中药气泡浴对痉挛型双瘫脑性瘫痪患儿的疗效

目的观察中药气泡浴对痉挛型双瘫脑瘫患儿的疗效。方法痉挛型双瘫脑瘫患儿在常规康复的基础上,对照组13例患儿行单纯气泡浴;实验组14 例行中药气泡浴。治疗前和治疗10 周后,使用粗大运动功能测试量表(GMFM-66)和改良Ashworth量表(MAS)分别评定患儿的运动功能和小腿三头肌肌张力。结果治疗后,两组GMFM-66 总分均较治疗前显著增加(P<0.001),MAS 评分均较治疗前明显下降(P<0.01);实验组GMFM-66 的B、D、E 区评分高于治疗前(P<0.05),对照组无显著性差异(P>0.05)。组间比较,治疗后实验组MAS评分低于对照组(P<0.05)。结论中药气泡浴能改善痉挛型双瘫脑瘫患儿粗大运动功能,降低小腿三头肌肌张力。     

肉毒毒素结合肌力训练治疗痉挛型双瘫患儿39例疗效观察

目的:探讨A型肉毒毒素(BTX-A)注射结合肌力训练对痉挛型双瘫患儿粗大运动功能的影响。方法:将72例痉挛型双瘫患儿依据其意愿分为观察组39例和对照组33例,均进行综合康复训练,且观察组在此基础上加用BTX-A注射和肌力训练。治疗前和治疗3个月后分别采用改良Ashworth量表(MAS)和粗大运动功能测试量表(GMFM)中站立相(D)和走、跑、攀登相(E)二项进行疗效评估。结果:治疗前后两组MAS评分和GMFM中D项、E项评分比较差异均有统计学意义(P<0.01),且治疗后两组比较差异均有统计学意义(P<0.05)。结论:BTX-A注射结合肌力训练能快速有效地缓解痉挛型双瘫患儿下肢肌肉的痉挛,提高患儿粗大运动功能。     

A型肉毒毒素联合上田法治疗痉挛型脑瘫儿童下肢肌张力障碍的疗效评价

目的 探讨A型肉毒毒素(BTX-A)联合上田法治疗痉挛型脑瘫患儿下肢肌张力障碍的疗效。方法 40例痉挛型下肢瘫脑瘫儿分为治疗组和对照组,治疗组 18例患儿采用 BTX-A肌肉注射联合上田康复手法进行治疗,对照组22例患儿单用上田康复法治疗,2组治疗前、后均用医师等级评价量表法(PRS)及 Ashworth痉挛评分法进行效果评价。结果 治疗组治疗后3 d PRS及Ashworth评分较治疗前有显著差异(P<0.05),治疗后2周治疗组评分较对照组差异有显著性意义(P<0.05)。2组治疗后8周评分差异无显著性意义。结论 BTX-A注射疗法联合上田康复手法能有效地治疗痉挛型脑瘫,起效快,并降低肌张力完全,可缩短康复疗程时间。     

A型肉毒毒素注射配合康复功能训练对痉挛型脑瘫患儿上肢功能的疗效观察

目的探索A型肉毒毒素(BTX-A)改善痉挛型脑瘫患儿上肢功能的疗效。方法愿意接受BTX-A治疗的27例痉挛型脑瘫患儿为治疗组,30例脑瘫患儿为对照组,治疗组在对照组治疗的基础上给予BTX-A局部注射。治疗前后行Carroll双上肢功能评定。结果两组患儿经过3个月治疗后,治疗组Carroll双上肢功能评定显著优于对照组（P＜0.01）。结论BTX-A对于改善痉挛型脑瘫患儿上肢功能有良好的作用。     

