脑梗死患者的运动及体感诱发电位研究

目的：研究脑梗死患者的运动诱发电位（ＭＥＰ）及体感诱发电位（ＳＥＰ）改变。方法：对３０便脑梗死患者在急性期行经颅磁刺激ＭＥＰ检测,对其中２０例同时行电刺激ＳＥＰ检测,１０例患者２月后复查ＭＥＰ,并以３０例健康者作为正常对照组。结果：急性期ＭＥＰ的异常率为９３％,主要表现为皮层ＭＥＰ消失,中枢运动传导时间（ＣＭＣＴ）延长,波形异常及阈刺激强度增高。ＳＥＰ的异常率为３０％,表现为皮层波的缺失及中枢传导时间延长。复查ＭＥＰ有９例明显改善。结论：对于脑梗死的诊断,ＭＥＰ较ＳＥＰ敏感,但将ＭＥＰ与ＳＥＰ联合应用,可从不同的两个侧面反映运动及感觉功能受损的情况,弥补了ＣＴ仅能提供颅内解剖学改变而不能反映功能状态的不足。     

经颅磁刺激运动诱发电位和体感诱发电位对HMSN的诊断价值

目的:了解遗传性运动感觉性神经病(HMSN)的经颅磁刺激运动诱发电位(MEP)和体感诱发电位(SEP)的变化。方法:对一家三代HMSN的12例患者和1例无症状者进行这二项检查。结果:MEP和SEP的异常率分别为92.3％,84.6％,结论:绝大多数HMSN患者的MEP和SEP均异常。     

114例神经衰弱的体感诱发电位分析

以８０例正常健康人的体感诱发电位结果为标准，对１１４例神经衰弱的体感诱发电位进行回顾性分析。结果发现，７１．１％的神经衰弱患者体感诱发电位异常，表现为波型畸变、潜伏期延长和波幅异常。表明神经衰弱患者存在脑功能障碍，体感诱发电位是评价神经衰弱患者脑功能损害的较敏感的客观指标。     

脊髓体感与运动诱发电位术中联合监测的应用价值

目的：探讨脊髓体感诱发电位(SEP)与运动诱发电位(MEP)在脊髓手术中联合监测的临床应用价值。方法：对18例脊柱手术患者进行术中SEP和MEP联合监测，并用日本矫形学会量表(JOA)对患者术后神经功能进行评价。结果：全部患者术中SEP的P1、N1波幅有暂时性波动，潜伏期无明显变化。10例患者MEP的D1波波幅降低，但经改变手术方向后恢复正常，另8例患者MEP无明显变化。术后JOA评分较术前明显改善。结论：SEP及MEP术中联合监测，其波形稳定可靠，有利于避免“假阴性／假阳性”结果及术后神经功能障碍的发生。     

精神分裂症患者体感诱发电位的研究

本文研究了41例精神分裂症患者的SEP。发现其波型变异大、稳定性差、主波群波幅降低。与正常对照组比较有显著差异。提示可将SEP和其它多项诱发电位结合起来,作为临床的一种辅助检查手段。     

30例痉挛性大脑性瘫痪患儿的BAEP、CT、EEG分析

大脑性瘫痪 (脑瘫 )为出生前到出生后一个月以内各种原因所致的非进行性脑损伤 ,主要表现为中枢性运动障碍及姿势异常 ,临床分为 7型 ,如痉挛型、手足徐动型等。本文对30例脑瘫患儿的脑干听觉诱发电位 (ＢＡＥＰ)、ＣＴ、脑电图(ＥＥＧ)进行分析 ,现报告如下。1　资料与方法　　病人组 :选择 1997～ 2 0 0 0年在我院儿科住院确诊为痉挛性脑瘫的患儿 30例 ,其中男 2 0例 ,女 10例 ,年龄2个月～ 3岁 ,平均 1 5岁。发病原因推测可能为多胎多产 5例 ,有窒息缺氧史 15例 ,产伤 2例 ,羊水吸入 3例 ,早产低体重儿 6例 ,原因不明 2例。临床表现为发…     

帕金森病患者正中神经和胫神经体感诱发电位研究

目的:同时观察帕金森病患者正中神经和胫神经体感诱发电位的异常并推测其发生机制。方法:选择30名帕金森病患者和20名健康对照者,刺激正中神经,记录顶叶体感诱发电位的N20、P25、N30波,额叶的P20、N30波的潜伏期和波幅。刺激胫神经,记录顶叶体感诱发电位的P40、N50、P60波的潜伏期和波幅。结果:帕金森病患者上肢额叶N30和下肢N50波幅明显降低(P<0·05)。结论:帕金森病患者上下肢SEP同时出现异常是黑质纹状体系统多巴胺缺乏的结果,下肢N50波幅比上肢N30与临床症状的严重性更有相关性。     

