按摩疗法对痉挛型脑性瘫痪患儿运动功能动态变化的影响

目的探讨按摩疗法对痉挛型脑性瘫痪(CP)患儿运动功能和肌张力动态变化的影响。方法随机选择本院符合痉挛型CP诊断的54例住院患儿(男31例,女23例;平均年龄5.18岁),对其进行24周40 min.d-1的按摩疗法治疗,治疗过程未予药物及其他治疗。分析其运动功能的动态变化。采用SPSS11.01软件进行统计学分析。结果痉挛性CP患儿在24周的按摩过程中,基本粗大运动能力呈逐步提高趋势,治疗前后比较差异有统计学意义(P<0.01);按摩8周时,患儿臂近端的肌张力有轻-中度降低(P<0.05),而在14周时出现明显升高,与治疗8周时比较差异有统计学意义(P<0.05),但在18周时再次下降。同时在上、下肢的远端评价,下肢的近端评价中也出现类似情况;按摩4周时,患儿肌力有轻-中度降低,但按摩10周后均出现明显提高(P<0.05),按摩14周后,患儿颈、上肢近端和下肢近端的肌力也显著提高(P<0.05)。结论按摩疗法治疗可提高痉挛型CP患儿基本粗大运动能力,相应提高其生活能力。     

Therapeutic Effects of Horseback Riding Therapy on Gross Motor Function in Children with Cerebral Palsy: A Systematic Review

ABSTRACT

Purpose: This systematic review examined the efficacy of hippotherapy or therapeutic horseback riding (THR) on motor outcomes in children with cerebral palsy (CP). Methods: Databases were searched for clinical trials of hippotherapy or THR for children with CP. Results: Nine articles were included in this review. Although the current level of evidence is weak, our synthesis found that children with spastic CP, Gross Motor Function Classification System (GMFCS) levels I–III, aged 4 years and above are likely to have significant improvements on gross motor function as a result of hippotherapy and THR. Evidence indicates that 45-min sessions, once weekly for 8–10 weeks, result in significant effects. Conclusions: The current literature on hippotherapy and THR is limited. Large randomized controlled trials using specified protocols are needed to more conclusively determine the effects on children with CP. From the current evidence, it appears that hippotherapy and THR have positive effects on gross motor function in children with CP.     

Relationships Between Lower Limb Muscle Strength and Locomotor Capacity in Children and Adolescents with Cerebral Palsy Who Walk Independently

ABSTRACT

This study aimed to quantify relationships between lower limb muscle strength and locomotor capacity for children and adolescents with cerebral palsy (CP) to identify key muscle groups for strength training. Fifty 6- to 16-year-olds with CP (Gross Motor Function Classification System level I or II) participated. Isometric muscle strength of hip flexor and abductor, knee flexor and extensor, and ankle dorsiflexor muscles was measured using hand-held dynamometry. Ankle plantar flexor concentric muscle strength was assessed as the maximal number of unilateral heel rises. Locomotor capacity was evaluated by the 6-min walk test (6MWT), 10-meter Shuttle Run Test (10mSRT), and Timed Up and Down Stairs Test (TUDS). With control for age, sex, and height, hip flexor and ankle plantar flexor strength explained 47.8% of the variance in the 6MWT and 32.9% of variance in the TUDS and hip abductor isometric strength explained 43.5% of the variance in the 10mSRT. Avenues for future research include randomized controlled trials that specifically target hip flexor muscles, as this has not previously been done, and determining factors other than strength that are likely related to locomotor capacity of children and adolescents with CP.     

Changes in Trunk and Head Stability in Children with Cerebral Palsy after Hippotherapy: A Pilot Study

ABSTRACT

Hippotherapy (HPOT) is a therapy that uses horse movement. This pilot investigation objectively evaluated the efficacy of HPOT in improving head/trunk stability in children with cerebral palsy (CP). The participants were six children with spastic diplegia and six children without disability. Head and trunk stability was challenged by using a motorized barrel and measured by a video motion capture system before and after a 12-week intervention of 45 min of HPOT a week. The variables measured were anterior–posterior (AP) translation of the head, and spine at five points and average AP head angles. At pre-testing, children with CP demonstrated significant differences in AP translation and AP head rotation compared with children without disability. Following HPOT, children with CP demonstrated significant reductions in head rotation and AP translation at C7, eye, and vertex. At post-testing, translation at C7 did not differ significantly between children with CP and children without disability. After HPOT intervention, children with CP reduced their AP head rotation and translation, suggesting that they had increased stability of the head and trunk in response to perturbations at the pelvis. The findings suggest that HPOT might improve head and trunk stability in children with CP.     

