A型肉毒毒素联合石膏固定对痉挛型双瘫患儿粗大运动功能影响的疗效观察

目的观察A型肉毒毒素联合石膏固定对痉挛型双瘫患儿粗大运动功能的影响。方法 2013年1月至2014年10月厦门市妇幼保健院儿童神经康复科收治住院的痉挛型双瘫患儿40例,随机分为观察组和对照组各20例。对照组单纯采用A型肉毒毒素注射后进行康复训练;观察组采用A型肉毒毒素注射联合石膏固定3周,拆除石膏后进行康复训练,分别于治疗前及治疗后1、3、6个月采用粗大运动功能量表(GMFM-88)D区和E区进行评估。结果观察组治疗后1、3、6个月GMFM-88D区、E区与治疗前比较差异有统计学意义(P0.01)。对照组治疗后3、6个月GMFM-88D区、E区与治疗前比较差异有统计学意义(P0.01)。观察组治疗后1、3、6个月GMFM-88D区、E区与对照组比较差异有统计学意义(P0.01)。结论 A型肉毒毒素注射联合石膏固定治疗痉挛型双瘫患儿尖足畸形,可降低肌张力,改善运动功能,有效提高粗大运动功能,比单纯采用A型肉毒毒素治疗疗效更好。     

悬吊运动训练对痉挛型脑性瘫痪患儿粗大运动功能、平衡功能及肌电图的影响

目的探究痉挛型脑性瘫痪(简称脑瘫)患儿进行悬吊运动训练对粗大运动功能、平衡功能以及肌电图的影响。方法选取我科2017年10月至2020年6月收治的痉挛型脑瘫患儿89例作为研究对象,随机分为对照组44例和观察组45例。对照组接受常规康复训练,观察组在对照组的基础上增加悬吊运动训练,均连续治疗6个月。观察两组粗大运动功能、肌电图、平衡功能以及日常生活能力。结果观察组粗大运动功能D区、E区评分、平衡功能评分、改良Barthel指数评分明显高于对照组,对照组内收肌、腓肠肌表面肌电均方根值(RMS)水平明显高于观察组,差异有统计学意义(P<0.05)。结论悬吊运动可以明显改善痉挛性脑瘫患儿的粗大运动功能,提高患儿的平衡能力,同时有效降低患儿体表的肌电分布,抑制肌张力的异常升高,提高日常生活能力。     

悬吊运动训练对痉挛型脑性瘫痪患儿粗大运动功能、平衡功能及肌电图的影响

目的探究痉挛型脑性瘫痪(简称脑瘫)患儿进行悬吊运动训练对粗大运动功能、平衡功能以及肌电图的影响。方法选取我科2017年10月至2020年6月收治的痉挛型脑瘫患儿89例作为研究对象,随机分为对照组44例和观察组45例。对照组接受常规康复训练,观察组在对照组的基础上增加悬吊运动训练,均连续治疗6个月。观察两组粗大运动功能、肌电图、平衡功能以及日常生活能力。结果观察组粗大运动功能D区、E区评分、平衡功能评分、改良Barthel指数评分明显高于对照组,对照组内收肌、腓肠肌表面肌电均方根值(RMS)水平明显高于观察组,差异有统计学意义(P<0.05)。结论悬吊运动可以明显改善痉挛性脑瘫患儿的粗大运动功能,提高患儿的平衡能力,同时有效降低患儿体表的肌电分布,抑制肌张力的异常升高,提高日常生活能力。     

中医康复理疗结合肉毒毒素A注射治疗小儿脑性瘫痪的临床观察

目的观察中医康复理疗结合肉毒毒素A注射治疗小儿脑性瘫痪(简称脑瘫)的临床疗效。方法 2013年3月至2015年3月郑州市儿童医院康复中心收治住院的脑瘫患儿80例,随机分为观察组和对照组各40例。对照组给予中医康复理疗,观察组给予中医康复理疗联合肉毒毒素A注射治疗。治疗6个月后观察两组治疗效果。结果观察组治疗后总有效率为82.5%(33/40),显著高于对照组的62.5%(25/40),差异有统计学意义(P0.05)。观察组治疗结束后3个月患者痉挛程度评分为(2.74±0.36)分,显著低于对照组(3.85±0.33)分,差异有统计学意义(P0.05)。两组不良反应发生率比较差异无统计学意义(P0.05)。结论中医康复理疗联合肉毒毒素A注射治疗小儿脑瘫临床疗效显著,可改善患儿认知功能,对提高患儿生活质量意义重大。     

