脑瘫患者粗大运动功能问卷的编制

目的编制脑瘫患者粗大运动功能问卷(CP-GMFQ),同时确定该问卷的信度、效度和反应度。方法共有160例脑瘫患者和家长参加此项研究,选取最初的27例对象进行重测信度研究(间隔7～18 d);在对所有研究对象进行GMFQ调查的同时进行中文版脑瘫粗大运动功能分级系统(GMFCS)和脑瘫粗大运动功能测试量表(GMFM)评价,确定GMFQ的平行效度;对随机选出的21例对象采用效应尺度进行反应度研究,在间隔3～7个月后再次进行GMFQ调查和GMFM评估;随机选取30例对象,进行GMFQ调查和GMFM测试所需时间的比较。结果GMFQ分具有良好的重测信度(ICC=0.9940);与GMFM各项分值和GMFCS评价之间具有良好的平行效度(相关系数=0.77～0.92);GMFQ分的效应尺度(0.34)介于GMFM88百分比与GMFM66分值之间;GMFQ调查的测试时间(平均4.7±1.6 min)显著少于GMFM测定(平均17.7±4.6 min)(P<0.001)。结论GMFQ具有良好的信度、效度和反应度,可以简便易行、科学合理地评价脑瘫患者的粗大运动功能。     

粗大运动功能测试量表与Peabody粗大运动发育量表在脑性瘫痪康复疗效评估中的应用

目的比较粗大运动功能测试量表 (GMFM )与Peabody粗大运动发育量表 (PDMS GM )两种粗大运动评估方法在脑瘫康复疗效评估中的应用价值。方法用GMFM和PDMS GM两种方法对 2 9例脑瘫儿童进行 3次评估 ,用t检验分析GMFM月相对百分比与PDMS GM月相对百分比之间的差异。结果GMFM的月相对百分比与PDMS GM的月相对百分比之间有显著性差异。结论GMFM的评估结果比PDMS GM更有利于疗效判断     

Health-related quality of life in childhood cerebral palsy

OBJECTIVE: To describe the health-related quality of life (HRQOL) of a cross-section of children with cerebral palsy (CP) using the Child Health Questionnaire. DESIGN: Survey of the parents or guardians of children with CP. SETTING: Outpatient clinics at a tertiary care children's hospital. PARTICIPANTS: Children (N=177; 98 boys, 79 girls; mean age +/- standard deviation [SD], 8.6+/-4.2y) with CP were enrolled as a convenience sample. Study subjects were stratified by severity of CP using the Gross Motor Function Classification System. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: HRQOL scores, as determined by the Child Health Questionnaire-Parent Form 50. RESULTS: Parents reported reduced HRQOL for their children with CP. In the physical function domain, most children scored over 3 SDs below a normative sample, and scores in parental impact domains were at least 1 SD below the normative sample. Psychosocial domains were less impaired. Most of the effects on physical and parent impact domains were greater in children with more severe CP, although they were significant in most strata of severity. CONCLUSIONS: Children with CP have reduced HRQOL and the degree to which it is reduced is related to the severity of their CP.     

Rehabilitation outcomes in children with cerebral palsy during a 2 year period

[Purpose] To observe motor and functional progress of children with cerebral palsy during 2 years. [Subjects and Methods] Pediatric cerebral palsy patients aged 3–15 years (n = 35/69) with 24-month follow-up at our outpatient cerebral palsy clinic were evaluated retrospectively. The distribution of cerebral palsy types was as follows: diplegia (n = 19), hemiplegia (n = 4), and quadriplegia (n = 12). Participants were divided into 3 groups according to their Gross Motor Functional Classification System scores (i.e., mild, moderate, and severe). All participants were evaluated initially and at the final assessment 2 years later. During this time, patients were treated 3 times/week. Changes in motor and functional abilities were assessed based on Gross Motor Function Measure-88 and Wee Functional Independence Measure. [Results] Significant improvements were observed in Gross Motor Function Measure-88 and Wee Functional Independence Measure results in all 35 patients at the end of 2 years. The Gross Motor Function Measure-88 scores correlated with Wee Functional Independence Measure Scores. Marked increases in motor and functional capabilities in mild and moderate cerebral palsy patients were observed in the subgroup assessments, but not in those with severe cerebral palsy. [Conclusion] Rehabilitation may greatly help mild and moderate cerebral palsy patients achieve their full potential.Key words: Cerebral palsy, Outcome, Physical therapy     

Effect of treadmill training with body weight support on gait and gross motor function in children with spastic cerebral palsy

