踝足矫形器佩戴时间对痉挛型脑性瘫痪儿童运动功能的影响

目的研究踝足矫形器（AFO）不同的佩戴时间对痉挛型脑性瘫痪（脑瘫）儿童运动功能的影响。 方法将52例痉挛型脑瘫儿童随机分为训练佩戴组16例、日间佩戴组19例和日夜佩戴组17例。3组患儿均给予常规康复治疗,训练佩戴组仅在运动训练时佩戴AFO;日间佩戴组平日运动时亦佩戴AFO,每日佩戴6~8 h;日夜佩戴组除清洗及进行部分训练项目时取下AFO外,其余时间均佩戴。3组患儿总疗程均为2个月。分别在康复治疗前、后测定患儿踝关节被动活动范围（APROM）,采用改良Ashworth量表（MAS）评定患儿痉挛情况,采用粗大运动功能测试量表（GMFM）中的D区及E区评定患儿的站立和步行能力。 结果3组患儿的APROM、MAS评分和GMFM评分治疗前比较,差异无统计学意义（P&rt;0.05）。治疗后,日间佩戴组、日夜佩戴组患儿的APROM、MAS评分和GMFM评分均高于训练佩戴组（P<0.05）,日间佩戴组和日夜佩戴组的APROM、MAS评分组间比较,差异无统计学意义（P&rt;0.05）,日间佩戴组GMFM评分明显高于日夜佩戴组（P<0.05）。 结论日间佩戴AFO 6~8 h对于缓解痉挛型脑瘫儿童踝跖屈肌群痉挛并提高其运动能力,较仅训练时佩戴AFO或日夜佩戴AFO更有效。     

The effect of hinged ankle-foot orthoses on sit-to-stand transfer in children with spastic cerebral palsy

OBJECTIVE: To investigate the effectiveness of the hinged ankle-foot orthosis (AFO) on sit-to-stand (STS) transfers in children with spastic cerebral palsy. DESIGN: Before-after trial. SETTING: University-affiliated hospital. PARTICIPANTS: Nineteen spastic diplegic children (age range, 2-6 y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The transitional movement of STS was tested in random order with children while wearing the barefoot and hinged AFOs. The temporal, kinematic, and kinetic data during the task were collected by using a motion analyzer (with 6 infrared cameras). Statistical comparison between barefoot and hinged AFO was done with the Wilcoxon signed-rank test. RESULTS: Total duration of STS transfer was significantly shortened with the hinged AFO (P <.05). The initial knee flexion, the initial angle, and the final angle of ankle dorsiflexion were increased with the AFO, compared with when barefoot (P <.05). However, the increased pelvic tilt and hip flexion while barefoot was not reduced with the AFO. The maximal moment and power of hip and knee joints were significantly increased with the AFO (P <.05), whereas the maximal moment and power of the ankle joint were not significantly changed when wearing the AFO. CONCLUSIONS: Although proximal compensatory strategy of increased pelvic tilt and hip flexion did not change with the hinged AFO, some improvements of temporal, kinematic, and kinetic parameters were identified during the task. These findings suggest that a hinged AFO is beneficial for STS transfer activity for children with spastic diplegia.     

Ankle-foot orthoses: effect on gait in children with cerebral palsy

PURPOSE: In this study our aim was to evaluate the effectiveness of Ankle-Foot Orthoses (AFOs) on gait function in patients with spastic cerebral palsy for whom orthoses were indicated to control dynamic equines deformity. METHOD: Twenty-four spastic cerebral palsied patients with dynamic equines deformity were included in the study. Videotape recordings were performed to each patient on the same day with barefoot and AFOs. Temporal distance factors including velocity, cadence, stride length, stride width and Clinical Gait Assessment Score (CGAS) were compared across two conditions. RESULTS: The use of AFOs during gait, produced a statistically significant increase in velocity (p=0.011) and stride length (p<0.001), no significant difference in cadence (p=0.501), and stride width (p=0.796), and a significant decrease in CGAS (p<0.001), compared to barefoot condition. CONCLUSIONS: Cerebral palsied children with dynamic equines deformities can benefit from AFOs for ambulation.     