A型肉毒毒素对痉挛型双瘫患儿运动功能的影响

目的 观察肉毒毒素注射对痉挛型双瘫患儿（具备行走能力且处于运动发育平台期）下肢痉挛及运动功能的改善作用。 方法 选取2013年2月至2014年12月期间在我院神经康复科住院或门诊治疗的痉挛型双瘫患儿21例，入选患儿均具备行走能力且处于运动功能发育平台期。根据患儿下肢痉挛情况给予下肢肉毒毒素神经阻滞治疗及康复干预。分别在肉毒毒素注射前、注射后1个月、3个月及6个月时采用改良Tardieu量表评价下肢痉挛改善情况（以小腿三头肌为例）；采用粗大运动功能量表（GMFM-88）评定患儿C、D、E能区改善情况；采用10m步行测试（10MWT）评定患儿治疗前、后步行功能改善情况。 结果 本研究21例痉挛型双瘫患儿经肉毒毒素注射后，其踝关节被动关节活动范围较治疗前增大，其中快角改善幅度明显大于慢角，并且伸膝状态下快角扩大范围较屈膝时显著。在肉毒毒素注射后3个月及6个月时，发现患儿GMFM-88量表C、D、E能区评分均较治疗前有所提高，其中肉毒毒素注射后6个月时患儿D能区评分较治疗前显著改善（P<0.05）。肉毒毒素注射后1个月、3个月及6个月时入选患儿10m步行测试所用时间较治疗前明显缩短（P<0.05）。 结论 肉毒毒素注射联合康复训练能进一步改善痉挛型双瘫患儿（具备独走能力）下肢痉挛病情，提高站立能区运动能力及步行速度，该联合疗法值得在脑瘫治疗领域进一步研究、推广。     

电刺激治疗痉挛型双瘫患儿疗效的表面肌电分析

目的应用表面肌电图对脑瘫患儿电刺激前后的肌电活动进行分析。方法对20例痉挛型双瘫患儿进行功能性电刺激,并于治疗前后分别用临床方法和表面肌电仪进行评估。结果治疗后患儿功能位测试肱二头肌、股四头肌的肌电积分降低,而自主收缩测试的肌电积分升高。结论经电刺激治疗可使患儿肌张力降低,肌力增强。表面肌电仪可以作为电刺激治疗痉挛型双瘫患儿的疗效客观评估方法。     

肉毒素治疗脑瘫患儿小腿三头肌痉挛的疗效观察

目的：观察A型肉毒毒素（BTX-A）局部注射结合康复训练治疗脑瘫患儿小腿三头肌痉挛的疗效.方法：将20例脑瘫患儿随机分为观察组和对照组各10例,2组均接受常规康复训练,观察组增加小腿三头肌BTX-A局部注射治疗,于治疗前后给予下肢改良Ashworth评分（MAS）,并评定伸膝踝关节背屈度.结果：治疗1、2、3个月后,观察组MAS评分明显低于治疗前及同时间点对照组（P＜0.01,0.05）;2组伸膝踝关节背屈度均较治疗前及同时间点对照组明显提高,且观察组更高于对照组（P＜0.01,0.05）;对照组在治疗3个月后MAS评分才低于治疗前（P＜0.05）.结论：BTX-A局部注射结合康复训练比单纯康复训练治疗小腿三头肌痉挛疗效更好.     

A型肉毒毒素治疗痉挛型脑瘫用药剂量分析

目的探讨A型肉毒毒素(BTX-A)阻滞术缓解脑瘫患儿痉挛的最佳用药剂量。方法对61例痉挛型脑瘫患儿(年龄27~144个月)采用BTX-A阻滞术治疗,按BTX-A剂量系数将患儿分为A、B、C、D、E5组,根据Ashworth评分和体重每次用量为30~160IU,平均(69.0±32.4)IU。结果55人次接受BTX-A阻滞术治疗后肌张力有所下降,功能有所提高,有效率为90.16%,疗效持续时间8~32周,平均(17.56±8.30)周。C组(2≤剂量系数<3)的疗效持续时间最长。结论最佳的小腿三头肌的BTX-A用药剂量计算公式为剂量(IU)=(修改的Ashworth评分+2.5)×体重(kg)。     

A型肉毒毒素配合踝关节支具治疗痉挛性脑性瘫痪动力性尖足畸形的临床价值

目的探讨A型肉毒毒素(BTX-A)配合踝关节支具对痉挛性脑瘫的动力性尖足畸形治疗的临床价值。方法28位儿童采用BTX-A注射治疗肌痉挛,BTX-A注射的起始剂量为3～5IU/kg,注射后1周配带踝关节支具。结果采用BTX-A注射小腿三头肌同时配带AFO支具的肌张力有明显降低,关节活动度有一定程度的提高,改善了患者的运动功能。结论BTX-A提供安全有效的治疗痉挛性脑瘫动力性尖足畸形.     

