Direct Parenting Methods to Facilitate the Social Functioning of Children with Cerebral Palsy

Studies with typically developing children have supported the efficacy of parents’ direct efforts to facilitate social development. In this study, it was hypothesized that use of direct parenting methods would be associated with aspects of social functioning of children with cerebral palsy. Study participants were 60 children with cerebral palsy, ages 5–12 (M = 8.75; SD = 1.82), 62.3% male and their parents or guardians. Direct parenting methods were assessed with a modified empirically validated survey strategy. In contrast with findings from the typically developing population, there were no significant associations between direct parenting methods and children’s social functioning. Findings suggest the need to develop alternative models of multidimensional influences on social development of children with cerebral palsy.     

脑瘫患儿父母焦虑状况的护理干预

目的探讨脑瘫惠儿父母存在的心理焦虑问题及有效的护理干预措施。方法根据脑瘫患儿父母存在的心理焦虑问题,采取相关的心理护理措施。应用焦虑自评量表（SAS）,对144名住院的脑瘫患儿父母分别在患儿开始进行第1疗程治疗时和经过治疗2—4个疗程后的焦虑状况进行比较。结果经过患儿2-4个疗程的治疗、康复训练以及对其父母的心理干预后,患儿父母的焦虑症状明显低于干预前（p〈0．05）,差别有统计学意义。结论对脑瘫患儿父母进行的心理干预有利于提高患儿的治疗效果。     

脑瘫患儿父母焦虑情绪与应对方式的调查

目的 :调查脑瘫患儿父母焦虑情绪与应对方式的相关性。方法 :通过问卷调查 178例患儿父母焦虑情绪与应对方式 ,并采用直线相关分析应对方式与焦虑情绪的关系 ,比较脑瘫患儿父母与一般患儿父母的差异。结果 :脑瘫患儿父母的焦虑水平显著高于一般患儿父母 (P <0 .0 5 ) ,其焦虑水平与消极应对方式呈显著正相关 (P <0 .0 1)。结论 :应该提高脑瘫患儿父母的应对能力 ,降低焦虑水平。     

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     

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。     

核心控制训练在小儿脑性瘫痪中的应用

目的探讨核心控制训练对脑瘫患儿运动功能的影响。方法40例脑瘫患儿分为对照组(n=20)和治疗组(n=20),对照组采用常规综合康复治疗,治疗组在对照组治疗的基础上增加核心控制训练。治疗前后采用粗大运动功能评定量表(GMFM-88)进行评定。结果治疗3个月后,两组患儿GMFM-88评分较治疗前显著提高(P<0.001),治疗组优于对照组(P<0.05),治疗组GM-FM-88评分提高值显著优于对照组(P<0.001)。结论核心控制训练能有效提高脑瘫患儿粗大运动功能。     

Psychological Correlates of Quality of Life in Children with Cerebral Palsy

Psychosocial outcomes have come to the front as a main concern for individuals with Cerebral Palsy (CP), promoting the need to understand the quality of life experienced by children and adolescents diagnosed with CP. As a result, the current study examined the relationships among quality of life in children with CP, the psychological symptoms and parenting characteristics of the parents of these children, and the emotional and behavioral functioning of these children. Results of this study suggested that these variables are related in interesting ways. Further, parenting stress, parents’ depressive symptoms, and children’s internalizing behavior problems were significant predictors of the quality of life experienced by the children in this sample. Thus, the direct benefits from optimizing parents’ mental health as well as that of their children may prove to be an important intervention in helping to improve the quality of life of children who have been diagnosed with CP.     

高压氧综合治疗小儿脑性瘫痪的临床观察

目的本文采用高压氧综合治疗小儿脑性瘫痪88例。方法将对照组与高压氧组进行了对照观察。结果高压氧组总有效率83％；对照组总有效率41％。结论高压氧综合治疗可以增效，疗效与年龄、类型、瘫痪部位有直接的相关性。     

脑性瘫痪患儿摄食与口运动障碍的探讨

目的：探讨脑性瘫痪儿童摄食和口运动功能障碍的特征。方法：通过问卷与现场观察评价摄食能力,神经运动学检查评价口腔器官的运动功能,按照正常儿童摄食发育和口运动情况判定结果。结果：８８％的脑瘫患儿存在口运动障碍,主要表现为口腔器官肌肉痉挛,主动运动减少且不协调和／或不随意运动;９０％以上患儿有不同程度的摄食障碍,表现为咀嚼困难,吸吮和吞咽困难等。结论：口运动及摄食障碍是脑瘫患儿的严重问题之一,正确的评价和治疗具有重要意义。     

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.     

