卒中偏瘫患者100例,随机分为治疗组50例和对照组50例,2组基本治疗相同;对照组对偏瘫下肢进行抗痉挛模式训练,治疗组对偏瘫下肢进行功能性运动训练,2组治疗均为40 min/次,1次/天,5.5 d/周,总共治疗4周。治疗前后分别采用徒手肌力检查(MMT)、改良Ashworth痉挛分级(MAS)、下肢Fugl-Meyer运动功能评分(FMA)和改良Bathel指数(MBI)等评价2组患者下肢的肌力、肌张力、运动功能和日常生活能力,并进行比较。结果:治疗前2组患者下肢MMT分级、MAS分级、FMA下肢运动积分和MBI评分组间差异均无统计学意义(P>0.05)。治疗后,治疗组下肢MMT分级、FMA和MBI评分均有明显改善,与对照组差异有统计学意义(P<0.05),肌张力在治疗前后却无明显改变(P>0.05)。结论:功能性运动训练能明显改善脑卒中偏瘫下肢的肌力和日常生活功能,对下肢肌张力无不良影响。     

Differences of the Truncal Expansion and Respiratory Function between Children with Spastic Diplegic and Hemiplegic Cerebral Palsy

[Purpose] We attempted to determine whether differences of respiratory function could be found in terms of truncal expansion, respiratory muscle strength, and pulmonary function test (PFT) between children with spastic diplegic and hemiplegic cerebral palsy. [Subjects and Methods] We recruited 19 children with spastic diplegic CP (diplegic-CP group) and 10 children with spastic hemiplegic CP (hemiplegic-CP group). For all the children, clinical factors associated with respiratory functions were assessed in terms of truncal expansion (chest and waist expansion), respiratory muscle strength (maximal inspiration and expiration pressures: MIP and MEP), and pulmonary function test (FVC, FEV₁, and FEV₁/FVC). [Results] Overall, the diplegic-CP group showed lower truncal circumference, respiratory muscle strength, and pulmonary function values than the hemiplegic-CP group. However, in the comparison of the two groups significant differences were only found in waist expansion, MIP, MEP, FVC, and FEV₁. [Conclusion] The results of this study indicate that children with diplegic CP have much poorer waist expansion, weaker respiratory muscle, and lower pulmonary function values. These findings will provide valuable information for use in the clinical assessment and treatment of children with spastic CP.Key words: Spastic cerebral palsy, Respiratory muscle strength, Pulmonary function test     

Objective measurement of muscle strength in children with spastic diplegia after selective dorsal rhizotomy

OBJECTIVES: To examine changes in isometric muscle strength at the elbow, knee, and ankle at 6 months and 1 year after selective dorsal rhizotomy (SDR) and to determine if SDR altered the frequency of muscle cocontraction. DESIGN: Prospective outcome study of a consecutive sample. SETTING: Children's hospital. PATIENTS: Ten children with spastic diplegia (7 independent and 3 dependent ambulators who used assistive devices) and 8 age-matched controls. INTERVENTIONS: SDR; physical and occupational therapy; elbow, knee, and ankle measured for flexion and extension strength during three 10-second isometric contractions for each muscle group; and monitored cocontraction measured via muscle electrodes. MAIN OUTCOME MEASURES: Absolute and normalized values of isometric strength; and alterations in the frequency of cocontraction at 6 months and 1 year postoperatively. RESULTS: Children with spastic diplegia showed significantly weaker knee extensors, ankle dorsiflexors, and ankle plantarflexors than age-matched controls. There were no significant differences in strength between the 2 groups in the elbow flexors, elbow extensors, and knee flexors. Isometric strength did not increase or decrease significantly after SDR. Cocontraction during knee extension was normalized after SDR, whereas cocontraction during ankle plantarflexion was unchanged by SDR in the majority of children. CONCLUSION: SDR did not result in a significant decrease in muscle strength in ambulatory children with spastic diplegia. The normalization of the electromyographic patterns at the knee and not the ankle after SDR lends support to the premise that in children with cerebral palsy cocontraction is multifaceted, representing a volitional strategy to enhance control, as well as a disorder of the mechanisms that govern patterns of muscle activity.     

功能性肌力训练在痉挛型脑瘫儿童中的应用

目的:观察功能性、闭链的肌力训练对痉挛型脑瘫儿童下肢的运动功能及步行能力的影响。方法:痉挛型脑瘫患儿20例,根据年龄、痉挛分型、运动功能评分进行配对,每对随机分成治疗组和对照组,对照组进行常规的神经发育技术治疗,治疗组在此基础上进行功能性肌力训练,治疗前和治疗6周后评估两组脑瘫患儿粗大运动功能、肌张力、关节活动度、步行能力。结果:治疗组粗大运动功能C、D、E区得分高于对照组(C区58.69±12.85,D区49.74±19.38,E区33.50±17.13,P<0.05),步行能力的改善优于对照组(10m步行时间13.90±5.28s,1min步行距离43.0±12.5m,P<0.05),关节活动度的改善大于对照组(踝背屈角度13.9±3.8°,P<0.05),而肌张力没有明显增加(肌张力平均秩10.50,P>0.05)。结论:功能性下肢肌力训练计划有助于改善脑瘫患儿的运动功能。     