踝足矫形器对脑瘫患儿异常步态的影响

目的:研究踝足矫形器对改善痉挛型脑瘫患儿步态的影响。方法:对30例脑瘫患儿配戴踝足矫形器前、后进行步态分析。结果:脑瘫患儿配戴踝足矫形器后,跨步长、步速明显提高,其中跨步长由0.38±0.13m增加至0.45±0.17m,步速由0.36±0.19m/s增加至0.47±0.14m/s;首次着地时踝关节的跖屈角度明显减少,由-11.98±8.43°减至-3.94±4.31°;髋关节站立相最大伸展角度由-7.41±10.06°增加至-14.10±10.60°;迈步相踝关节最大背屈角度明显提高,平均由-8.19±9.63°增至-4.25±3.71°;矢状面踝关节角度活动范围明显降低,平均由14.44±9.99°减至9.40±5.77°。结论:配戴踝足矫形器可以明显减轻脑瘫患儿异常步态模式的程度。     

不同类型的踝足矫形器对痉挛型脑瘫患儿行走功能的影响

目的 :研究三种不同设计方式的踝足矫形器 (anklefootorthosis,AFO)对痉挛型脑瘫患儿行走功能的影响。方法 :根据 31例患儿的不同情况 ,选择设计使用标准固定式AFO、标准带绞链AFO和地面反射型AFO ,观察三种踝足矫形器对踝足跖屈和背屈、内翻和外翻的控制情况、对痉挛的抑制程度 ,观察行走的速度、步幅及AFO设计对膝的影响。结果 :三种不同设计类型的AFO可控制矢状面和冠状面的踝足运动 ,减轻痉挛 ,提高行走的速度及步幅。结论 :痉挛型脑瘫患儿使用AFO可以提高其行走功能     

Ankle-foot orthoses: effect on gait in children with cerebral palsy

Purpose: In this study our aim was to evaluate the effectiveness of Ankle-Foot Orthoses (AFOs) on gait function in patients with spastic cerebral palsy for whom orthoses were indicated to control dynamic equines deformity. Method: Twenty-four spastic cerebral palsied patients with dynamic equines deformity were included in the study. Videotape recordings were performed to each patient on the same day with barefoot and AFOs. Temporal distance factors including velocity, cadence, stride length, stride width and Clinical Gait Assessment Score (CGAS) were compared across two conditions. Results: The use of AFOs during gait, produced a statistically significant increase in velocity (p=0.011) and stride length (p<0.001), no significant difference in cadence (p=0,501), and stride width (p=0.796), and a significant decrease in CGAS (p<0.001), compared to barefoot condition. Conclusions: Cerebral palsied children with dynamic equines deformities can benefit from AFOs for ambulation.     

Kinematical measure for spastic reaching in children with cerebral palsy

BACKGROUND: Practitioners need more sensitive measure to quantify reaching movement for judgment of the treatment effects and reflecting the degrees of motor impairment in upper extremities. The purposes of this study were to identify the specific kinematic characteristics between normal and spastic reaching under different levels of accuracy, and to determine the most sensitive kinematic variable for quantifying the interference of spasticity on reaching. METHODS: Ten normal subjects as control group and ten subjects with spastic cerebral palsy as experimental group were studied. Participants were asked to reach, at a self-selected pace, toward two different sizes of buttons (one with accuracy constraint and the other with non-accuracy constraint) away from normalized distance. Motion analysis system was used to record the trajectory of reaching performance. Kinematic variables of reaching movement were computed and analyzed. FINDINGS: Measure for movement smoothness presented larger effect size (0.24-0.43) than other kinematic variables adopted in this study. Under high-accuracy reaching, children with spastic cerebral palsy had a prolonged movement time than normal children (P<0.05). Modified Ashworth score was significantly correlated to normalized jerk score, number of movement unit and movement time (r=0.56-0.75). Number of movement unit was the most sensitive kinematic variable to discriminate between normal and spastic reaching. INTERPRETATION: Development of reliable, valid, and sensitive multi-joint biomechanical evaluation is required, particularly for natural and goal-oriented reaching movement. It is concluded that measure of movement smoothness may be applied as valid and sensitive index to quantify the level of coordinative motor performance for subjects with spastic movement disorder.     

