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GMFM-66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高于基线阶段［（1.9±1.1）个月］（P<0.05）；在GMFM 5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个项目难度与个体能力分布具有良好的相似性，20个项目治疗前、后难度值经配对t检验显示17个项目差异无统计学意义，同时治疗前、后项目难度值也表现出很高的相关性（r=0.992 1），表明运动发育推拿法并没有显著改变GMFM-B区20个项目的难度分布、难度值以及难度顺序。结论 运动发育推拿法在短期内能有效地提高脑瘫患儿的整体粗大运动功能，而且获得的粗大运动功能提高可以在短期内得到维持。

Effects of motor-development massage therapy on gross motor function in children with cerebral palsy

Objective To study the effects of motor-development massage therapy on gross motor function in children with cerebral palsy. Methods According to the inclusion and exclusion criterion 142 study participants were included from children with cerebral palsy who had been treated in Rehabilitation Center of Children′s Hospital, Fudan University from Aug. 2000 to Sept.2006, with male 93 ,female 49; spastic 126,athetoid 8,mixed 7 and ataxic 1.The average age is 21.84 months(range from 5 to 95 months)before therapy. The changes of gross motor function in children with cerebral palsy before and after motor-development massage therapy were analyzed by the scoreof gross motor function measure(GMFM). In order to further study the effects of motor-development massage therapy on gross motor Function in children with cerebral palsy, two group samples (baseline group with 26 cases and follow-up group with 31 cases) were determined from the total study participants for analysis according to certain inclusion and exclusion criteria. Differences of change of GMFM scores were compared during baseline period, therapy period and follow-up period. Relative validity was adopted to determine the GMFM dimension with the most significant gross motor function change in total study participants. Rasch analysis was used to compare the change of item difficulty of the GMFM dimension with the most significant gross motor function change before and after therapy. Results GMFM scores increased significantly after a therapy period of （3.3±1.4）months in most children of 142 participants（P<0.001）.The average monthly change value of GMFM 66 and 88 scores in baseline group was significantly higher in therapy period ［（2.4±1.0 ）months］than in baseline period［（1.9±1.1 ）months］（P<0.05）. The average monthly change value of four dimensions of GMFM-88 scores(except dimension A) was significantly higher in therapy period than in baseline period, which was more apparent with dimension D and E（P<0.05）. The average monthly change value of GMFM scores (except dimension A)in follow-up group was significantly higher in therapy period ［（2.7±1.1 ）months］than in follow-up period［（2.5±1.2 ）months］（P<0.05）. When evaluating the change of gross motor function before and after therapy in total study participants, dimension B of GMFM got the highest relative validity(RV=100%),then GMFM-88 (RV=94%) and GMFM-66（RV=79%）.Rasch analysis revealed similar distribution of 20 item difficulty and individual capacity of dimension B before and after therapy in total participants. There was no ststistical difference in 17 of 20 items with paired t test. Also high correlation existed between item difficulty values before and after therapy（r=0.992 1）. The results showed motor-development massage therapy hadn't greatly changed the difficulty distribution, difficulty value and difficulty order of 20 items of dimension B of GMFM. Conclusions Motor-development massage therapy could effectively enhance the total gross motor function of children with cerebral palsy in a short period.Moreover, those enhanced gross motor function could maintain for a short period.