磁共振弥散张量对35例偏瘫型脑瘫患儿的康复评价

目的 探讨磁共振弥散张量成像（DTI）在偏瘫型脑瘫儿童的应用.方法 35例偏瘫型脑瘫患儿为研究组,10例正常儿为对照组,均进行头颅MRI的扫描和DTI的检查,测量研究组与对照组感兴趣区域部位的FA值.结果 同年龄对照组左侧和右侧FA值比较,差异无统计学意义;不同年龄段研究组与对照组感兴趣区FA平均值比较,差异有统计学意义（P＜0.05）.研究组不同年龄段患侧与健侧FA值比较,患侧的FA值明显降低,差异有统计学意义（P＜0.05）.同年龄研究组左侧偏瘫和右侧偏瘫不同部位FA值分别与对照组比较,患侧FA值显著降低,差异有统计学意义（P＜0.05）.根据脑瘫患儿Carroll上肢功能测试,比较不同级别FA值,上肢功能分级越严重,患侧FA值越低,差异有统计学意义（P＜0.05）.结论 DTI可以作为偏瘫型脑瘫患儿的早期诊断依据,并能对一些普通影像检查无异常而临床症状明显的患儿作出明确诊断.     

引导式教育在脑瘫康复中的应用

引导式教育是一种教育与治疗相结合的方法，对神经系统受损的人尤其有效。由于它将教育与治疗系统地融汇于一天24h的生活中，今儿童积极参与，并促进性格的健康发展。引导式教育是安德斯、彼图1952年在匈牙利布达佩斯创办并设立了“弱能人士引导式教育国家学院及引导员学院”。现在有许多国家都在推行引导式教育如英国、美国、新西兰、挪威、德国、日本等。中国的引导式教育刚刚起步，而香港在这方面已作出了很大的成就。1引导式教育1．1引导式教育与脑瘫儿童脑性瘫痪是指出生前至生后1个月内发育时期非进行性脑损伤所致的综合症，主要表现…     

脑瘫康复中的外科矫形治疗

1手术治疗的目的与原则脑瘫是一种上运动神经原性损害的疾病 ,由于病变程度和大脑病损部位的不同 ,临床表现也不同。对于痉挛型脑瘫 ,受累部位肌肉的主动或被动收缩均可引起拮抗肌的收缩 ,严重地影响相关动作的完成 ,尤其是协调性强 ,比较精细的动作 ,如手的精细动作。因此 ,上肢痉挛的外科矫形治疗效果远不如下肢痉挛的好。外科手术并不是痉挛型脑瘫的主要治疗手段 ,只有当长期的其他治疗方法无效时 ,才能根据患者的要求考虑手术治疗。1.1手术治疗的目的　进一步改善患者的肢体功能 ,补充非手术疗法的不足 ,为运动训练创造条件 ,提高患者的…     

引导式教育在脑瘫康复中的价值

目的了解引导式教育配合传统康复治疗在脑瘫康复中的疗效。方法 59例患者分为引导组(n=38)和对照组(n=21),引导组全程予以引导式教育并配合传统康复治疗,对照组仅给予单纯传统康复治疗。在治疗前后分别进行粗大运动、智力水平和日常生活能力评定。结果引导组治疗后粗大运动能力提高值较对照组无显著性差异(P>0.05),智力水平、日常生活能力提高值较对照组明显增加(P=0.001)。结论引导式教育与传统康复手段相结合可以更加有效促进其日常生活能力、智力恢复。     

综合康复治疗小儿脑瘫疗效观察

目的 探讨综合康复治疗小儿脑瘫的临床效果及应用价值.方法 回顾性分析118例小儿脑瘫患儿的一般资料,按照随机、对照的原则分为观察组和对照组,各为59例.对照组患儿采用运动治疗,观察组患儿采用神经发育疗法、药物治疗、推拿按摩、物理疗法、运动疗法等综合康复进行治疗,观察两组患儿的临床治疗效果.结果 观察组临床治疗总有效率为98.3％,对照组临床治疗总有效率为86.4％,观察组明显高于对照组(P＜0.05);观察组患儿治疗前评分为(50.1±5.2)分,治疗后为(75.9±5.8)分,治疗后明显提高(P＜0.05);对照组患儿治疗前评分为(50.8±5.4)分,治疗后为(66.1±5.0)分,治疗后明显提高(P＜0.05);两组治疗后评分相比,观察组评分明显高于对照组,差异具有统计学意义(P＜0.05).结论 临床采用综合康复治疗小儿脑瘫效果较采用单一的治疗方法更好,能够明显的改善患儿的病情和预后,提高患儿的生存质量和生活质量,值得临床进一步推广应用.     

