针刺治疗脑性瘫痪患儿手功能障碍

脑性瘫痪(简称脑瘫)患儿合并手功能障碍是致残的重要因素。依据中医经络理论,运用头针加体针的治疗方法,治疗了43例合并手功能障碍的脑瘫患儿,取得了86%的总有效率。     

针刺治疗小儿脑性瘫痪合并智力障碍

智力障碍是小儿脑性瘫痪（cereloral palsy，CP）的常见症状。有报道，CP患儿合并智力障碍的比例达74．5％，重度CP患儿合并智力障碍者更高达90％。CP患儿合并智力障碍表现为学习能力低下，应知应会的能力绝对落后于同龄儿。智力障碍能导致其他各项能力减低并进而影响小儿总体发育水平。近年来，笔者采用针灸结合头部穴位按摩治疗促进患儿智力的发育。提高小儿CP的康复效果。     

小儿脑性瘫痪引导式教育疗法

引导式教育是目前国际上公认的治疗小儿脑性瘫痪最有效的方法之一。它的显特点是以娱乐性和节律性意向性向患儿提供目的意识、激发他们的兴趣及主动参与意识，通过患儿与引导之间复杂的教与学的互动活动，最大限度地引导诱发患儿自身的潜力、即诱发患神经系统的功能形成和功能障碍的康复，达到疗育促通、创建有效功能。引导式教育强调以儿童需要为中心，将脑瘫患儿作为“全人”来对待，除对他们的运动功能进行康复外，还对他们的语言、智力开发、交往、性格、品德、意志、生活技能和体能等结合起来进行全面系统地教育训练，使患儿在德、智、体等各个方面得到同步发展。尤其是近年来引导式教育将教育训练与幼儿园和中、小学化课学习相结合的模式日益受到国际社会的广泛重视。     

针灸与推拿治疗小儿脑性瘫痪23例

为探讨小儿脑性瘫痪(脑瘫)针灸与推拿的效果，对23例小儿脑瘫患儿进行针灸和推拿治疗，结果显示联合治疗要好于用单一方法治疗，并且年龄越小效果越显著。     

小儿脑性瘫痪引导式教育疗法

引导式教育是目前国际上公认的治疗小儿脑性瘫痪最有效的方法之一。它的显著特点是以娱乐性和节律性意向性向患儿提供目的意识、激发他们的兴趣及主动参与意识,通过患儿与引导者之间复杂的教与学的互动活动,最大限度地引导诱发患儿自身的潜力、即诱发患者神经系统的功能形成和功能障碍的康复,达到疗育促通、创建有效功能。引导式教育强调以儿童需要为中心,将脑瘫患儿作为“全人”来对待,除对他们的运动功能进行康复外,还对他们的语言、智力开发、交往、性格、品德、意志、生活技能和体能等结合起来进行全面系统地教育训练,使患儿在德、智、体等各个方面得到同步发展。尤其是近年来引导式教育将教育训练与幼儿园和中、小学文化课学习相结合的模式日益受到国际社会的广泛重视。     

以针灸为主治疗小儿脑性瘫痪

目的探讨小儿脑性瘫痪有效治疗方法。方法应用传统医学疗法与现代康复医学疗法相结合进行治疗。结果46例脑性瘫痪患儿治疗3～6个月,显效24例,有效18例,总有效率91.3％,显效率52.2％。结论综合康复疗法是治疗脑性瘫痪的较好疗法。     

三位一体法治疗小儿脑性瘫痪14例

小儿脑性瘫痪是一种较棘手的病症.临床上采用针灸、推拿、配合运动疗法治疗本病，结果表明疗效确实，且明显优于其他疗法。早发现、早治疗尤为重要。对于降低小儿致残率，有着不可估量的现实意义。     

针刺与易化技术结合治疗儿童脑性瘫痪

目的：探讨针刺与易化技术治疗脑性瘫痪的效果及影响因素。方法：采用针刺和易化技术治疗246例脑瘫患儿，并进行治疗前、后的运动功能评定。结果：显效95例，有效127例，总有效率90．2％，其中34例达正常儿童发育水平；治疗效果与开始治疗的年龄、持续时间、类型、病情程度及有无合并症有关。结论：针刺与易化技术结合可促进脑瘫患儿尽快康复，早期、长期治疗更有效。     

