肌电生物反馈配合悬吊治疗对痉挛型脑性瘫痪患儿下肢肌力和H反射的影响

目的研究肌电生物反馈配合悬吊治疗对痉挛型脑性瘫痪患儿下肢肌力和H反射的影响。方法选取2016-08—2017-08河南省省立医院98例痉挛型脑性瘫痪患儿,采用单双号法随机平均分为对照组与联合组,均给予运动训练、推拿、脑循环等常规疗法,对照组加用悬吊训练,联合组加用悬吊训练+肌电生物反馈疗法,治疗12周,比较2组治疗效果。结果治疗后,2组儿童改良巴氏指数量表(ADL)评分、粗大运动功能量表(GMFM-88)D区和E区评分显著提升(P0.05),改良Ashworth痉挛等级量表(MAS)评分、足背屈角均显著降低和综合痉挛评分量表(CSS)评分均显著降低(P0.05),且联合组变化幅度大于对照组(P0.05);治疗后,联合组H反射潜伏期显著长于对照组(P0.05),波幅和最大H波/最大M波(H/M值)显著小于对照组(P0.05)。结论肌电生物反馈联合悬吊运动治疗痉挛型脑瘫患儿,可明显改善其日常生活能力、下肢运动能力、肌痉挛症状、关节活动度、肌张力和收缩性,效果显著,值得推广。     

A型肉毒毒素注射配合综合康复训练治疗痉挛型偏瘫型脑瘫患儿临床分析

目的探讨A型肉毒毒素治疗痉挛型偏瘫型脑瘫患儿的临床疗效。方法选择痉挛型偏瘫型脑瘫儿童40例,随机分为A型肉毒毒素治疗组20例和单纯康复治疗组（对照组）20例。治疗组将A型肉毒毒素注射到患儿腘伸肌群和小腿三头肌群,注射后第2天开始进行康复训练（共6个月）。所有患者治疗前及治疗后2周、1个月、3个月、6个月进行腘窝角和足背屈角角度的测量、改良的Ashworth量表、粗大运动功能分级量表进行评价。结果治疗组的腘伸肌群和小腿三头肌群肌张力和粗大运动功能评分均比注射前改善明显（P〈0.05）,治疗效果明显优于对照组（P〈0.01）。结论 A型肉毒素配合康复治疗可以有效降低患儿患侧的肌张力,有助于提高运动功能,缩短治疗时间。     

中药熏蒸对痉挛型脑瘫患儿的疗效观察

目的 评估中药熏蒸对脑瘫患儿的临床疗效。方法 68例脑瘫患儿随机分为2组，对照组采有功能训练、小儿按摩、蜡疗、痉挛肌常规治疗，观察组除常规治疗外加用中药熏蒸。结果 观察组总有效率（94．1％）明显高于对照组（88．2％）.前者与后者的关节活动度均有明显改善（P〈0．05）。结论 中药熏蒸能有效改善痉挛型脑瘫患儿的运动功能、缓解肌肉痉挛，降低肌张力。     

注射鼠神经生长因子对痉挛型脑瘫运动功能的改善作用

目的观察不同途径注射鼠神经生长因子(恩经复)改善痉挛型脑瘫运动功能的效果。方法在河南省内3家医疗单位采用统一标准,对照组296例患儿给予综合康复治疗,3周一疗程,每疗程结束后休息2周,共治疗3个疗程。穴位注射组281例以及肌内注射组287例患儿在综合康复治疗的基础上分别于每周二、四、六给予穴位及肌内注射鼠神经生长因子,每疗程10次,每疗程结束后休息2周,开始下一疗程治疗,共计3个疗程。每疗程均进行疗效评估。结果穴位注射组与肌内注射组在降低肌张力(Ashworth评分、sEMG数值)、提高运动功能(盖泽尔评分、GMFM评分)方面均优于对照组(P0.05),穴位注射组优于肌内注射组(P0.05)。结论对于3岁以下痉挛型脑瘫患儿,穴位注射鼠神经生长因子安全有效。     

