慢性病和功能障碍老年人身体活动的健康效果：系统综述的系统综述

目的 基于世界卫生组织国际分类家族(WHO-FICs)构建身体活动对慢性病和功能障碍老年人健康及健康相关状况的干预效果范畴及架构。 方法 运用《国际疾病分类第十一次修订本》(ICD-11)和《国际功能、残疾和健康分类》(ICF)对老年人的健康及健康状况进行系统分析。检索PubMed、CBM、Scopus、Web of Science、Embase、中国知网、维普、万方等数据库,收集建库至2022年8月8日关于身体活动干预对慢性病和功能障碍老年人健康及健康相关状况康复效果的系统综述进行综述。 结果 最终纳入系统综述11篇,来自6个国家,共涉及316项相关随机对照试验和28 169名参与者,主要包括老龄化、公共健康、康复、身体锻炼等领域。与老年人健康状况相关的疾病主要集中于痴呆、帕金森病、精神分裂症、抑郁症、认知障碍,骨质疏松症、关节炎、肌少症,慢性心力衰竭、冠心病、高血压、脑卒中,2型糖尿病,慢性肺病。干预方案中,活动形式有平衡、功能和耐力训练、灵活性训练,步行、伸展、上下肢训练、瑜伽、气功、太极拳等,活动频率每周1~7次,活动强度为中度,活动持续时间4周~10年。健康结局涉及降低疾病风险,促进整体认知功能、精神功能、肌肉耐力、心肺耐力、柔韧性等的改善和发展,改善步行、移动、平衡、灵活性、姿势控制等基本动作技能,改善睡眠质量,缓解焦虑,减少压力,增加社会参与和人际互动交流,提升幸福感等。 结论 基于WHO-FICs构建了慢性病和功能障碍老年人参与身体活动产生的健康效果的理论架构。老龄化导致的健康及健康相关状况主要涉及认知、心理和精神系统,骨骼肌肉关节系统,心血管系统,代谢系统,呼吸系统。身体活动的干预方案可以分为体适能类、技能类和运动项目类。健康和功能结局主要表现在降低慢性病的发病率,改善功能,提高身体活动水平,促进心理健康,提高生活质量和福祉。     

不同身体活动对脑性瘫痪儿童青少年健康效益的系统综述

目的 系统综述不同身体活动对脑瘫儿童青少年的健康效益。方法 采用主题词和自由词相结合的检索策略,检索建库至2023年12月在Web of Science、PubMed、EBSCO、Cochrane、中国知网数据库中发表的脑瘫儿童青少年参与身体活动干预后健康和功能结局的随机对照试验,并进行系统综述。结果 共纳入10项研究,涉及402例参与者(3～24岁),物理治疗证据数据库量表评分6～8分,来自澳大利亚、美国、巴西和荷兰,主要来源于康复医学、神经科学、残疾研究、物理治疗等领域,发表日期集中在2013年至2020年。身体活动类型包括体适能类(体能体适能、技能体适能)、运动技能类(粗大运动技能、精细运动技能)和适应性身体活动类(移动技能、休闲类)。每次20～60 min,每周1～5次,持续7～26周;干预强度为中等至高强度,干预场所涉及社区和家庭、学校、康复机构。有3种指导和支持模式：运动康复,适应性体育活动,以及运动康复与适应性体育活动相结合。健康效益体现在身体活动相关的健康行为、身体功能、活动和参与以及生活质量4个方面,包括提升身体活动水平,减少久坐行为;增强肌肉力量,提高心肺功能,改善...     

