Kinematic characteristics of postural control during reaching in preterm children with cerebral palsy

The relationships between kinematic characteristics of sitting posture during reaching movements of the dominant arm and 1) the kinematics of the reaching movement itself and 2) functional performance during daily life activities (PEDI) were assessed in 51 sitting preterm children with cerebral palsy (CP). The children were 2-11 y, 33 had spastic hemiplegia (SH) and 18 bilateral CP (Bi-CP). The data were compared with those of 26 typically developing children (TD). Sitting posture before the onset of reaching of children with CP differed from that of TD children: they sat with a more reclined pelvis and a more collapsed trunk. The more reclined pelvic position was associated with a better quality of reaching movements. The different sitting postures of pelvis and trunk were not related to functional performance during daily life activities. Displacement of the head, trunk, and pelvis of the children with CP did not differ from that of the TD children. Nevertheless, in the children with CP a more stable head, a more mobile trunk, and a more stable pelvis were related to better functional performance and/or a better quality of reaching. This suggests that physiotherapeutic guidance of children with CP should focus rather on the latter postural parameters than on the different sitting posture of pelvis and trunk.     

Neural and musculoskeletal contributions to the development of stance balance control in typical children and in children with cerebral palsy

Studies on the development of automatic postural responses in both typically developing children and children with cerebral palsy were performed. With the appearance of "pull-to-stand" behavior, typically developing children first began to show muscle responses to platform movements in mainly the ankle muscles. With increased development, additional agonist muscles were added to the response pattern and a consistent distal to proximal sequence began to emerge. Well-organized responses were seen with the onset of independent stance and walking, along with the reduction of antagonist muscle co-activation. The older children with cerebral palsy who were pre-walkers had immature muscle activation patterns like those seen in the typically developing children at the pull-to- stand stage of development. These included disorganized muscle responses and increased frequency of coactivation of both proximal–distal and agonist–antagonist muscles. In order to determine if musculoskeletal constraints contributed to these response patterns, normal children were asked to stand in a crouched posture similar to that of children with CP. This caused postural muscle response patterns to more closely approximate those of children with spastic diplegia.     

Changing Panorama of Cerebral Palsy in Children of Low Birth Weight

Of 2,840 out-patients who visited the Tokyo Metropolitan Kita Rehabilitation Center in 1965, 1968, 1970, 1973, 1975 and 1978, 278 children with cerebral palsy (CP) of low birth weight were studied to analyse changes in type of CP in relation to gestational week, birth weight, perinatal factors and subsequent complications. 1. The incidence of handicap associated with low birth weight in new out-patients had not changed. 2. The number of doubly handicapped CP patients was gradually increasing while number of uncomplicated CP patients was gradually decreasing. 3. The number of children with tension athetosis was remarkably decreasing; the number of children with spastic quadriplegia was gradually increasing. Increase in number of the spastic type was found especially in the group whose birth weight was over 1,500 gm. and gestational week over 37 weeks. The numbers of spastic diplegia and hemiplegia patients had not significantly changed. 4. In the athetoid group, the complication of severe jaundice was apparently decreasing since 1970 while the number of asphyxia cases was gradually increasing. In the spastic group, there were no remarkable changes in the perinatal complications. 5. Of spastic quadriplegia patients 78.3% were of IQ of less than 67 while 33.3% of spastic hemiplegia and 23.5% of spastic diplegia patients had IQs of less than 67.31.4% of the athetoid type had IQs of less than 67. 6. In the asphyxia group, 34 of 82 children with low birth weight CP (41.5%) had epilepsy. Our results suggest that the causes of brain damage in low birth weight infants are not merely preventable perinatal factors, but are due to a more complex interaction of prenatal and perinatal factors.     

