水疗对痉挛型脑瘫患儿的疗效观察

目的评估水疗对脑瘫患儿的临床疗效。方法71例脑瘫患儿随机分为两组，对照组采用功能训练、按摩、蜡疗、痉挛肌常规治疗．观察组除常规治疗外加用水疗。评定方法包括胡莹媛等残疾儿童功能评定法中的运动功能评定、关节活动度测．量。结果观察组总有效率（94．4％）明显高于对照组（88．6％），前者和后者的关节活动度均有明显改善（P〈0．05）。结论水疗能有效改善痉挛型脑瘫患儿的运动功能、缓解肌肉痉挛、改善平衡能力和身体协调性。     

中药熏蒸对痉挛型脑瘫患儿的疗效观察

目的 评估中药熏蒸对脑瘫患儿的临床疗效。方法 68例脑瘫患儿随机分为2组，对照组采有功能训练、小儿按摩、蜡疗、痉挛肌常规治疗，观察组除常规治疗外加用中药熏蒸。结果 观察组总有效率（94．1％）明显高于对照组（88．2％）.前者与后者的关节活动度均有明显改善（P〈0．05）。结论 中药熏蒸能有效改善痉挛型脑瘫患儿的运动功能、缓解肌肉痉挛，降低肌张力。     

痉挛型脑瘫患儿的按摩治疗体会

目的探讨按摩在痉挛型脑瘫的应用。方法将60例痉挛性脑瘫随机分为治疗组和对照组,治疗组2次/d,对照组1次/d。治疗前和治疗30d给予评定。结果60例痉挛型脑瘫的肌张力明显降低,功能显著改善。结论2次/d手法按摩较为有效。     

蜡疗治疗痉挛型脑瘫68例

目的 探讨蜡疗对痉挛型脑瘫的改善作用。方法 随机将我院收治的132例痉挛型脑瘫患儿分为观察组68例和对照组64例，2组均采用我院常规康复治疗，观察组在其基础上增加蜡疗。3个疗程后进行评估。结果 观察组治疗总有效率高于对照组（P〈0．05）。结论 蜡疗佐治痉挛型脑瘫安全、有效．无任何不良反应。     

痉挛肌治疗仪治疗痉挛型脑瘫患儿踝趾屈肌群痉挛临床观察

目的观察痉挛肌治疗仪对尖足痉挛型脑瘫患儿踝关节改善角度的作用。方法将符合入选标准的痉挛型脑性瘫痪患儿按就诊时间、性别随机分为2组：治疗组（痉挛肌治疗仪加综合康复治疗组）和对照组（综合康复治疗组）,连续治疗3个月,治疗前和治疗结束后分别以足背屈角改善角度作为评估指标进行评估。结果痉挛肌治疗组患儿踝关节改善角度明显高于对照组（P〈0．05）。结论痉挛肌治疗仪可以辅助降低踝趾屈肌群痉挛,明显改善踝关节活动度,从而可以改善痉挛型脑瘫患儿的站立、行走模式,是脑性瘫痪患儿安全、有效的临床康复治疗手段之一。     

痉挛型脑瘫患儿康复治疗时的护理

小儿脑瘫是指患儿在出生前到出生后1个月内发育时期的非进行性脑损伤所致的综合征。痉挛型是脑瘫中最常见的类型,其临床特点:腱反射亢进,肌张力增高,上肢屈肌张力高,下肢伸肌张力高。头、颈、躯干部的姿势异常,缺少四肢的灵活性活动,易出现关节的挛缩和变形,影响患儿的运动功能     