音乐疗法对脑瘫患儿针灸治疗中焦虑和疼痛的影响

目的 探讨音乐疗法对脑瘫患儿针灸治疗中焦虑和疼痛的影响.方法 将46例脑瘫患儿随机分成两组:A组为音乐干预治疗组,B组为对照组.A组患儿在针刺过程中予聆听音乐,乐曲为患儿所喜爱的儿歌.对照组只予针灸治疗,不予聆听音乐.留针30 min,期间不转针.分别记录46名患儿针刺前和针后1 min、15 min及拔针后的BP、HR、RR和SPO2.同时,以mYPAS评估针刺前和针后1 min、15 min及拔针后患儿的焦虑状态,以CHEOPS和FACES评估患儿的针灸后疼痛情况.结果针刺后1 min两组同MAP、HR升高比较无明显差异性(P＞0.05);针刺15 min A组的HR较针刺前差异无显著性(P＞0.05),对照组的HR较针刺前非常显著升高(P＜0.01);拔针后两组MAP、HR均非常显著升高(P＜0.01),但A组MAP、HR升高不如对照组明显.两组患儿针刺后1 min mYPAS评分均非常明显高于针刺前(P＜0.01),两组比较差异无显著性(P＞0.05);针刺15 min A组mYPAS评分与针剌前差异无显著性(P＞0.05),与B组比较差异有非常显著性(P＜0.01);两组拔针后mYPAS评分非常明显高于针刺前(P＜0.01),但B组升高明显(P＜0.05).A组CHEOPS评分或FACES评分基本满意率均高于对照组.结论音乐疗法不能短时间内缓解患儿的焦虑、疼痛感,但能在患儿停止哭闹后经音乐治疗师的引导开始专心聆听音乐,从而明显缓解其紧张焦虑情绪和疼痛感.试验还观察到音乐疗法干预脑瘫患儿针灸时的焦虑情绪和疼痛感可能与音乐治疗能降低脑瘫患儿的血压和心率有关.但由于本试验是小样本型,音乐疗法干预脑瘫患儿针灸时的焦虑情绪和疼痛感的效果还需要大样本试验去验证,而且此效果对临床针灸治疗脑瘫患儿效果的影响还有待于我们下一步的试验去研究.     

Efficacy of forced-use therapy in hemiplegic cerebral palsy

OBJECTIVE: To determine the efficacy of forced-use therapy (FUT) on the improvement of upper-extremity function in children with hemiplegic cerebral palsy (CP). DESIGN: Prospective case series. SETTING: Outpatient ambulatory clinic in South Korea. PARTICIPANTS: Thirty-one patients with hemiplegic CP were assigned to the FUT group (n=18) or to the control group (n=13). The mean age of the patients in the FUT group was 33.2 months and in the control group it was 43.2 months. INTERVENTIONS: The FUT group wore a short-arm Scotchcast on the unaffected arm for 6 weeks and also participated in a conventional rehabilitation program that included stretching exercises and functional occupational therapy for the upper extremity. The control group underwent the conventional rehabilitation program only. MAIN OUTCOME MEASURE: Hand function tests, including the box and block test (BBT), Erhardt Developmental Prehension Assessment (EDPA), and WeeFIM instrument taken before and after 6 weeks of treatment. RESULTS: Before treatment, there was no significant difference between groups in the BBT, EDPA, and WeeFIM scores. After 6 weeks of treatment, however, the FUT group showed significant improvement in the affected arm in the BBT and EDPA scores, compared with the control group (P<.05). The self-care score on the WeeFIM was also significantly improved in the FUT group (P<.05). CONCLUSIONS: FUT combined with a conventional rehabilitation program appears to be more effective than a rehabilitation program alone in improving affected hand function in children with hemiplegic CP.     