脑性瘫痪并发言语障碍的诊断、评估与康复：基于WHO-FICs研究

目的 依据世界卫生组织国际健康分类家族(WHO-FICs)对脑性瘫痪并发言语障碍进行诊断、功能分析和康复干预研究。方法 基于《国际疾病分类》第11次修订本(ICD-11)研究相关诊断,基于《国际功能、残疾和健康分类》(ICF)研究相关功能分类,基于《国际健康干预分类》(ICHIβ-3)对言语康复进行系统分析,并制定结构化康复策略。结果 脑性瘫痪ICD-11分类为08神经系统疾病,进一步分为8D20.0痉挛型单侧脑瘫、8D20.1痉挛型双侧脑瘫(8D20.10痉挛型四肢瘫脑瘫、8D20.11痉挛型双侧脑瘫)等临床亚型;常并发的言语障碍涉及6A00智力发育障碍、6A01发育性言语或语言障碍、MA80言语障碍、MA81言语不流畅、MA82语音障碍。脑性瘫痪并发的言语功能障碍主要涉及ICF s1神经系统结构、s3涉及发声和言语的结构、b3发声和言语功能、d1学习和应用知识,以及环境和个人等多个因素;在b3发声和言语功能中,主要涉及的功能包括b310发声功能、b320构音功能和b330言语的流畅和节奏功能。脑性瘫痪言语功能的康复策略,涉及ICHIβ-3身体结构和功能、活动与参与、环境因素等领域的康复治疗方法。结论 基于WHO-FICs的ICD-11、ICF和ICHIβ-3,系统构建了脑性瘫痪并发言语障碍的评估与康复方法体系,包括疾病分类、言语并发症分类,言语功能的分类、评估与康复,建立脑性瘫痪并发言语功能障碍的临床诊断、功能分析和康复干预的方法体系和编码方法。     

基于WHO-FICs架构智力残疾儿童青少年身体活动与运动康复的健康结局：系统综述的系统综述

目的 基于世界卫生组织国际分类家族(WHO-FICs)构建智力残疾儿童青少年参与身体活动和运动康复的健康和功能结局的研究架构,系统分析智力残疾儿童青少年的主要健康与功能障碍表现、参与身体活动的方案以及健康和功能结局。 方法 运用《国际疾病分类第十一次修订本》(ICD-11)和《国际功能、残疾和健康分类》(ICF),对智力残疾儿童青少年身体活动干预方案以及健康与功能结局进行系统分析,构建智力残疾儿童青少年健康与功能状况、身体活动干预方案以及健康与功能结局架构。检索Scopus、PubMed、Embase、Web of Science、中国知网、维普、万方数据,收集建库至2022年8月18日公开发表的智力残疾儿童青少年参与身体活动与运动康复的健康及功能结局的系统综述,进行系统综述。 结果 最终纳入系统综述8篇,来自5个国家,包括190项随机对照试验和7 011例参与者,研究领域主要涉及智力障碍、儿童神经病学、康复科学、残疾与健康、适应性体育、特殊教育等,发表时间集中在2018年至2022年。常见的健康状况主要有唐氏综合征、孤独症谱系障碍、脆性X综合征、Prade-Willi综合征、智力障碍、认知障碍;身体活动干预形式分为体适能类、技能类和活动类3类,活动频率每周1~5次,活动强度为中-高强度,持续时间1周~1.5年;健康结局体现在智力功能和适应性行为、身体活动、心理行为健康与社会适应、整体生活质量和福祉方面。 结论 基于WHO-FICs构建了智力残疾儿童青少年参与身体活动和运动康复的健康效果的理论架构。智力残疾儿童青少年主要功能障碍表现为智力功能和适应性行为、活动和心理健康、生活质量和福祉3个层面。其中智力功能和适应性行为层面涉及概念性技能、社交性技能和实践性技能,活动和参与层面表现为低体育活动参与度、久坐和肥胖,活动能力低,没有发展基本运动能力和身体素质。生活质量和福祉层面涉及情绪和情感、自尊、一般自我概念、幸福感、友谊、与他人的关系或社会成熟度、生活质量和福祉等。身体活动方式可以分为体适能类、技能类和运动项目类。主要健康和功能结局主要表现在三个领域：智力功能与适应性行为,活动和参与以及心理行为健康与社会适应、生活质量和福祉。在智力功能和适应性行为领域,主要健康结局涉及认知功能(执行功能、认知可塑性、工作记忆等)、心理功能(情绪自我控制、自我价值和自尊)。在活动和参与领域,主要健康结局涉及体适能(肌力和肌耐力、速度、灵敏性)和动作技能(基本动作技能、平衡、核心稳定性),提高体育活动参与度,促进其更好地适应与赋能(社交、亲社会行为等),达成健康目标(降低疾病风险、缓解焦虑和抑郁、肥胖管理)。在心理行为健康与社会适应、生活质量和福祉领域,参与身体活动与运动康复可以提升儿童青少年整体的生活质量和福祉。     

