肌电生物反馈综合治疗促进痉挛性双瘫型脑瘫患儿下肢运动功能的疗效观察

目的:观察神经康复重建疗法治疗痉挛性双瘫型脑瘫患儿下肢运动功能障碍的疗效。方法:24例痉挛性双瘫型脑瘫患儿随机分为治疗组和对照组,每组12例,所有患儿均接受Bobath技术、推拿、脑循环治疗。治疗组在以上基础上应用WOND2000F2型神经康复重建仪,对双下肢进行肌电触发的生物反馈刺激。在疗程开始与结束时,用改良的Ashworth量表测定患儿腓肠肌肌张力的变化、用关节量角器测量踝关节被动活动的角度变化,采用粗大运动功能测量量表(GMFM)中D和E功能区进行站立与步行功能评定。结果:治疗后,两组患儿的观察指标均有不同程度改善(P0.01—0.001),但治疗组疗效优于对照组(P0.05—0.01)。结论:神经康复重建治疗能降低痉挛性双瘫型脑瘫患儿的下肢肌张力,增加胫前肌肌力和踝关节活动度,明显提高下肢运动功能。     

Gross motor function measure for children with cerebral palsy

The aim of this study was to compare the pattern of motor dysfunction in Hong Kong Chinese children with spastic diplegic and the athetoid type of cerebral palsy (CP) by the Gross Motor Function Measure (GMFM). The GMFM was first tested on its content validity in differentiating the items suitable for testing on upper and lower limb function, followed by test-retest and inter-rater reliability studies, before it was used in a within-subject experiment comparing upper and lower gross motor function in two types of CP, respectively. Children with spastic diplegia (n=18) and with athetosis (n=19) were recruited from three pre-school centres, schools for physically handicapped children and centres of the Hong Kong Spastic Association in Hong Kong. The GMFM, a standardized outcome measure of the motor function in children with CP, was used in comparing mean scores of motor tasks involving upper limbs and those not involving upper limbs in the athetoid and spastic cerebral palsied children. The scores were significantly higher for the children in the spastic diplegic group, but there was no significant difference in the performance of static and dynamic motor tasks of the GMFM between the children in the two groups.     

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     

Performance of static standing balance in children with spastic diplegic cerebral palsy under altered sensory environments.

Seven children with spastic diplegic cerebral palsy and 14 age- and gender-matched nondisabled children participated in the present study for an investigation and comparison of their static standing balance under altered sensory environments. The type of visual input (full, occluded, or sway referenced vision) and the type of somatosensory input (fixed or compliant foot support) were varied factorially to give six sensory environments. Each participant was tested barefooted for 30 s under all six conditions. A force platform collected the ground reaction force, from which standing balance was calculated as the sway area of the center of pressure. The results showed that when somatosensory information was reliable (fixed foot support), there was no significant difference in stance stability between the children with spastic diplegic cerebral palsy and their matched controls, and both types of children were equally affected by the type of visual input. However, when somatosensory information was unreliable (compliant foot support), the difference in stance stability between the children with spastic diplegic cerebral palsy and their matched controls was significantly greater when the visual input was deprived (occluded) or unreliable (sway referenced) than when it was reliable. These results suggest that the children with spastic diplegic cerebral palsy may have difficulties in resolving intersensory conflicts for maintenance of standing balance, or the demands of motor control in sensory conflict conditions outweigh the motor ability of children with spastic diplegic cerebral palsy.     

痉挛型双瘫脑性瘫痪患儿智力水平及智力结构分析

目的探讨痉挛型双瘫脑瘫患儿智力水平及智力结构情况。方法采用中国韦氏幼儿智力量表和中国韦氏儿童智力量表对67 例痉挛型双瘫脑瘫患儿(分低龄组、高龄组)进行测试。结果低龄组(≤6 岁5 个月)患儿平均总智商(71.10±15.95),高龄组(>6 岁5 个月)平均总智商(73.12±16.02),总智力低下率44.78%,低于脑瘫患儿的平均智力低下率。高龄组言语智商明显优于操作智商(P<0.01),Bannatyne 四因素中概念因素和获得因素的分测验得分高于空间因素和序列因素分测验(P<0.05)。结论痉挛型双瘫脑瘫患儿智力水平落后,但优于脑瘫患儿的平均智力水平,其智力结构存在不均衡现象。     

