注意缺陷多动障碍儿童视反馈平衡功能训练前后行为问题及平衡功能改善的观察

Observation of behavior problem and posture stability before and after visual feedback balance training in children with attention deficit hyperactivity disorder

目的:探讨视反馈平衡功能训练20次对注意缺陷多动障碍患儿行为问题及平衡功能的影响。方法:选择2001-09/2003-09北京大学精神卫生研究所门诊就诊儿童29例,为病例组,男25例,女4例,平均年龄(12±2)岁。对照组29例,为附近小学按性别、年龄(相差不超过6个月)配对的正常儿童。采用Neurocom公司出产的BalanceMaster机型对注意缺陷多动障碍患者进行治疗。①基础训练:患儿在坐、站及行进中进行重心转移训练,共30min。②游戏训练:通过重心转移完成技术难点,共20min。治疗过程为一对一的训练模式。治疗2～6次/周,20次为1个疗程,共2～4个月。评估方法:①治疗前后评定固定平面睁眼和闭眼、海绵垫平面睁眼和闭眼、左/右脚睁眼和闭眼8种状态下被试的静态直立平衡功能,并与正常儿童比较。平衡功能测试不同感觉状态下重心摇摆度,识别参与控制姿态的视觉、前庭和本体等3种平衡功能,每一个状态测3次,20s/次。记录3次的平均摇摆速率。②治疗前后进行Conners儿童行为问卷调查:该量表可得出6个因子分,包括行为问题、学习问题、躯体问题、多动、焦虑和多动指数。③Rutter儿童行为问卷调查:问卷评分分为3级,总分的最高分为62分,凡≥13分者有行为问题,分为违纪行为或称反社会行为和神经症行为。④注意缺陷多动障碍评定量表-IV(父母版)调查:包括18个条目的量表,每个条目对应精神障碍诊断与统计手册第4版中注意缺陷多动障碍18个症状标准中的一条。每一条目按照0～3评分。总分为18个条目的评分总和。各项测试病例组患儿于治疗前后各评定1次,对照组仅评定1次平衡功能。结果:纳入患者29例和正常儿童29例,均进入结果分析。①注意缺陷多动障碍患儿治疗前海绵垫平面闭眼、左/右腿睁眼、闭眼条件下摇摆速率明显高于正常对照,差异显著[治疗前分别为(1.6±0.5),(1.2±0.6),(1.2±0.5),(2.8±1.0),(2.8±1.0)°/s,对照组分别为(1.1±0.4),(0.9±0.2),(1.0±0.4),(1.9±0.7),(2.1±0.7)°/s,t=-3.287,-2.443,-2.529,-3.542,-3.032,P<0.05]。治疗后海绵垫平面睁眼条件下摇摆速率明显低于治疗前,差异非常显著[治疗前后分别为(0.8±0.3),(0.6±0.2)°/s,t=3.808,P<0.01]。治疗后左、右腿单腿闭眼站立摇摆速率均明显低于治疗前,差异显著[左侧治疗前后分别为(2.8±1.0),(2.0±0.6)°/s,右侧治疗前后分别为(2.8±1.0),(2.2±0.7)°/s,t=3.957,2.758,P<0.05],达到正常水平。②训练20次后Conner测试中多动分和多动指数明显下降,差异显著[治疗前后多动分分别为(5.5±2.8),(4.0±2.4)分,治疗前后多动指数分别为(12.8±4.5),(10.8±5.6),t=3.348,2.299,P<0.05]。③Rutter测试中总分、违纪行为分明显下降,差异非常显著[治疗前后总分分别为(17.0±6.4),(12.8±5.9)分,治疗前后违纪行为分分别为(3.4±1.7),(2.2±1.9)分,t=3.832,4.137,P<0.01]。④注意缺陷多动障碍评定量表-IV问卷测试中注意缺陷分、多动、冲动分、总分均明显下降,差异显著[治疗前后注意缺陷分分别为(15.9±3.5),(13.3±5.1)分,治疗前后多动、冲动分分别为(10.2±4.8),(7.6±5.1)分,治疗前后总分分别为(26.1±6.1),(20.9±9.1)分,t=2.136,3.260,2.930,P<0.05]。⑤患者在海绵垫平面睁眼的变化幅度与Rutter行为量表中违纪行为变化幅度成正相关(r=0.526,P=0.012)。结论:视反馈平衡功能训练能提高患儿的姿势稳定性,同时能较全面的改善患儿的行为问题。

