悬吊运动治疗对痉挛型偏瘫脑性瘫痪患儿步行能力的疗效分析

目的 分析悬吊运动治疗对痉挛型偏瘫脑性瘫痪(脑瘫)患儿步行能力的影响,为临床治疗提供科学依据.方法 选取2018年7月-2019年7月在上海市儿童医院康复科就诊的痉挛型偏瘫脑瘫患儿作为研究对象,以随机数字表法将患儿分为常规治疗组和悬吊运动治疗组.常规治疗组给予常规康复训练,悬吊运动治疗组在常规治疗的基础上联合悬吊运动治...     

基于儿童悬吊运动系统的躯干控制训练治疗痉挛型脑性瘫痪的疗效研究

目的：观察基于儿童悬吊运动(sling exercise therapy,SET)系统的躯干控制训练治疗痉挛型脑性瘫痪(以下简称脑瘫)的临床疗效。方法：将符合入组标准的24例痉挛型脑瘫患儿随机分为两组,每组12例,对照组采用常规康复训练(45min/次),治疗组在常规康复训练的基础上联合儿童悬吊运动训练系统进行躯干控制训练(20min/次),两组均治疗1次/天、5天/周,共计3个月。观察患儿治疗前后粗大运动功能测试量表(gross motor function measure scale-88,GMFM-88)D区、E区评分及Berg平衡量表(Berg balance scale,BBS)评分变化情况;运用表面肌电图记录患儿腹直肌、竖脊肌、腹外斜肌、臀大肌的表面肌电信号,观察患儿肌肉协同收缩率(co-contraction ratio,CR)的变化;比较两组治疗后的临床疗效。结果：治疗结束后,两组患儿在GMFM-D、GMFM-E、BBS评分及CR值上均有明显改善(P<0.01);治疗组在改善GMFM-D、GMFM-E及BBS评分方面优于对照组(P<0.05);治疗组在改善臀...     

针刺配合运动训练治疗痉挛型脑性瘫痪临床观察

目的:观察针刺配合运动训练治疗痉挛型脑性瘫痪患儿的临床疗效。方法:80例脑瘫患儿随机分为观察组和对照组,每组40例,观察组予以针刺配合运动训练治疗;对照组予以运动训练治疗,采用Gesell发育量表(GDS)、粗大运动功能测定(GMFM)和Ashworth痉挛评定量表(MAS)评分比较2组患儿的康复效果。结果:与治疗前相比,治疗4周后观察组和对照组GDS、GMFM和MAS评分均有明显差异(P0.05或P0.01);与对照组相比,观察组GDS、MAS和GMFM评分均有有显著差异(P0.05),且观察组GDS及MAS有效率优于对照组,相比有明显差异(P0.05)。结论针刺配合运动训练治疗痉挛型脑性瘫痪较单一运动训练治疗有更好疗效。     

痉挛型脑性瘫痪运动功能的康复现状

痉挛性脑性瘫痪(CP)患儿的运动功能的临床治疗和康复已取得了相当的进展。痉挛型CP的康复首选功能训练，主要是采用Bobath法、Vojta法、上田疗法及Peto引导式教育等方法改善患儿的肢体运动功能、生活自理能力和社会适应能力。在功能训练的基础上，早期应用矫形支具可以帮助患儿开发残存功能和代偿功能。目前神经阻滞技术和肉毒杆菌毒素的应用在降低CP患儿肌张力、缓解肌痉挛方面取得了显的治疗效果。而各种矫形手术的日趋完善也为痉挛型CP患儿最大限度地恢复肢体运动功能带来了希望。     

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     

康复指导在痉挛型脑性瘫痪康复中的疗效观察

目的 探讨康复指导在痉挛型脑瘫患儿康复中的应用价值.方法 在医院进行综合康复的痉挛型脑性瘫痪患儿116例,能配合家庭康复训练的56例为治疗组,不能配合进行家庭康复训练的60例患儿为对照组,两组患儿均进行运动训练,针刺、低频电治疗、智力训练,治疗组还由治疗师或医师根据患儿病情指导家长进行康复指导;治疗前和治疗3个月后采用粗大运动功能测试量表(GMFM)进行测试.结果 两组患儿治疗前后GMFM各项得分和总分均有非常显著性差异(P<0.01).治疗后治疗组与对照组GMFM各项得分和总分比较均有显著性差异(P<0.05).结论 家庭康复训练能提高痉挛型脑性瘫痪患儿粗大运动功能.     