Effects of forward tilted seating and foot-support on postural adjustments in children with spastic cerebral palsy: An EMG-study

ObjectiveTo evaluate the effect of 15° forward (FW) seat inclination and foot-support in children with cerebral palsy (CP) on postural adjustments during reaching.DesignObservational study repeated-measures design; step two of two-step-project.SettingLaboratory unit within University Hospital and two special education schools.Participants19 children (ten unilateral spastic CP (US-CP); nine bilateral spastic CP (BS-CP); Gross Motor Function Classification System levels I-III; 6–12 years old). Participants were able to take part for one one-hour session.InterventionReaching while sitting in four seating conditions (FW or horizontal seat; with or without foot-support) applied in randomized order.Outcome measuresSimultaneously, surface electromyography (EMG) of neck, trunk and arm muscles and kinematics of head and reaching arm (step one of two-step-project) were recorded. Primary outcome parameters were the ability to modulate EMG-amplitudes at baseline and during reaching (phasic muscle activity). Other EMG-parameters were direction-specificity (1st control level), and 2nd level of control parameters: recruitment order, and anticipatory postural activity. Motor behaviour measures: ability to modulate EMG-amplitudes to kinematic characteristics of reaching and head stability.ResultsOnly foot-support was associated with increased tonic background EMG-amplitudes and decreased phasic EMG-amplitudes of the trunk extensors in children with US-CP and BS-CP (mixed-models analyses; p-values <0.01). The foot-support effect was also associated with better kinematics of reaching (Spearman's Rho; p-values <0.01).ConclusionIn terms of postural adjustments during forward reaching, foot-support enhanced the children's capacity to modulate trunk extensor activity, which was associated with improved reaching quality. FW-tilting did not affect postural muscle activity.     

脑性瘫痪儿童的MRI特征

目的 探讨脑性瘫痪(脑瘫)患儿脑MR／的表现及其与出生胎龄和脑瘫类型的关系。方法 回顾性分析104例脑瘫患儿的病史、l临床与MR／表现。结果 早产与足月儿脑瘫类型构成显著不同,早产儿以痉挛性双瘫多见(占66．O％),而足月儿偏瘫和失调型高于早产儿。104例脑瘫患儿MR／异常率为84．7％,早产和足月儿组MHI异常率差异无显著性。痉挛型双瘫、四肢瘫、偏瘫、手足徐动型和失调型脑瘫MR／异常率分别为89．4％、100％、100％、54．5％和90．O％。31／42例痉挛性双瘫表现为脑室周围白质软化症(PVL),而以早产儿双瘫更多见(90％);各类型脑瘫的MR／异常表现不同,双瘫以PVL为主,徐动型表现为基底节病变或．PVL失调型绝大部分存在先天性小脑发育不全,偏瘫型突出表现为单侧脑损伤。出生胎龄与MRI特点有关,早产儿组以PVL为特征,见于除失调型外的其他脑瘫类型;足月儿脑瘫MR／异常表现变化多且病变广泛。结论MR／有助于评价各型脑瘫的病理特点及其与出生胎龄的关系．对脑瘫病因的推测有帮助。     

Interferons and cerebral palsy

OBJECTIVE: To explore the association of neonatal interferons (IFNs) with spastic cerebral palsy (CP) and with other measured substances. STUDY DESIGN: Assays of archived neonatal blood of 31 predominantly term children with CP and 65 children in a control group were obtained by recycling immunoaffinity chromatography with laser-enhanced fluorescence and chemiluminescence detection. RESULTS: Fourteen of 31 children with spastic CP had concentrations of IFNs-alpha, beta, and gamma exceeding any control. Levels of interleukins-1, 6, 8, tumor necrosis factor-alpha, chemokines, colony stimulating factors, transforming growth factor-beta, complement components and regulators, certain neuropeptides, and thyroid hormones also differed from control levels in these 14 children. The 17 children with CP whose IFN concentrations were within the control range had levels of inflammatory cytokines higher than but near to control values; 13 of these 17 had values for coagulation factors that exceeded control values. Seven of 9 children with spastic diplegia had high IFNs, and 8 of 10 hemiplegic children had normal IFNs. CONCLUSION: Neonatal IFNs exceeding control concentrations were associated with other biochemical and clinical indicators of inflammation and with spastic diplegia. In these children with CP, IFNs within the control range were associated with concentrations of other inflammatory markers that were near to control values and with spastic hemiplegia.     