康复机器人对痉挛型脑性瘫痪患儿的康复效果

目的分析康复机器人训练对痉挛型脑性瘫痪患儿康复治疗的效果。方法选择2014-10—2016-10我院收治的痉挛型脑性瘫痪患儿94例,按随机数字表法分为对照组和观察组各47例,对照组采用常规康复训练,观察组在对照组基础上增加康复机器人辅助的减重步行训练,治疗前和治疗后3个月分别采用粗大运动功能测量表(GMFM)和日常生活能力评分(ADL)评定2组患儿的运动功能和生活能力。结果治疗后3个月,对照组E区GMFM评分及ADL评分均高于治疗前(P0.05),D区GMFM评分与治疗前比较差异无统计学意义(P0.05),观察组D区、E区GMFM评分及ADL评分均高于治疗前(P0.05),且观察组D区、E区GMFM评分及ADL评分均显著高于对照组(P0.05)。结论康复机器人训练能够有效改善痉挛型脑性瘫痪患儿的下肢运动功能,显著提高患儿的日常行动能力。     

甲钴胺在脑性瘫痪患儿嗅鞘细胞移植治疗中的应用效果观察

目的探讨甲钴胺在脑性瘫痪患儿嗅鞘细胞移植治疗中的疗效。方法 32例脑性瘫痪患儿随机分为2组,对照组予常规嗅鞘细胞移植治疗,观察组予甲钴胺+嗅鞘细胞移植治疗,应用小儿脑瘫粗大运动评价量表(GMFM-88)对患儿治疗前及治疗疗程结束4周后运动功能的肌力进行评估,应用改良Ashworth法评估患儿的肌张力,同时应用脑瘫日常生活活动能力量表(ADL)评价患儿日常生活活动能力。结果治疗后2组GMFM-88评分、ADL评分均明显提高,小腿肌张力明显降低,且观察组GMFM-88评分、ADL评分明显高于对照组,小腿肌张力明显低于对照组,差异均有统计学意义(P0.05)。结论嗅鞘细胞移植治疗小儿脑性瘫痪具有确切的疗效,同时联合应用甲钴胺可进一步改善患儿的运动功能及肌张力,提高日常生活活动能力。     

鼠神经生长因子注射头部运动区治疗痉挛型脑瘫临床观察

目的 对比头部运动区注射鼠神经生长因子治疗痉挛性脑瘫的临床疗效及安全性。方法 纳入2013-06—2017-06就诊于菏泽市立医院儿科6个月~6岁的痉挛性脑瘫患儿150例,随机分为实验组和治疗组,所有患儿接受运动及综合康复治疗。实验组在对照组基础上进行鼠神经生长因子18μg头部运动区注射,1次/d,10次为1个疗程,共进行3个疗程,每个疗程间隔10d。观察2组粗大运动功能量表(GMFM-88)评分情况。结果 所有患者3个疗程后GMFM-88评分较治疗前显著提高,差异有统计学意义(P0.05);实验组3个疗程后GMFM-88评分显著高于对照组,差异有统计学意义(P0.05);实验组治疗后6个月~3岁患儿评分与3~6岁患儿比较差异无统计学意义(P0.05)。结论 鼠神经生长因子可有效改善6个月~6岁痉挛型脑瘫患儿的运动功能,值得临床推广。     

水疗对痉挛型脑瘫患儿的疗效观察

目的评估水疗对脑瘫患儿的临床疗效。方法71例脑瘫患儿随机分为两组，对照组采用功能训练、按摩、蜡疗、痉挛肌常规治疗．观察组除常规治疗外加用水疗。评定方法包括胡莹媛等残疾儿童功能评定法中的运动功能评定、关节活动度测．量。结果观察组总有效率（94．4％）明显高于对照组（88．6％），前者和后者的关节活动度均有明显改善（P〈0．05）。结论水疗能有效改善痉挛型脑瘫患儿的运动功能、缓解肌肉痉挛、改善平衡能力和身体协调性。     