基于悬吊运动系统的骨盆稳定性训练法对痉挛型脑性瘫痪儿童粗大运动功能的影响

目的:探讨基于悬吊运动(sling exercise therapy,SET)系统骨盆稳定性训练法对痉挛型脑性瘫痪(脑瘫)儿童粗大运动能力的影响,提高痉挛型脑瘫儿童粗大运动功能的康复疗效。方法:采用前瞻性队列研究。纳入2018年1月—2019年6个月安徽医科大学第一附属医院小儿神经康复中心收治的72例痉挛型脑瘫(偏瘫和双瘫);随机分为SET组(n=36)和对照组(n=36),两组均给予综合康复训练,共6个月,SET组同时加用SET系统支持下的骨盆稳定性训练。治疗前(入院时)和治疗后(治疗后6个月)分别采用粗大运动功能功能测试(GMFM-88及D区,E区)、徒手肌力评定(MMT)、儿童平衡量表(PBS)、改良Ashworth量表(MAS)、日常生活活动能力(ADL)量表对两组患儿进行评定。结果:SET组与对照组治疗前后差值组间GMFM-88评分相比(t=-5.31,P<0.01)差异有显著性意义;SET组与对照组治疗前后差值组间GMFM-D区(t=-9.085,P<0.01)和GMFM-E区(t=-6.239,P<0.01)评分相比差异有显著性意义;SET组与对照组治疗...     

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进择台适的病例结合外科手术治疗,能更好地达到康复效果。     

Experienced Problems of Young Adults With Cerebral Palsy: Targets for Rehabilitation Care

Nieuwenhuijsen C, Donkervoort M, Nieuwstraten W, Stam HJ, Roebroeck ME; and the Transition Research Group South West Netherlands. Experienced problems of young adults with cerebral palsy: targets for rehabilitation care.

Objective

To determine the problems experienced by young adults with cerebral palsy (CP) and the relationship between those problems and personal and CP-related characteristics.

Design

Cross-sectional study.

Setting

Rehabilitation centers in the southwest Netherlands.

Participants

Young adults (N=87; aged 18-22y) with CP and normal intelligence (roughly corresponding to an intelligence quotient >70, excluding participants who attended schools for those with learning disabilities).

Interventions

Not applicable.

Main Outcome Measures

We used the Canadian Occupational Performance Measure in a semistructured interview to assess participants for experienced problems. We further categorized experienced problems according to the domains of the International Classification of Functioning, Disability and Health and assessed the relationship between those problems and personal and CP-related characteristics (eg, age, sex, level of gross motor functioning, manual ability, level of education) using appropriate correlation coefficients.

Results

Approximately 70% of participants experienced problems in daily life, addressing the areas of self-care (59%), productivity (52%), and leisure activities (37%). More specifically, problems were most prevalent in recreation and leisure (30%), preparing meals (29%), housework (14%), and dressing (14%). Problems in functional mobility, paid or unpaid work, and socialization were considered as most important (represented by the highest mean importance score). Mobility problems were associated with lower levels of gross motor functioning (Spearman ρ=.39), and problems with self-care were associated with lower levels of manual ability (Spearman ρ=.40).

Conclusions

Although frequently addressed during pediatric rehabilitation care, problems with mobility and self-care still prevail in young adults with CP. In addition, during the transition into adulthood, young adults with CP may experience problems regarding domestic life and work, which they consider important.     