不随意运动型脑性瘫痪患儿不同亚型运动功能预后的回顾性分析

目的分析不随意运动型脑性瘫痪(简称脑瘫)患儿不同亚型运动功能预后。方法回顾性调查46例不随意运动型脑瘫患儿的临床特点,对张力障碍型、舞蹈徐动型、徐动痉挛型3种不同亚型患儿脑瘫粗大运动功能分级系统(GMFCS)分级、粗大运动功能测试量表(GMFM88量表)评估结果进行分析。结果舞蹈徐动型、张力障碍型、徐动痉挛型组间比较GMFCS级别差异有统计学意义,其中徐动痉挛型级别最低,舞蹈徐动型最高(F=71.596,P0.001);徐动痉挛型在GMFM88量表各功能区均明显低于舞蹈徐动型(P0.001);张力障碍型在站立位、行走与跑跳能区明显低于舞蹈徐动型(P0.001)。结论舞蹈徐动型脑瘫患儿多在4岁前获得自身行走能力,张力障碍型患儿部分可获得自身行走能力,徐动痉挛型患儿运动功能较其他类型明显落后,较难获得自身行走能力。     

Neuroimaging evaluation of cerebral palsy

MRI can demonstrate and differentiate the various insults and anomalies that can be responsible for cerebral palsy. Recent advances have resulted in techniques and sequences that allow prompt detection of cytotoxic edema and evaluation of brain perfusion. MRI precisely demonstrates the various patterns of injury, distinguishing insults owing to profound asphyxia, partial prolonged asphyxia, and mixed partial prolonged and profound asphyxia. Infants and children can be studied with MRI, and ultrafast MRI permits evaluation of the fetal central nervous system. In the fetus, the cause of ventriculomegaly can be determined, such as cerebrospinal fluid flow obstruction, brain malformation, or brain destruction with or without hemorrhage. Results from fetal MRI have led to better understanding of many brain abnormalities.     

运动想象疗法对偏瘫型脑性瘫痪患儿上肢功能的疗效观察

目的探讨运动想象疗法对偏瘫型脑性瘫痪(简称脑瘫)患儿上肢功能的影响。方法 2015年3月至10月在佳木斯大学附属第三医院门诊或住院治疗的痉挛型偏瘫儿童20例,随机分为观察组与对照组各10例。观察组采用运动想象疗法与常规康复训练,对照组仅采用常规康复训练,治疗前及治疗后10周采用上肢Peabody运动发育量表、儿童功能独立性评定(WeeFIM)、肱二头肌厚度、前臂旋后角度进行评分,观察运动想象疗法对于偏瘫型脑瘫患儿上肢功能康复的疗效。结果治疗10周后,两组偏瘫侧肢体Peabody精细运动评分、儿童功能独立性评分、肱二头肌厚度、前臂旋后角度均较治疗前提高,差异有统计学意义(P0.05);观察组Peabody精细运动评分、儿童功能独立性评分、肱二头肌厚度及前臂旋后角度均显著高于对照组,差异有统计学意义(P0.05);Peabody精细运动评分与肱二头肌肌肉厚度的评价结果呈正相关(r=0.78,P0.05)。结论运动想象疗法有助于提高偏瘫型脑瘫儿童的上肢运动功能,增大前臂旋后角度及肌肉厚度。     

Early detection of cerebral palsy: sensitivity and specificity of two motor assessment tools

The early detection of cerebral palsy is an important goal of NICU follow-up clinics, and a variety of different neuromotor assessment tools are used to assess its presence. This study aimed to examine retrospectively the sensitivity and specificity of the Bayley Motor Scale and the Movement Assessment of Infants (MAI) in correctly identifying infants at four months' corrected age as either "normal" or "suspect/abnormal." The MAI was more than twice as sensitive as the Bayley Motor Scale at detecting early signs of cerebral palsy. However, the Bayley Motor Scale had fewer "false positives" for cerebral palsy than the MAI. Sensitivity and specificity for these two instruments were compared to those of other neurological assessment tools in previously published studies.     