“痉挛三针”对痉挛型脑瘫儿童运动功能的影响

目的观察"痉挛三针"对痉挛型脑瘫儿童运动功能的影响。方法选择我院治疗的86例痉挛型脑瘫患儿,依据随机数字表法分为观察组与对照组各43例。对照组采用头针针灸结合康复训练治疗,观察组在对照组的治疗基础上加用"痉挛三针"。比较2组治疗前后的改良Ashworth评分、GMFM-88中D区与E区评分及治疗效果。结果治疗后2组改良Ashworth评分均不同程度降低,GMFM-88中D区与E区评分均有所提高,观察组显著优于对照组;观察组总有效率(90.7%)显著优于对照组(81.4%),差异有统计学意义(P0.05)。结论 "痉挛三针"可有效降低痉挛型脑瘫儿童内收肌肌张力,使患儿获得更好的独立行走及跑跳等运动功能。     

A型肉毒毒素注射配合综合康复训练治疗痉挛型偏瘫型脑瘫患儿临床分析

目的探讨A型肉毒毒素治疗痉挛型偏瘫型脑瘫患儿的临床疗效。方法选择痉挛型偏瘫型脑瘫儿童40例,随机分为A型肉毒毒素治疗组20例和单纯康复治疗组（对照组）20例。治疗组将A型肉毒毒素注射到患儿腘伸肌群和小腿三头肌群,注射后第2天开始进行康复训练（共6个月）。所有患者治疗前及治疗后2周、1个月、3个月、6个月进行腘窝角和足背屈角角度的测量、改良的Ashworth量表、粗大运动功能分级量表进行评价。结果治疗组的腘伸肌群和小腿三头肌群肌张力和粗大运动功能评分均比注射前改善明显（P〈0.05）,治疗效果明显优于对照组（P〈0.01）。结论 A型肉毒素配合康复治疗可以有效降低患儿患侧的肌张力,有助于提高运动功能,缩短治疗时间。     

脑功能障碍治疗仪联合综合方案治疗痉挛型脑瘫患儿疗效观察

目的观察脑功能障碍治疗仪联合综合方案治疗痉挛型脑瘫患儿的临床效果。方法将我院2013-11—2014-11收治的60例痉挛型脑瘫患儿为研究对象,按随机数字表法分为对照组与观察组各30例。对照组接受常规综合康复训练方案,观察组在对照组基础上采用脑功能治疗仪联合治疗方案,采取CSS(综合痉挛量表)与GMFCS(粗大运动功能量表)评估患儿的恢复情况。结果治疗6周、12周、24周后,观察组CSS评分分别为(8.5±0.8)分、(8.3±0.7)分、(8.4±0.8)分,GMFCS评分分别为(59.7±9.5)分、(68.7±10.2)分、(70.9±10.3)分,与对照组相比差异均有统计学意义(P0.05)。结论痉挛型脑瘫患儿采用脑功能障碍治疗仪联合综合康复训练方案,可改善患儿下肢肌群痉挛症状,强化其步行与站立功能,且操作简单,患儿耐受性高,值得推广。     

穴位注射对痉挛型脑瘫患儿肌张力及智力影响临床分析

目的观察穴位注射对痉挛型脑瘫患儿肌张力及智力的影响。方法痉挛型脑瘫患儿70例随机分为治疗组和对照组各35例。治疗组用穴位注射和功能训练,对照组单用功能训练。结果治疗组总有效率为94.3%,对照组为71.4%,治疗组疗效明显优于对照组(P0.05)。在改善肌张力及智力方面,治疗组也明显优于对照组(P0.05)。结论穴位注射能够明显降低痉挛型脑瘫患儿的肌张、提高智力,与对照组比较疗效明显。     

儿童痉挛型脑性瘫痪的神经外科治疗

目的 探讨神经外科治疗痉挛型脑性瘫痪的方法和效果.方法 对351例2~14岁(平均4.8岁)痉挛型脑瘫患者施行选择性脊神经后根切断术(SPR)135例,其中颈胸段26例,腰骶段109例;选择性周围神经缩窄术(SPN)216例,其中单神经干92例,多神经干124例.结果 随访期间6-31个月,平均17.8个月.颈胸段和腰骶段SPR痉挛改善率:上下肢分别为82.7%和91.4%,肢体运动功能改善率:上下肢分别为83.7%和72.5%.SPN痉挛改善率:上下肢分别为67.4%和92.7%,运动功能改善率:上下肢分别为54.9%和84.3%.结论 神经外科治疗痉挛型脑瘫为有效的康复训练创造了机会和条件.术前正确的评估,选择恰当的手术方式,掌握手术技巧,方能提高手术效果减少并发症.     

