手-臂双侧强化训练对偏瘫型脑瘫患儿上肢功能康复及日常生活能力的影响

目的探讨手-臂双侧强化训练对偏瘫型脑瘫患儿上肢功能康复及日常生活能力的影响。 方法选取新疆维吾尔自治区人民医院康复科自2014年5月至2016年1月收治的偏瘫型脑瘫患儿84例，根据其入院先后顺序分为对照组和观察组，每组42例。对照组患儿给予综合康复训练，观察组患儿采用手-臂双侧强化训练，比较2组患儿训练前后的上肢功能和日常生活能力评分，分析其康复效果。 结果训练前对照组和观察组患儿的患侧上肢改良Ashworth痉挛量表（MAS）的分级评分分别为（2.31±0.85、2.28±0.91），腕关节主动背伸角度为（16.84±5.25）°、（17.02±5.32）°]，抓握和视觉-运动整合的Peabody精细运动发育量表（PDMS-FM）评分为（34.96±6.47）、（35.12±6.63），（76.93±21.05）、（77.36±20.78）]，上肢技巧质量量表（QUEST）评分为（78.25±13.25、78.69±12.88）、日常生活能力的改良巴氏指数量表（MBI）评分为（50.24±10.63、49.84±10.49），差异均无统计学意义（P>0.05）；训练后，观察组MAS分级评分（1.18±0.49）分明显低于对照组（1.87±0.76），腕关节主动背伸角度（32.56±7.95）°、抓握和视觉-运动整合的PDMS-FM评分（43.16±6.58）、（85.26±19.66）]、QUEST评分（86.52±11.06）、MBI评分（76.25±11.63）均明显高于对照组（24.73±6.82）°、（38.22±7.64）、（79.25±22.03）]、（81.37±12.43）、（63.02±12.18），差异均具有统计学意义（P<0.05）。 结论采用手-臂双侧强化训练能明显改善偏瘫型脑瘫患儿的手臂结构及功能，显著改善患儿的上肢功能，有助于其生长发育，同时还可提高患儿的日常生活能力，具有重要的临床价值，值得在临床中推广。

Effects of hand-arm bimanual intensive training the children with cerebral palsy on upper limb function rehabilitation and activity of daily living

ObjectiveTo explore the effect of hand-arm bimanual intensive training on upper limb function rehabilitation and daily living ability of children with cerebral palsy. MethodsEighty-four children with cerebral palsy who came to Xinjiang Uygur Autonomous Region People’s Hospital from May 2014 to January 2016 were selected, and they were divided into control group and observation group by the time they came, each group had 42 patients. The patients in control group were treated by comprehensive rehabilitation training, and the patients in observation group were treated by hand-arm bimanual intensive training. The upper limb function and daily living ability score of two groups before and after treatment were compared, and the rehabilitation effect of the two groups were compared. ResultsBefore the training, the grading of the modified Ashworth scale (MAS) for the affected upper limb of children in the control group and observation group was (2.31±0.85/2.28±0.91); the wrist dorsiflexion angle was (16.84±5.25)°/(17.02±5.32)°]; the Peabody developmental motor scale-fine motor (PDMS-FM) of prehension and visual motor integration was (34.96±6.47)/(35.12±6.63), (76.93±21.05)/(77.36±20.78)]; the quality of upper extremity skills test (QUEST) was (78.25±13.25/78.69±12.88); the modified Barthel index (MBI) of daily living ability was (50.24±10.63/49.84±10.49); and there were no statistical differences between above (P>0.05). After training, MAS score of the observation group was (1.18±0.49), which was significantly lower than that of the control group (1.87±0.76) (P<0.05); the active wrist dorsiflexion angle was (32.56±7.95)°; the PDMS-FM score was (43.16±6.58), (85.26±19.66)]; the QUEST score was (86.52±11.06); the MBI score was (76.25±11.63), which was significantly higher than that of the control group (24.73±6.82)°, (38.22±7.64), (79.25±22.03)], (81.37±12.43), (63.02±12.18); and there were statistical differences (P<0.05). ConclusionHand-arm bimanual intensive training can significantly improve the structure and function of hemiplegic arm children with cerebral palsy, also improve children’s upper limb function, contribute to its growth and development, improve the children’s daily living ability, and it has important clinical value, is worthy of promotion in clinical practice.