AIM： To discuss the effect of visual feedback balance training for 20 times on the behavior program and balance functions of children with attention deficit hyperactivity disorder （ADHD）. METHODS： Twenty-nine children [25 males and 4 females, mean aged （12±2） years] were recruited from the child psychiatric clinics at Mental Health Institute of Peking University from September 2001 to September 2003 as the case group. Twenty-nine normal children （age and sex matched） from nearby primary school were recruited as the control group. The ADHD children were treated with the Balance Master produced by Neurocom company. ①Primary training, 30 minutes： The ADHD children shifted their gravity during sitting, standing and walking for 30 minutes. ② Games training： The game was completed by shifting gravity for 20 minutes. The one-to-one training pattern was used in the treatment, 2-6 times in every week, and 20 times as a course for totally 2-4 months. Evaluation methods： ①Static posture stability was tested under 8 different conditions （firm surface with eyes open, firm surface with eyes closed, foam pad with eyes open, foam pad with eyes closed, unilateral stance with eyes open and closed）, one condition was tested for three times, 20 s per time. The mean sway velocity was recorded. ② Conner＇s behavior rating scaleparent questionnaire was applied before and after therapy： The scaled consisted of six factors, including behavior problem, learning problem, body complaining, hyperactivity, anxiety and hyperactivity index. ③ Rutter children＇s behavior scale, it was scored by three grades, the highest total score was 62. When total score beyond 13, it meant the child had behavior problem, antisocial behavior or neurotic behavior. ④ ADHD scale-Ⅳ （parent version）： The 18 items of Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition （DSM-Ⅳ） were used as a rating scale for ADHD symptom. Each item was scored by 0-3 grades. ADHD children had these tests before and after therapy respectively, and those in the normal control only had balance function test. RESULTS： All the 29 ADHD children and 29 normal children entered the analysis of results. ① The sway velocities of gravity under the conditions of foam surface with eyes closed, unilateral stance with eyes open and close before therapy in the ADHD group were significantly higher than those in normal controls [Before therapy： （1.6±0.5）, （1.2±0.6）, （1.2 ±0.5）, （2.8±1.0）, （2.8±1.0）°/s, normal control： （1.1±0.4）, （0.9±0.2）, （1.0 ±0.4）, （1.9±0.7）, （2.1±0.7）°/s, t=-3.287, -2.443, -2.529, -3.542, -3.032, P 〈 0.05]. After therapy the sway velocity decreased under the condition of foam surface with eyes open [Before and after therapy were （0.8±0.3）, （0.6 ±0.2）°/s, t=3.808, P 〈 0.01]. And also after therapy the sway velocity decreased under the condition of unilateral sLance with eye close [left was （2.8±1.0）, （2.0±0.6） °/s; right was （2.8±1.0）, （2.2±0.7）°/s, t=3.957, 2.758, P 〈 0.05]. ②Mter training for 20 times, the scores of hyperactivity factor and index of Conner＇s behavior rating scale decreased significantly [hyperactivity factor： （5.5±2.8）, （4.0±2.4）, index： （12.8±4.5）, （10.8±5.6）, t =3.348, 2.299, P 〈 0.05]. ③ The total score and score of breaking rule behavior were very significantly decreased [total score before and after therapy： （17.0±6.4）, （12.8±5.9）; score of breaking rule behavior before and after therapy： （3.4±1.7）, （2.2±1.9）, t=3.832, 4.137, P 〈 0.01].④ The scores of inattention, hyperactivity-impulse and total scores of DSM-Ⅳ questionnaire were significantly decreased [（15.9±3.5）, （13.3±5.1）; （10.2 ±4.8）, （7.6±5.1）; （26.1±6.1）, （20.9±9.1）, t=2.136, 3.260, 2.930, P 〈 0.05]. ⑤ There was a positive correlation between the changing range of foam surface eye open and the score of breaking rule behavior in Rutter children＇s behavior scale （r=-0.526, P=0.012）. CONCLUSION： visual feedback balance training can improve the posture stability and behavior problems of ADHD children.