脑性瘫痪病儿硬踝足矫形器的制作及应用

目的研究硬踝足矫形器对脑性瘫痪(脑瘫)病儿运动功能的影响。方法用高温聚乙烯板料为20例患儿制作并使用硬踝足矫形器,观察其对关节运动及痉挛的影响。结果硬踝足矫形器能够在三个平面提供合理的运动控制,能较好地控制踝跖屈、内外翻及抑制痉挛。结论硬踝足矫形器是脑瘫患儿改善步态较为理想的矫形器。     

为脑瘫患儿设计的动态踝足矫形器

近年来 ,随着人们对矫形器生物力学功能认识的逐步深入 ,矫形器在痉挛型脑瘫患儿康复中的应用也越来越多。笔者应用生物力学原理设计的动态踝足矫形器 ,采用了功能性足托和动态踝 ,在脑瘫患儿的康复治疗中取得了较好的成效。1动态踝足矫形器的设计与构造动态踝足矫形器采用后片式踝足矫形器的结构形式 ,用抗疲劳强度和刚性具佳的聚丙烯塑料制成 ,而且足和小腿两部分连成一体 ,形成一定的初始踝角度 ,而且踝部能够围绕初始踝角度在一定范围内进行背屈 /跖屈活动 ,以达到控制和稳定踝关节的目的。本矫形器在足部特别设计了一个功能性足托 ,具…     

早期使用踝足矫形器对脑性瘫痪婴儿预后的影响

目的:分析早期使用踝足矫形器行站立位运动训练对脑性瘫痪(脑瘫)婴儿预后的影响。方法:选取2003-05/2004-05天津儿童医院康复科收治的8～12个月龄痉挛型双瘫及四肢瘫脑瘫患儿共80例,以随机双盲法分为两组:观察组40例,对照组40例。实验过程:观察组在常规康复治疗的基础上,从治疗初即开始使用踝足矫形器行站立位运动训练。训练内容如下:①辅助下站立位抗重力训练,包括“自由站”与“捆站”两种方式。②双下肢能充分承重基础上行单下肢承重。③双下肢能充分承重基础上行躯干运动训练。④为独站、独走准备的立位运动训练。⑤以上内容循序渐进进行,1h/d。直至下肢能完全承重,异常站立姿势有效控制,患儿能独走后再考虑停用踝足矫形器。对照组按常规康复治疗,在24个月的观察期内,能独走后需要时再使用踝足矫形辅助站行,改善步态。实验评估:①采用残疾儿童综合功能评定量表在治疗前和治疗12,24个月后进行功能评估。量表内容包括5个方面(认知功能、言语功能、运动能力、自理动作、社会适应能力),每个方面包括10项具体内容,采用百分制评分标准(每项完成得2分,大部分完成得1.5分,完成一半得1分,小部分完成得0.5分,不能完成0分,满分为100分)。②观察组与对照组治疗12,24个月后可独走(3步以上)患儿人数。结果:对照组中途脱落4例,最终76名患儿进入结果分析。①治疗前综合功能评定两组相比差异无显著性意义(P>0.05)。②治疗12个月后运动能力、自理动作和社会适应性方面分数观察组均高于对照组[(10.35±3.38),(8.25±2.71)分;(2.61±0.97),(2.01±0.82)分;(8.30±4.37),(6.36±3.26)分;P均<0.05],认知功能和言语功能两组相比差异无显著性意义(P>0.05),综合功能总分观察组高于对照组[(35.05±9.62),(29.00±7.10)分,P<0.05]。③治疗24个月后运动能力、自理动作和社会适应性方面分数观察组显著高于对照组[(15.15±2.25),(12.61±4.03)分;(4.35±1.24),(3.45±1.67)分;(10.61±4.71),(7.05±3.57)分;P均<0.001],认知功能和言语功能方面分数观察组高于对照组[(7.70±3.22),(6.22±3.15)分;(15.61±3.04),(13.50±5.02)分;P均<0.05],综合功能总分观察组显著高于对照组[(53.60±13.32),(42.83±10.48)分,P<0.001]。④观察组治疗12,24个月后能独走患儿人数均高于对照组[9例(22.5%),19例(47.5%);2例(5.6%),6例(16.7%),P<0.05]。结论:痉挛型脑瘫患儿8～12月龄开始使用踝足矫形器行站立位运动训练,可以更好地改善患儿综合功能,有助于实现尽早步行。     