脑瘫选择性脊神经后根切断术的运动疗法

采用选择性腰骶段脊神经后根切断术治疗脑癍患者的下肢痉挛,并且于手术前后配合运动疗法。选取研究对象60例,男45例,女15例;年龄范围4～33岁;其中传统手术方法15例,选择性脊神经后根切断术45例。通过对传统手术方法组与选择性脊神经后根切断术组的比较,以及手术前有无运动疗法的比较,证明了脑瘫选择性脊神经后根切断术配合术前术后运动疗法,疗效明显提高,并讨论了术后运动疗法的机理、方法及程序。     

Effects of music on anxiety and pain in children with cerebral palsy receiving acupuncture: A randomized controlled trial

Objectives

To study the effects of music on anxiety and pain in children with cerebral palsy receiving acupuncture daily in a clinical setting.

Design

A randomized controlled trial.

Setting

Acupuncture Unit at Shenzhen Hospital of Traditional Chinese Medicine in Shenzhen City of China.

Participants

Sixty children with cerebral palsy undergoing acupuncture.

Methods

Intervention: Children listened to their favorite music or a blank disc for 30 min. Measurements: (1) the modified Yale preoperative anxiety scale for children's anxiety (mYPAS); (2) children's hospital of eastern Ontario pain scale (CHEOPS) and Wong-Baker faces pain rating scale (FACES) for pain intensity; (3) vital signs including mean arterial blood pressure (MAP), heart rate (HR) and respiratory rate (RR).

Results

An independent sample t-test showed significantly lower mYPAS scores in the music group 30 min after the intervention compared with the control group (t = 4.72, P = 0.00). Significant differences between groups were found in mYPAS scores (F = 4.270, d.f. = 1, P = 0.043, Partial η² = 0.069) and over treatment duration (F = 143.421, d.f. = 1.521, P = 0.000, Partial η² = 0.712). A significant interaction was also found (F = 4.298, d.f. = 1.521, P = 0.025, Partial η² = 0.069). LSD's post hoc testing confirmed that the mYPAS scores significantly increased from the baseline to 1 min (P = 0.000, 95% CI 14.913, 20.257) and then gradually decreased from 1 to 30 min (P = 0.000, 95% CI −18.952, −13.714). For pain intensity scores, a highly significant time effect was found in both the CHEOPS (F = 87.347, d.f. = 2, P = 0.000, Partial η² = 0.601) and FACES (F = 225.871, d.f. = 1.822, P = 0.000, Partial η² = 0.796), and a significant interaction effect was found as well (F = 4.369, d.f. = 2, P = 0.015, Partial η² = 0.070; F = 5.859, d.f. = 1.822, P = 0.005, Partial η² = 0.092). However, no significant difference between groups was present (F = 2.343, d.f. = 1, P = 0.131, Partial η² = 0.039; F = 3.738, d.f. = 1, P = 0.058, Partial η² = 0.061). Significant differences between groups were found in MAP and HR (P < 0.05) and over time (P < 0.05), but no significant effects in RR were apparent (P > 0.05). A significant interaction effect was found in HR (P < 0.05), but not in MAP or RR (P > 0.05).

Conclusions

This study demonstrates that listening to music while receiving acupuncture can relieve anxiety among children with cerebral palsy; however, no effect was observed in terms of pain reduction. Further research is needed to explore the types of music which best impact an individual's treatment. Whether music results in fewer accidents and side effects of acupuncture should be investigated. Music can be considered as adjunctive therapy in clinical situations that may be anxiety-provoking for children.     

Parents' perspectives on occupational therapy and physical therapy goals for children with cerebral palsy

Contemporary rehabilitation literature emphasises functional goals for children with disabilities and use of a collaborative goal-setting process grounded in principles of family centred service delivery.

Purpose.?To explore parents' experiences with goals and goal setting.

Method.?We conducted a qualitative study with 11 focus groups and two individual interviews with 39 parents of children with cerebral palsy living in western Canada. We used an inductive, thematic analysis to identify prominent themes.

Results.?The analysis revealed five themes representing goals that were meaningful to parents and provided insight into parents' experiences with goal-setting processes in occupational and physical therapy: (1) movement as the means to functional success; (2) physical health and fitness are important therapy goals; (3) the importance of leading happy, fulfilling lives and being accepted by others; (4) ‘We can't do it all’: balancing therapy with the demands of everyday life; and (5) shifting roles and responsibilities in goal setting.

Conclusions.?The variability noted both in parents' desired role in goal setting and in goals important to parents highlights the importance of establishing trusting relationships with families so that family goals, values, individual circumstances, and desired level of participation in goal setting can be openly discussed.     