Somatosensory and visual evoked potentials in children with cerebral palsy: correlations and discrepancies with MRI findings and clinical picture

PURPOSE: To determine if there is any association between the findings of visual evoked potentials (VEPs), somatosensory evoked potentials (SEPs), and magnetic resonance imaging (MRI) findings with the neurodevelopment and severity in children with cerebral palsy (CP). METHODS: The present study included 15 children with spastic diplegic CP and five children with spastic hemiplegic CP and 42 healthy children as controls. The number of the controls was two-times greater than the study group to increase statistical power of this study. VEPs and SEPs were recorded in the CP children and compared with healthy controls. All MR scans were obtained using a 1.5 T MR scanner. RESULTS: A significant difference was found in the latencies P100 (VEP) between the CP and controls. No correlations between increased P100 latencies and asphyxia, prematurity, the CP severity, MRI findings and mental retardation were noted. A significant difference in N13-N20 conductions (SEPs) between the subjects with CP and the control group was found. SEPs were positively correlated with mental retardation in CP children. The brain lesions in MRI showed a significant correlation with the CP severity scores and mental retardation. CONCLUSION: The differences in VEPs and SEPs were determined between CP children and healthy children. The MRI findings were positively correlated with the CP severity and mental retardation.     

痉挛型偏瘫儿童上肢精细运动功能发育进程研究

目的 采用非线性混合效应模型评估痉挛型偏瘫患儿的患侧和对侧上肢精细运动功能发育进程,进一步明确痉挛型偏瘫患儿的精细运动功能发育特性。方法 纳入2000至2012年在上海地区8家儿童康复机构和6所特殊教育学校接受康复治疗和教育的先天性痉挛型偏瘫连续病例。采用脑瘫患儿精细运动功能测试量表（FMFM）进行精细运动功能评估,分别测定以患侧和对侧为主导的FMFM分值。以非线性混合效应模型构建患侧和对侧的精细运动发育曲线,获得FMFM极限值以及达到极限值90％时的年龄（年龄-90）用于临床解释。结果 536例偏瘫患儿进入分析,男360例（67.2%）,女176例,右偏瘫284例(53.0%),左偏瘫252例。首次评估时年龄最小5个月,最大17.8 岁,平均年龄为（3.4±3.2）岁。共有792对FMFM测试结果用于模型构建,平均每例患儿有1.48对FMFM测试结果,其中73例完成了2次测试,54例完成3次以上测试。采用Stable limit模型拟合对侧精细运动发育模型,采用Peak/decline模型拟合患侧精细运动发育模型,两模型均拟合成功。对侧的FMFM极限值为73.4分,明显高于患侧的64.0分。年龄-90对侧为2.7岁,患侧为3.3岁。患侧FMFM分值在到达极限值后呈缓慢下降趋势,降幅约为12%（极限值64.0分降至56.5分）。结论 痉挛型偏瘫患儿患侧上肢的精细运动功能发育极限低于对侧,到达发育极限的时间晚于对侧,且在到达极限后呈逐步下降趋势。针对偏瘫患儿的精细运动功能训练应充分重视两侧功能发育的特性。     