渐进性抗阻训练在痉挛型脑瘫康复中的临床研究进展

渐进性抗阻训练(PRT)在是否有助于提高痉挛型脑性瘫痪(简称脑瘫)患儿的功能, 特别是在国际功能、残疾和健康分类(儿童青少年版)(ICF-CY)框架下的活动和参与层面存在争议, 目前尚缺少有力的循证依据。本文通过对PRT的历史发展、训练方法以及临床研究进展和争议问题进行综述, 以期启发儿童康复工作者的关注和开展循证研究, 探究如何更好地发掘渐进性抗组训练这一康复治疗技术在痉挛型脑瘫康复治疗中的作用, 具有一定的参考意义。     

基于WHO-FICs作业治疗改善脑卒中上肢功能效果的系统综述

目的 基于世界卫生组织国际分类家族(WHO-FICs)构建作业治疗改善脑卒中上肢功能的PICO架构,并分析主要作业疗法改善脑卒中患者上肢功能的效果。方法 运用WHO-FICs框架,检索Web of Science、PubMed、CNKI、SinoMed等数据库,收集建库至2022年10月关于作业治疗干预脑卒中上肢功能的相关文献,并进行系统综述。结果 最终纳入10项随机对照试验,382例参与者(≥18岁),来自6个国家,主要来源于康复医学、物理和康复医学、神经科学、生物工程医学、作业治疗等研究领域,发表年限集中于2013年以后。纳入文献物理治疗证据数据库(PEDro)量表评分平均7.5分。基于WHO-FICs框架,纳入文献中涉及的疾病类型涵盖脑出血(8B00)、缺血性脑卒中(8B11)、蛛网膜下腔出血(8B01)、肌张力和异常反射(MB47)、偏瘫(MB53)。主要功能障碍包括关节活动功能(b710)、关节稳定性功能(b715)、肌肉力量功能(b730)、肌张力功能(b735)、运动反射功能(b750)、随意运动控制功能(b760)、不随意运动功能(b765)。主要活动受限和参与局限包括...     

全身振动训练仪联合绳带疗法训练在痉挛型脑瘫患儿康复治疗中的应用

目的 探讨全身振动训练仪联合绳带疗法训练在痉挛型脑瘫患儿康复治疗中的应用效果。方法 选取2019年1月至2020年10月我院收治的70例痉挛型脑瘫患儿,采用交替分组法分为观察组和对照组各35例。两组均给予常规康复干预,在此基础上,对照组加用绳带疗法训练,观察组在对照组基础上联合全身振动训练仪干预。比较两组干预前、干预3个月后粗大运动功能[粗大运动功能测定(GMFM)中的D区、E区]、平衡能力[Berg平衡量表(BBS)]、患侧肘屈肌与腕屈肌的肌张力[改良Ashworth痉挛量表(MAS)评定]。结果 与干预前比较,两组干预3个月后D区、E区GMFM评分均升高,且观察组均高于对照组(P<0.05);与干预前比较,两组干预3个月后BBS评分均升高,且观察组高于对照组(P<0.05);与干预前比较,两组干预3个月后肘屈肌、腕屈肌的MAS评分均降低,且观察组均低于对照组(P<0.05)。结论 痉挛型脑瘫患儿康复治疗中应用全身振动训练仪联合绳带疗法训练,可有效改善患儿粗大运动功能与平衡能力,增强患儿肌力。     

基于ICF-CY的脑性瘫痪儿童运动功能评定及水疗方案

应用《国际功能、残疾和健康分类(儿童和青少年版)》(ICF-CY)理论架构和分类体系,对脑瘫儿童运动功能障碍进行评定,脑瘫儿童在骨骼发育、关节结构、肌肉功能及其神经反射等方面,存在头、躯干及四肢等活动障碍;基于ICF-CY架构,将脑瘫功能障碍与水疗干预方法匹配,构建脑瘫儿童水疗康复方法体系。     