高选择性脊神经后根切断术治疗痉挛性脑瘫

目的探讨应用高选择性脊神经后根切断术(SPR)治疗痉挛性脑瘫的疗效。方法对58例接受SPR治疗的痉挛性脑瘫患者,进行术后8~40个月的随访,并对其术后痉挛情况、交叉腿、尖足情况、肌力、感觉等情况进行评估。结果 14例肌张力Ⅳ级的患者术后平均肌张力降为1.71级,32例肌张力Ⅲ级的患者术后平均肌张力降为1.56级,12例肌张力Ⅱ级的患者术后平均肌张力降为1.16级。30例剪刀步态完全消失(51.72%),19例明显改善(32.76%),仍有9例改善不明显(15.51%)。合并尖足者共31例,术后足跟着地者27例。术后随访能独立行走者29例(50%),需搀扶者18例(31.03%),不能行走者11例(18.97%)。结论 SPR对解除痉挛、降低肌张力等方面是安全可靠、作用持久的,配合必要的康复训练,可明显改善肢体活动功能,提高生活质量。     

Functional assessment following selective posterior rhizotomy in spastic cerebral palsy

This study used the Pediatric Evaluation of Disability Inventory as a functional assessment tool for children with spastic cerebral palsy undergoing selective posterior rhizotomy. Sixteen patients were followed for 3–12 months following surgery. Improvement in self-care, mobility, and social functional skills were found. Overall, the patients required less caregiver assistance and needed fewer modifications for self-care. The results suggest that selective posterior rhizotomy improves the quality of life in children with spastic cerebral palsy.     

Effects of self-controlled feedback on learning of a throwing task in children with spastic hemiplegic cerebral palsy

The purpose of this study was to examine the effect of self-controlled feedback on learning a throwing task in children with spastic hemiplegic cerebral palsy (SHCP). In order to achieve the research objectives, using a semi-experimental method, 20 children with SHCP (7–12 years old) were selected from special schools in Tehran, Iran. After showing the participants how to do the throwing task, a pre-test with 10 trials was conducted to homogenize the participants. Then, they were randomly assigned to two groups (self-control group and yoked group) to be examined in acquisition, retention, and transfer phases. Children in self-control group requested feedback when necessary during the acquisition phase. In contrast, participants in yoked-group replicated the feedback schedules of their counterparts in self-control group without any choice. A multivariate analysis of variance (MANOVA) was performed to analyze the data. Based on the results, a significant difference was not found between the self-control and yoked-group in acquisition phase (F = .538, p < .473). However, there was a significant difference between the two groups in retention (F = 11.72, p < .003) and transfer (F = 6.74, p < .018) phases. Thus, based on the better results obtained in the self-control condition, this type of feedback can be used in physiotherapy programs related to children with CP to improve their motor skills and independence movements.     

Treatment of articulatory impairment in a child with spastic dysarthria associated with cerebral palsy

Background: A comparative study of treatment modalities for improving articulation in a 13-year-old child with severe spastic dysarthria associated with spastic cerebral palsy (SCP) was conducted.

Method: A multiple treatment design examined the effect of phonetic placement therapy (PPT) and sEMG-facilitated biofeedback relaxation therapy over a 6-week period. Treatment outcomes were measured using acoustic and perceptual analysis.

Results: Results revealed significant improvement in single word intelligibility following PPT with the improvements maintained following sEMG treatment. sEMG-facilitated biofeedback relaxation treatment indicated the occurrence of a pre-cursor skill in increased motor control. Intelligibility at paragraph or sentence level did not change following either treatment. Perceptually, there was no change to any parameters of articulation following either treatment. However, subtle changes were observed on acoustic analysis. Functionally, the participant reported no changes to feelings of well-being or distress regarding her speech disorder over the period of intervention.