痉挛型脑瘫患儿的关节活动训练

痉挛型脑瘫患儿因肌张力较高 ,常引起肌腱挛缩和关节变形 ,所以 ,关节活动度训练是降低肌张力、减少并发症、纠正异常姿势的有效方法[1、2 ] 。关节活动训练包括以下几方面 :被动关节活动、主动关节活动和正常姿势维持[3] 。1被动关节活动训练被动关节活动的原则是 :①慢 (速度慢 ) :充分牵拉肌腱 ,使肌肉放松 ,通常在关键位置需停 1— 3ｍｉｎ(时间逐渐延长 ,以避免引起患儿不适 ) ;②满 (全关节范围活动 ) :如肌腱有挛缩 ,牵拉时不要引起疼痛 ,关节活动范围要逐渐扩大 ;③常 (每天坚持做 ) :每日做 2次 ,根据痉挛程度 ,每次持续 15— 30ｍ…     

Cortical thumb orthosis for children with spastic hemiplegic cerebral palsy

An orthosis was developed to control the position of the indwelling "cortical" thumb and improve function of the spastic hand of children with spastic hemiplegic cerebral palsy. A clinical evaluation was made of five children, 20 to 26 months old, with mild to moderate spastic hemiplegic cerebral palsy. All five children exhibited an indwelling thumb at rest and during reaching and grasping activities, using a "raking," ulnar type of prehension pattern. In all five children the orthosis was effective in changing the position of the thumb and improving the prehension pattern to a radial grasp in which objects were held between the thumb and the fingers, usually in a three-jaw chuck or large cylindrical prehension pattern, depending on the size of the object being manipulated. Possible explanations for the improved hand function include placement of the thumb in a more functional position, inhibition of muscle tone in thumb adductors and flexors, and the opportunity for increased sensory input and successful practice using the hand.     

Rehabilitation management of children with spastic diplegic cerebral palsy

Spastic diplegia has been recognized as the type of cerebral palsy most frequently associated with prematurity. Due to constantly improving neonatal care in developed countries, more and smaller premature infants are surviving, and the number of spastic diplegic children can be expected to increase. This paper reviews the incidence, pathophysiology, and associated handicaps of patients with this type of cerebral palsy. The role of the physiatrist and aspects of traditional management are discussed. Recent advances in treatment of spasticity and lower extremity bracing are stressed as they seem to be particularly suitable to spastic diplegic patients.     

42例痉挛型脑瘫患儿的步态分析

目的 探讨痉挛型脑瘫患儿的步态分析及其在脑瘫康复中的作用。方法 采用三维力台测试、红外摄相等技术,为42例脑瘫患儿做步态分析。得出时间历程、力台参数、关节角度变化范围3项数据。结果 对3项数据做统计学处理,表明各型别之间无显著性差异（P＞0．05）。结论 痉挛型脑瘫患儿的步态分析表现个体差异较大,对脑瘫康复的评价、训练、治疗、疗效评估均有一定帮助。     