脑性瘫痪合并癫(疒间)的临床特征及危险因素探讨

目的探讨脑性瘫痪患儿伴发癫癎的临床特点及其相关危险因素。方法对2004-01—2005-12期间青岛市残疾儿童医疗康复中心治疗的185例脑瘫患儿进行详细的病史采集、脑电图以及影像学检查、认知功能评定,分析不同类型脑瘫患儿癫癎的伴发率、发作类型、发病年龄等临床特征,采用Logistic逐步回归分析验证性别、出生体重、新生儿期惊厥史、围生期高危因素、认知水平、影像学改变等因素对合并癫癎的影响效应。结果25.9%(48/185例)脑瘫患儿伴发了癫癎,脑瘫类型包括痉挛型四肢瘫、偏瘫、双瘫、混合型、失调型和不随意运动型。这6型脑瘫患儿癫癎伴发率依次为58.97%、31.58%、16.07%、20.69%、12.5%和7.14%;伴发癫癎的患儿中29例(60.42%)在1岁内发病,而痉挛偏瘫和失调型脑瘫伴发癫癎发病都在1岁之后。Logistic回归分析发现产时高危因素、新生儿期惊厥史、IQ/DQ低下、影像学显示皮质受损均是伴发癫癎的危险因素,早产、新生儿疾病、孕期因素与伴发癫癎无明显关系,而单纯脑白质损伤是脑瘫伴发癫癎的保护性因子。结论癫癎是脑瘫患儿的常见并发症,尤其见于四肢瘫和偏瘫,往往较早发病,以婴儿痉挛和部分性发作为主要类型。新生儿期惊厥史、IQ/DQ低下、皮质受损对脑瘫患儿伴发癫癎有预示价值。     

Bilateral spastic cerebral palsy--prevalence through four decades, motor function and growth.

The aim was to depict changes in the prevalence and severity of bilateral spastic cerebral palsy (CP) over a 40-year period. Another objective was to characterise the group born in 1991-1998 with respect to gross motor function, spasticity and growth. Data were obtained from the CP register of western Sweden and rehabilitation records. RESULTS: After a rise to 1.27 per 1000 live births in 1983-1986, the prevalence decreased significantly, in children born both preterm and at term, to 0.69 in 1995-1998. After 1975, more children were born preterm than at term. There was a significant decrease in severe bilateral spastic CP during the same period, mainly in children born at term. In all, 46% of the children born at term and 33% of those born preterm had a severe motor impairment, i.e. no walking ability. In the 167 children born in 1991-1998, the gross motor function classification system (GMFCS) level was I in 14%, II in 34%, III in 10%, IV in 25% and V in 17%. The GMFCS level correlated with the gross motor function measure (GMFM) and the Ashworth spasticity scores, as well as with the deviation in postnatal weight and height. We conclude that the prevalence of bilateral spastic CP has decreased since the mid-1980s, parallel to a reduction in the severity of the motor impairment. Children born preterm have predominated since the mid-1970s. The severity of the motor impairment correlated with the degree of spasticity, GMFM and growth. The percentage of children who were underweight was substantial.     

Passive range of motion in a population-based sample of children with spastic cerebral palsy who walk

While passive range of motion (PROM) is commonly used to inform decisions on therapeutic management, knowledge of PROM of children with spastic cerebral palsy (CP) is limited. A population-based sample of 178 children with spastic CP (110 male; unilateral, n = 94; bilateral, n = 84; age range 4-17 years) and 68 typically developing children (24 male; age range 4-17 years) were recruited to the study. All children were able to walk a minimum of 10 m over a straight flat course, with or without assistive devices. Gross Motor Function Classification System (GMFCS) levels of participants with CP were: Level I = 55, Level II = 88, Level III = 21, and Level IV = 14. Ankle dorsiflexion, knee extension, popliteal angle, hip abduction, hip internal rotation, and hip external rotation were measured using a goniometer. The results indicate that the children with CP had significantly reduced PROM compared to the children with typical development. Children with CP demonstrated reduced length in the hamstrings, hip adductor, iliopsoas and gastrocnemius-soleus musculature, and contracture at the knee joint. Among children with CP, there were significant reductions in range with increasing functional limitation (higher GMFCS level) and variations based on unilateral or bilateral involvement. This was particularly the case for the hamstrings and hip adductor musculature, where PROM varied considerably across GMFCS Levels I to IV.     