小儿脑瘫的家庭康复

目的探讨小儿脑瘫的家庭康复。方法对 15例脑瘫患儿进行系统的家庭康复治疗 1年。结果基本正常 3例 ,有效10例 ,无效 2例。结论小儿脑瘫的家庭康复治疗是一种有效、经济、简单易行的康复治疗方法     

小儿脑瘫髋内旋畸形的手术治疗及康复

为矫正臂中小股痉挛性髋内旋畸形,对８例脑瘫髓内旋畸形患儿共１１髋采用Ｓｔｅｅｌ的手术方式 ,即将臂中小肌的止点由大转子前移至股骨近端的转子间线之下,使其功能由髋内旋转变髓外旋,从而改善步态,使下肢在行走时接近中立位或轻度外翻位。     

虚拟现实技术在脑瘫儿童康复中的应用

虚拟现实技术是一种由计算机技术和电子技术创造的类似真实的虚拟环境,它通过多种传感设备为用户提供视、听、触等直观而又自然的感官体验,用户可根据自身的感觉对虚拟世界中的物体进行考察和操作,使参与者“沉浸”其中［1,2］。虚拟现实技术具有沉浸感（Immersion）、交互性（Interaction）和构想（Imagination ）三大特征,它是集计算机图形技术、多媒体技术、传感器技术、人机交互技术、网络技术、立体显示技术以及仿真技术等多种科学技术综合发展起来的计算机领域的最新技术,也是力学、数学、光学、机构运动学等各种学科的综合应用［2,3］。目前在我国主要应用在军事、医学、心理学、教育、科研、商业、影视、娱乐、制造业、工程训练等方面。     

引导式教育在小儿脑瘫康复中的作用

目的探讨引导式教育在脑瘫患儿康复的作用。方法对60 例脑瘫患儿采用引导式教育(观察组),56 例脑瘫患儿予以综合康复疗法(对照组),观察两组患儿康复效果。结果治疗后,观察组患儿的运动功能、生活自理能力和社会适应能力高于对照组(P<0.05)。结论引导式教育有利于脑瘫患儿的康复。     

脑瘫5例康复治疗分析

脑瘫是脑性瘫痪的简称，是各种原因所致的妊娠到新生儿期之间的大脑、中枢神经系统损害。国际上统计脑瘫患儿的发病率为0．1％～0．5％，我国的发病率为0．18％～0．4％，并且世界范围内脑瘫的发病率有上升的趋势，我国有脑瘫患儿100万，边远山区发病率是城市的2倍。1995年，香港“关怀行动”组织，选择我市作为云南省的贫困区，在我院首次开展职业治疗方法，取得一定疗效，使原来认为不可能恢复或放弃治疗的肢体残疾和心理障碍得到不同程度的康复。现对脑瘫5例康复治疗分析如下。     

儿童脑性瘫痪的MRI诊断价值

目的：探讨磁共振成像对儿童脑瘫的诊断价值。材料与方法：回顾性研究110例脑瘫患儿的头颅MRI资料（0．15T）,其中痉挛性脑瘫51例,锥体外系脑瘫21例,肌张力低下脑瘫12例,混合型脑瘫26例。结果：102例患儿（93％）颅脑MRI显示异常。其中脑萎缩38例,脑室周围白质软化灶21例,皮层下条状白质异常信号病灶16例,皮层梗塞病烂12例,脑 软化灶17例,基底节病灶3例,脑白质脊鞘发育延迟26例,无天畸形12例,8例病人MRI检查未见明确异常。结论：MRI对儿童脑瘫的诊断和治疗具有重要价值。     

小儿痉挛型脑性瘫痪的康复治疗

目的：探讨采用以训练为主、结合外科手术来治疗痉挛型脑瘫,观察其临床疗效。方法：根据患儿的年龄、功能障碍程度及智力水平制定不同的训练方案,并对２１例患儿辅以手术治疗。结果：总有效率达７３．３％,其中结合手术治疗有效率达９０．０％,与非手术组比较疗效明显较优（Ｐ＜０．０５）。结论：在功能训练的基础上选择合适的病例结合外科手术治疗,能更好地达到康复效果     

Test-Retest Reliability of Discrete Gait Parameters in Children With Cerebral Palsy

Klejman S, Andrysek J, Dupuis A, Wright V. Test-retest reliability of discrete gait parameters in children with cerebral palsy.