Effects of the standing program with hip abduction on hip acetabular development in children with spastic diplegia cerebral palsy

Purpose: Early identification and intervention with conservative measures is important to help manage hip dysplasia in children with a high adductor and iliopsoas tone and delay in weight bearing. The effect of a daily standing program with hip abduction on hip acetabular development in ambulatory children with cerebral palsy was studied. Method: The participants were 26 children with spastic diplegia cerebral palsy (CP), classified at Level III according to the Gross Motor Function Classification System (GMFCS). Thirteen children stood with hip abduction at least 1 h daily from 12 to 14 months of age to 5 years with an individually fabricated standing frame with hip abduction. Results: At the age of 5 years, radiologic results of the study group were compared with a comparison group of 13 children with spastic diplegia CP who had not taken part in a standing program. The migration percentage in all children who stood with abduction remained within stable limits (13–23%) at 5 years of age, in comparison to children who did not stand in abduction (12–47%) (p?Conclusions: The results indicate that a daily standing program with hip abduction in the first 5 years may enhance acetabular development in ambulatory children with spastic diplegia CP.

• Implications for Rehabilitation

• Abnormal acetabular development is a problem related to mobility problems and spasticity muscles around the hip.

• The literature suggests that postural management and standing programs could reduce levels of hip subluxation and increase function in children with cerebral palsy.

• A standing program with hip abduction can be a beneficial to develop more stable hips in children with spastic diplegic GMFCS level III.

     

生物反馈综合治疗促进痉挛性双瘫型脑瘫患儿下肢运动功能的疗效观察

目的 探讨生物反馈综合治疗对痉挛性双瘫型脑瘫患儿下肢运动功能障碍的疗效.方法 将37例痉挛性双瘫型脑瘫患儿随机分为观察组17例和对照组20例.除进行常规康复训练和药物治疗外,观察组对患儿双下肢进行生物反馈刺激,治疗前后进行粗大运动功能测量量表(GMFM)中的D项和E项评定.结果 治疗后两组患儿的观察指标均有不同程度改善(P＜0.01),但观察组疗效优于对照组(P＜0.05).结论 生物反馈综合治疗可明显提高脑瘫患儿下肢运动功能.     

Risk factors and clinical profiles in Turkish children with cerebral palsy: analysis of 625 cases

The aim of the study was to investigate risk factors, clinical profiles and gross motor function levels of Turkish children with cerebral palsy (CP). A total of 625 consecutive children with CP, who were rehabilitated in the pediatrics rehabilitation clinic between 2000 and 2004 years, were included. Factors causing CP were investigated by interviewing the families and by scanning medical files. Risk factors were recorded as consanguineous marriage, maternal disorder, preterm birth, birth asphyxia, low birth weight, multiple pregnancy, neonatal convulsion, kernicterus, postnatal central nervous system infection and brain injury. Swedish classification was followed in CP typing. Of 625 children with CP, 370 (59.2%) were males and 255 (40.8%) were females, with ages ranging between 2 and 13 years (the mean age was 5.11+/-2.19 years). It was determined that 47.8% of the cases were spastic diplegic CP, 27.7% were spastic tetraplegic CP, 12.8% spastic hemiplegic CP and 11.7% were other types (ataxic, dyskinetic and mixed CP types). The most frequently encountered risk factors were low birth weight (45.1%), preterm birth (40.5%), birth asphyxia (34.6%) and consanguineous marriage (23.8%). Low birth weight, preterm birth, birth asphyxia and consanguineous marriage were top-ranked risk factors that were determined in Turkish children with CP. Compared with other countries, consanguineous marriage is still an important problem in Turkey.     