OBJECTIVE: To examine the effect of treadmill training with body weight support (TBWS) on gait and gross motor function in children with spastic cerebral palsy (CP). DESIGN: Eight children with spastic CP participated in the study. Their temporal-distance gait parameters, Gross Motor Function Measure, muscle tone, and selective motor control were assessed three times: two times under their regular therapeutic treatment (condition A), and one time after receiving the TBWS treatment in addition to their regular therapeutic treatments (condition B). There were two treatment schedules, AAB and ABA. Except for the first one (taken at study entry), the assessments were always taken after 12 wks of treatment. The children were equally divided into two groups and randomly assigned to the two schedules. The two groups were matched according to category of the Gross Motor Function Classification System. RESULTS: The TBWS treatment significantly improved the children's gait (increases in stride length and decreases in double-limb support percentage of gait cycle) and their Gross Motor Function Measure (dimension D and E scores as well as the total score). No significant improvements on muscle tone or selective motor control were noted. CONCLUSIONS: The TBWS treatment improved some gait parameters and gross motor functions in children with spastic CP.     

脑瘫患儿粗大运动功能与日常生活能力的相关性研究

目的分析脑瘫患儿粗大运动功能与日常生活能力之间的相关性。方法对42例脑瘫患儿(男性26例、女性16例,年龄49.5±21.5个月;痉挛型四肢瘫11例、痉挛型双瘫22例、痉挛型偏瘫5例、徐动型2例、肌张力障碍型2例)采用脑瘫粗大运动功能分级系统(GMFCS)和粗大运动功能测试量表(GMFM)进行粗大运动功能分级和评估;采用能力低下儿童评定量表(PEDI)进行日常生活能力评定,分析不同GMFCS等级脑瘫患儿的日常生活能力表现,以及粗大运动功能与日常生活能力之间的相关性。结果患儿的GMFCS等级越高,PEDI标准分越低;GMFM66与PEDI的移动能力和自理能力的尺度化分之间的相关性最高(r=0.84),与社交能力尺度化分的相关系数为0.72。结论脑瘫患儿的粗大运动功能在很大程度上影响其日常生活能力,应把粗大运动功能训练作为脑瘫康复的主要训练项目,并依据不同GMFCS分级确定日常生活能力训练目标。     

An evaluation of quality of life of mothers of children with cerebral palsy

PURPOSE: To evaluate the quality of life of mothers with children suffering from cerebral palsy compared with those who have children with minor health problems. METHOD: Forty mothers with a child suffering from cerebral palsy and 44 mothers with a child suffering from minor health problems participated in a comparative study. The Turkish version of the Medical Outcomes 36-Item Short Form Health Survey (SF-36) was used to assess a mother's quality of life. The severity of a child's motor disability was assessed using the Gross Motor Function Classification System (GMFCS). RESULTS: With the exception of the SF-36 physical functioning subscale, the mean scores on the SF-36 subscales were significantly lower in mothers of children with CP than those of the comparison group. The quality of life scores of mothers were significantly correlated with the severity of a child's motor disability (except physical functioning subscale). Significant correlations were found between GMFCS and the role physical; vitality; role emotional; and mental health subscales of the SF-36. CONCLUSIONS: The quality of life profile of mothers of children with cerebral palsy is different from those who have a child with minor health problems. Different coping strategies and psychosocial programmes must be designed and implemented to decrease the burden of care.     

Functional priorities reported by parents of children with cerebral palsy: contribution to the pediatric rehabilitation process

Background:

Collaborative actions between family and therapist are essential to the rehabilitation process, and they can be a catalyst mechanism to the positive outcomes in children with cerebral palsy (CP).

Objectives:

To describe functional priorities established by caregivers of CP children by level of severity and age, and to assess changes on performance and satisfaction on functional priorities reported by caregivers, in 6-month interval.

Method:

75 CP children, weekly assisted at Associação Mineira de Reabilitação, on physical and occupational therapy services. The following information was collected: gross motor function (Gross Motor Function Classification System-GMFCS) and functional priorities established by caregivers (Canadian Occupational Performance Measure-COPM). Data were collected in two moments, with a 6-month interval.

Results:

The main functional demands presented by caregivers were related to self-care activities (48.2%). Parents of children with severe motor impairment (GMFCS V) pointed higher number of demands related to play (p=0.0036), compared to the other severity levels. Parents of younger children reported higher number of demands in mobility (p=0.025) and play (p=0.007), compared to other age groups. After 6 months, there were significant increase on COPM performance (p=0.0001) and satisfaction scores (p=0.0001).

Conclusions:

Parents of CP children identified functional priorities in similar performance domains, by level of severity and age. Orienting the pediatric rehabilitation process to promote changes in functional priorities indentified by caregivers can contribute to the reinforcement of the parent-therapist collaboration.     