穴位注射对痉挛型脑瘫患儿肌张力及智力影响临床分析

目的观察穴位注射对痉挛型脑瘫患儿肌张力及智力的影响。方法痉挛型脑瘫患儿70例随机分为治疗组和对照组各35例。治疗组用穴位注射和功能训练,对照组单用功能训练。结果治疗组总有效率为94.3%,对照组为71.4%,治疗组疗效明显优于对照组(P0.05)。在改善肌张力及智力方面,治疗组也明显优于对照组(P0.05)。结论穴位注射能够明显降低痉挛型脑瘫患儿的肌张、提高智力,与对照组比较疗效明显。     

抗痉挛治疗仪在治疗脑卒中后上肢痉挛中的作用

目的探讨抗痉挛治疗仪在治疗脑卒中后上肢痉挛中的临床效果。方法将40例脑卒中后上肢痉挛的患者随机分为两组,对照组进行常规的康复训练,治疗组在常规康复训练的基础上加用抗痉挛治疗仪进行治疗;分别采用上肢改良Ashworth量表(MAS)、疼痛视觉模拟评分法(VAS)及简化Fugl-Meyer运动功能评定量表(FMA)上肢部分对两组患者治疗前及治疗30d后上肢痉挛程度、疼痛程度及上肢运动功能的变化进行比较。结果治疗前两组MAS分级,VAS评分及FMA评分比较,差异均无统计学意义(P0.05)。治疗后两组MAS分级及VAS评分显著低于治疗前(P0.05),且治疗组降低程度更加显著;两组FMA评分均有显著提高,且治疗组提高程度优于对照组。结论抗痉挛治疗仪能有效降低脑卒中患者肱二头肌痉挛程度,并能缓解疼痛,提高其运动功能。     

MOTO-med训练对脑瘫患儿肢体运动功能障碍的影响

目的观察MOTO-med训练对脑瘫患儿肢体运动功能障碍的影响。方法收集2013-01—2015-10我院收治的86例脑瘫患儿为研究对象,随机数字表法分为研究组和对照组各43例,对照组实施基础治疗,研究组在对照组基础上联合MOTO-med训练,对2组治疗后运动功能障碍[腘绳肌张力(Ashworth评分)、粗大运动评估量表(GMFM88量表)中的D、E两功能区得分、步态参数]的改善作用进行比较。结果 2组治疗后Ashworth评分均较治疗前显著减小,且治疗后研究组Ashworth评分较对照组显著减小,差异均有统计学意义(P0.05);2组治疗后粗大运动的D、E能区得分分别均较治疗前显著升高,且研究组粗大运动的D、E能区得分分别均较对照组显著升高,差异有统计学意义(P0.05);2组治疗后健侧步长、患侧步长、步速均较治疗前显著增大,且研究组健侧步长、患侧步长、步速均较对照组显著增大(P0.05)。结论 MOTO-med训练对脑瘫患儿肢体运动功能障碍临床疗效显著,有较广泛的推广应用价值。     

Parameters for predicting favorable responses to botulinum toxin in children with cerebral palsy

We sought markers for predicting a favorable outcome of botulinum toxin A injected to the lower-extremity muscles of 26 children with hemiplegic or diplegic cerebral palsy. Clinical assessment preceding and 1 month following injection included gross motor function measure, a modified Ashworth scale, and evaluation of range of motion of knee extension and ankle dorsiflexion. Response to treatment was classified based on a parent questionnaire. The 19 children (73%) considered by their parents as being good responders were compared to the 7 (27%) considered as being poor responders. In the good responders, the preinjection Ashworth scale (spasticity) was significantly higher (P < .05) and gross motor function measure scores (function) were lower (P < .05). Sixty-eight percent of the good responders were nonindependent walkers compared to 14% of the poor responders (P < .05). There were no differences in age, type of cerebral palsy, and dose of injection. An Ashworth scale indicating increased muscle tone, lower gross motor function measure scores, and nonindependent ambulatory status were predictive for a favorable response to botulinum toxin A injections and can guide patient selection and expectations of treatment outcome.     

