脑性瘫痪儿童的步态特征分析

背景：脑瘫患儿的步态异常较常见，如何控制改善步态是康复治疗的重点。 目的：分析脑瘫患儿步态的生物力学参数，并观察支具控制对不随意运动型脑瘫患儿运动能力的影响。 方法：研究对比脑瘫患儿和正常儿童在起步过程中以及步行中的生物力学参数，起步过程中的生物力学参数包括时空参数，膝、踝关节活动度的运动学参数以及动力学参数；步行中的生物力学参数包括时空参数。不随意运动型脑瘫患儿均接受支具控制辅助下徒手体位控制、减重步态训练、S-E-T的3个月治疗，治疗前后采用88项粗大运动评价量表A区和视频对照进行疗效评估。 结果与结论：脑瘫患儿和正常儿童在起步过程中的生物力学参数测试对比中，除了右脚为起步脚的额状轴地面反力峰值外，其余各项生物力学参数均有明显差异；步行中的生物力学参数测试对比中，脑瘫患儿较正常儿童支撑相和双足支撑相延长、步长和复步长缩短。支具控制脑瘫患儿观察中，与治疗前比较，GMFM88项A区平均得分显著提高，视频示患儿治疗后不自主动作减少，头颈躯干较稳定，生活能力有好转，癫痫及认知障碍和基底节区有影像学改变的患儿进步幅度较小，舞蹈-徐动型和张力障碍型比徐动痉挛型患儿运动能力进步幅度大。

Gait analysis in cerebral palsy children

BACKGROUND:Abnormal gaits are very common in children with cerebral palsy, and how to improve the gait is the focus of rehabilitation therapy. OBJECTIVE:To analyze the biomechanical parameters of gaits in cerebral palsy children and to observe the effects of brace control on the exercise capacity of dyskinetic cerebral palsy children. METHODS: In this paper, we compared the biomechanical parameters of children with cerebral palsy and normal children in the initial process of walking and during walking. Biomechanical parameters in the initial process of walking include spatial and temporal parameters, kinematic and kinetic parameters of the range of motion of the knee and ankle. Biomechanical parameters during walking include spatial and temporal parameters. With the aid of hand brace, dyskinetic cerebral palsy received postural control, gait training, and sling exercise therapy for 3 months. The Gross Motor Function Measure (GMFM-88) assessment and video control were conducted for evaluation of therapeutic efficiency. RESULTS AND CONCLUSION: Biomechanical parameters in the initial process of walking showed significant differences between children with cerebral palsy and normal children except for the peak of ground reaction force at frontal axis with the right foot to start walking. Biomechanical parameters during walking showed that the stance phase and bipedal stance phase were prolonged, while the step length and stride length were shortened in the children with cerebral palsy compared with the normal children. For cerebral palsy children with brace control, the GMFM-88 scores were significantly decreased after treatment, involuntary movements were reduced shown on the video, the neck and body were stable, and life skills were improved. Children with epilepsy and  cognitive impairment or who had imaging changes in the basal ganglia showed a little improvement, and children with dance-athetoid type and dystonia type had a better progress than those with athetoid spasm.