A型肉毒素治疗痉挛型脑瘫临床观察

目的:探讨肉毒毒素A(BTXA)注射配合康复训练对痉挛型脑瘫患儿运动功能及日常生活活动能力(activities of daily living,ADL)的影响。方法:选择例100例双下肢痉挛型脑瘫儿童随机分为BTX-A组和对照组各50例,2组均采用常规康复训练,A型肉毒毒(botulinumtoxin A,BTX2A)组加用兰州产BTX-A干粉制剂,(于-20~-5℃避光保存,以生理盐水稀释后立即使用),运用“反向牵拉指压法“进行下肢痉挛肌局部注射,注射后次日开始进行痉挛肌牵伸及功能训练。观察两组患儿的肌张力与ADL变化。结果:治疗1个月和3个月后,治疗组患儿的肌张力、ADL改善情况明显优于对照组(P&lt;0.01)。结论:康复训练仍是有效的脑瘫治疗手段,BTX-A注射配合康复训练可明显改善痉挛型脑瘫患儿运动功能和日常生活能力。两者结合可明显缩短疗程、提高疗效。     

Gait improvement by low-dose botulinum toxin A injection treatment of the lower limbs in subacute stroke patients

[Purpose] Lower-limb spasticity after stroke may be associated with worse functional outcome. Our study aim was to establish whether a low-dose botulinum toxin A (BTX-A) injection in subacute stroke patients can improve spasticity, gait, and daily living abilities. [Subjects] Twenty-three subacute stroke patients were randomly allocated to BTX-A treatment group (11 patients) and control group (12 patients). [Methods] In the BTX-A treatment group patients, 200 units BTX-A was injected into the triceps surae (150 iu) and posterior tibial (50 iu) by electrical stimulation-guided. The patients in the control group received the same volume of placebo solution into the same injection locations. Gait analysis (step length, cadence, speed), the 6-min walking test, Fugl-Meyer Assessment (FMA) of the lower limbs, modified Ashworth scale assess (MAS) assessment of the lower limbs, surface electromyography (sEMG), and modified Barthel index (MBI) assessment were performed before and at 4,8 weeks after treatment. [Results] We found that the FMA of the low limbs and MBI were significantly improved in both groups. The gait analysis, FMA, and MBI results in the BTX-A treatment group were better than those in the control group. MAS and surface electromyography (sEMG) showed better improvement of spasticity in the treatment group. [Conclusion] Early low-dose botulinum toxin A (BTX-A) injection in subacute stroke patients into the lower-limb may improve gait, spasticity, and daily living abilities.Key words: Botulinum toxin A, Stroke, Spasticity     

A型肉毒毒素缓解脑瘫儿童小腿三头肌痉挛最佳剂量研究

目的确定治疗脑瘫痉挛的理想A型肉毒毒素(BTX-A)剂量计算公式中的系数。方法将58例脑瘫患儿(男性38例、女性20例,年龄27～144个月,平均59.3±24.6个月)按剂量系数分为A、B、C、D、E五组,给予不同剂量的BTX-A治疗。结果从运动功能改善的角度考虑,D组的BTX-A剂量比较适合;从疗效持续时间的角度考虑,C组的BTX-A剂量比较适合,理想的系数应为1.8。结论小腿三头肌初次BTX-A理想剂量的计算公式应为:剂量(I U)=(1+1.8×MAS评分)×体重(kg)。     

Botulin toxin A in the treatment of dynamic equinovarus foot in cerebral palsied children

Background. Contracture of the triceps in the calf occurs in most CP children especially those with diplegia and spastic hemiplegia. The purpose of our research was to evaluate the effective of TB-A in the treatment of these contractures and the associated disturbances of the dynamic position of the foot in CP children.
Material and methods. Thirty five CP children (19 with diplegia and 16 with hemiplegia) received botulinum toxin A (TBX-A-Dysport) for the dynamic contracture of the triceps surae muscle and secondary equinovarus foot deformity. These children ranged in age from 2-11 years (mean 4.6). Previous conservative treatment had failed to alleviate these conditions. Goniometric measurements of the passive range of motion and the evaluation of dynamie equinovarus foot were performed prior to injection of BTX-A to 54 gastrocnemius muscles, and again at 2, 6, and 12 weeks post injection.
Results. The results showed high effectiveness for TBX-A, e.g. marked reduction in equinovarity in 47 and 49 ankle joints (68%- 78%) at 2 and 6 weeks respectively, and in 19 joints (35%) at 12 weeks post-treatment, and moderate reduction in 12 (22%), 8 (15%) and 14 (26%) joints respectively. These improvements were statistically significant. In some children the positive effect was present up to 16 and 20 weeks post injection. No change was found on follow-up in 5 ankle joints (9%) at 2 weeks and in 7 (13%) at 6 and 12 weeks. Reversion to baseline scores was observed in 14 ankle joints (26%). The TB-A therapy was cllosely integrated with physiotherapy and the use of AFO orthosis when necessary.
Conclusions. Botulin toxin therapy is effective in the treatment contractures of the triceps of the calf and equinovarus foot in children with cerebral palsy.     