Evaluation of physical growth in cerebral palsied children and its possible relationship with gross motor development

The object of this study was to detect any possible relation between the current gross motor function score for cerebral palsy children and their physical growth parameters. We measured 71 children with spastic cerebral palsy (35 diplegic, 25 quadriplegic and 11 hemiplegic) and a control group of 80 normal children. Measures taken for cerebral palsy and normal children included stature, weight, head circumference and mid upper-arm circumference, and, additionally for the cerebral palsied children, duration of the disease, birth weight, presence or absence of orofacial dysfunction, distribution of paralysis and degree of spasticity. Motor abilities were measured using the Gross Motor Function Measure. Results showed a significant decrease in the stature, current weight, head circumference and mid upper-arm circumference of both sexes of the quadriplegic children, and significant decreases in the current weight of the diplegic girls and the head circumference of the hemiplegic girls. There were also significant decreases in all scores of the quadriplegic children compared to the diplegic and hemiplegic children. Diplegic children had significantly decreased standing, walking and running, and total scores, compared to the hemiplegic children. Total score at age of testing was independently predicted by the duration of the disease, distribution of paralysis, presence or absence of orofacial dysfunction, spasticity index and the current body weight. Our findings indicate that in spastic cerebral palsy the physical growth parameters were markedly decreased in the quadriplegic form compared to other forms. Only current body weight, from the growth parameters, in addition to other relevant clinical data, can be considered predictors of the current gross motor abilities of those children.     

Comparison of Spatiotemporal Gait Parameters between Children with Normal Development and Children with Diplegic Cerebral Palsy

[Purpose] The purpose of this study was to determine the differences in spatiotemporal gait parameters between children with spastic diplegic CP and children with normal development (ND). [Subjects and Methods] Sixteen children (eight children with spastic diplegic CP and eight ND children) were recruited for participation as volunteers in this study. The children with CP had a Gross Motor Function Classification (GMFC) System level of between I and II. [Results] Walking velocity, cadence, stride length, and step width of children with CP with a GMFC of between I and II were a level of 60%, 77%, 73%, and 160%, respectively, of those of ND children. The percentages of right and left double-limb support were 188% and 179% higher, respectively, and the proportion of single limb support was shorter by 83% and 82%. [Conclusion] Our results provide objective evidence of distinct differences in spatiotemporal gait parameters between children with spastic diplegic CP with a GMFC level I or II and ND children and would be helpful to persons involved in the care of these children.Key words: Cerebral palsy, Spatiotemporal gait parameter, Gait pattern     

脑性瘫痪儿童智商水平与粗大运动分级关系初探

目的对粗大运动功能(GMF)分级与智商水平的相关性进行探讨。方法使用GMF量表、韦氏儿童智力量表和韦氏学龄前儿童智力量表对90例患儿进行评定,并进行统计学分析。结果手足徐动型患儿的总智商(IQ),语言智商(VIQ)在正常范围内,但与正常儿童平均水平相比仍偏低(P<0.05),VIQ与操作性智商(PIQ)无显著性分离(P>0.05);痉挛型患儿及总体受试患儿的平均IQ、VIQ和PIQ低于正常范围(P<0.05),VIQ与PIQ分离(P<0.05);痉挛型患儿的智商与GMF存在线性相关关系,手足徐动型患儿智商与GMF间无明显相关关系。结论不同类型脑性瘫痪儿童的智商水平与智力结构存在差异,智商值与粗大运动功能的相关性也存在差异。     

Effect of seat surface inclination on postural control during reaching in preterm children with cerebral palsy

BACKGROUND AND PURPOSE: Because it is debatable whether seat surface inclination improves motor function in children with cerebral palsy (CP), the effect of seat surface tilting on postural control and quality of reaching was studied. SUBJECTS: The subjects were 58 children with CP aged 2 to 11 years (34 with unilateral spastic CP, 24 with bilateral spastic CP). METHODS: During the task of reaching movements, surface electromyographic and kinematic data were recorded for posture and reaching with the dominant arm in 3 sitting conditions: horizontal seat surface, seat surface tilted forward 15 degrees, and seat surface tilted backward 15 degrees. RESULTS: In the children with unilateral spastic CP, forward tilting improved postural efficiency and quality of reaching. In the children with bilateral spastic CP, both forward and backward tilting of the seat surface was associated with more postural instability and did not affect the quality of reaching. DISCUSSION AND CONCLUSION: The results suggest that, in terms of postural control and quality of reaching, children with unilateral spastic CP benefit from a forward-tilted position and children with bilateral spastic CP benefit from a horizontal sitting position.     