Conclusions: Clinically, the PPT and sEMG treatments demonstrated improvement in single word articulation, despite no perceptible changes to overall intelligibility. It is likely that the severity of the participant's dysarthria was a factor in the minimal changes observed following treatment. Future studies examining the treatments in children with mild and/or moderate dysarthria are required.

Antecedentes: Se desarrolló un estudio comparativo de modalidades de tratamiento para mejorar la articulación en un niño de 13 años con disartria espástica severa asociada a parálisis cerebral espástica (SCP). Métodos: Se diseño un tratamiento múltiple a través del cual se examinó el efecto de la terapia fonética (PPT) y la terapia de relajación por medio de bioretroalimentación facilitada por electromiografía (sEMG) a lo largo de un periodo de seis semanas. Los resultados del tratamiento fueron medidos utilizando análisis perceptuales y acústicos. Resultados: Los resultados revelaron una mejoría significativa en inteligibilidad de palabras únicas después de la PPT manteniéndose las mejorías después del tratamiento sEMG. El tratamiento de relajación a través de bioretroalimentación facilitada por sEMG indicó la presencia de de una capacidad pre-cursor en el aumento del control motriz. La inteligibilidad a nivel del párrafo o de la oración no cambió después de ambos tratamientos. Perceptualmente no hubo cambios en alguno de los parámetros de la articulación después de ambos tratamientos. Sin embargo hubo cambios mínimos en el análisis acústico. Funcionalmente el participante no reportó cambios en cuanto a la sensación de bienestar o de tensión en relación a la alteración en el habla durante el periodo de la intervención. Conclusiones: Clínicamente los tratamientos con PPT y sEMG mostraron una mejoría en la articulación de palabras únicas, a pesar de no haber cambios perceptibles en general en cuanto a la inteligibilidad. Es posible que la severidad de la disartria del participante fuera un factor determinante en los cambios mínimos que se observaron después del tratamiento. Se requieren estudios a futuro que examinen los tratamientos en niños con disartria leve y/o moderada. Palabras clave: Disartria espástica, bioretroalimentación, sEMG, articulación, alteración en el habla, parálisis cerebral     

Effect of upper limb deformities on gross motor and upper limb functions in children with spastic cerebral palsy

The aims of this study were to investigate the nature and extent of upper limb deformities via the use of various classifications, and to analyze the relationship between upper limb deformities and gross motor or upper limb functionality levels. Upper extremity data were collected from 234 children with spastic cerebral palsy (CP) who were admitted to the university hospital for intensive rehabilitation. Upper limb deformities were classified according to the Zancolli classification for finger and wrist extension ability, the Gshwind and Tonkin classification for supination ability, and the House classification for thumb-in-palm deformity. Digital deformity was also classified. Upper limb function was assessed using the Upper Extremity Rating Scale (UERS) and the Upper Limb Physician's Rating Scale (ULPRS). Gross motor function was assessed using the Gross Motor Functional Classification System (GMFCS). Among the 234 children observed, 70.5% had a limitation in forearm supination, and 62.8% had problems with wrist and finger extension in at least one limb. Thumb-in-palm deformity of at least one hand was found in 47.0% of patients. Swan neck deformity was the most common finger deformity. Upper limb functional measures, the ULPRS and the UERS, significantly correlated with the degree of upper limb deformity, as assessed by the Gschwind and Tonkin, Zancolli, and House classifications. Further, the degree of upper limb deformity was significantly related to the GMFCS level in children with bilateral CP, but not in children with unilateral CP. Limitation of forearm supination was the most common upper limb deformity in children with spastic CP. The degree of upper limb deformity significantly affected upper limb function in these children.     