Objectives

To examine the test-retest reliability of discrete gait parameters in children with cerebral palsy (CP) in Gross Motor Function Classification System (GMFCS) levels I, II, and III; to calculate the measurement error between testing sessions of these parameters in the total sample and within GMFCS subgroups using the standard error of measurement; and to evaluate the minimal detectable change (MDC) to identify discrete gait parameters that are most sensitive to change in children with CP.

Design

Test-retest reliability study.

Setting

Rehabilitation facility with human movement laboratory.

Participants

Ambulatory children with CP (N=28).

Interventions

Not applicable.

Main Outcome Measures

Intraclass correlation coefficients (ICCs), standard error of measurement, and MDC of discrete gait parameters.

Results

Parameters measured in the sagittal plane and temporal-spatial parameters were highly reliable across all GMFCS levels (ICC range, .84-.97), while test-retest reliability in the frontal and transverse planes varied from poor to excellent (ICC range, .46-.91). Using MDC as a guide, hip and pelvis parameters in the transverse and frontal planes were least responsive for GMFCS levels I and III (MDC ranges, 8.3°-18.0° and 2.7°-23.4°, respectively), whereas ankle kinematics were the least responsive for level II (MDC range, 8.2°-11.9°). Reliability was dependent on mobility level, with children in GMFCS level III exhibiting greater test-retest variability overall.

Conclusions

Our findings suggest that select discrete gait parameters measured using computerized gait analysis are reliable and potentially responsive measures of performance and can be used as outcome measures in intervention studies.     

早产所致脑性瘫痪的磁共振成像特征及临床意义

目的探讨早产所致脑性瘫痪的磁共振成像(MRI)特征。方法回顾性分析16例早产所致脑性瘫痪患儿的临床资料和颅脑MRI图像,并以同期16例年龄匹配的正常小儿头颅MRI作对照。结果16例均诊断为脑性瘫痪痉挛型双瘫。16例早产所致脑性瘫痪患儿在MRI上表现为脑室周围白质在T2WI上的异常高信号、脑室周围深部白质减少、侧脑室变大伴或不伴变形,胼胝体萎缩。上述特点符合脑室周围白质软化(PVL)。结论PVL是早产所致脑性瘫痪的MRI特征性表现,这有助于脑性瘫瘫病因和类型的判断。     

Reliability of the Tardieu Scale for Assessing Spasticity in Children With Cerebral Palsy

Gracies J-M, Burke K, Clegg NJ, Browne R, Rushing C, Fehlings D, Matthews D, Tilton A, Delgado MR. Reliability of the Tardieu Scale for assessing spasticity in children with cerebral palsy.

Objective

To measure the Tardieu Scale's reliability in children with cerebral palsy (CP) when used by raters with and without experience in using the scale, before and after training.

Design

Single-center, intrarater and interrater reliability study.

Setting

Institutional ambulatory care.

Participants

Referred children with CP in the pretraining phase (n=5), during training (n=3), and in the posttraining phase (n=15).

Interventions

The Tardieu Scale involves performing passive muscle stretch at 2 velocities, slow and fast. The rater derives 2 parameters; the Spasticity Angle X is the difference between the angles of arrest at slow speed and of catch-and-release or clonus at fast speed; the Spasticity Grade Y is an ordinal variable that grades the intensity (gain) of the muscle reaction to fast stretch. In phase 1, experienced raters without formalized training in the scale graded elbow, knee, and ankle plantar flexors bilaterally, without and with a goniometer. In phase 2, after training, the experienced and nonexperienced raters graded the same muscles unilaterally.

Main Outcome Measures

Intrarater and interrater reliability of the Tardieu Scale.