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。     

Mediating effects of the ICF domain of function and the gross motor function measure on the ICF domains of activity,and participation in children with cerebral palsy

[Purpose] This study aimed to evaluate the mediating effect of gross motor function, measured using the Gross Motor Function Measure (GMFM) and of general function, measured using the International Classification of Functioning, Disability and Health-Child and Youth Check List (ICF-CY), on the ICF domains of activity and participation in children with cerebral palsy (CP). [Subjects] Ninety-five children with CP, from Seoul, Korea, participated in the study. [Methods] The GMFM was administered in its entirety to patients without orthoses or mobility aids. The ICF-CY was used to evaluate the degree of disability and health of subjects. [Results] GMFM score and ICF-CY function were negatively correlated to ICF-CY activity and participation. ICF-CY partially mediated the effects of the GMFM on activity and participation. [Conclusion] When establishing a treatment plan for a child with CP, limitations in activity and participation, as described by the ICF-CY, should be considered in addition to the child’s physical abilities and development. In addition, the treatment plan should focus on increasing the child’s activity and participation level, as well as his/her physical level.Key words: Cerebral palsy, Gross Motor Function Measure, International Classification of Functioning     

学龄期脑瘫儿童粗大运动功能与智力的相关性初探

目的探讨学龄期脑瘫儿童粗大运动功能与智力的相关性。方法采用脑瘫粗大运动功能分级系统(GMFCS)、韦氏学龄儿童智力量表（WISC）和儿童社会适应行为量表,对93例学龄期脑瘫儿童进行评估。结果粗大运动分级结果与智商无相关性（r=0.184,P>0.05）,粗大运动分级结果与社会适应行为无相关性（r=0.056,P>0.05）。结论学龄期脑瘫儿童粗大运动功能与智力无相关性。     

小儿脑性瘫痪康复治疗中新的量化评估方法

目的 探讨小儿脑性瘫痪康复的量化评估问题。方法 100例脑性瘫痪患儿康复治疗前后分别用修订的小儿脑性瘫痪运动评价量表 (GMFM)进行评估。结果 治疗 20 d后,脑性瘫痪患儿功能区得分和实际得分均显著高于治疗前 (P均     

Validation of a model of gross motor function for children with cerebral palsy

BACKGROUND AND PURPOSE: Development of gross motor function in children with cerebral palsy (CP) has not been documented. The purposes of this study were to examine a model of gross motor function in children with CP and to apply the model to construct gross motor function curves for each of the 5 levels of the Gross Motor Function Classification System (GMFCS). SUBJECTS: A stratified sample of 586 children with CP, 1 to 12 years of age, who reside in Ontario, Canada, and are known to rehabilitation centers participated. METHODS: Subjects were classified using the GMFCS, and gross motor function was measured with the Gross Motor Function Measure (GMFM). Four models were examined to construct curves that described the nonlinear relationship between age and gross motor function. RESULTS: The model in which both the limit parameter (maximum GMFM score) and the rate parameter (rate at which the maximum GMFM score is approached) vary for each GMFCS level explained 83% of the variation in GMFM scores. The predicted maximum GMFM scores differed among the 5 curves (level I=96.8, level II=89.3, level III=61.3, level IV=36.1, and level V=12.9). The rate at which children at level II approached their maximum GMFM score was slower than the rates for levels I and III. The correlation between GMFCS levels and GMFM scores was (.91. Logistic regression, used to estimate the probability that children with CP are able to achieve gross motor milestones based on their GMFM total scores, suggests that distinctions between GMFCS levels are clinically meaningful. CONCLUSION AND DISCUSSION: Classification of children with CP based on functional abilities and limitations is predictive of gross motor function, whereas age alone is a poor predictor. Evaluation of gross motor function of children with CP by comparison with children of the same age and GMFCS level has implications for decision making and interpretation of intervention outcomes.     

An evaluation of quality of life of mothers of children with cerebral palsy

Purpose: To evaluate the quality of life of mothers with children suffering from cerebral palsy compared with those who have children with minor health problems. Method: Forty mothers with a child suffering from cerebral palsy and 44 mothers with a child suffering from minor health problems participated in a comparative study. The Turkish version of the Medical Outcomes 36-Item Short Form Health Survey (SF-36) was used to assess a mother's quality of life. The severity of a child's motor disability was assessed using the Gross Motor Function Classification System (GMFCS). Results: With the exception of the SF-36 physical functioning subscale, the mean scores on the SF-36 subscales were significantly lower in mothers of children with CP than those of the comparison group. The quality of life scores of mothers were significantly correlated with the severity of a child's motor disability (except physical functioning subscale). Significant correlations were found between GMFCS and the role physical; vitality; role emotional; and mental health subscales of the SF-36. Conclusions: The quality of life profile of mothers of children with cerebral palsy is different from those who have a child with minor health problems. Different coping strategies and psychosocial programmes must be designed and implemented to decrease the burden of care.     

