基于Bobath理念的核心稳定性训练对痉挛型脑性瘫痪儿童运动功能的影响

目的:观察基于Bobath理念的核心稳定性训练对痉挛型脑性瘫痪(SCP)儿童运动功能的影响。方法:选取2018年1月—2019年9月在南京医科大学附属儿童医院康复医学科治疗的SCP儿童124例,按随机数字表法分为对照组和观察组,每组62例。对照组给予常规康复治疗,主要包括抗痉挛(关节活动、被动牵拉)、作业、语言、按摩、运动训练(躯干旋转、髋内收、骨盆旋前及控制、肢体活动、站坐及平衡、提腿行走、屈膝),1次/d,40 min/次,6 d/周,共持续治疗3个月。观察组在对照组基础上给予基于Bobath理念的核心稳定性训练,主要包括静态训练(髋伸展、髋膝踝屈曲、点支撑、桥式等)和动态训练(划桨、躯干支撑、躯干旋转、追视玩具等),1次/d,80 min/次,6 d/周,共持续治疗3个月。于治疗3个月后采用改良Ashworth量表(MAS)评估痉挛状态;于治疗前及治疗1、3个月后采用Peabody精细运动发育量表(PDMS-FM)评估精细运动功能,采用粗大运动功能量表(GMFM-88)评估粗大运动功能,采用Berg平衡量表(BBS)评估平衡能力,采用日常生活活动能力量表(ADL)评估日常生活能力。结果:治疗前,2组PDMS-FM、GMFM-88、BBS和ADL评分比较,差异无统计学意义(P>0.05)。治疗3个月后,观察组痉挛改善有效率高于对照组,差异有统计学意义(P<0.05)。与治疗前比较,2组治疗1、3个月后PDMS-FM、GMFM-88、BBS、ADL评分均明显提高;与治疗1个月后比较,2组治疗3个月后PDMS-FM、GMFM-88、BBS、ADL评分均明显提高,差异有统计学意义(P<0.05)。与对照组治疗后同一时间点比较,观察组PDMS-FM、GMFM-88、BBS和ADL评分均明显更高,差异有统计学意义(P<0.05)。结论:基于Bobath理念的核心稳定性训练可改善SCP儿童痉挛状态及运动功能,提高平衡功能及日常生活活动能力,值得临床推广。

Effect of Core Stability Training based on Bobath Concept on Motor Function of Children with Spastic Cerebral Palsy

Objective:To observe the effect of core stability training based on Bobath concept on motor function of children with spastic cerebral palsy(SCP).Methods:A total of 124 children with SCP were treated in the department of rehabilitation medicine of Children's Hospital of Nanjing Medical University from January 2018 to September 2019,which were divided into the control group and the observation group according to the random number table,with 62 cases in each group.The control group was given conventional rehabilitation treatment,which mainly included anti-spasm(joint movement,passive traction),homework,language,massage,sports training(trunk rotation,hip adduction,pelvic pronation and control,limb movement,standing and balance,walking with legs raised,knee bending),one time a day,40 min a time,six days a week,continuous treatment for three months.The observation group was given core stability training based on Bobath's concept on the basis of the control group,which mainly included static training(hip extension,hip,knee and ankle flexion,point support,bridge training,etc.)and dynamic training(paddling,trunk support,trunk rotation,chase toy etc.),one time a day,80 min a time,six days a week,continuous treatment for three months.After treatment for three months,the modified Ashworth scale(MAS)was used to assess spasticity;Before treatment and after treatment for one month and three months,the Peabody development motor scale-fine motor(PDMS-FM)was used to assess fine motor function,and the gross motor function measure-88(GMFM-88)was used to assess gross motor function,the Berg balance scale(BBS)was used to assess balance ability,and the activity of daily living scale(ADL)was used to assess the ability of daily living.Results:There was no significant difference in the PDMS-FM,GMFM-88,BBS and ADL scores of the control group and the observation group before treatment(P>0.05).After treatment for three months,the effective rate of spasticity improvement in the observation group was higher than that in the control group,the difference was statistically significant(P<0.05).Compared with before treatment,the PDMS-FM,GMFM-88,BBS and ADL scores in the control group and the observation group after treatment for one month and three months were higher;compared with the treatment after one month,the PDMS-FM,GMFM-88,BBS and ADL scores in the control group and the observation group after treatment for three months were higher,the difference was statistically significant(P<0.05).Compared with the control group at the same time,the PDMS-FM,GMFM-88,BBS and ADL scores in the observation group were higher,the difference was statistically significant(P<0.05).Conclusion:The core stability training based on Bobath concept can effectively improve the spasticity symptoms,motor function,balance function and activities of daily living of children with SCP,it's worthy of further clinical promotion.