Cerebral palsy in Norway: prevalence, subtypes and severity.

BACKGROUND/AIM: To describe prevalence, subtypes and severity of cerebral palsy (CP) in Norway using criteria proposed by the Surveillance of Cerebral Palsy in Europe (SCPE) network. MATERIAL: All children in Norway with CP born in January 1996-December 1998 were registered in the Cerebral Palsy Registry of Norway. The Medical Birth Registry of Norway provided the perinatal data. RESULTS: A total of 374 children with CP were identified with a prevalence of 2.1 per 1000 live births. Detailed information was obtained from 294 (79%) children. Median age at clinical assessment was 6.9 years (range: 1.9-10.2 years). Thirty-three percent of the children had spastic unilateral CP, 49% spastic bilateral, 6% dyskinetic, 5% ataxic CP and 7% were not classified. Severely impaired vision and hearing were present in 5% and 4% of the children, respectively. Active epilepsy was present in 28%, mental retardation in 31% and severely impaired or no speech in 28% children. The most severe impairments in gross motor function were observed in children with low Apgar scores, and the most severe impairments in fine motor function in children born at term, with normal birth weight and low Apgar scores. CONCLUSION: Compared with other populations, the prevalence of CP as well as the proportions of subtypes and gross motor impairments were similar, whereas fine motor impairments and associated impairments were more common. The classification of children with mixed forms of CP is still a challenge. Children were more severely affected if Apgar scores were low, and if they were born at term.     

中文版脑瘫儿童粗大运动功能分级系统的信度和效度研究

目的 确定中文版脑瘫儿童粗大运动功能分级系统（Gross Motor Function Classification System ,GMFCS）的信度和效度。方法 共有来自上海三家康复机构的91名0-12岁脑瘫儿童参加了此项研究，选择35名脑瘫儿童测定GMFCS的重测信度；以66名脑瘫儿童为对象测定GMFCS的评价者间信度；分别以88名脑瘫儿童的粗大运动功能评估量表（GMFM）和54例脑瘫儿童的Peabody粗大运动发育量表（PDMS-GM）的各项测试结果为效标确定GMFCS的平行效度；对88例同时接受GMFCS和GMFM评价的儿童的测试结果进行结构效度检测，以GMFCS为应变量，GMFM五个功能区的百分比为自变量进行多重逐步回归分析，判断粗大运动中五个分区功能对GMFCS的影响程度。结果 GMFCS具有良好的重测信度（ICC值为0.99），同时具有良好的评估者间信度（ICC为0.95-0.98）；GMFCS与GMFM和PDMS-GM各项分值之间有良好的平行效度，Spearman相关系数在-0.57到-0.84在之间；粗大运动功能中的坐位能力和行走能力是影响GMFCS的主要因素，校正决定系数为0.709（p<0.001）。 结论 中文版脑瘫儿童粗大运动功能分级系统的具有良好的信度和效度，适用于国内对脑瘫儿童进行功能分级。     

SCPE的工作、标准化和定义-SCPE活动概貌:欧洲脑瘫登记协作网(英文)

欧洲脑瘫监测组织(SurveillanceofCerebralPalsyinEurope,SCPE)协作网络的主要目的是建立欧洲脑瘫病例的中央数据库。对脑瘫患病率变化趋势的监控有利于对脑瘫危险因素的研究以及提高脑瘫患儿的生活质量。在脑瘫多中心协作登记工作中,为了准确一致地鉴定脑瘫病例,研究人员采用明确、统一的脑瘫定义。SCPE协作组发现每1000个存活儿中脑瘫的患病例为1.5～3例。在1980至1996年间的出生组群中(n=9128),53.9%的脑瘫患儿为双侧痉挛性脑瘫,31.0%的为单侧痉挛性脑瘫,6.6%为运动障碍,4.1%为共济失调。在脑瘫患儿中,20.4%患儿出生体重不足1500g,而25.5%的孕龄不足32周。29.5%的脑瘫患儿出现了智力障碍(IQ<50)。不能步行(甚至在协助下)的脑瘫患儿比例为30.3%。12.5%的脑瘫患儿出现了严重的视力缺损。做好登记工作有助于了解脑瘫流行病学的特征,是进行脑瘫流行病学研究的一种最佳方式。     