自体骨髓间充质干细胞回输对脑性瘫痪儿童运动功能发育的影响

背景：自体骨髓干细胞对神经系统疾病具有一定的治疗作用,但对脑瘫治疗缺乏系统有对照的临床研究。 目的：分析自体骨髓间充质干细胞移植对脑性瘫痪儿童运动功能发育的影响。 方法：将34例脑性瘫痪者按其家长是否同意使用自体骨髓干细胞移植治疗分为治疗组和对照组,治疗组采取自体骨髓间充质干细胞移植结合康复训练,对照组只采用康复训练,分别在治疗前和治疗后3个月做粗大运动功能测试量表(GMFM)评估并进行对比。 结果与结论：与治疗前比较,2组治疗后3个月GMFM评分均增高,而GMFM评分增加量均降低,差异均有显著性意义 (P < 0.05)。治疗组GMFM评分增加量高于对照组(P < 0.05)。 提示自体骨髓间充质干细胞移植治疗脑性瘫痪是有效的,对促进脑性瘫痪患儿运动功能发育有积极作用。     

Assessing functional differences in gross motor skills in children with cerebral palsy who use an ambulatory aid or orthoses: can the GMFM‐88 help?

The purpose of this study was to determine whether the Gross Motor Function Measure (GMFM-88) is sensitive to within-child changes in function as a result of children who use an ambulatory aid or orthoses in comparison with unaided or barefoot function. Data from 257 children (140 males, 117 females) with cerebral palsy (CP) were analyzed from a 5-year longitudinal study. The children's age ranged from 2 to 15 years (mean 7y 4mo; SD 2y 11mo), and type of CP, included spastic (n=206 [80.2%1), dyskinetic (n=13 [5.1%]), ataxic (n=9 [3.5%]), hypotonic or mixed (n=27 [10.5%]), and those missing (n=2 [0.8%]), and in motor ability (Gross Motor Function Classification System [GMFCS] levels I, n=40, II, n=34, m, n=93, IV, n=76, and V, n=14). Paired t-tests between barefoot and aided assessments showed significantly higher GMFM-88 total scores overall (n=257) for aided assessment and for three subgroups (ankle-foot orthoses only, ambulatory aid only, ankle-foot orthoses plus ambulatory aid), providing evidence that the GMFM-88 is sensitive to functional changes as a result of using an aid and/or orthoses. With regard to changes within the orthoses-only group, significant changes varied by GMFCS level. The GMFM-88 might provide a clinically useful tool to help in understanding the impact of ambulatory aids and orthoses on gross motor skills of children with CP.     

Medium-term functional benefits in children with cerebral palsy treated with botulinum toxin type A: 1-year follow-up using gross motor function measure

One of the main goals when treating spasticity is to relieve pain and improve function. Intramuscular injection of botulinum toxin type A (BTX-A) has gained widespread acceptance in the treatment of spastic cerebral palsy. Several studies have clearly shown the short-term functional benefit of BTX-A treatment. Information is limited, however, on the efficacy of medium and long-term regimens, using repeated injection of BTX-A. The aim of the present open-label, prospective study was to evaluate functional outcome in children with spastic cerebral palsy after 1 year of treatment with BTX-A, using the Gross Motor Function Measure (GMFM) as a validated outcome measure. Patients ( n =25, age 1.5–15.5 years) were treated with BTX-A for adductor spasm ( n =12) or pes equinus ( n =13). The local effect was evaluated using passive range of motion and modified Ashworth Scale. Apart from a significant improvement in joint mobility and reduction of spasticity compared to pretreatment values ( P  < 0.01), we demonstrated a significant improvement of gross motor function after 12 months of treatment, with a median gain of 6% in total and goal scores ( P  < 0.001). An increase in GMFM scores was particularly evident in younger and moderately impaired children (Gross Motor Function Classification System level III). Whether the observed improvement in gross motor function in children with cerebral palsy is specifically related to therapy with BTX-A or represents at least in part the natural course of motor development still needs clarification.     