Factors Associated with Enhanced Gross Motor Progress in Children with Cerebral Palsy: A Register-Based Study

Aim: To examine associations between interventions and child characteristics; and enhanced gross motor progress in children with cerebral palsy (CP). Methods: Prospective cohort study based on 2048 assessments of 442 children (256 boys, 186 girls) aged 2–12 years registered in the Cerebral Palsy Follow-up Program and the Cerebral Palsy Register of Norway. Gross motor progress estimates were based on repeated measures of reference percentiles for the Gross Motor Function Measure (GMFM-66) in a linear mixed model. Mean follow-up time: 2.9 years. Results: Intensive training was the only intervention factor associated with enhanced gross motor progress (mean 3.3 percentiles, 95% CI: 1.0, 5.5 per period of ≥3 sessions per week and/or participation in an intensive program). Gross motor function was on average 24.2 percentiles (95% CI: 15.2, 33.2) lower in children with intellectual disability compared with others. Except for eating problems (–10.5 percentiles 95% CI: –18.5, –2.4) and ankle contractures by age (–1.9 percentiles 95% CI: –3.6, –0.2) no other factors examined were associated with long-term gross motor progress. Conclusions: Intensive training was associated with enhanced gross motor progress over an average of 2.9 years in children with CP. Intellectual disability was a strong negative prognostic factor. Preventing ankle contractures appears important for gross motor progress.     

Changes in Muscle Activation Following Ankle Strength Training in Children with Spastic Cerebral Palsy: An Electromyography Feasibility Case Report

ABSTRACT

Children with cerebral palsy (CP) are likely to experience decreased participation in activities and less competence in activities of daily living. Studies of children with spastic CP have shown that strengthening programs produce positive results in strength, gait, and functional outcomes (measured by the Gross Motor Function Measure). No investigations have analyzed electromyography (EMG) activity before and after strength training to determine whether any changes occur in the GMFM. This feasibility case report quantified dorsiflexor and plantarflexor muscle activation changes during performance of 3–5 selected GMFM items following a plantarflexor strength training in two children with cerebral palsy. Increased plantarflexor strength and increased ability to selectively activate muscles were found. Little carryover to performance on GMFM items was observed. It is feasible to use EMG during performance on selected GMFM items to evaluate motor control changes following strength training in children with CP.     

The Relationship Between Manual Ability and Ambulation in Adolescents with Cerebral Palsy

ABSTRACT

This study examined the relationship between gross motor function and manual ability in 120 adolescents with cerebral palsy (CP) (15.2, SD 2.1 years, 59.8% male). Adolescents were evaluated using the Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS). A neurologist classified CP subtype. Most adolescents were ambulatory with or without utilization of aids (GMFCS level I: 35.0%, II: 30.0%, III: 5.8%, IV: 10.8%, and V: 18.3%). MACS levels were I: 34.2%, II: 25.8%, III: 16.7%, IV: 7.5%, and V: 15.8%. Correlations between GMFCS and MACS were strong in youth with quadriplegia (r = .89, p < .001), moderate in individuals with diplegia (r = .58, p = .01), but weakly associated for adolescents with hemiplegia (r = .24, p = .23). The findings provide evidence for maintaining a clinical distinction between spastic quadriplegia and spastic diplegia. Manual ability may not be congruent with mobility in adolescents with CP and should be specifically evaluated given its importance to daily life functioning.     