核心肌群训练引导康复在痉挛型脑瘫患儿中的应用

目的 探讨核心肌群训练引导康复在痉挛型脑瘫患儿中的应用效果。方法 选取2018年11月～2019年11月焦作市妇幼保健院儿童康复科收治的痉挛型脑瘫患儿88例为研究对象,采用奇偶法进行分组,奇数纳入观察组44例,偶数纳入对照组44例。对照组采用常规康复训练,观察组在对照组基础上联合核心肌群训练引导康复。比较两组粗大运动功能与平衡能力。结果 训练后,观察组粗大运动功能量表(GMFM-88)评分、Berg平衡量表(BBS)评分均较对照组高,差异有统计学意义(P0.05)。结论 对痉挛型脑瘫患儿应用核心肌群训练引导康复,可有效提高患儿粗大运动功能,改善平衡能力。     

感觉统合治疗在脑性瘫痪康复中应用的系统综述北大核心CSCD

目的系统综述感觉统合治疗在脑瘫儿童康复中的研究进展。方法采用主题检索方式,检索Web of Sciences、PubMed、中国知网、万方、维普数据库建库至2021年11月27日与感觉统合治疗在脑瘫康复中应用的相关文献,提取文献内容,对感觉统合治疗的实施方案、运用于脑瘫儿童的康复效果等方面进行综述。结果纳入6篇文献,主要集中在感觉统合治疗对脑瘫儿童姿势控制能力、粗大运动功能、智力水平及认知功能、治疗模式方面的研究。结论感觉统合治疗对于脑瘫儿童运动功能、姿势控制、智力水平的康复具有积极的治疗效果。根据儿童的感觉统合障碍程度以及儿童的年龄、性别、耐受性等,为儿童制定合适的康复治疗计划,使得感觉统合治疗效果最大化。     

Current evidence does not support whole body vibration in clinical practice in children and adolescents with disabilities: a systematic review of randomized controlled trial

BackgroundWhole body vibration has been used alone or combined with other interventions in rehabilitation of children and adolescents with disabilities; however, there is limited evidence to support this approach.ObjectivesTo review the strength, quality, and conclusiveness of evidence supporting the use of whole body vibration in children and adolescents with disabilities.MethodsElectronic database search included Medline, AMED, Embase, Cochrane, SportDiscus, CINAHL and PEDro from the inception to June 2018. Studies investigating the effects of whole body vibration, alone or combined with other interventions, compared to minimal intervention or other interventions were included. The outcomes measured were: body structure and function (lean body mass, bone mineral density, knee muscle strength and overall stability) and activity and participation (gait speed, walking distance, gross motor function, self-care and mobility).ResultsFifteen randomized trials involving 403 participants were included. Methodological quality of eligible trials was moderate (mean of 5.5 points on the 10-point PEDro scale). Overall, whole body vibration was no better than minimal intervention. In all comparisons where additional effect of whole body vibration was better than other interventions, the effect size ranged from low to high in the trials, but ranged from very-low to low quality at short and medium-term follow-up. Sensitivity analysis for health condition and low-quality studies showed impact on trunk bone mineral density of additional effect of whole body vibration at medium-term compared to other interventions.ConclusionThe low to very-low quality of evidence suggests caution in recommending the use of this approach. New studies could change the findings of this review. PROSPERO registration: CRD42017060704.     

Whole-body vibration training improves the walking ability of a moderately impaired child with cerebral palsy: a case study

[Purpose] Strength training is recommended for children with cerebral palsy. However, it is difficult for moderately impaired children with cerebral palsy, who require crutches for ambulation, to participate in this type of training. The purpose of this study was to investigate whether whole-body vibration training is an effective method of strengthening in a moderately impaired child with cerebral palsy. [Subject and Methods] This report describes an 8-year-old Japanese boy with cerebral palsy, who was ambulatory with crutches. The subject participated in physical therapy twice a week for 5 weeks. Whole-body vibration training was selected to complement the standing practice. The patient’s crutch-walking ability, gross motor function, and spasticity were evaluated. [Results] The number of steps and walking duration were reduced in a 5-m walk test with crutches and gross motor function was improved. Further, the spasticity was reduced. [Conclusion] Whole-body vibration training is an effective physical therapy intervention in moderately impaired children with cerebral palsy, who are unable to walk without crutches.Key words: Cerebral palsy, Whole-body vibration, Walking ability     

Upper-limb injections of botulinum toxin-A in children with cerebral palsy: a critical review of the literature and clinical implications for occupational therapists.