Perceived Family Environment and Symptoms of Emotional Disorders: The Role of Perceived Control,Attributional Style,and Attachment

Findings from decades of research suggest that a perceived lack of parental care and overprotection are positively related to later symptoms of emotional disorders in children and adolescents. The present study used a cross-sectional design to evaluate models investigating reported family environment during childhood, current attachments, control-related cognitions, and current symptoms of emotional disorders in adolescence. It was hypothesized the effect of a perceived controlling and rejecting family environment during childhood would influence current depression and anxiety, and that these effects would be partially accounted for by the quality of current attachments, perceived control, and attributional style. A sample of 234 university students was assessed. Regression analyses of variables, including analyses of indirect effects, were conducted. As predicted, current attachment, perceived control, and attributional style helped to account for relationships between some family variables, and depression and anxiety. Findings are discussed with respect to the interplay of family variables and models of emotional disorders.

"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。     

磁共振成像在小儿脑瘫康复治疗中的应用价值

目的：探讨MRI在儿童脑瘫康复中的应用价值。材料与方法：对88例脑瘫患儿的临床和MRI资料进行回顾性分析,其中痉挛型脑瘫51例,肌张力低下型脑瘫7例,强直型脑瘫4例,共济失调型脑瘫7例,手足徐动型脑瘫4例,混合型脑瘫15例;在脑瘫治疗过程中27例病人进行了MRI随访。结果：MRI显示脑软化灶14例,大脑脑萎缩改变36例,小脑萎缩6例,脑室周围白质软化症17例,脑先天畸形11例。有15例患儿伴有大脑白质的髓鞘发育延迟。MRI显示脑瘫病灶的敏感性为95％。经过综合性康复治疗,患儿脑内的鞘发育延迟和脑萎缩病灶的改善及病人的肢体功能的康复程度之间存在显著性关联（x^2＝6．31,P＜0．05）。结论：MRI对儿童脑瘫的康复治疗具有重要的指导价值。     

Relationship Between Age and Spasticity in Children With Diplegic Cerebral Palsy

Pierce SR, Prosser LA, Lauer RT. Relationship between age and spasticity in children with diplegic cerebral palsy.

Objective

To examine the relationship between passive torque, reflex activity, co-contraction, and age during the assessment of spasticity of knee flexors and extensors in children with spastic diplegic cerebral palsy (CP).

Design

Retrospective.

Setting

Pediatric orthopedic hospital.

Participants

Children (N=36) with spastic diplegic CP.

Interventions

Not applicable.

Main Outcome Measures

Spasticity of the knee flexors and knee extensors (as measured by peak passive torque, mean passive torque, reflex activity of the medial hamstrings, reflex activity of vastus lateralis, and co-contraction) was assessed during passive movements completed using an isokinetic dynamometer with concurrent electromyography.

Results

A significant positive relationship was found between age and mean knee flexor passive torque (P<.05), while a significant negative relationship was found between age and mean percentage of the range of motion with co-contraction (P<.05).

Conclusions

Our results suggest that passive stiffness may play a larger role in spasticity than reflex activity as children with spastic diplegic CP age. Additional research is needed to determine whether subject age could influence the effectiveness of interventions, such as serial casting or botulinum toxin, for spasticity in children with spastic diplegic CP.     

Design of a Device to Exercise Hip Extensor Muscles in Children with Cerebral Palsy

Children with cerebral palsy (CP) often have weak hip extensor muscles and gait-related difficulties. Current therapeutic techniques do not provide sufficient exercise for this muscle group. In addition to calisthenics, therapists use a traditional tricycle to strengthen leg muscles, yet the mechanics of traditional tricycles are not effective in exercising hip extensor muscles. A new therapeutic tricycle was designed specifically to exercise the hip extensor muscles, and tests compared the traditional tricycle to the new hip extensor tricycle in effectiveness of promoting hip extensor activity in two subjects without CP. The tests demonstrated that the hip extensor tricycle was more effective in promoting hip extensor activity. Tests are underway to investigate the effect of the hip extensor tricycle in improving hip extensor strength and gait in patients with cerebral palsy. This paper describes the design of the hip extensor tricycle and a preliminary investigation of its effectiveness.     

糖尿病患儿父母焦虑及应对方式的调查研究

目的了解糖尿病患儿父母的焦虑及应对方式，以更好地提供心理及行为方面的护理。方法采用状态-特质焦虑量表及Jalowice的应对压力量表对30例糖尿病患儿父母进行调查。结果糖尿病患儿父母状态焦虑（SAI）均分明显高于正常人群，不同文化程度父母SAI均分不同，其母亲SAI评分与年龄成正相关（P〈0．05）；在部分应对策略使用方面，其父母之间有差异（P〈0．05），另外，其父母SAI评分与情感的、保守的应对方式相关性具有统计学意义。结论糖尿病患儿父母均存在不同程度的焦虑，应予以高度重视，及时提供心理护理。