作业疗法对脑瘫患儿日常生活活动能力的疗效(62例病例分析)

目的 观察作业疗法（OT）对脑性瘫痪（CP）患儿日常生活活动能力（ADL）的疗效。方法 对62例CP患儿进行OT治疗，于入院后1周内进行ADL初评，根据评定结果制定训练目标和计划，进行ADL训练；于出院前进行疗效评定。结果 治疗后，患儿的ADL评分明显提高（P〈0．01），障碍程度明显减轻（x^2=10．48，P〈0．01）．总有效率87．1％。结论 OT治疗能有效提高CP患儿的ADL。     

Effect of Adaptive Seating Devices on the Activity Performance of Children With Cerebral Palsy

Rigby PJ, Ryan SE, Campbell KA. Effect of adaptive seating devices on the activity performance of children with cerebral palsy.

Objective

To evaluate the short-term impact of 2 adaptive seating devices on the activity performance and satisfaction with performance of children with cerebral palsy (CP), as observed by their parents.

Design

Baseline-intervention-baseline study.

Setting

Homes of participating families.

Participants

Parents and their children (N=30), mean age of 4 years 6 months, with Gross Motor Function Classification System levels III and IV CP participated.

Interventions

Two special purpose seating devices: one for sitting support on the floor or on a chair, the other for postural control on a toilet.

Main Outcome Measures

Changes in activity performance and satisfaction were measured through parent ratings on the Canadian Occupational Performance Measure. We interviewed parents biweekly using the Home Activity Log to describe and explain their child's activity performance during the 3 study phases.

Results

Parents identified 139 activity performance issues (4.6 a child): 58.3% in self-care, 34.5% in play, and 7.2% in socialization and quiet recreation. We used paired t tests to demonstrate significantly improved performance and satisfaction with self-care and play activities when the children used the adaptive seating devices during the 6-week intervention phase. Three themes arose from the analysis of comments made by parents during Home Activity Log interviews: adaptive seating can have an enabling influence on the child, caregivers and family find adaptive seating useful, and the adaptive seating devices did not meet every family's needs.

Conclusions

Parents reported that their young children with CP were more able to engage in self-care and play activities when using specific adaptive seating devices in their home. Parents indicated that their child's activity performance decreased after the seating devices were removed from their homes.     

Measuring Mobility Limitations in Children With Cerebral Palsy: Development, Scalability, Unidimensionality, and Internal Consistency of the Mobility Questionnaire, MobQues47

Roorda LD, Scholtes VA, van der Lee JH, Becher J, Dallmeijer AJ. Measuring mobility limitations in children with cerebral palsy: development, scalability, unidimensionality, and internal consistency of the Mobility Questionnaire, MobQues47.

Objectives

To develop a questionnaire that specifically and comprehensively measures mobility limitations in children with cerebral palsy (CP) and to investigate certain psychometric properties (scalability, unidimensionality, internal consistency) of this questionnaire.

Design

Cross-sectional study.

Setting

Private physical therapy practices and outpatient departments of hospitals and rehabilitation centers.

Participants

Children with CP undergoing physical therapy or rehabilitation. The Mobility Questionnaire, 47-item (MobQues47), was completed by the mothers of these children (N=323; mean age ± SD, 7.1±2.9y; 57% boys; Gross Motor Function Classification levels: I [48%], II [26%], III [19%], IV [7%]).

Interventions

Not applicable.

Main Outcome Measures

Mokken scale analysis was used to investigate (1) scalability, indicating that the items form a scale; (2) unidimensionality, indicating that the items measure only 1 concept; and (3) internal consistency, indicating the degree of interrelatedness of the items.

Results

The MobQues47, made up of 47 items, was developed on the basis of 3 pilot studies and careful operationalization of the concept (or construct) of mobility limitations. The scalability (coefficient H=.70), unidimensionality, and internal consistency (coefficient ρ=.99) of the MobQues47 were found to be very good.