The incidence of cerebral palsy.

The clinician is often held responsible for obstetric events that are suspected of being related to cerebral palsy. To review the incidence of cerebral palsy and to aid the clinician in this situation, a search of published studies was conducted. Composite rates of cerebral palsy in different birth weight infants and cerebral palsy with and without serious mental retardation were calculated. The cumulative incidence rate at the age of 5 to 7 years was 2.7 cases of cerebral palsy for 1000 birth cohorts. Approximately 36% of all cerebral palsy occurred in the infant less than 2500 gm. Serious mental retardation (intelligence quotient less than 50) accompanied cerebral palsy approximately 30% of the time for the term infant and 18% of the time when the infant was less than 2500 gm. On the basis of a past estimation that 70% of cerebral palsy is of antepartum or unknown origin, the term infant at risk for intrapartum-attributed cerebral palsy may be about 1 in 2000 term births.     

Overactive bladder: prospects and limitations of botulinum toxin

Botulinum toxin is the most potent poison known to man. It is produced by Clostridium botulinum and consists of a heavy chain which is responsible for the internalization of the toxin into the cytosol and a light chain that has the ability to cleave proteins within the nerve terminal. As those proteins are essential for normal vesicular transport and fusion of acetylcholine, botulinum toxins are able to prevent its release at the presynaptic membrane, resulting in a chemodenervation of the detrusor muscle after intravesical injection of the toxin and an impressive reduction of symptoms of overactive bladder. Clinical studies show success rates between 60 and 96% for neurogenic and non-neurogenic detrusor overactivity. Thus, application of botulinum toxin to the lower urinary tract appears to be an efficient, safe and minimally invasive procedure.     

早期干预改善脑瘫患儿进食功能的效果

目的观察早期干预对脑性瘫痪(脑瘫)患儿进食困难的治疗效果。 方法温州市第二人民医院于2002-03—2004-10，对收治的34例脑瘫患儿(观察组)进行摄食及口咽运动康复训练6个月至1年后进行进食功能评价；对同期康复门诊42例脑瘫患儿(对照组)在常规康复初期即进行进食功能评价，将两组评价结果进行比较。 结果观察组较对照组各种进食功能障碍，吸吮困难、吞咽困难、食物送入手或口困难、用杯喝水困难，咀嚼半固体或固体食物困难的发生率明显降低，两组差异具显著性，P<0.05。 结论对可能有发育障碍的脑瘫患儿及早开始进行进食能力及口咽运动训练能改善其进食功能。     

脑性瘫痪患儿合并癫疒间32例临床分析

目的探讨合并癫疒间的脑性瘫痪患儿的临床特点及癫疒间治疗效果。 方法总结1999年10月至2004年5月在西安交通大学第二医院住院的合并癫疒间的脑性瘫痪患儿的癫疒间发生率、临床类型、头颅计算机体层成像(CT)和(或)磁共振成像(MRI)、脑电图等方面的特点以及抗癫疒间治疗效果。 结果139例脑性瘫痪患儿中有32例合并癫疒间，占230%(32/139)；常见的癫疒间类型为强直 阵挛发作12例(375%)和部分性发作6例(188%)；25例(781%)癫疒间首发于1岁前；合并癫疒间脑性瘫痪儿童的头颅影像异常及脑电图异常分别占30例(938%)和27例(844%)；常见的头颅影像异常为脑发育不良11例(367%)、脑积水6例(200%)，余为脑萎缩、缺氧缺血性脑病样改变等13例(433%)；脑电图异常中局灶性和弥漫性所占比例分别为482%(13/27)和518%(14/27)；癫疒间多发生于痉挛性脑性瘫痪中(688%)；813%(26/32)的癫疒间需要2种及2种以上的抗癫疒间药物治疗。 结论脑性瘫痪患儿中癫疒间的发生率较高，其头颅影像学和脑电图分别以脑发育不良和弥漫性背景活动异常伴疒间样波发放为主；脑性瘫痪儿童的癫疒间大多为难治性，需要联合用药治疗。     