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。     

Motor control assessment for rhizotomy in cerebral palsy

OBJECTIVE: To apply motor control assessment for selection of appropriate spastic cerebral palsy children to receive selective posterior rhizotomy (SPR). DESIGN: Forty children with spastic cerebral palsy (3-16 yr) were divided into three groups: "independent ambulator," "dependent ambulator," and "nonambulator." Another 18 healthy children were selected as the control group. Both motor control (tested by using polyelectromyography (PEMG)) and clinical ambulatory capability were assessed within 1 mo before SPR and 12 mo after. PEMG patterns were classified into seven patterns according to electromyographic activities during hip/knee flexion and extension. Gait patterns, which were analyzed by computer DynoGraphy, were classified into four patterns for children with ambulatory capability. RESULTS: PEMG and gait patterns were correlated with ambulatory ability. PEMG patterns 2-3 could predict independent ambulatory ability, whereas patterns 6-7 will interfere with ambulatory ability. PEMG patterns showed significant improvement after SPR in the ambulatory groups (P < 0.05), whereas they did not improve in the nonambulator group. Children with cerebral palsy with co-contraction of proximal/distal muscles had better results after SPR, whereas those with diffuse co-contraction or reduced electromyography activities had poor results. CONCLUSIONS: PEMG patterns may allow the physician to select the appropriate children with spastic cerebral palsy to receive SPR with good results.     

肉毒杆菌毒素肌肉注射疗法在小儿脑瘫康复训练中的应用

目的观察肉毒杆菌毒素Ａ（ＢＴＸ－Ａ）肌肉注射矫治小儿脑瘫功能畸形的疗效和副作用,及其在康复训练中的应用意义。方法ＢＴＸ－Ａ剂量为１～２ＩＵ／ｋｇ痉挛肌运动点注射。注射后１个月不出现效果,则增加剂量重复注射。结果１２例不能行走或走不稳的患儿,治疗后２个月内,５例能平稳行走,５例扶物自行,上肢畸形７例中３例恢复,３例改善;１例无效。随防２～１７个月未见复发和副作用。结论该法实用、安全、有效、无组织损害。适用于痉挛型或伴有痉挛的徐动型脑瘫患儿。     

Colonic transit time and constipation in children with spastic cerebral palsy

OBJECTIVES: To evaluate colonic motility and to investigate contributing factors to colonic dysmotility in children with spastic cerebral palsy (CP). DESIGN: Cross-sectional study. SETTING: A university-based rehabilitation hospital. PARTICIPANTS: Thirty-eight children with spastic CP. INTERVENTIONS: Not applicable.MAIN OUTCOME MEASURES: Colonic transit time was measured by using a Sitzmarks. The nutrient intake during 3 consecutive days was analyzed by using the ESHA Food Processor program. RESULTS: A significant relationship between colon transit time and stool frequency was observed (P<.05). All children with constipation and 17 (60.8%) of 28 without constipation showed an abnormal segmental colon transit time in at least 1 segment of the colon. A transit time delay at the proximal segment of colon was remarkable in CP children with constipation. In children without constipation, a transit time delay was marked at the rectosigmoid colon only. Constipation and transit time delay were significantly related to ambulatory function (P<.05). CONCLUSIONS: A transit time delay at total or segmental colon was frequently observed in children with CP. Constipation and colonic motility were related to ambulatory function.     

A型肉毒毒素用于治疗痉挛型脑性瘫痪的临床研究

目的:探讨A型肉毒毒素注射治疗痉挛型脑性瘫痪儿童肌肉痉挛的疗效。方法:选择痉挛型脑性瘫痪儿童200例,A型肉毒毒素注射组(注射组)和单纯康复治疗组(对照组)各100例。其中注射组将A型肉毒毒素准确注射到患儿痉挛肌群,注射后次日开始进行康复训练(共12周)。所有病例在治疗前及治疗后1周、2周、4周、8周、12周分别采用改良Ashworth量表、粗大运动功能量表及医师等级评价量表进行相关评价。结果:注射组在注射后各观察时点肌肉痉挛改善程度和运动功能评分均优于注射前(P<0.05),注射组治疗效果明显优于对照组。结论:A型肉毒毒素注射治疗可以快速、有效地缓解痉挛;注射治疗结合康复训练相较于单纯康复训练,更有助于提高运动功能、缩短治疗时间。     