Shoulder muscle atrophy and its relation to strength loss in obstetrical brachial plexus palsy

BackgroundTreatment/prevention of shoulder muscle strength imbalances are major therapeutic goals for children with obstetrical brachial plexus palsy. The study aims were to characterize muscle atrophy in children/adolescents with unilateral obstetrical brachial plexus palsy, to quantify the agonist-antagonist muscle volume balance and the association between muscle volume and strength.MethodsEight boys and four girls (age = 12.1, standard deviation = 3.3) participated in this case-control study. Three-dimensional magnetic resonance images of both shoulders were acquired. The unimpaired shoulder served as a reference. Volumes of deltoid, pectoralis major, supraspinatus, infraspinatus, teres major, subscapularis were calculated based on 3D models, derived through image segmentation. Maximal isometric torques were collected in six directions.FindingsAll the major muscles studied were significantly atrophied. The teres major demonstrated the biggest difference in atrophy between groups (51 percentage points), the pectoralis major was the least atrophied (23 percentage points). The muscle volume distribution was significantly different between shoulders. Muscle volume could predict maximal voluntary isometric torques, but the regression coefficients were weaker on the impaired side (72% to 91% of the strength could be predicted in the uninvolved side and 24% to 90% in the involved side and external rotation strength could not be predicted).InterpretationThis study demonstrates muscle atrophy varied across all the main shoulder muscles of the glenohumeral joint, leading to significant muscle volume imbalances. The weaker coefficients of determination on the impaired side suggest that other variables may contribute to the loss of strength in addition to atrophy.     

Effects of interactive games on motor performance in children with spastic cerebral palsy

[Purpose] Motor control and muscle strength impairments are the prime reasons for motor behavior disorders in children with spastic cerebral palsy. These impairments lead to histological changes in muscle growth and the learning of motor skills. Therefore, such children experience reduced muscle force generation and decreased muscle flexibility. We investigated the effect of training with Nintendo Wii Fit games on motor performance in children with spastic cerebral palsy. [Subjects and Methods] Forty children with cerebral palsy spastic diplegia aged 6–10 years diagnosed with level-3 functional capabilities according to the Gross Motor Classification System (GMFCS) were enrolled. Participants were divided randomly into equal groups: group (A) that practiced with the Nintendo Wii Fit game for at least 20 minutes/day for 12 weeks and group (B) that underwent no training (control group). The Movement Assessment Battery for Children-2 (mABC-2) was used to assess motor performance, because it mainly involves motor tasks very similar to those involved in playing Nintendo Wii Fit games, e.g., goal-directed arm movements, balancing, and jumping. [Results] There were significant improvements in the subscales of the motor performance test of those who practiced with the Nintendo Wii, while the control group showed no significant changes. [Conclusion] Using motion interactive games in home rehabilitation is feasible for children with cerebral palsy.Key words: Games, Motor, Pediatrics     

深层肌肉刺激疗法对痉挛型双瘫患儿步态的影响

目的:研究深层肌肉刺激疗法对痉挛型双瘫患儿步态的影响。方法:将32例痉挛型双瘫患儿随机分为观察组和对照组各16例。2组均进行常规康复训练,观察组在此基础上给予深层肌肉刺激治疗,分别于治疗前和治疗12周后使用三维步态分析仪进行步态分析。结果:治疗12周后,2组步幅、步速均较治疗前有明显增加(均P<0.05),且治疗后观察组患儿步幅、步速均较对照组高(均P<0.05),其余各项参数2组间比较均差异无统计学意义。2组髋关节最大伸展角度和踝关节最大跖屈角度均较治疗前明显增大(均P<0.05),观察组膝关节最大屈曲角度、踝关节最大跖屈角度均较对照组明显增大(均P<0.05),且观察组膝关节最大伸展角度较治疗前及对照组均明显增大(均P<0.05),其余各项参数在统计学上无显著性差异。结论:在常规康复疗法的基础上,应用深层肌肉刺激疗法能改善痉挛型双瘫患儿步态,是痉挛型双瘫患儿康复的一种有效方法和手段。     

Test-retest reliability of isokinetic muscle strength of the lower extremities in patients with stroke