Conclusions

The MobQues47 is a unidimensional scale with excellent internal consistency that can be used to measure caregiver-reported mobility limitations in children with CP.     

头针配合运动疗法治疗痉挛型脑性瘫痪的疗效观察

目的观察头针配合运动疗法治疗痉挛型脑性瘫痪的疗效。方法将80例痉挛型脑瘫患儿随机分为观察组和对照组,每组40例。观察组采用头针配合运动疗法治疗,对照组只采用运动疗法治疗。治疗3个月后比较两组的小儿功能独立性评定(WeeFIM)和粗大运动功能测试量表(GMFM)评分。结果治疗期间所有患儿均无不良反应。观察组WeeFIM评分、GMFM评分均优于对照组(P<0.05)。结论头针能促进运动疗法改善痉挛型脑瘫患儿的肢体运动功能的效果。     

石蜡疗法配合作业疗法对痉挛型脑瘫患儿拇指内收的效果观察

目的观察石蜡疗法配合作业疗法治疗痉挛型脑瘫患儿拇指内收的效果。方法 100例痉挛型脑瘫患儿随机分为观察组(n=50)和对照组(n=50),观察组采用作业疗法及石蜡疗法;对照组仅接受作业疗法。治疗3个月后比较两组的疗效。结果治疗后两组患儿均有改善,但观察组显著优于对照组(P<0.001)。结论石蜡疗法配合作业疗法可促进痉挛型脑瘫患儿拇指功能的恢复,效果优于单纯作业疗法。     

悬吊训练联合肌内效贴对不随意运动型脑瘫患儿姿势控制能力的影响

目的：探讨悬吊运动训练联合肌内效贴对不随意运动型脑瘫患儿姿势控制能力的影响。方法：选取不随意运动型脑瘫患儿40例随机分为对照组和观察组各20例，2组患儿均给予常规康复训练，对照组在常规康复训练基础上予以悬吊运动训练，观察组在常规康复训练基础上进行肌内效贴贴扎下的悬吊训练，分别于治疗前后采用儿童平衡量表（PBS），“起立-行走”计时测试（TUGT）和Pro-Kin 254平衡测试系统分别评估2组患儿的姿势控制能力。结果：治疗12周后，2组患儿PBS评分较治疗前均升高(P<0.05)，TUGT、运动长度、运动椭圆面积和总偏移指数较治疗前均降低(P<0.05)，组间比较结果显示观察组PBS评分高于对照组(P<0.05)，TUGT、运动长度、运动椭圆面积和总偏移指数均低于对照组(P<0.05)。结论：肌内效贴可作为悬吊训练中的补充手段，在有限的训练时间内进一步改善不随意运动型脑瘫的姿势控制能力，该方案值得在临床上推广与应用。     

Compartment Syndrome After Serial Casting in Spastic Diplegic Cerebral Palsy: A Case Report

Muchow RD, Flannery WD, Miedaner JA, Noonan KJ, McCarthy JJ. Compartment syndrome after serial casting in spastic diplegic cerebral palsy: a case report.We present the case of a 24-year-old woman with spastic diplegic cerebral palsy who developed left lower extremity compartment syndrome after serial casting to treat an equinus contracture. To our knowledge, this represents the first case of compartment syndrome that has occurred from cast application to treat a deformity. The cast was the second placed in the treatment series and was removed 18 hours later because of increased pain. The clinical picture progressed despite the cast being removed. Accordingly, the patient presented to the emergency department with uncontrollable pain and a peroneal nerve deficit. Compartment pressures were measured in the anterior, lateral, superficial, and deep posterior compartments and were 80, 56, 31, and 90mmHg, respectively. She required 4-compartment fasciotomy, eventual skin grafting of her lateral wound, and late gastrocnemius lengthening for recurrent equinus contracture. The purpose of this report is to alert clinicians to the potential for compartment syndrome to occur as a result of serial casting applied to correct deformity.