痉挛型双瘫的临床特征

目的：探讨痉挛型双瘫的临床特征,为脑功能的全面康复提供基础资料。方法：对５０ 例痉挛型双瘫患儿的临床资料进行回顾性分析。结果：５０ 例中３５ 例为早产儿（７０％）,高危因素依次为早产、低体重、缺氧、硬肿症、颅内出血;１５ 例为足月儿（３０％）,高危因素主要为窒息、缺氧缺血性脑病。５０ 例患儿运动神经功能异常,全部表现为骨盆带及下肢痉挛及由此所致的姿势异常,双上肢受累较轻。平均精细运动年龄１８．５ 个月,粗大运动年龄８．７５ 个月（Ｐ＜ ０．０１）。半数患儿同时合并斜视、语言发育迟缓和／ 或运动性构音障碍。结论：痉挛型双瘫的病因,运动神经系统表现具有特征性,对其正确的认识评价有助于康复计划的制订。     

Addressing spasticity-related pain in children with spastic cerebral palsy.

Children with spastic cerebral palsy (CP) often suffer pain as a result of their spasms. Some studies have suggested that the pain experienced by these children may be poorly controlled or respond poorly to treatment. Limited research is available that addresses the treatment of pain due to spasms in children. Therefore, clinicians do not have empirical evidence to guide their decisions. Many current treatment options have not been tested for their effect on pain. Previous research has been guided more by the ability of these treatments to increase functional abilities. Pain also is an important indicator of quality of life; however, this has been overlooked in research.     

痉挛型脑性瘫痪患儿静脉输液方法的研究

目的探讨对痉挛型脑性瘫痪患儿于姿势控制后行静脉输液穿刺的效果。方法将接受静脉输液治疗的痉挛型脑瘫患儿158例随机分为常规组77例，按护理基本技术操作规程实施常规输液；干预组81例，在姿势控制后进行输液。比较2组输液时间和一次性穿刺成功率。结果常规组一次穿刺成功率64．3％，干预组一次穿刺成功率88．3％，2组比较差异有统计学意义（P〈0．05）。常规组平均耗时（5．77±3．60）min，干预组平均耗时（4．92±3．21）min，2组比较差异无统计学意义（P〉0．05）。结论对痉挛型脑性瘫痪患儿进行合理的姿势控制后行静脉输液．可有效提高穿刺成功率。     

痉挛型脑性瘫痪患儿静脉输液方法的研究

目的 探讨对痉挛型脑性瘫痪患儿于姿势控制后行静脉输液穿刺的效果.方法 将接受静脉输液治疗的痉挛型脑瘫患儿158例随机分为常规组77例,按护理基本技术操作规程实施常规输液;干预组81例,在姿势控制后进行输液.比较2组输液时间和一次性穿刺成功率.结果 常规组一次穿刺成功率64.3%,干预组一次穿刺成功率88.3%,2组比较差异有统计学意义(P＜0.05).常规组平均耗时(5.77±3.60)min,干预组平均耗时(4.92±3.21)min,2组比较差异无统计学意义(P＞0.05).结论 对痉挛型脑性瘫痪患儿进行合理的姿势控制后行静脉输液,可有效提高穿刺成功率.     

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.     

Botulinum toxin type a injections to salivary glands: combination with single event multilevel chemoneurolysis in 2 children with severe spastic quadriplegic cerebral palsy

We describe 2 children with severe spastic quadriplegic cerebral palsy (CP) who have significant drooling and frequent aspiration pneumonia. They underwent simultaneous botulinum toxin type A (BTX-A) injections to salivary glands for drooling and prevention of aspiration pneumonia along with single-event multilevel chemoneurolysis (SEMLC) with BTX-A and 5% phenol for severe diffuse spasticity. There was significant improvement in drooling, frequency of aspiration pneumonia, and spasticity without adverse effect. BTX-A injections into the salivary glands, in addition to SEMLC, for these 2 children with medically complicated severe spastic quadriplegic CP, were safe and highly successful procedures, which improved their health-related quality of life.