Neurodevelopmental management strategies for children with cerebral palsy: optimizing function, promoting participation, and supporting families

There is a spectrum of outcomes in health, functional skills, and participation among children with one of the cerebral palsy syndromes. Medical advances have allowed us to better understand the importance of goal-oriented management and attention to nutrition, safe feeding, seizures, deformity, and spasticity. However, ensuring long-term successful outcomes require coordination between medicine, social services, education, and rehabilitation and continually examining how to promote functioning and participation. Until multicentered population registries and networks for clinical trials are established, our knowledge of evidence-based outcomes will remain partial and incomplete.     

家庭训练计划提高脑性瘫痪患儿精细运动能力的疗效观察

目的观察由治疗师指导家长使用家庭训练方案提高脑性瘫痪(简称脑瘫)患儿精细运动能力的作用。方法 2015年1月至12月辽宁省儿童医院儿科收治不同类型脑瘫患儿60例,随机分为观察组和对照组各30例。对照组入院后予常规康复训练,观察组在康复治疗基础上指导家长在家中使用Peabody运动发育量表第2版(PDMS-2)家庭训练方案,每日1次,每次30min,治疗6个月后比较两组疗效及精细运动发育商的变化。结果观察组治疗总有效率为90.0%(27/30),显著高于对照组66.7%(20/30),差异有统计学意义(P0.05)。两组治疗后观察组精细运动发育商显著高于对照组,差异有统计学意义(P0.05)。结论由家长实施的家庭训练结合康复治疗能明显提高脑瘫患儿的精细运动能力。     

Effects of virtual reality in body oscillation and motor performance of children with cerebral palsy: A preliminary randomized controlled clinical trial

Background and purposeVirtual reality is an adjuvant technique to rehabilitation of children with cerebral palsy (CP). It has been gaining prominence in this field because of its accessibility and great levels of motivation it promotes in treatment. However, there is a lack of studies addressing the effects of virtual reality-based therapy on activity levels regarding postural stability, especially considering the level of evidence presented by studies addressing this issue. Therefore, we aim to evaluate the effects of intervention in body sway and gross motor function of children with CP using an active video game.Materials and methodsIn this blind randomized controlled trial, fifteen children with CP, Gross Motor Function Classification System (GMFCS) I-II, regularly attending conventional physical therapy programs, were randomly assigned to an intervention (IG:n = 7) or to a control group (CG:n = 8). In both groups, children remained attending conventional therapy. In addition, IG underwent intervention using an active video game twice a week for 45 min and eight weeks. Standing body sway was assessed using a force plate, and Gross Motor Function Measure (GMFM) dimensions D (Standing) and E (Walking, Running and Jumping) were tested.ResultsFollowing the virtual reality-based intervention, the IG only showed significant improvements in the GMFM dimensions D (p = 0.021) and E (p = 0.008). Improvements were clinically significant (D = 10.8%; E = 14.0%). For the CG, no variable analyzed showed differences after eight weeks.ConclusionsIntervention using an active video game is a promising tool that can improve the gross motor function of children with CP, GMFCS I-II.     

Pharmacotherapy of spasticity in children with cerebral palsy

Spasticity is a common disability in children with cerebral palsy. Pharmacological and non-pharmacological treatments, including physical therapy, occupational therapy, orthotics, rhizotomy, and orthopedic surgery, all play important roles in the management of spasticity. The purpose of this article is to provide an overview of available medications for treatment of spasticity in children with cerebral palsy. Common medications include benzodiazepines, dantrolene sodium, baclofen, tizanidine, botulinum toxins, phenol, alcohol and intrathecal baclofen. In general, oral medications and intrathecal baclofen are used for treating generalized spasticity, whilst chemodenervation agents (botulinum toxins, phenol, and alcohol) are used to treat localized spasticity. There is more sufficient evidence for the recommendation of botulinum toxin A as an effective anti-spasticity treatment in children with cerebral palsy. However, more data concerning safety and long-term effects of botulinum toxin A is needed. Further study is needed to determine which kinds of medications can cause substantial improvement in daily activity, participation level, self-competence, or quality of life in children with cerebral palsy.