针刺治疗小儿脑性瘫痪运动功能障碍的疗效观察

目的:探讨CMFM量表在针刺治疗小儿脑性瘫痪康复评估中的价值.方法:采用以穴位注射为主治疗了39例脑瘫患儿,并采用GMFM量表对针刺治疗前后的运动功能动态改变以评分法进行评估.结果:经过3个疗程的治疗GMFM总百分比值从治疗前的26.8±20.5治疗后上升到36.0±22.4,P＜0.0001.结论:GMFM量表对粗大运动的评估能较客观的反映了运动功能改善的状况,可作为针灸治疗脑瘫患儿运动功能障碍疗效的评价指标.     

三种粗大运动评估方法在婴幼儿脑瘫中的应用研究

[目的]比较三种粗大运动评估方法在婴幼儿脑瘫中的应用价值. [方法]用Peabody粗大运动发育量表(Peabody Developmental Motor Scale-Gross Motor,PDMS-GM)、粗大运动功能测试量表(Gross Motor Function Measure,GMFM)和儿心量表中的粗大运动能力评估三种方法分别评估63例0～3岁脑瘫儿,在(3.9±1.8)月后对其中33例进行复评.在PDMS-GM的原始分、GMFM的总百分比和儿心量表的大运动原始分三者之间进行相关分析;痉挛型脑瘫分型和PDMS粗大运动发育商(gross motor quotient,GMQ)之间进行相关分析. [结果]PDMS-GM的原始分、GMFM的总百分比和儿心量表的大运动原始分三者之间呈高度正相关(P＜0.001);痉挛型脑瘫分型与GMQ之间的相关性随着年龄增大而增加. [结论]儿心量表能够初步判断脑瘫儿童粗大运动发育水平,PDMS-GM和GMFM可以更加精确地反映脑瘫儿粗大运动水平.     

Prospective controlled cohort study to evaluate changes of function,activity and participation in patients with bilateral spastic cerebral palsy after Robot-enhanced repetitive treadmill therapy

BackgroundRobot-enhanced therapies are increasingly being used to improve gross motor performance in patients with cerebral palsy.AimTo evaluate gross motor function, activity and participation in patients with bilateral spastic cerebral palsy (BS-CP) after Robot-enhanced repetitive treadmill therapy (ROBERT) in a prospective, controlled cohort study.MethodsParticipants trained for 30–60 min in each of 12 sessions within a three-week-period. Changes in Gross Motor Function Measure (GMFM 66) scores, standardized walking distance, self-selected and maximum walking speed (ICF domain “Activity”), and Canadian Occupational Performance Measure (COPM; “Participation”) were measured. Outcome measures were assessed three weeks in advance (V1), the day before (V2) as well as the day after, and 8 weeks after ROBERT (V3 + V4).Results18 patients with BS-CP participated; age 11.5 (mean, range: 5.0–21.8) years, body weight 36.4 (15.0–72.0) kg. GMFCS levels I–IV were: n = 4; 5; 8; 1. There was no significant difference comparing V1 and V2. GMFM 66 (total +2.5 points, Dimension D +3.8 and E +3.2) and COPM (Performance +2.1 points, Satisfaction +1.8 points) showed statistically significant improvements for V3 or V4 compared to V1 or V2 representing clinically meaningful effect sizes. Age, GMFCS level, and repeated ROBERT blocks correlated negatively with GMFM improvement, but not with COPM improvement.InterpretationFollowing ROBERT, this prospective controlled cohort study showed significant and clinically meaningful improvements of function in ICF domains of “activity” and “participation” in patients with BS-CP. Further assessment in a larger cohort is necessary to allow more specific definition of factors that influence responsiveness to ROBERT program.     

肌电生物反馈对痉挛型脑瘫患儿下肢运动功能影响的Meta分析

目的:应用Meta分析评价肌电生物反馈治疗痉挛型脑瘫的作用。方法:检索PubMed、Embase、Cochrane图书馆及中国生物医学文献数据库、CNKI、维普、万方数据库中2009年1月~2019年6月关于肌电生物反馈治疗痉挛型脑瘫的随机对照试验,利用RevMan 5.3软件进行Meta分析。结果:纳入10项随机对照试验,共613个病例;肌电生物反馈可以改善脑瘫患儿踝关节活动度(MD=5.06,95%CI=4.01~6.10,P<0.01),改善粗大运动功能(GMFM D区MD=3.75,95%CI=2.75~4.75,P<0.01;GMFM E区MD=6.04,95%CI=4.82~7.26,P<0.01),改善腓肠肌痉挛程度(MD=5.19,95%CI=-0.52^-0.39,P<0.01)。结论:肌电生物反馈在改善脑瘫患儿下肢运动功能方面具有一定效果,但所纳入研究的方法有局限性,还需更严格的设计和高质量的研究方法进一步证明。     