78例儿童孤独症患者体感诱发电位分析

目的:通过观察和分析儿童孤独症患者体感诱发电位(SEP)的改变,探讨其在儿童孤独症诊断中的临床意义。方法:对1岁零8个月至8岁的78例孤独症儿童进行SEP检查,观察皮层第一个电位P40潜伏期及P40、N50、P60、N75波幅的改变。结果:78例孤独症患儿皮层电位P40潜伏期均有延长,其中双侧延长55例,单侧延长23例,并波幅分化差或左右不对称18例。结论:孤独症患者体感传导通路皮层电位潜伏期延长和波幅的改变,提示皮层下(包括脑干、丘脑)和相关皮层功能受损的可能,结合影像学检查,对评价神经系统功能及预后有一定的价值,对孤独症患儿临床诊断有帮助。     

37例大脑性瘫痪患儿的脑电图及临床分析

大脑性瘫痪 (脑瘫 )以运动与姿势异常为其诊断要点 ,但本质上属脑组织非进行性病变 ,即脑损伤。脑损伤儿是指出生前后或幼儿、少儿时期因多种原因导致中枢神经发生障碍的小儿 ,可见有多种障碍 ,表现为多种症状与多种征候群。笔者拟就 1994年 1月～ 1997年 12月收集的脑瘫儿脑电图资料进行分析如下。1　临床资料 :一般资料 :本组 37例中 ,男 2 1例 ,女 16例 ;年龄 5 0天至5岁。其中早产儿 4例 ,难产 3例 ,过期产 1例 ,高危妊娠 7例 ,高热惊厥 3例 ,新生儿重症黄疸 1例 ,其余均为足月顺产。临床表现 :37例中痉挛型四肢瘫者 2 3例 ,偏瘫者 1例 …     

脑瘫病人选择性后根切断术的体感诱发电位、神经传导速度检测

报告２０例脑瘫病人选择性后根切断术（ＳＰＲ）治疗前后体感诱发电位（ＳＥＰ）、运动神经传导速度（ＭＣＶ）检测结果。ＳＥＰ较术前潜伏期缩短者在ＥＢ点为６３％、ＦＯ点４１％、Ｎ１点４１％、Ｐ１点４１％、Ｎ２点５０％，神经传导速度亦较术前明显缩短。对ＳＰＲ的机制进行了讨论。     

运动发育推拿法对脑瘫患儿粗大运动功能的影响

目的分析运动发育推拿法对脑瘫患儿粗大运动功能的影响。方法从2000年8月至2006年9月在复旦大学附属儿科医院康复中心接受康复治疗的脑瘫患儿中依照纳入和排除标准确定总体研究对象,通过粗大运动功能测试量表（GMFM）分值的前后变化,分析经过运动发育推拿法治疗后脑瘫患儿粗大运动功能的改变状况;在总体研究对象中按照纳入和排除标准确定基线组和随访组的分析样本,比较基线阶段、治疗阶段及随访阶段的GMFM分值改变程度之间的差异,采用相对效度（RV）确定反映总体研究对象粗大运动功能改变最为显著的GMFM功能区;使用Rasch分析法分析粗大运动功能改变最为显著的功能区项目在治疗前、后的难度改变状况,进一步分析运动发育推拿法对脑瘫患儿粗大运动功能的影响。结果研究期间共纳入142例总体研究对象,其中男性93例,女性49例;包括126例痉挛型,8例徐动型,7例混合型,1例共济失调;接受治疗前平均年龄21.84（5-95）个月。142例总体研究对象在接受了（3.3±1.4）个月治疗后,与治疗前相比GMFM各项分值在治疗后明显上升（P〈0.001）。共确定26例基线组和31例随访组分析样本。26例基线组研究对象GMFM66和88分值在治疗阶段[（2.4±1.0）个月]的平均每月改变值明显的高于基线阶段[（1.9±1.1）个月]（P〈0.05）;在GMFM5个功能分区中除A区外其余4个功能分区治疗阶段的平均每月改变值均高于基线阶段,尤其以D区和E区更为明显（P〈0.05）。31例随访组研究对象GMFM各项分值除A区外治疗阶段[（2.7±1.1）个月]的平均每月改变值明显高于随访阶段[（2.5±1.2）个月]（P〈0.05）。在评价总体研究对象治疗前、后粗大运动功能改变状况时,GMFM-B区分值RV最高（100%）,其次为GMFM-88分值（94%）和GMFM-66分值（79%）。Rasch分析结果显示总体研究对象治疗前、后GMFM-B区20个项目难度     