This paper provides a review of the research literature that reports on the effectiveness of botulinum toxin-A (BtA) to reduce tone and improve functional use of the upper limbs of children who have cerebral palsy. Evaluation of the findings suggest that injections of BtA have demonstrated promising short-term results by reducing tone and increasing active range of motion in some children. Positive changes in function were also reported, however, only four studies used valid functional outcome measures. Children appropriate for BtA injections may be those with moderate tone, adequate grip strength, some distal voluntary control, intact sensation, and motivation to participate in postinjection training. Future research examining functional outcomes and the effect of repeated injections is needed. Active involvement of occupational therapists in the development and investigation of the most appropriate postinjection upper-limb training may help ensure optimal outcomes for children with cerebral palsy.     

Effects of additional inspiratory muscle training on mobility capacity and respiratory strength for school-children and adolescents with cerebral palsy: a randomized controlled trial

BackgroundChildren and adolescents with cerebral palsy often have poor respiratory function, which is often not addressed.ObjectiveTo examine if adding inspiratory muscle training to sensorimotor exercises would improve mobility capacity and respiratory function in children and adolescents with cerebral palsy.MethodsForty school-children and adolescents with cerebral palsy aged 8–15 years with Gross Motor Function Classification System I–III, participated in this randomized controlled trial. The experimental group received 45 min of sensorimotor physical therapy in addition to 15 min of inspiratory muscle training for 18 sessions over six weeks. In contrast, the control group received 45 min of sensorimotor training session, three times a week over six weeks. The primary outcome measure was the six-minute walk test. The secondary outcome measures were maximal inspiratory and maximal expiratory pressure, as well as pulmonary function tests.ResultsTime by group interaction showed no statistical significance between the groups in any outcome measures except for peak expiratory flow. The mean difference of 9.6 cm H₂O (95% CI: 2.3, 16.8) in the MIP from baseline to 2-month follow-up supports the experimental intervention. Post-training, the between-group mean difference was 19.8 (95% CI: -18.0, 57.6) meter in the six-minute walk test.ConclusionAdding inspiratory muscle training to sensorimotor physical therapy did not impact mobility capacity in children and adolescents with cerebral palsy.     

Impact of caring for children with cerebral palsy on the general health of their caregivers in an African community

Caring for children with physical disabilities such as cerebral palsy can have an impact on the health of their caregivers. Records show a dearth of literature on the health impact of caring for children with cerebral palsy (CP) in Africa. This study compared the general health of caregivers of children with cerebral palsy (CGCP) with that of caregivers of age-matched children without cerebral palsy (CGNCP). The relationship between severities of motor disorder in children with CP and the general health of their caregivers was also investigated. Participants comprised 71 CGCP and 70 CGNCP in the Yoruba community of South-Western Nigeria. The General Health Questionnaire was administered to all participants and the severity of motor disorder was assessed in children with cerebral palsy using the Gross Motor Function Measure-66. Results showed significantly higher General Health Questionnaire scores in the caregivers of children with cerebral palsy than in the caregivers of age-matched children without cerebral palsy group (U=1237.5, P=0.00). No significant correlation was found between the Gross Motor Function Measure and General Health Questionnaire scores of the caregivers of children with cerebral palsy (rho=-0.104). Caring for children with cerebral palsy apparently had a negative impact on the health of their caregivers when compared with the health of caregivers of children without cerebral palsy. It seemed that severity of motor disorder in cerebral palsy had no direct bearing on the health status of caregivers.     