4~12岁脑性瘫痪患儿粗大运动、手操作和交流功能的相关性分析

目的分析4~12岁不同类型脑瘫患儿粗大运动功能、手功能和语言交流功能分级水平及其相关性。方法选取诊断及分型明确,年龄在4岁以上能够配合检查的脑瘫患儿318例(痉挛型双瘫132例、四肢瘫27例、偏瘫32例、不随意运动型54例,共济失调型41例、混合型32例),均进行粗大运动功能(GMFCS)、手功能(MACS)、交流功能(CFCS)的分级。用Spearman′s相关系数分析不同类型脑瘫的GMFCS、MACS和CFCS中每2个分类系统间的相关性和总的关联。结果脑瘫类型不同,GMFCS、MACS和CFCS三种功能分级系统的功能级别分布也不同,痉挛型双瘫、偏瘫的总体功能障碍最轻,而痉挛型四肢瘫、不随意运动型功能受限最严重。三个功能分类系统的相同分级的总一致性为39.31%(125/318)。三种功能分级呈中度相关,在不同脑瘫类型间的相关程度也不同。GMFCS水平与MACS水平在四肢瘫和不随意运动型患儿相关性最高(rs四肢瘫=0.95;rs不随意=0.93,P<0.05),在偏瘫患儿中不具相关性(P>0.05)。GMFCS水平与CFCS在偏瘫和四肢瘫儿童高度相关(rs偏瘫=1.00、rs四肢瘫=0.82,P<0.05),但是在双瘫患儿中不具相关性(rs=0.15,P>0.05)。MACS与CFCS在四肢瘫和混合型患儿的相关性最高(rs四肢瘫=0.86和rs=0.82,P<0.05),但是双瘫和偏瘫患儿中未发现相关性(P>0.05)。结论脑瘫类型不同,三种功能分级系统的功能级别的分布不同,且三种功能分类系统在不同脑瘫类型的相关性也不同,其联合应用可对脑瘫患儿日常生活中的表现提供更全面功能框架的描述。     

穴位疏通法结合Vojta训练治疗痉挛型脑瘫疗效观察

目的观察穴位疏通法结合Vojta训练治疗痉挛型脑瘫的疗效。方法220例痉挛型脑瘫患儿随机分为治疗组和对照组，各110例。治疗组采用中医传统针刺及按摩手法，结合Vojta训练；对照组采用静脉滴注脑活素等药物。采用粗大运动功能评定量表（GMFM）于治疗前后对两组患儿进行评定。结果治疗组患儿的GMFM评分显著优于对照组（P〈0.001）。结论穴位疏通法结合Vojta训练对改善痉挛型脑瘫患儿的运动功能有明显疗效。     

小于3岁痉挛型脑性瘫痪儿童粗大运动与精细运动发育的相关性研究

目的比较小于3岁痉挛型脑性瘫痪儿童粗大运动与精细运动发育之间的相关性。方法以同时接受粗大运动功能测试量表（GMFM）评定和精细运动功能评定量表（FMFM）评定的193例小于3岁的痉挛型脑性瘫痪儿童为研究对象，比较GMFM各项分值与FMFM分值在不同月龄和类型患儿中的相关程度，通过多元逐步回归分析确定GMFM5个功能区分值对FMFM分值的影响程度。结果在不同月龄和类型的脑性瘫痪患儿中，GMFM各项分值与FMFM分值具有良好的相关性（r=0．26～0．85，P〈0．05），多元逐步回归分析结果显示GMFM的A区和B区分值对FMFM分值的影响力较大，校正决定系数为0．748，A区的作用更为强烈。结论小于3岁的痉挛型脑性瘫痪儿童的粗大运动与精细运动存在着良好的相关性，对不同年龄和类型的脑性瘫痪儿童都应该重视粗大运动与精细运动训练相结合，同时必须加强基本运动功能训练。