对小儿脑性瘫痪精细运动功能评估量表的应用评价

目的探讨精细运动功能评估量表（FMFM）的敏感性、实用性。方法收集45例脑瘫患儿随机分为A、B、C3组,每组各15例,治疗前后使用FMFM进行评估。组A和组B患儿根据评估结果制定康复计划,综合康复治疗后分别于90d、30d后再次评估。组C患儿康复不参考测试结果,常规综合康复治疗90d后再次评估。结果1．各组治疗前后FMFM量化评估对比均有显著差异（P〈0．05）;2．组A与组B治疗前后FMFM改变量进行比较,组A较组B明显（P〈0．05）;3．组A与组C治疗前后FMFM改变量进行比较,组A较组C明显（P〈0．05）。结论FMFM能客观反映疗效、有较高灵敏性和一定的临床康复指导意义,可做为一种可信评估方法推广使用。     

100例脑性瘫痪患儿的临床分析

目的从年龄、病因、诊断及治疗等方面综合观察和分析脑瘫患儿,确定其疗效结果。方法将我院脑瘫门诊康复诊治就诊的100例患儿进行回顾性研究分析,综合治疗以三个月为一疗程,参照婴幼儿运动功能评定量表(GM-FM)作为评估指标,探讨其疗效。结果患儿年龄越小,治疗时间越长,临床治疗效果越好。结论小儿脑病要早期诊断、早期干预、坚持治疗,以提高脑瘫患儿的生存质量。     

急性脑血管病患者脑干听觉诱发电位研究

目的研究急性脑血管病患者脑干听觉诱发电位（ＢＡＥＰ）变化。方法２４３例发病７天内的急性脑血管病患者和１２２例正常人进行ＢＡＥＰ检查。结果急性脑血管病患者ＢＡＥＰ异常率为８５．６％，明显高于正常对照组２５．４％，Ｐ＜０．０１。病情严重患者ＢＡＥＰ异常率为１００％，而轻、中型患者分别为７９．２％和８３．７％，与严重患者比较，Ｐ＜０．０１。ＢＡＥＰ异常主要表现为主波潜伏期和波间期延长，主波消失或分化不良。结论脑干听觉诱发电位可作为判断急性脑血管病的预后和观察病情变化的一项客观指标。     

Eye hand coordination in children with cerebral palsy

Reaching to grasp an object of interest requires complex sensorimotor coordination involving eye, head, hand and trunk. While numerous studies have demonstrated deficits in each of these systems individually, little is known about how children with cerebral palsy (CP) coordinate multiple motor systems for functional tasks. Here we used kinematics, remote eye tracking and a trunk support device to examine the functional coupling of the eye, head and hand and the extent to which it was constrained by trunk postural control in 10 children with CP (6–16 years). Eye movements in children with CP were similar to typically developing (TD) peers, while hand movements were significantly slower. Postural support influenced initiation of hand movements in the youngest children (TD & CP) and execution of hand movements in children with CP differentially depending on diagnosis. Across all diagnostic categories, the most robust distinction between TD children and children with CP was in their ability to isolate eye, head and hand movements. Results of this study suggest that deficits in motor coordination for accurate reaching in children with CP may reflect coupled eye, head, and hand movements. We have previously suggested that coupled activation of effectors may be the default output for the CNS during early development.     

Basic motor capacity in relation to object manipulation and general manual ability in young children with spastic cerebral palsy

Objective: Limited resources in terms of elementary functions may be a limiting factor for functional activities. The objective of the study was to examine basic hand motor capacities in young children with bilateral spastic cerebral palsy (BSCP) and to compare with deficits in functional activities. Method: Eighty-eight children with BSCP, 3–6 years of age, manipulated a grip object (200 g) equipped with a uniaxial force sensor. Basic motor capacity was assessed based upon (1) maximal grip strength and (2) production of fast repetitive grip force changes (FFC) while holding the object on the table. Subjects’ performance on this task was compared to the grip force amplitude and force rate assessed while the subject was lifting the same object. Results were compared between different degrees of manual ability according to the Manual Ability Classification System (MACS). Results: In children with BSCP, even in high-functioning children with MACS 1, fast grip force changes and grip strength were 2 SDs and more below the mean of controls. Differences increased from MACS 2 to 4 but not between MACS 1 and 2. During lifting children with BSCP used considerable proportions of their maximum grip strength (40–90%) and of their grip force rates during 70% vs. 86%. In some children with low manual abilities (MACS 3/4), grip force rates during lifting were higher than during FFC. Conclusion: In children with BSCP, basic motor capacity may influence manual ability, particularly in children with MACS 3 and 4. In some of these children, the underlying processes during lifting may also differ qualitatively.     