Effects of Strength Training Aided by Electrical Stimulation on Wrist Muscle Characteristics and Hand Function of Children with Hemiplegic Cerebral Palsy

Nine children with spastic hemiplegic cerebral palsy underwent 24 sessions of wrist muscles strengthening in the extended wrist range aided by electrostimulation. Isometric strength of flexors and extensors was registered in three wrist positions (30° of flexion, neutral, and 30° of extension) to infer on angle–torque curves. Passive stiffness of wrist flexors and wrist flexion angle during manual tasks and hand function were also documented. Significant strength gains were observed at 30° of wrist extension for flexors (p = 0.029) and extensors (p = 0.024). No gains were observed at 30° of flexion. The difference in extensor strength between the three test positions changed after intervention (p < 0.034), suggesting a shift in the angle–torque curve. No changes were observed in passive stiffness (p = 0.506), wrist angle (p < 0.586), or hand function (p = 0.525). Strength training in specific joint ranges may alter angle–torque relationships. For functional gains to be observed, however, a more aggressive intervention and contextualized task training would probably be needed.     

躯干肌强化训练对脑性瘫痪患儿平衡功能的影响

目的探索不同的躯干肌训练方法对脑性瘫痪(CP)患儿平衡功能的影响。方法CP患儿80例,分为常规组(34例)和躯干肌训练组(46例),常规组采用我科常规平衡训练方法,躯干肌训练组则在常规平衡训练方法的基础上增加对躯干肌的训练,两组其他康复治疗相同。由专人采用社会适应性行为评定ADL量表和GMFM运动疗效评定量表中平衡项目量表对患儿的平衡功能进行评定。结果常规组和躯干肌训练组治疗后ADL评分和GMFM平衡评分与治疗前相比有显著变化(P<0.05或P<0.01),评分普遍增高,且躯干肌训练组高于常规组,差异均具有非常显著性意义(P<0.01)。结论选择性强化对部分躯干肌的训练,即在加强前屈和后伸肌群训练的同时,增加躯干旋转肌群的训练,可更加有效地提高对CP患儿平衡功能障碍的训练效果。     

Development and Pilot Testing of the Challenge Module: A Proposed Adjunct to the Gross Motor Function Measure for High-Functioning Children with Cerebral Palsy

ABSTRACT

The aim was to develop a Challenge Module (CM) as a proposed adjunct to the Gross Motor Function Measure for children with cerebral palsy who have high-level motor function. Items were generated in a physiotherapist (PT) focus group. Item reduction was based on PTs’ ratings of item importance and safety via online surveys. The proposed CM items were pilot-tested with children in Gross Motor Function Classification System Level I. The focus group identified 35 items for consideration. The first item-reduction survey (n = 86 PT respondents) resulted in 20 items. A second survey yielded two additional items. Seven pilot-test participants (6–14 years) had a CM total mean score of 74.5% (SD = 19.4). Three easy items were subsequently removed and two items combined. Of seven additional items suggested by the children during testing, two were accepted in a third item-reduction survey. The final result was a 20-item CM to evaluate advanced motor skills. The CM requires refinement through Rasch scaling and formal validation.     

Pretend Play of Children with Cerebral Palsy

ABSTRACT

Background and Purpose: Evaluate self-initiated pretend play of children with cerebral palsy. Method: Twenty preschool children participated in the study. Pretend play ability was measured by using the child-initiated pretend play assessment culturally adapted to Brazil. Results: There were significant negative correlations between the children's motor severity level and their elaborateness of play with conventional-imaginative and symbolic play materials and a number of object substitutions in symbolic play. This indicated that children with greater motor limitations had diminished play ability. In this sample, 35% of the children showed typical play styles, identified by good scores in elaborate pretend play actions, number of object substitutions, and ability to self-initiate play, whereas 65% showed delay in their play. Implications: The type of pretend play deficits that might be expected in children with cerebral palsy were described. Furthermore, suggested directions for therapeutic intervention to enhance pretend play performance in cerebral palsy children were proposed.     

Longitudinal Changes in Physical Caregiving for Parents of Children with Cerebral Palsy

Abstract

Aims: To determine changes in physical caregiving for parents of children with cerebral palsy (CP) over a two-year period based on children’s gross motor function level and age.

Methods: 153 parents of children with CP rated their physical caregiving using the Ease of Caregiving for Children three times over two years. Parents and assessors classified children’s gross motor function using the Gross Motor Function Classification System (GMFCS). Physical caregiving was compared at three test times among parents of children grouped by GMFCS level (I, II–III, and IV–V) and age (1.7–5.9 and 6–11?years) using a three-way mixed ANOVA.