Clinical effects of botulinum toxin A and phenol block on gait in children with cerebral palsy

OBJECTIVE: To compare the treatment effectiveness of botulinum toxin type A (BTX-A) and phenol blocks in managing lower limb spasticity and gait dysfunction in children with cerebral palsy. DESIGN: This is a case-controlled study that took place in a tertiary center's gait laboratory. A total of 27 ambulatory children with cerebral palsy spastic diplegia, aged from 3 to 7 yrs, and 20 normal children were recruited into this study. Sixteen children with cerebral palsy received BTX-A injections, and 11 received phenol motor point blocks. Gait analyses were assessed by a portable computer-assisted system (Computer DynoGraphy, Infotronic, The Netherlands). Both the BTX-A and phenol groups received gait analysis at 1 wk before and 2 mos after injection treatments. RESULTS: Significant improvements in gait variables of velocity and cadence were noted in children with cerebral palsy after BTX-A injections as compared with the phenol block group. Gaitline and cyclogram patterns also improved significantly in the BTX-A group. The adverse clinical effects of BTX-A injections were less severe as compared with phenol injections. CONCLUSIONS: BTX-A injections demonstrated superior treatment effects in improving gait variables and patterns in children with spastic diplegia as compared with phenol blocks. BTX-A injections also revealed fewer clinical side effects and were well tolerated by children with cerebral palsies.     

肌电反馈疗法对痉挛型双瘫患儿肌力康复疗效观察

目的探讨肌电反馈疗法对痉挛型双瘫患儿肌力康复的疗效。方法将42例痉挛型双瘫患儿随机分成治疗组(n=22)和对照组(n=20),对照组予以常规康复训练,治疗组在此基础上给予肌电反馈治疗。两组患儿均于治疗前及治疗3个月后进行徒手肌力测定,对治疗组患儿尚进行表面肌电评估。结果治疗组患儿治疗后肌力高于对照组(P<0.05),并且经表面肌电仪测定肌电积分值(iEMG)及RMS值增加,差异有统计学意义(P<0.05)。结论肌电反馈疗法对痉挛型双瘫患儿肌力康复疗效满意;表面肌电仪评估肌力有肯定价值。     

Inhibition of the triceps surae stretch reflex by stimulation of the deep peroneal nerve in persons with spastic stroke

OBJECTIVE: To reduce the triceps surae stretch reflex by electrical stimulation of the deep peroneal nerve. DESIGN: Intervention study. SETTING: Research institution. PARTICIPANTS: Sample of convenience of 10 spastic stroke individuals. INTERVENTION: After the deep peroneal nerve was stimulated between 0.9 and 4 times tibialis anterior motor threshold, the triceps surae was stretched to elicit a reflex. MAIN OUTCOME MEASURE: The triceps surae stretch reflex was quantified by the amplitude of the reflex electromyography (EMG) in soleus and medial gastrocnemius muscles and mean ankle moment. Paired t test and the Wilcoxon signed rank test (p < .05) were used to evaluate the effect of conditioning stimulation. RESULTS: The soleus stretch reflex EMG was reduced significantly (p < .001) by stimulating the deep peroneal nerve to 25%+/-6% (standard error) of the unconditioned value (relaxed triceps surae). The optimal interval between stimulation and stretch was 141+/-15 msec. The velocity threshold increased significantly (p = .006) from a median value of 8 degrees per second to 33 degrees per second and the area under the stretch velocity/stretch reflex relation decreased significantly (p < .001) (soleus EMG). CONCLUSIONS: The stretch reflex of relaxed triceps surae in persons with spastic stroke can be extensively reduced by stimulating the deep peroneal nerve at several times motor threshold of the tibialis anterior.     

针刺治疗小儿痉挛型脑瘫

探讨针刺疗法对小儿痉挛型脑瘫运动功能恢复的影响。２１６例９个月～３岁痉挛型脑瘫患儿随机分为对照组９４例和治疗组１２２例,均接受功能训练。治疗组再予针刺治疗。２组于治疗前后进行Ｇｅｓｅｌｌ发育商评定。结果：治疗组总的发育商及动作 育商在治疗后显著提高（Ｐ〈０．００１）,与对照组比较,差异有显著性（Ｐ〈０．００１）。提示：针刺结合功能训练能有效的提高痉挛型脑瘫患儿的治疗效果。