Altered arm posture in children with cerebral palsy is related to instability during walking

BackgroundToddlers learning to walk adopt specific ‘guard’ arm postures to maintain their balance during forward progression. In Cerebral Palsy (CP), the cause of the altered arm postures during walking has not been studied.AimTo investigate whether the altered arm posture in children with CP is a compensation for instability during walking.MethodsVertical and horizontal hand position, and upper arm elevation angle in the sagittal plane were determined in eleven children with unilateral CP, fifteen children with bilateral CP using 3D gait analysis and compared to twenty-four TD children. A correlation analysis of these measures of arm posture to step width was made to examine the relationship between arm posture and instability.ResultsThe hand position of children with CP was more elevated and anterior, and their upper arm was rotated more posterior than TD children. Children with unilateral CP held their most affected hand higher than their least affected. Increasing the speed accentuated the differences between groups for hand elevation. Step width correlated positively with horizontal hand position of the least affected arm in children with CP.ConclusionChildren with CP appear to rely on ‘guard’ arm postures as a compensation strategy to maintain balance while walking comparable to newly walking toddlers. Importantly, this pattern is seen on the least affected side. The substantially altered arm posture on the most affected side in children with unilateral CP, however, suggests that spasticity and associated movements are also important contributing factors.     

Early diagnosis of spastic diplegia, spastic hemiplegia, and quadriplegia

A retrospective study examined early neurodevelopmental behaviors of children with spastic diplegia, spastic hemiplegia, and quadriplegia (spastic, athetoid, or mixed) who had been followed up longitudinally in a high-risk infant follow-up clinic. Compared with peers with normal outcomes, children with all three types of cerebral palsy had significantly lower scores on the Bayley Mental Scale at 4 months of age; children with hemiplegia and quadriplegia also scored significantly lower on the Bayley Motor Scale. On the Movement Assessment of Infants at 4 months of age, the children with hemiplegia and quadriplegia showed significantly higher risk scores than the nonhandicapped group. The Movement Assessment of Infants was more than three times as sensitive as the Bayley Motor Scale in detecting motor abnormalities in 4-month-old infants with diplegia and more than twice as sensitive in detecting early abnormalities of hemiplegia. At 1 year of age, however, the Bayley Motor Scale was extremely sensitive in picking up motor deficits in children with all three types of cerebral palsy.     

Haptic Exploratory Procedures of Children and Youth with and without Cerebral Palsy

Aims: Compare haptic exploratory procedures (EPs) and exploratory movements (EMs) of children. This study also tested the interrater reliability of a novel digital recording method. Methods: Participants were 31 children with typical development (TD) (aged 6 years 1 month to 15 years 9 months; 14 male) and 23 children with spastic unilateral cerebral palsy (CP) (aged 6 years to 15 years 5 months; 13 males; right hemiplegia, n = 12). Results: There were no statistically significant differences between groups for expected EP (p = .15), additional EPs (p = .78), or EMs (p = .69) but there was for mean duration of exploration (p < .001) and accuracy (p < .001). This suggests that although children with CP performed similar haptic EPs for each object as children with TD, they took more time and were less accurate in their identification. There was substantial agreement between the two raters' observations of expected EP, κ = .64, p < .0005. Conclusion: Children with CP performed similar haptic EPs as their TD peers. However, despite similarities, the results indicate that for children with CP manual ability was not the primary determinant of accuracy or speed of identification. This study provides evidence for a reliable method of recording haptic EPs.     