脑瘫患儿父母健康教育需求调查分析

目的 探讨脑瘫患儿父母对健康教育的需求。方法 采用自行设计问卷调查方法,对2009年3~7月住院的165例脑瘫患儿父母进行调查。结果 患儿父母的疾病知识比较欠缺;父母在患儿健康促进中对自身价值认识不够,知行未合一;对解决实际问题的健康教育需求较多,最愿意接受的是听同种病儿康复后的经验介绍,教育方法需求大多选择医护讲解和演示,听录音及电话,保健咨询。结论 健康教育是医院的重要职能,应重视健康教育内容和形式,以满足患儿父母对健康促进的需要。     

A multivariate model of determinants of motor change for children with cerebral palsy

The purpose of this article is to describe the development of a theory- and data-based model of determinants of motor change for children with cerebral palsy. The dimensions of human functioning proposed by the World Health Organization, general systems theory, theories of human ecology, and a philosophical approach incorporating family-centered care provide the conceptual framework for the model. The model focuses on relationships among child characteristics (eg, primary and secondary impairments, personality), family ecology (eg, dynamics of family function), and health care services (eg, availability, access, intervention options). Clarification of the complex multivariate and interactive relationships among the multiple child and family determinants, using statistical methods such as structural equation modeling, is necessary before determining how physical therapy intervention can optimize motor outcomes of children with cerebral palsy. We propose that the development and testing of multivariate models is also useful in physical therapy research and in the management of complex chronic conditions other than cerebral palsy. Testing of similar models could provide physical therapists with support for: (1) prognostic discussions with clients and their families, (2) establishment of realistic and attainable goals, and (3) interventions to enhance outcomes for individual clients with a variety of prognostic attributes.     

Activity training on the ground in children with cerebral palsy: Systematic review and meta-analysis

Purpose: To systematically review the evidence about whether activity training on the ground is effective on activity or participation in children with cerebral palsy. Methods: Randomized controlled trials (RCTs) were searched in databases using relevant keywords. RCTs were included with children (≤18 years) with cerebral palsy who received activity training on the ground only or activity training on the ground combined with another type of physiotherapy. Outcome measures classified as measures of activity or participation according to the International Classification of Functioning, Disability, and Health were analyzed. Results: Nine RCTs (257 participants) were included in this review. Individual studies resulted in conflicting results when activity training on the ground was compared to no intervention. Based on meta-analysis, activity training on the ground was not more effective than no intervention (standardized mean difference [SMD]: 0.18; confidence interval [CI]: ?1.49 to 1.86) or other therapies (SMD: ?0.09; CI: ?0.86 to 0.69) (I² > 75%) on improving activity or participation. Results from a single study demonstrated that activity training on the ground combined with other physiotherapy intervention was not more effective than no intervention (SMD: ?0.18 CI: ?0.89 to 0.54). Conclusions: The available evidence shows little effect of activity training on the ground on activity or participation in children with cerebral palsy, suggesting that rigorous trials with larger samples and larger “dosage” of activity training on the ground are needed in the future.     

Computer-mediated support for adolescents with cerebral palsy or spina bifida

Social support plays a key role in improving health outcomes for children with chronic conditions. Internet connections are an important component of adolescents' social networks and may overcome geographic and environmental barriers for those with disabilities. This article focuses on the processes associated with a 6-month online support intervention for adolescents with cerebral palsy or spina bifida. Specifically, the purpose was to determine the extent to which adolescents used an online peer support intervention, the processes used, and the perceived benefits and satisfaction with the intervention. Five peer mentors with the same disabilities provided information, affirmation, and emotional support. The online environment created a safe space to foster reciprocal interpersonal connections and appropriate social comparison. Two-thirds of the participants viewed the computer-mediated support intervention as fun. Factors influencing the perceived utility of the intervention included typing speed, cognitive skills, and perceived need for additional support. Girls were significantly more likely to contribute messages than were boys. Peer mentors wished that this type of support program had been available when they were teens, appreciated the supportive elements, and reported learning from the teen participants. Health professionals wanting to implement online support need to consider the age and ability levels of participants and the optimal length and format of the support program.