Results

After training, nonexperienced raters had mean ± SD intrarater and interrater agreement rates across all joints and parameters of 80%±14% and 74%±16%, respectively. For experienced raters, intrarater and interrater agreement rates before training were 77%±13% and 66%±15%, respectively, versus 90%±8% and 81%±13%, respectively, after training (P<.001 for both). Specific angle measurements at the knee were less reliable for the angles of catch measured at fast speed. Across all joints, agreement rates were similar using visual or goniometric measurements.

Conclusions

Both parameters of the Tardieu Scale have excellent intrarater and interrater reliability when assessed at the elbow and ankle joints of children with CP, with no difference noted between visual and goniometric measurements. Angle measurements were less reliable at the knee joints. Training was associated with a highly significant improvement in reliability.     

"动作疗法"在脑瘫家庭康复中的应用

１４例〉３岁的脑瘫患儿采用日本九州大学附属障碍儿民漱司策的”动作疗法“进行康复训练,时间约１年。结果：基本正常３例,显著进步５例,有效４例,无效２例,其中痉挛型效果明显。提示：“动作疗法”为家长提供了一种简单蝗学,适合家族康复的方法。     

Evaluation of the Catch in Spasticity Assessment in Children With Cerebral Palsy

van den Noort JC, Scholtes VA, Becher JG, Harlaar J. Evaluation of the catch in spasticity assessment in children with cerebral palsy.

Objective

To evaluate whether the catch in clinical spasticity assessment in cerebral palsy (CP) is the consequence of a sudden velocity-dependent increase in muscle activity, resulting from hyperexcitability of the stretch reflex in spasticity.

Design

Cross-sectional study.

Setting

A special school for children with physical disabilities.

Participants

Children with CP (N=20; age range, 5-14y; mean weight ± SD, 35±14kg; mean length ± SD, 139±19cm).

Interventions

Spasticity assessment tests (using slow and fast passive stretch) were performed in the medial hamstrings, soleus, and medial gastrocnemius muscles of the children by 2 experienced examiners.

Main Outcome Measures

Surface electromyography (EMG) was recorded and joint motion was simultaneously measured using 2 inertial sensors. The encounter of a catch by the examiner was compared with the presence of a sudden increase in muscle activity (“burst”). The average rectified value (ARV) of the EMG signal was calculated for each test.

Results

The study shows a sudden increase in muscle activity in fast passive stretch, followed by a catch (hamstrings 100%, soleus 95%, gastrocnemius 84%). The ARV in slow passive stretch was significantly lower.

Conclusions

The results confirm that in children with CP, an increase in muscle activity is primarily responsible for a catch in fast passive muscle stretch.     

Relation of Stride Activity and Participation in Mobility-Based Life Habits Among Children With Cerebral Palsy

Objective

To examine the relation between walking performance and participation in mobility-related habits of daily life in children with cerebral palsy (CP). To date, walking outcomes in CP have been capacity-based (what a child does in structured setting). Physical activity performance (what a child really does in daily life) has been documented to affect the relation of capacity-based gross motor measures and participation.

Design

Cross-sectional prospective cohort study.

Setting

Regional pediatric specialty care centers.

Participants

A cohort of ambulatory children with CP (N=128; age, 2 to 9y; 41% girls; 49% having hemiplegia) participated.

Interventions

Not applicable.

Main Outcome Measures

Walking performance was quantified from a 5-day sample of accelerometry data. Stride activity was summarized through the outcomes of the average number of total strides per day (independent of intensity) and the average number of total strides per day at >30 strides/min (marker of intensity). Mobility-based participation was assessed by using the Assessment of Life Habits for Children questionnaire categories of personal care, housing, mobility, and recreation. Regression models were developed controlling for sex, age, cognition, communication, pain, and body composition.

Results

The average number of total strides per day was positively associated with the personal care, housing, mobility, and recreation Assessment of Life Habits for Children questionnaire categories (β=.34–.41, P<.001). The average number of total strides per day at >30 strides/min was associated with all categories (β=.54–.60, P<.001).

Conclusions

Accelerometry-based walking activity performance is significantly associated with levels of participation in mobility-based life habits for ambulatory children with CP. Evaluation of other factors and the direction of the relation within the International Classification of Functioning, Disability and Health is warranted to inform rehabilitation strategies.     

肺吸虫脑病的MRI诊断

本文报告2例肺吸虫脑病的MRI表现并就MRI的诊断价值作一评价。