Relationships between problematic behaviors and motor abilities of children with cerebral palsy

[Purpose] This study aimed to examine whether motor abilities of children with cerebral palsy are related to their problematic behaviors. [Subjects] The subjects were children with mental retardation who were undergoing physical therapy. [Methods] Twenty-one examiners, 13 physical therapists, and 8 occupational therapists treated and examined the subjects by using the Japanese version of the Aberrant Behavior Checklist. The Japanese version of the Aberrant Behavior Checklist scores were compared between the Gross Motor Function Classification System I to III (12 subjects) and Gross Motor Function Classification System IV and V groups (17 subjects). [Results] Lethargy and stereotypy scores significantly differed between the groups, proving that patients with Gross Motor Function Classification System levels IV and V have more severe problematic behaviors. [Conclusion] In this study, only five types of problematic behaviors, namely irritability, lethargy, stereotypy, hyperactivity, and inappropriate speech, were examined. Despite this limitation, the study clarifies that problematic behaviors of children with cerebral palsy, except lethargy and stereotypy, have little relationship with their motor abilities.Key words: Cerebral palsy, Motor abilities, Problematic behaviors     

脑瘫患儿吞咽障碍及其与粗大运动功能分级的关系

目的探讨脑瘫患儿吞咽障碍的特点及其与粗大运动功能分级的关系。方法对2009年6月～2010年6月在本院脑瘫康复中心门诊及住院治疗的脑瘫患儿进行吞咽障碍调查、口运动评估和粗大运动功能评估,分析不同粗大运动功能分级的脑瘫患儿的吞咽问题。结果105例脑瘫患儿中,58例(56.2%)存在吞咽障碍,其中21.9%为轻度吞咽困难,34.3%为中重度吞咽困难。不同粗大运动功能分级 (Gross Motor Function Classification System, GMFCS)的吞咽障碍调查(Dysphagia Disorders Survey, DDS)及口运动评分不同(P<0.001)。DDS和口运动评分与GMFCS水平的相关系数分别为0.767和-0.504(P<0.01)。不同GMFCS分级的吞咽障碍和口运动障碍不同(P<0.001),DSS分级、口运动障碍和GMFCS分级呈正相关关系(r=0.55, r=0.27)。结论脑瘫患儿吞咽障碍主要发生在口腔期,GMFCS水平越高,吞咽障碍和口运动障碍的比例越高,程度越重,GMFCS水平Ⅳ～Ⅴ级者吞咽障碍和口运动障碍更突出。     

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。     

“医教结合”的家庭康复对重度脑瘫患儿运动功能的疗效初探

目的：初步探讨采用“医教结合”的家庭康复模式对重度脑瘫患儿运动功能促进的有效性。方法重度脑瘫患儿3名（男2例,女1例）,由专业康复机构医师和治疗师定期进行康复评估和治疗方案制订,并对家长（照料者）和特殊教育学校教师进行指导与培训,开展家庭康复治疗。治疗前、后6个月采用粗大运动功能测试量表（ gross motor function measure , GMFM）、精细运动功能测试量表（ fine motor function measure scale ,FMFM）对患儿的粗大和精细运动功能进行评估。结果治疗6个月后,GMFM66项总分、GMFM88项坐位、爬与跪两项和FMFM能力分均高于治疗前,差异具有统计学意义（均P＜0.05）。结论“医教结合”的家庭康复模式可以发挥医学康复和特殊教育的共同促进作用,充分利用家庭康复资源,从而有效改善脑瘫患儿运动功能。     

学龄期脑瘫儿童构音障碍与瘫痪类型、运动功能、智力和语言发育水平的相关性研究

目的分析学龄期脑瘫儿童的构音障碍与脑瘫类型、运动功能、智力及语言发育水平的关系。方法采用Frenchay 活动量表、粗大运动功能分级系统、韦氏儿童智力量表、语言发育评定法(S-S)对全校102 名脑瘫学生进行评估。结果与结论所有脑瘫学生均有不同程度的构音障碍,不同障碍程度在构音8 个分项的障碍表现不同。构音障碍的程度与脑瘫类型、智力水平及语言发育水平相关,与粗大运动障碍程度无关。     

电针结合功能训练对脑性瘫痪患儿粗大运动功能的影响

目的观察电针结合功能训练对脑瘫患儿粗大运动功能的影响。方法选取137 例脑瘫患儿,分为观察组(n=81)和对照组(n=56)。观察组采用电针疗法结合功能训练,对照组则单纯采用功能训练。3 个月后采用粗大运动功能测试量表(GMFM)评价疗效。结果治疗后两组患儿GMFM评分明显增加(P<0.01);观察组治疗后GMFM评分明显高于对照组(P<0.01)。结论电针结合功能训练在改善脑瘫患儿GMFM方面明显优于单纯功能训练。