Results: Among all analyses, a two-way interaction was found between children’s GMFCS level and test time on ease of caregiving, p?<?0.01. Change over two-year period was found for parents of children in level I and II–III, p?<?0.01, but not parents of children in levels IV–V. At each test time, parents of children in level I reported the greatest ease of caregiving followed by parents of children in levels II–III, and levels IV–V, who reported the lowest ease of caregiving, p?<?0.001.

Conclusions: Findings support evaluation and monitoring of physical caregiving for parents of children with CP over time.     

Younger Children with Cerebral Palsy Respond Better Than Older Ones to Therapist-Based Constraint-Induced Therapy at Home on Functional Outcomes and Motor Control

Aims: To examine the differences in efficacy of home-based constraint-induced therapy (CIT) on functional outcomes and motor control in two age groups of children with cerebral palsy (CP). Methods: Twenty-three children with spastic unilateral CP receiving 4-week home-based CIT by a therapist were divided into younger (6–8 years; n = 11) and older (9–12 years; n = 12) groups. The home-based CIT involved intensive functional training of the more affected upper-limb while restraining the less affected upper-limb. The outcome measures were Peabody Developmental Motor Scale-2nd edition (PDMS-2) that was being used in a modified way, Functional Independence Measure for Children (WeeFIM), and reach-to-grasp kinematic parameters, including reaction time (RT), normalized movement time (MT), normalized movement units (MUs), peak velocity (PV), and maximum grip aperture (MGA). The outcome measures were assessed at baseline, 4-weeks (post-treatment), 3- and 6-months (follow-up). Results: The younger group showed greater changes in visual motor integration skills and RT at all post-tests after intervention than the older group. Groups had comparable changes on any other measures. Conclusions: Younger children with CP responded better to home-based CIT on some areas of upper-limb functions and reach-to-grasp motor control strategies than older children.     

Hand Function in a Population-Based Sample of Young Children with Unilateral or Bilateral Cerebral Palsy

Aim: To describe aspects of hand function in a population-based sample of young children with clinical signs of unilateral or bilateral cerebral palsy (CP). Method: A cross-sectional study with data from national CP registers in Norway. Manual ability was classified with the Manual Ability Classification System (MACS) or Mini-MACS. Hand use in bimanual activities was measured with the Assisting Hand Assessment (AHA) for unilateral CP or the newly developed Both Hands Assessment (BoHA) for bilateral CP. Results: From 202 children, 128 (57 females) were included (Mini-MACS/MACS levels I–V, mean age 30.4 months; SD = 12.1). Manual abilities were distributed across levels I–III in unilateral CP and levels I–V in bilateral CP. Variations in AHA and BoHA units were large. One-way ANOVA revealed associations between higher AHA or BoHA units and Mini-MACS/MACS levels of higher ability (p < 0.01) and higher age (p < 0.04). Conclusions: Compared with young children with unilateral CP, children with bilateral CP showed greater variation in Mini-MACS/MACS levels, and both sub-groups showed large variations in AHA or BoHA units. The classifications and assessments used in this study are useful to differentiate young children's ability levels. Such information is important to tailor upper limb interventions to the specific needs of children with CP.     

The Effect of Bimanual Training with or Without Constraint on Hand Functions in Children with Unilateral Cerebral Palsy: A Non-Randomized Clinical Trial

Aim: To compare the effect of bimanual training with or without constraint on manual functions in children with unilateral cerebral palsy (UCP). Methods: Seventeen children aged 6–11 years with UCP participated in one of two intensive therapeutic camps: bimanual (n = 9) incorporating one hour of constraint (“Hybrid”) or Bimanual (n = 8). Each camp met for 2 weeks, 5 days per week for 6 hours each day. The Assisting Hand Assessment (AHA) and the Jebsen Taylor Test of Hand Function (JTTHF) examined bimanual and unimanual functions pre, post- and 3-months post-intervention. Results: A significant improvement was noted in AHA scores for both groups between the pre-, post- and three months post-intervention [Hybrid (F2; 16 = 85.5, p < 0.01); Bimanual (F2; 16 = 15.4, p < 0.01)] with no significant differences between groups over time (F2; 30 = 0.74, p = 0.48). For the JTTHF, a significant improvement was noted in the affected hand following the Hybrid program (F2; 30 = 7.45, p = 0.01), while following the Bimanual program a significant difference was noted only in the less-affected hand (F2; 16 = 6.02, p < 0.01]. Conclusion: Both interventions Hybrid and Bimanual were similarly effective for improving use of the affected hand in bimanual tasks. The unique contribution of each intervention, the Hybrid program on the affected and the Bimanual on the less-affected side, warrants further examination.     