束带强化核心稳定性训练结合感觉统合训练 对痉挛型脑性瘫痪患儿体位控制的影响

目的 探讨束带强化核心稳定性训练结合感觉统合训练对痉挛型脑性瘫痪(SCP)患儿体位控制的影响。方法 选取2014年6月-2017年6月本院收治的SCP患儿100例,依据随机数字表法分为束感组和常规组,每组各50例,常规组给予常规康复及感觉统合训练,束感组在此基础上给予束带强化核心稳定性训练,比较2组痉挛状态、粗大运动功能、体位控制。结果 束感组痉挛改善有效率明显高于常规组(P<0.05); 束感组和常规组治疗3、6个月后粗大运动功能量表(GMFM)、Berg平衡量表(BBS)得分明显高于治疗前,束感组治疗3、6个月后GMFM、BBS得分明显高于常规组(P<0.05)。结论 束带强化核心稳定性训练结合感觉统合训练可有效缓解SCP患儿的痉挛症状,有利于改善患儿粗大运动功能、体位控制能力。     

Bedtime diazepam enhances well-being in children with spastic cerebral palsy

In work with children with cerebral palsy at Ashirvad, Child Development and Research Centre, Chennai, India, the authors were confronted with fretful children who resisted any attempt to mobilize their limbs due to hypertonia and muscle spasm. It was found that administering a bedtime dose of diazepam to reduce hypertonia and muscle spasm alongside passive stretching exercises significantly improved the behaviour of the child. There was significant improvement in the well-being of the child during the activities of daily living and this reduced the family's burden of caring for the child. In this double blind, placebo-controlled, randomized clinical trial, each child received a bedtime dose of diazepam or placebo. The bedtime diazepam relaxed the muscles and this made the passive stretching easy and the movements sustained the muscle relaxation during the day. There were fewer unwarranted crying spells during the day and less wakefulness during the night. The adverse effect of day time sedation was not observed with the use of a single dose of diazepam at bedtime.     

Gait analysis of children with spastic hemiplegic cerebral palsy

An experiment was carried out in the key laboratory for Technique Diagnosis and Function Assessment of Winter Sports of China to investigate the differences in gait characteristics between healthy children and children with spastic hemiplegic cerebral palsy.With permission of their parents,200 healthy children aged 3 to 6 years in the kindergarten of Northeastern University were enrolled in this experiment.Twenty children aged 3 to 6 years with spastic hemiplegic cerebral palsy from Shengjing Hospital,China were also enrolled in this experiment.Standard data were collected by simultaneously recording gait information from two digital cameras.DVracker was used to analyze the standard data.The children with hemiplegic cerebral palsy had a longer gait cycle,slower walking speed,and longer support phase than did the healthy children.The support phase was longer than the swing phase in the children with hemiplegic cerebral palsy.There were significant differences in the angles of the hip,knee,and ankle joint between children with cerebral palsy and healthy children at the moment of touching the ground and buffering,and during pedal extension.Children with hemiplegic cerebral palsy had poor motor coordination during walking,which basically resulted in a short stride,high stride frequency to maintain speed,more obvious swing,and poor stability.     

选择性脊神经后根部分切断术治疗痉挛性脑瘫的疗效分析

目的探讨选择性脊神经后根部分切断术治疗痉挛性脑瘫的疗效。方法回顾分析显微手术治疗104例痉挛性脑瘫患者的临床资料。2006年3月以前83例采用L2-S1椎板切开行选择性脊神经后根部分切断术,其中3例同时行C5-T1选择性脊神经后根部分切断术。3月以后21例患者行改良腰骶段选择性脊神经后根切断术。结果全部患者平均随访31.2月,肢体痉挛缓解率95.2%,步态功能改善率81.7%,生活质量提高率88.5%。术后并发症:肢体痉挛状态复发6.7%,一过性肢体感觉障碍4.8%,一过性肌无力3.8%,腰椎不稳或前凸2.9%,一过性尿潴留2.9%。结论选择性脊神经后根部分切断术是治疗痉挛性脑瘫下肢痉挛状态安全有效的手术方法。改良腰骶段选择性脊神经后根切断术可以有效地防止脊椎不稳或腰椎前凸的发生。