Bobath技术的应用现状及发展趋势

通过整理文献,就Bobath技术国内外应用现状的差异和发展水平进行综述整理,简述Bobath技术的治疗原则,同时对Bobath技术的发展作一展望,以期增加对Bobath技术的了解。     

脑卒中后进食吞咽障碍的Bobath理论的应用

本文介绍在吞咽障碍病例的治疗过程中如何运用Bobath理论.在治疗方法中,促进躯干和头部的稳定和定向运动,帮助患者重组下颌、舌骨和喉部的分离运动,改善口腔颜面部运动功能十分重要.     

Bobath握手和双桥运动翻身法对护理人力成本的影响

目的探讨Bobath握手和双桥运动翻身法为偏瘫患者翻身时对护理人力成本的影响。方法选取脑梗死偏瘫BrunnstromⅠ-Ⅱ期的患者200例,分为对照组和观察组各100例,观察组应用Bobath握手和双桥运动翻身法,对照组采用常规一人翻身法。结果患者恢复独立自主翻身率、翻身时间、需要另一护士协助翻身人次、护理人力成本两组比较差异均具有统计学意义(P0.01)。结论应用Bobath握手和双桥运动翻身法可促进脑梗死BrunnstromⅠ-Ⅱ期偏瘫患者主动参与,提高患者主观能动性,节省护理人力成本,方法容易掌握,值得推广应用。     

The Bobath (NDT) concept in adult neurological rehabilitation: what is the state of the knowledge? A scoping review. Part II: intervention studies perspectives

Abstract

Objective: The study’s purpose was to describe the range of knowledge pertaining to the Bobath (NDT) concept in adult neurological rehabilitation, synthesizes the findings, identify knowledge gaps and develop empirically based recommendations for future research. Methods: A scoping review of research and non-research articles published from 2007 to 2012. Two independent reviewers selected studies based on a systematic procedure. Inclusion criteria for studies were electronically accessible English language literature with Bobath and/or Neurodevelopmental Therapy as the subject heading in the title/keyword/abstract/intervention comparison with respect to adult neurological conditions. Data were abstracted and summarized with respect to study design, theoretical framework, clinical application including population representation, study fidelity, intervention comparison, duration of care, measurement and findings. Results: Of the 33 publications identified 17 were intervention studies (11 RCT’s/1 prospective parallel group design/5?N-of-1). One other paper was a systematic review. Conclusions: The intervention studies, primarily RCT designs, have serious methodological concerns particularly related to study/treatment fidelity and measurement resulting in no clear clinical direction. Aspects such as theoretical framework, therapist skill, quality of movement measurement and individualized interventions require careful consideration in the design of Bobath studies.

• Implications for Rehabilitation

• Future intervention studies should be based on the current Bobath theoretical framework and key aspects of clinical practice.

• Study and treatment fidelity issues need to be carefully considered when interpreting the results of existing RCT’s evaluating the Bobath concept.

• N-of-1 randomized, observational, factorial and mixed method study designs should be considered as alternative study options.

     

Bobath技术对缓解偏瘫上肢屈肌痉挛即刻效应的作用

目的:观察健康人采用Bobath压手时手部的压力及其压力/体重的百分比、性别、利手的关系;同时观察压力大小与缓解偏瘫患者上肢痉挛即刻效应之间的关系。方法:健康人组共27例,分成男、女两个组;偏瘫组患者共14例,分别测量Bobath压手时的手部压力、压力/体重百分比和体重。评估采用机械性健康秤测量体重和手部压力,用改良的Ashworth量表(Modified Ashworth Scale,MAS),对偏瘫患者上肢肱二头肌牵伸前后的张力进行评估,分析即刻效应。结果:健康男性组利手的压力大于非利手,差异具有显著性意义(P<0.05)。健康男、女两组之间的手部压力、压力/体重的差异亦具有显著性(P<0.05)。偏瘫组中缓解痉挛有效与无效组之间的手部压力,虽有差异但无显著性意义(P>0.05);而在偏瘫组中,解痉有效组中的中青年男性患者手部压力、压力/体重比值均大于解痉无效组,且差异具有显著性意义(P<0.05)。结论:Bobath压手时的手部压力、压力/体重百分比直接影响偏瘫患者的解痉效果。其中年龄、性别、利手因素可能影响Bobath压手的效果。     

脑瘫患儿腰无力临床治疗方法探讨

目的探讨脑瘫患儿腰无力的治疗方法。方法将75例符合纳入标准的脑瘫腰无力患儿随机分为治疗组与对照组,治疗组40例给予普通针刺、穴位注射、Bobath法以及肌兴奋治疗仪综合康复治疗;对照组35例单纯给予Bobath法治疗。观察两组的总体疗效及不同年龄段的疗效。结果治疗组总有效率高于对照组,差异有统计学意义(P0.05),低年龄段治疗效果优于高年龄段,差异有统计学意义(P0.01)。结论综合方法治疗脑瘫患儿腰无力疗效显著,且年龄越小效果越好。     

新Bobath疗法对脑瘫患儿独坐能力的影响

目的：探讨引入核心稳定性训练的新Bobath疗法对脑瘫患儿独坐能力的影响。方法：将60例脑性瘫痪儿童随机分为2组,每组30例。对照组采用传统的Bobath疗法,观察组采用引入核心稳定性训练的新Bobath疗法进行治疗。每天1次,每次40分钟,每周治疗5次,共治疗3个月。采用粗大运动功能量表（ GMFM-88项）-B区对2组患儿治疗前后独坐能力的功能进行评估,并进行统计学分析。结果：治疗3个月后,2组患儿治疗后的GMFM ～B区评分均较治疗前提高（ p＜0．05）,观察组的疗效优于对照组,差异有统计学意义（p＜0．05）。结论：引入核心稳定性训练的新Bobath疗法对改善脑瘫患儿坐位能力效果更加显著。     

针刺配合Bobath法治疗痉挛型脑性瘫痪的临床观察

目的观察针刺配合Bobath法治疗痉挛型脑性瘫痪的康复效果。方法30例脑瘫患儿为针刺组,使用针刺配合Bobath法治疗。30例脑瘫患儿为运动组,采用Bobath法治疗。比较两组患儿的康复效果。结果针刺组总有效率为93%,运动组总有效率80%;两组患儿治疗后粗大运动功能测定（GMFM）评分较治疗前均有提高（P＜0.05）,针刺组评分高于运动组（P＜0.05）;两组治疗后痉挛改善针刺组总有效率76.7%,运动组总有效率50%。结论针刺配合Bobath法治疗痉挛型脑性瘫痪较单一Bobath法治疗有更好疗效。     

麦粒灸结合Bobath技术对脑卒中早期踝关节运动功能的影响

目的:探讨麦粒灸结合Bobath技术对脑卒中早期下肢踝关节运动功能的影响。方法:选取62例本病患者随机分为治疗组32例和对照组30例,两组基础治疗药物相同。治疗组采用麦粒灸结合Bobath疗法的康复训练,对照组则只进行Bobath康复训练,各治疗4周。分别于治疗前后对下肢运动功能、踝关节运动功能进行Fugl-m eyer评定。结果:治疗组总有效率为87.50%,对照组为73.33%(P<0.05);早期介入麦粒灸结合对照疗法对脑卒中患者在仰卧位、坐位和站位下踝关节的背屈、跖屈运动评分均明显优于单纯对照疗法(P<0.05)。结论:早期介入麦粒灸结合Bobath技术对脑卒中偏瘫下肢踝关节运动功能有积极的改善作用。