脑瘫儿童的语言特征初探

目的 探讨各类型脑瘫儿童语言发育与构音的特点。方法 采用中国康复研究中心制定的S—S语言发育迟缓检查法和构音障碍检查法，对76例不同类型脑瘫儿童进行语言发育和构音能力的全面评定，并进行对比分析。结果 语言障碍见于73．1％的患儿。痉挛型双瘫患儿语言听理解与口语表达一致，语言发育迟缓和运动性构音障碍发生率分别为45．95％和48．65％，且二者常并存。痉挛型四肢瘫和徐动型脑瘫患儿听理解与口语表达发育分离，理解明显好于表达，语言发育迟缓发生率分别为90％和64．7％。徐动型、共济失调型和痉孪型四肢瘫构音障碍突出，见于所有息儿。偏瘫患儿较少发生语言问题。结论 语言障碍是脑瘫的主要临床表现之一，不同脑瘫类型的语言表现各有特征性，康复时应对患儿进行认真的语言—言语评定。     

颈总动脉周围交感神经网剥脱切除术治疗脑性瘫痪

用颈总动脉周围交感神经网剥脱切除术治疗脑性瘫痪５８例，其中痉挛型４１例，混合型１４例，手足徐动型３例，手术平均随访５个月，５０例有效占８６．２％，本手术效果的主要表现是患者的流涎减轻或消失，语言功能改善，肢体的痉挛减轻。本手术产生疗效的机理可能与改善脑组织的微循环有关。     

Implementation of constraint-induced movement therapy for young children with unilateral cerebral palsy in Jordan: a home-based model

Purpose.?The aim of this study was to investigate the feasibility of implementing constraint-induced movement therapy (CIMT) in Jordan, a country with a different culture to that of the western world where CIMT has previously been investigated.

Method.?Twenty children with unilateral cerebral palsy (CP) were randomised to either CIMT or neurodevelopmental treatment (NDT). NDT is the usual treatment method in Jordan for children with CP and was used in the control group. Fourteen children fulfilled the treatment; mean age was 47 months (SD 19 months) in the CIMT group and 65 months (SD26 months) in the NDT group. Jordanian therapists learned the CIMT method in a 2-day workshop. CIMT was based on 2-h per day for eight weeks, with the families being responsible for the training aside from a weekly session with the therapist, i.e. a home-based model. Children in the NDT group had 2?h of training per week by therapists.

Results.?Hand function, measured with Assisting Hand Assessment on a scale of 0–100 AHA-units, improved from 41.6 (12.6) to 48 (11.6) in the CIMT group and from 56 (18.7) to 56.6 (18.8) among controls. ANOVA show a group effect of treatment (F(1,12) == 7.77; p == 0.016).

Conclusions.?A treatment effect of CIMT can be seen after a 2-day workshop in a novel environment.     

Assessing pain in patients with severe cerebral palsy: development, reliability, and validity of a pain assessment instrument for cerebral palsy

OBJECTIVES: To develop the Pain Assessment Instrument for Cerebral Palsy (PAICP) and to study its test-retest reproducibility and construct validity. DESIGN: Cross-sectional validation study. SETTING: Homes for severely handicapped. PARTICIPANTS: A total of 164 adults with severe cerebral palsy (CP), caregivers, and physiotherapists, and 9 healthy children. INTERVENTIONS: The PAICP contains drawings of situations, some situations of which usually produce pain. Patients rate the pain associated with each activity using a Faces Pain Scale. Reproducibility and construct validity was assessed in a pilot study with CP patients and healthy children. Construct validity and agreement between the pain scores of the patients and proxies was assessed in 160 patients with severe CP. MAIN OUTCOME MEASURE: Pain score on the PAICP. RESULTS: The measure showed adequate test-retest reproducibility. A significant difference was found between the mean scores for "painful" and "not painful" situations. We also found moderate agreement between the scores of the patients and proxies for daily activities but only for those activities in which the proxies were personally involved. CONCLUSIONS: The PAICP has adequate test-retest reproducibility and construct validity. It provides an indication of the pain experienced by patients in situations in which proxies are not personally involved and may also be more valid than proxy measures for other situations.