脑性瘫痪的定义、诊断标准及临床分型

在2005年中华医学会儿科学分会神经学组和2007年中国康复医学会儿童康复专业委员会制定发表的《小儿脑性瘫痪的定义、分型和诊断条件》的基础上,《中国脑性瘫痪康复治疗指南》编写委员会参考国外有关小儿脑性瘫痪诊疗指南和最新文献报道,多次组织讨论编写.以便更好地指导临床医师对小儿脑性瘫痪定义的理解,提高脑性瘫痪的诊断和分型水平,与国际接轨.     

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.     

Quality of life and functional outcome in early school-aged children after neonatal stroke: A prospective cohort study

BackgroundQuality of life (QoL) is recognized internationally as an efficient tool for evaluating health interventions. To our knowledge, QoL has not been specifically assessed in children after neonatal arterial ischemic stroke (AIS).AimTo study the QoL of early school-aged children who suffered from neonatal AIS, and QoL correlation to functional outcome.MethodWe conducted a multicenter prospective cohort study as part of a larger study in full-term newborns with symptomatic AIS. Participating families were sent anonymous QoL questionnaires (QUALIN). Functional outcome was measured using the Wee-FIM scale. Healthy controls in the same age range were recruited in public schools. Their primary caregivers filled in the QUALIN questionnaires anonymously. We used Student's t-test and a rank test to compare patients and controls' QoL and functional outcomes.Results84 children with neonatal AIS were included. The control group was composed of 74 children, of which ten were later excluded due to chronic conditions. Mean ages and QUALIN median scores did not differ between patients and controls. Median Wee-FIM scores were lower in hemiplegic children than in non-hemiplegic ones (p < 0.001). QoL scores did not seem correlated to functional outcome.InterpretationThose results could support the presence of a “disability paradox” in young children following neonatal AIS.     

Periventricular leukomalacia: an ophthalmic perspective

Periventricular leukomalacia (PVL) is a common magnetic resonance imaging (MRI) finding in cases of hypoxic ischemic encephalopathy. PVL, in MRI, is identified by the increased signal intensity of periventricular white matter on T2-weighted sequences which is more conspicuous in the posterior cortex. It occurs because of perinatal damage to the cerebral cortex. This insult is in the form of hypoxia, metabolic insults, prematurity, seizures, or infection. Periventricular area is most prone to damage owing to its immaturity and vascular supply. PVL is proven to affect vision in children. Depending on the area and cause of affection, PVL is associated with variable ophthalmic manifestations. It is known that visual function is closely linked to the overall neurodevelopment of a child.A multidisciplinary approach is required to promote the growth and development of these children, and in the midst of multiple disabilities, visual function should not be overlooked. A comprehensive knowledge of the ophthalmological presentation in the developing world can aid us in an early and accurate diagnosis and in intervention for better therapeutic recovery and rehabilitation of these children.     

针灸推拿联合功能性训练治疗小儿脑瘫运动障碍的Meta分析

目的析针灸推拿联合功能性训练和单纯功能性训练治疗小儿脑瘫的临床疗效。方法 收集2005-2020年发表的针灸推拿治疗小儿脑瘫RCT,在PubMed、Embase、Cochrane Library、Ebsco Medline、中国知网（CNKI）、万方数据库、维普数据库（VIP）、中国生物医学文献数据库（SionMed）全面检索,根据既定标准筛选文献。对纳入研究进行偏倚风险评价;通过I2检验评估研究间的异质性以选择拟合模型后,以儿童神经发育中期（3周岁）为界分亚组进行Meta分析;采用Egger检验检测发表偏倚,运用敏感性分析评估结果的稳定性,并评价结局指标的质量等级。结果 共纳入文献19篇,样本1 812例。联合治疗组为针灸推拿联合功能性训练,训练组为单纯功能性训练。结局指标显示联合治疗组疗效更优。主要结局指标为总有效率：联合治疗组为89.19%,训练组为69.38%,其OR为3.75,95%CI为（2.86,4.92）,且两个年龄段的联合治疗组总有效率无明显差异;Barthel指数：SMD=3.16,95%CI（2.91,3.40）,P＜0.000 1;粗大运动功能测试（GMFM）：SMD=1.40,95%CI（1.08,1.73）,P＜0.000 1,3岁以内联合治疗的康复速度高于3~6岁联合治疗;综合功能评定（FCA）：SMD=0.53,95%CI（0.35,0.71）,P＜0.000 1。Egger检验提示3个结局指标不存在发表偏倚。GRADE证据质量分级显示：总有效率、Barthel指数和FCA为中等级别,GMFM为低级别。结论 针灸推拿联合功能性训练能够提高小儿脑瘫运动障碍治疗疗效,加快康复进程。     

中西医结合治疗缺血性进展性卒中临床研究

目的:观察中西医结合治疗缺血性进展性卒中的临床疗效。方法:将220例进展性卒中患者分为中西医结合治疗组(观察组)与西医治疗组(对照组),每组110例。观察组在西医治疗的基础上根据中医辨证给予中药治疗,对照组给予西医治疗。结果:观察组愈显率92.7%,对照组愈显率81.8%。观察组疗效优于对照组(P0.05)。观察组治疗后第7天、第14天、第21天NIHSS评分较治疗前均降低,观察组降低程度优于对照组(P0.05)。结论:缺血性进展性卒中在西医规范化治疗的基础上进行中医辨证治疗可明显提高临床疗效。     

头针结合康复训练治疗小儿脑性瘫痪40例

目的:观察头针结合康复训练治疗小儿脑性瘫痪的临床疗效。方法:选择2012年5月—2015年5月在本院儿科以及针灸科就诊的脑性瘫痪患儿40例,按照随机数字表法分为治疗组和对照组,每组20例。治疗组给予头针结合康复训练治疗,对照组给予康复治疗。结果:治疗组患儿治疗后自理能力、认知力、运动能力评分与对照组比较,有统计学意义(P0.05);治疗组有效率为70%,对照组有效率为40%,两组有效率比较,差异有统计学意义(P0.05)。结论:头针结合康复训练治疗小儿脑性瘫痪疗效显著。