脑性瘫痪患儿150例血清TORCH抗体检测的意义

目的分析150例脑性瘫痪(脑瘫)患儿的TORCH抗体检测结果,为防治提供依据。方法对150例1个月~3岁脑瘫患儿采用间接酶联免疫吸附方法进行TORCH-IgG检测,1~6个月患儿同时检测TORCH-IgM。分析比较阳性与阴性患儿间的高危因素、脑瘫分型、并发症、头颅CT、脑干听觉诱发电位、眼底检查、脑电图等情况。结果共检测出TORCH-IgG阳性患儿58例(阳性率38.58%);阳性中以巨细胞病毒(CMV)为最常见,其次为弓形体(TOX);母子TORCH阳性符合率达85.71%。高危因素中阳性患儿以窒息、早产、黄疸、低体质量为多见,阴性患儿以窒息、早产、颅内出血为主。脑瘫分型在阳性患儿以痉挛型四肢瘫和偏瘫多见,而阴性患儿以痉挛性双瘫和偏瘫为多见。阳性患儿并发症较阴性患儿多,尤以智力低下为最明显。阳性患儿的头颅CT、脑干听觉诱发电位、眼底检查、脑电图异常率明显较阴性患儿高。结论TORCH感染是婴幼儿脑瘫的重要病因之一,对孕妇、新生儿及婴幼儿常规进行TORCH抗体检测是防治脑瘫发生的重要措施之一。     

Measuring Exertion During Caregiving of Children and Young Adults with Cerebral Palsy Who Require Assistance for Mobility and Self-Care

ABSTRACT

Our purpose was to compare objective and subjective measures of energy exertion during caregiving tasks. Participants were primary caregivers (N = 19) of children and young adults (aged 3 –22 years) with cerebral palsy (CP) who require assistance for mobility and self-care (67% classified in level V on the Gross Motor Function Classification System). Measures of exertion were collected during two caregiving tasks: (1) transfers and (2) dressing. Objective measures included volume of oxygen (V02), heart rate (HR), and the subjective measure was a rating of perceived exertion (Borg RPE). Controlling for baseline status, perceived exertion correlated with VO2 (0.43, p < .01) and HR (0.29, p < .01) during the tasks. Caregivers with high baseline HR and VO2, had high Borg RPE scores following a task. Correlations were found between HR and VO2 during caregiving tasks (0.63, p < .01). Patterns of association with caregiver and child characteristics were similar for VO2 and Borg RPE. Subjective measures of exertion appear to capture the strain of caregiving. Understanding a caregiver's perception of exertion can guide therapists in assessing the need for equipment, pharmacological, or respite interventions.     

Reproducibility of Task-Oriented Bimanual and Unimanual Strength Measurement in Children with Unilateral Cerebral Palsy

Aim: To examine reproducibility of the arm-hand strength measured while performing the bimanual crate task and the unimanual pitcher task. Methods: 105 children diagnosed with unilateral Cerebral Palsy, aged between 6 and 18?years, participated in this study. The test–retest reliability of the force generated during bimanual crate task and unimanual pitcher task of the Task-oriented Arm-hAnd Capacity instrument was investigated using intraclass correlation two-way random model with absolute agreement. The intraclass correlations were calculated for two age groups (6–12 and 13–18?years old). Results: The results showed good test–retest reliability for the crate and pitcher task with the non-affected hand for both age groups. The results of the pitcher task for the affected hand showed moderate test–retest reliability for both age groups. Conclusion: The Task-oriented Arm-hAnd Capacity instrument has moderate to good test–retest reliability. It is a simple and objective instrument to assess task-oriented strength in children with unilateral cerebral palsy.