OBJECTIVE: To i the test-retest reliability of isokinetic strength measurements of 3 muscle groups of the lower extremities in stroke patients. DESIGN: Isokineth tests of bilateral hip flexors, knee extensors, and ankle plantarflexors at 2 angular velocities, performed during 2 sessions scheduled 1 week apart for each subject. SETTING: Outpatilitation clinic of a local hospital in Taiwan. PARTICIPANTS: Nts with mild spastic hemiparesis secondary to stroke and with poststroke onset time of at least 6 months. All subjects could communicate and voluntarily move the affected lower extremity. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The maximal peak torque, total work, and average power of the 3 muscle groups on the affected side examined during each test were quantified by using the normalization and the deficit methods. The normalization method divides the measured strength value by the patient's body weight, whereas the deficit method divides the difference between the strengths of the unaffected and affected extremities by the strength of the unaffected extremity. RESULTS: The normalized strength measures for muscles on the affected side showed good to excellent test-retest reliability (intraclass correlation coefficient [ICC] range,.62-.94; P<.05), whereas the deficit strength measures did not always show good reliability (ICC range,.13-.91). The knee extensors and ankle plantarflexors, but not the hip flexors, on the affected side showed better test-retest reliability of isokinetic strength generated at faster velocity (ICC range,.73-.94) than that generated at slower velocity (ICC range,.62-.88). The normalized peak torque (ICC range,.76-.94) and total work (ICC range,.83-.91) were more reliable than the normalized average power (ICC range,.62-.90) for all 3 muscle groups on the affected side. CONCLUSIONS: Quantitative assessment of muscle strength of the affected lower extremity in patients with mild spastic hemiparesis secondary to stroke is feasible using isokinetic testing. However, the test-retest reliability of isokinetic strength measures is affected by the quantifying method, testing velocity, and strength measures.     

痉挛型脑瘫儿童步行时的动态足底压力特征

目的：了解痉挛型脑瘫儿童步行时的动态足底压力特征。方法：试验组痉挛型脑瘫儿童20例，对照组为52例具有正常步行能力的健康儿童．运用Uhraflex连续性足底压力步态分析系统．对两组儿童进行了步行时动态足底压力运动力学数据采样，经过电脑数据录入分析，取得动态足底压力曲线及特征量参数（包括双测的z1、z2、z3、t1、t2、t3、ts）。对实验组和对照组的步态分析曲线及各参数进行分析和统计分析。结果：得到典型足底压力双峰图及相应特征量数据的实验组儿童10例，其步态的足底压力特征量参数与对照组相比，双侧的单足支撑时间、右侧的tz1、tz2、tz3表现出显著性差异，脑瘫儿童双侧的单足支撑时间均较正常儿童短，右侧的tz1、tz3增加，而tz2缩短。结论：部分痉挛型脑瘫患儿动态足底压力曲线不能表现出典型的双峰曲线。能得到典型足底压力双峰图及相应特征量数据的实验组儿童中，双侧的单足支撑时间均较正常儿童短，右侧的tz1、tz3增加，而tz2缩短。     

Swelling of the upper extremity, function and muscle strength of shoulder joint following mastectomy combined with radiotherapy.

Swelling of the arm, mobility of the shoulder joint and muscle strength were examined in 76 patients with breast cancer 4.5 to 14 years (mean 8 years) after primary therapy. Marked arm swelling was found on the operated side in 31% of the patients operated by radical mastectomy and in 18% of those having undergone total mastectomy. The swelling was more marked in the upper arm than in the forearm. Patients irradiated postoperatively with a megavoltage technique showed more often and more oedema than those treated with a kilovoltage technique. Obese patients had more swelling than patients of normal weight. Of the various movements of the shoulder joint, abduction, adduction, flexion, extension, horizontal extension and internal rotation were significantly reduced on the operated side in comparison with the non-operated side, but the differences were not great. Neither swelling of the arm nor the patient's weight had any effect on the function of the shoulder joint, as expressed in terms of abduction. Of the muscle groups in the shoulder joint adductors, flexors and extensors were significantly weaker on the operated than on the non-operated side. The muscle strength of the operated side averaged 25% weaker than that of the control side. Swelling of the arm did not reduce the muscle strength of the shoulder joint.     

超声成像技术在痉挛型脑性瘫痪患儿腓肠肌定量评定中的应用

目的 探讨临床应用超声弹性成像定量评估痉挛型脑瘫患儿腓肠肌的形态结构及生物力学特性的可行性。 方法 2020年12月至2021年12月,选取深圳市儿童医院康复医学科治疗的痉挛型脑瘫(偏瘫或双瘫)患儿36例为试验组,同期招募年龄、性别匹配的健康儿童30例为对照组。二维灰阶高频超声及剪切弹性成像检查试验组偏瘫侧或肌张力较高一侧、对照组随机一侧的腓肠肌内侧头,记录肌肉厚度(MT)、肌纤维长度(FL)、羽状角(PA)和剪切波速度(SWV)。采用改良Ashworth量表(MAS)和粗大运动功能测试(GMFM)评估试验组腓肠肌肌张力和粗大运动功能。 结果 试验组腓肠肌内侧头MT、FL显著小于对照组(|t| > 3.937,P < 0.001),PA、SWV显著大于对照组(|t| > 6.105,P < 0.001)。试验组MT、FL与GMFM评分呈正相关(r > 0.391, P < 0.05),SWV与MAS评分呈正相关(r = 0.734, P < 0.001)。 结论 超声成像可用于量化评估痉挛型脑瘫患儿腓肠肌的形态和硬度。