粗大运动功能测试量表与Peabody粗大运动发育量表在脑性瘫痪康复疗效评估中的应用

目的比较粗大运动功能测试量表 (GMFM )与Peabody粗大运动发育量表 (PDMS GM )两种粗大运动评估方法在脑瘫康复疗效评估中的应用价值。方法用GMFM和PDMS GM两种方法对 2 9例脑瘫儿童进行 3次评估 ,用t检验分析GMFM月相对百分比与PDMS GM月相对百分比之间的差异。结果GMFM的月相对百分比与PDMS GM的月相对百分比之间有显著性差异。结论GMFM的评估结果比PDMS GM更有利于疗效判断     

Selective dorsal rhizotomies in the treatment of spasticity related to cerebral palsy

Rationale Selective dorsal rhizotomy (SDR) is a surgical technique developed over the past decades to manage patients diagnosed with cerebral palsy suffering from spastic diplegia. It involves selectively lesioning sensory rootlets in an effort to maintain a balance between elimination of spasticity and preservation of function. Several recent long-term outcome studies have been published. In addition, shorter follow-up randomized controlled studies have compared the outcome of patients having undergone physiotherapy alone with those that received physiotherapy after selective dorsal rhizotomy. Materials and methods In this account, we will discuss the rationale and outcome after SDR. The outcome is addressed in terms of the gross motor function measurement scale (GMFM), degree of elimination of spasticity, strength enhancement, range of motion, fine motor skills, activity of daily living, spastic hip, necessity for postoperative orthopedic procedures, bladder and sphincteric function, and finally possible early or late complications associated with the procedure. Conclusion We conclude that SDR is a safe procedure, which offers durable and significant functional gains to properly selected children with spasticity related to cerebral palsy.     

运用中药经验方养心健脾汤治疗亚健康状态心脾两虚型的临床观察

目的：观察运动发育推拿法治疗小儿脑瘫四肢瘫患儿的粗大运动功能的康复疗效。方法：对12例四肢瘫惠儿采用运动推拿法治疗,同时应用粗大运动功能测试量袁（Gross motor function measure,GMFM）对其进行治疗前后的评估,用t检验比较治疗前后的结果。结果：经过运动发育推拿法治疗后,效果明显优于治疗前。结论：运动发育推拿法对小儿脑瘫四肢瘫患儿的粗大运动功能确有康复效果。     

自体骨髓间充质干细胞移植治疗脑瘫2年随访

 目的 观察自体骨髓间充质干细胞(human mesenchymal stem cells,hMSCs)转化神经干细胞治疗脑瘫的临床效果。方法 选择2010-06至2011-06期间, GMFCS级别III～Ⅴ级,自愿接受干细胞移植的脑瘫患儿11例为移植组,同时选择年龄、性别及疾病严重程度相仿的11例脑瘫患儿为对照组。移植组采用hMSCs转化神经干细胞移植治疗和运动功能锻炼为主的康复治疗,对照组仅仅给予运动锻炼为主的康复治疗。采用脑瘫患儿粗大运动功能评定(GMFM)量表评价移植组和对照组在治疗前和治疗后1、3、6、12、18、24个月的GMFM得分。结果 (1)移植组治疗后1个月、3个月、6个月的GMFM较GMFM0上升率均明显高于对照组(P=0.025);移植组治疗后3个月GMFM3较1个月GMFM1的上升率比较有明显差异,而治疗后6个月GMFM6较3个月GMFM3的上升率比较无统计学差异,提示移植组运动能力在移植后2~3个月时快速显示明显的康复效果。对照组GMFM上升率无此特征;(2)随访12个月、18个月及24个月发现移植组和对照组的GMFM12、GMFM18、GMFM24较之前6个月的GMFM的上升率无差异,而较治疗之前的GMFM0的上升率有显著差异(P<0.01)。(3)两组治疗后1个月、3个月的语言商与治疗前语言商比较,上升率差异均无统计学意义,两组治疗后6个月、12个月移植组语言商较治疗前上升率明显高于对照组(P<0.01)而18个月及24个月随访提示语言商上升率较对照组无增快显现,但较治疗前语言商上升率有明显差异(P<0.05)。结论 hMSCs转化神经干细胞移植治疗脑瘫安全,有效,对脑瘫患儿的运动功能改善明显,在移植后3个月明显显效。6个月以后运动康复效果逐渐消失,但患儿运动能力无倒退现象。语言功能的改善显效较晚,在移植治疗后6个月后显效,12个月后语言快速改善效果消失,但没有语言能力的倒退。