Quality of Reach During a Game and During a Rote Movement in Children with Cerebral Palsy

This study builds on previous research that contrasted occupational forms in terms of the kinematic characteristics of reaching. Two ABA single subject experiments examined the reaching movements of two 4 year old girls with spastic diplegia cerebral palsy. During the A phases, the child reached for a cylinder. In the B phase (occupationally embedded movement condition), the child reached for a cylindrical doll while playing a game. Three dimensional motion analysis equipment recorded kinematic variables. Visual analysis of the data showed the occupationally embedded movement was characterized by fewer movement units, less movement time, and greater velocity for both children. The peak velocity occurred at a later point in the reach for one child. No differences were found with displacement. The study clearly illustrated that the quality of movement was different when reaching for a doll while playing a game as opposed to reaching with limited meaning and purpose.     

Clinical spectrum of cerebral palsy in north India--an analysis of 1,000 cases

One thousand children with cerebral palsy (CP) were reviewed to study their clinical profile, etiological factors and associated problems. Spastic quadriplegia constituted the predominant group (61 per cent), followed by spastic diplegia (22 per cent). Dyskinetic CP was present in 7.8 per cent of the cases. Acquired CP, particularly secondary to nervous system infections, constituted a significant proportion of cases. The clinical spectrum of CP is different in developing countries compared with developed countries. Associated problems were present in a majority (75 per cent) of cases, of which mental retardation was the commonest (72.5 per cent). Comprehensive assessment and early management of these problems are emphasized, which can minimize the extent of disabilities.     

非线性混合效应模型评估脑瘫患儿粗大运动功能发育进程

目的 采用非线性混合效应模型对不同级别脑瘫患儿粗大运动功能发育进程进行分析,以期为脑瘫患儿康复管理提供依据。方法 以2000年8月至2009年12月在上海7家康复机构和特殊学校接受康复诊治的脑瘫患儿为研究对象。采用中文译本的粗大运动功能测试量表（GMFM）进行粗大运动功能评估、中文版脑瘫粗大运动功能分级系统（GMFCS）进行粗大运动功能分级,分别将各GMFCS级别患儿的GMFM-66分值使用stable limit模型分析,获得各GMFCS级别患儿达到其GMFM-66的最大值以及达到最大值的速率（该值被转化为年龄-90,表示达到GMFM-66最大值90%时的年龄）。同时与加拿大相关研究（OMG）进行比较,分析不同干预背景下脑瘫患儿的粗大运动功能发育进程差异。结果 228例脑瘫患儿进入分析,其中男性152例（66.7%）,女性76例（33.3%）,痉挛型双瘫87例（38.2%）,痉挛型四肢瘫63例（27.6%）,痉挛型偏瘫48例（21.1%）,痉挛型三瘫4例（1.8%）,肌张力障碍型4例（1.8%）,徐动型11例（4.8%）,共济失调型11例（4.8%）。共有986次符合条件的GMFM-66测试结果,平均每例患儿有4.32次测试结果。首次评估时总体研究对象的平均年龄为2.95岁。GMFCS Ⅰ～Ⅴ级的GMFM-66最大值分别为81.2、62.4、52.9、40.8和24.4分,呈显著降低趋势;年龄-90分别为3.8、2.7、2.1、2.0和1.5岁,GMFCS Ⅲ和Ⅳ级间差别不大,在其余各级间表现出明显差别。本研究的GMFCSⅠ和Ⅱ级的GMFM-66最大值低于OMG,而GMFCS Ⅲ～Ⅴ级的GMFM-66最大值与之较为接近;各GMFCS级别的年龄-90均明显低于OMG。结论 本研究GMFCS Ⅰ级和Ⅱ级脑瘫患儿尽管粗大运动功能发育更早地进入了GMFM-66最大值区域,但运动功能发育的峰值水平低于OMG,应充分重视在4岁后轻度脑瘫患儿中积极实施具有针对性的多种康复干预手段。