Constraints on grip selection in cerebral palsy

The present study examined whether movement characteristics of individuals with spastic hemiparesis could be accounted for by disorders in movement planning. Two experiments were performed that tested minimisation of postural discomfort and minimisation of movement costs as constraints on grip selection. In the 1st experiment, spastic subjects and controls had to pick up a bar and place it in one of 5 boxes with either the left or right side down. In addition, awkwardness ratings of the different postures were given. Minimisation of posture discomfort as constraint on grip selection was examined. In line with previous studies, grip selection for the control subjects was based on minimisation of end posture discomfort. For the unimpaired hand of the spastic subjects, no discrimination was made in discomfort ratings among the different postures. Accordingly, with this hand, subjects showed no preference for a particular grip type. The posture ratings for the impaired hand were more varied both within and between spastic subjects, and minimisation of discomfort at either the start or end could not completely account for the grips chosen. Rather, the results suggest that minimisation of total posture discomfort acted as a constraint on grip selection for this hand. In the 2nd experiment, minimisation of total movement costs as a constraint on grip selection was tested. Spastic subjects and a control group had to grasp a bar on a clockface and rotate one end to the top position, starting from 15 different starting positions. Again, the end-state comfort effect was demonstrated in the control group. For the impaired hand of the spastic subjects, minimisation of total movement costs as expressed by a reduction of the total amount of joint rotation was shown to account for the grips chosen. The lack of consistency in grip selection for the unimpaired hand at some starting positions seemed to stem from an unresolved conflict between minimisation of end posture discomfort and minimisation of total movement costs. The combined results of the two experiments suggest that grip planning in spastic hemiparetic subjects is not disturbed per se. Rather, different constraints are imposed during the grip selection process. If movements are difficult to execute (i.e. because the hand is impaired), grip planning proceeded by a minimisation of total movement costs by choosing a task solution that reduced the total amount of joint rotation.     

脑性瘫痪儿童红外热成像特点观察研究

目的　探讨脑瘫儿童热像特点,为临床应用热像观察脑瘫患儿提供参考。 方法　选取广州市社会儿童福利院中符合入选标准的脑瘫儿童（n=42）和正常儿童（n=42）分别作为观察组和对照组,使用TMI-BX1便携式红外线热影像测温系统采集儿童全身热像,通过计算机抓取额头、前胸、上腹、下腹、脊椎T4、脊椎T12、脊椎L4、左手心、右手心、左足背、右足背共11个点的平均温度值,并统计分析。 结果　两组的左右侧肢端温度差异无统计学意义（P>0.05）,两组的头面及躯干温度均高于四肢肢端温度（P<0.01）;最高温度与最低温度的极差,观察组大于对照组（P<0.05）;两组的头面温度分别低于其腹部温度,两者差异均有显著意义（P<0.01）;观察组腹部温度高于背部温度,对照组反之,两组间比较差异有显著意义（P<0.01）。 结论　脑瘫儿童腹部温度高于背部温度,正常儿童均反之,此热像特点可为临床研究提供参考。     

The relationship between breast milk intake and speech in children with cerebral palsy

Background/aimCerebral palsy (CP) is a nonprogressive neurodevelopmental disorder that cause damage to the developing brain (0–3 years) for various reasons. Children with CP commonly have speech disorders due to impairment in neuromuscular control of oro-motor coordination. We focused on the relationship between breast milk intake and speech functions in children with CP.Materials and methodsThe gross motor function classification system (GMFCS) was used to categorize the gross motor function. The viking speech scale (VSS) was used to classify the speech in children with cerebral palsy. Children were subdivided into two groups as term and preterm based on gestational age. The duration of exclusive breast milk intake was defined as the period when the infant received breast milk alone. We used Spearman’s correlation coefficient to evaluate the relationship between the duration of breast milk intake, GMFCS, and VSS.Results The median level of viking speech scale was 2 in preterm-born children and 4 in term-born children. There was no correlation between age and VSS levels.We observed a statistically significant difference in terms of preterm- or term-born status among children with different VSS levels. There was a weak positive correlation between birth weight and VSS level, indicating better speech function in children with lower birth weight. There was a moderate negative correlation between the duration of exclusive breast milk intake, the total duration of breast milk intake, and the corrected age of weaning completion with VSS level.Conclusion The duration of breast milk intake may reflect the oromotor function and predict speech performance in children with cerebral palsy. We wanted to emphasize that speech language therapy is as important as motor rehabilitation.