The relationship between gross motor function impairment in cerebral palsy and sleeping issues of children and caregivers

AimTo investigate, among children and adolescents with cerebral palsy (CP), the relationship between impairment of the gross motor function and: (i) child sleep disorders; (ii) the need for nocturnal support; and (iii) the quality of sleep of their caregivers.MethodsFor children, we considered their scores on the gross motor function measure (GMFM-88) and on the sleep disturbance scale for children (SDSC), besides analyzing qualitative features about their sleep. For caregivers, we considered their scores in the Pittsburgh sleep quality index (PSQI).ResultsOur sample was comprised of 87 participants with mean age of 11.4 years old (±3.4). We observed correlations between GMFM-88 and disorders of initiating and maintaining sleep (DIMS) (r = −0.22; p = 0.039), sleep–wake transition disorders (SWTD) (r = 0.26; p = 0.017) and disorders of arousal (DA) (r = 0.23; p = 0.033). Children receiving nocturnal support presented lower scores in the GMFM-88 (p = 0.001) and higher scores in the SDSC (p = 0.029). For the caregivers, we found no correlation between GMFM-88 and PSQI. Nonetheless, their PSQI scores correlated with the SDSC scores (r = 0.24; p = 0.027).ConclusionImpairment of the gross motor function correlated with DIMS and the need for nocturnal support but might not have an impact on the caregivers’ sleep, which in turn correlated with child sleep disorders.     

混合性脑瘫的外科治疗

目的探讨立体定向核团毁损加选择性脊神经后根切断术治疗混合性脑瘫的手术疗效。方法对6例混合性脑瘫病人行立体定向苍白球腹后内侧部（Gpi，3例）或丘脑底核（STN，3例）毁损，加选择性脊神经后根切断术（L2-S1 5例，C5～C8 1例），手术同期进行2例，间隔约2周后分期进行4例。随访24个月，观察手术肢体痉挛、肌张力障碍及运动功能改善情况。结果6例病人Ashworth痉挛评分及Fahn肌张力障碍评分降低，运动功能明显改善。结论应用立体定向核团毁损加选择性脊神经后根切断术治疗混合性脑瘫疗效可靠。     

早期康复治疗对急性脑梗死患者运动、肌痉挛及生活活动能力的影响

目的：应用Fugl-Meyer量表、改良Ashworth量表和简化巴氏指数量表（BI）分别进行评定,探讨早期康复治疗对急性脑梗死偏瘫患者运动功能、肌痉挛及日常生活活动能力（ADL）的影响。方法：选择急性脑梗死偏瘫患者90例,随机分为康复治疗组和对照组。康复治疗组在临床药物治疗的同时进行规范的康复训练,对照组给予临床药物治疗及未经指导的自我锻炼,在患者入组时和30d后分别进行有关的功能评定,评价两组的疗效。结果：治疗前两组的一般资料、运动功能、肌痉挛与ADL的评定差异无统计学意义（P〉0．05）,经30d治疗后,运动能力和BI均有一定程度的改善,改善幅度康复治疗组明显优于对照组（P〈0．05）,肌痉挛评分康复治疗组也明显优于对照组（P〈0．05）。结论：早期康复治疗有助于改善急性脑梗死偏瘫患者的运动、肌痉挛及生活活动能力。     

Functional improvement in cerebral palsy patients treated with botulinum toxin A injections – preliminary results

Authors report the preliminary results of an open-label, prospective study to evaluate a functional benefit of botulinum toxin type A injections in diparetic cerebral palsy patients, using gross motor function measure (GMFM) score. In a group of 14 children (mean age 3.9 years, range 2-6) treated with Dysport 30 IU/kg, a statistically significant improvement (P < 0.05) was noticed in both simple measurements (Modified Ashworth Scale, Selective Motor Control, Passive Range of Movements, Physician Rating Scale and parental Clinical Global Impression) and complex functions (GMFM dimensions D and E) after 1 and 3 months. However, the simple measurement scores decreased (but not to the baseline) after 3 months; surprisingly, GMFM scores were still increasing (7.7% change after 3 months and 11.3% change after 6 months in nine patients). These results are in concordance with a few other data published to date. The study may support the concept of persistent functional gain in long-term treatment of spasticity caused by cerebral palsy with botulinum toxin type A.