脑性瘫痪功能康复训练的技法分析

Analysis of training techniques for the functional rehabilitation of cerebral palsy

目的:从国内外脑性瘫痪康复治疗的发展现状出发,对脑性瘫痪功能康复训练的常见技法进行分析,通过对这些观点的比较、分析、综合和概括,以探讨脑性瘫痪康复训练技法的选择和运用。资料来源:应用计算机检索Medline数据库1991-01/2003-12期间的相关文章,检索词“cerebralpalsy,functiontraining,rehabilitation”,限定文章语言种类为英文。同时计算机检索中国期刊全文数据库、万方数据库1995-01/2005-12期间的相关文章,检索词“脑性瘫痪、康复训练、功能”,限定文章语言种类为中文。并手工检索1998-2004期间关于脑性瘫痪康复训练的专著。资料选择:对资料进行初审,选取与脑性瘫痪、康复训练、功能有关的包括治疗组和对照组的文献、专著,然后筛除与功能康复技法无关的文献,对剩余的文献开始查找全文,以是否为对照临床试验和康复训练相关研究作为纳入标准。资料提炼:共收集到68篇关于脑性瘫痪康复训练的随机和未随机试验的文献和专著,15篇文献符合纳入标准,排除53篇。53篇中35篇是重复的同一研究,6篇是综述文献,12篇为Meta分析研究。资料综合:①脑性瘫痪的病因较为复杂,出生前、围产期及出生后的多种疾病均可致本病,有15%～20%的病例发病原因不清。②脑性瘫痪的治疗应该是综合性的,多方面的康复医疗,应采用物理、作业、语言、手术、中医手法等治疗方法进行矫治和训练,其中以建立在小儿发育神经学、运动神经学、生理学基础上的神经生理学疗法为基础的康复训练是重要的手段之一。康复治疗可促进脑细胞功能重建的理论基础是中枢神经可塑性理论。③常用的方法主要有:Vojta法、Bobath法、Rood法、上田法、引导式教育、感觉统合训练及作业疗法等。④对较小年龄和程度较重的脑性瘫痪儿童采用Vojta和Bobath等神经生理学疗法康复效果较显著。对年龄较大、有一定运动功能基础和语言智力较好患儿,需进行力量训练、协调性训练和控制能力训练。肌肉控制能力训练主观能动性较强,对加强膝关节控制能力、骨盆控制能力、肌肉力量、协调性和运动控制能力有较满意的康复效果,且经过重复的训练和学习,在患儿脑中形成正确的运动程序。结论:脑性瘫痪的康复在于早期持久的纠正异常的姿势和肢体的功能训练。脑性瘫痪康复的每一种训练,都有肯定的治疗效果,但要取得较理想的效果必须有选择性地综合运用这些方法,并规范这些技法。

OBJECTIVE： Based on the present status of development of rehabilitative treatment of cerebral palsy （CP） in domestic and abroad, to analyze the common techniques of functional rehabilitation training for patients with CP, and probe into its alternatives and applications by comparing, analyzing, synthesizing and summarizing these techniques. DATA SOURCES： Relevant literatures in Medline between January 1991 and December 2003 were searched by computer with the words of ＂cerebral palsy, function training, rehabilitation＂, and the language was limited to English. At the same time,relevant Chinese articles in Chinese periodical full text database and Wanfang database from January 1995 to December 2005 were searched by computer with the key words of ＂cerebral palsy, function training, rehabilitation＂. In addition,monographs about CP from 1998 to 2004 were searched manually. STUDY SELECTION： Data were retrieved in the first screening. Literatures and monographs including treatment group and control group related to CP, rehabilitation training and function were selected, and articles without relation to functional rehabilitation techniques were excluded. Full-text of the rest articles were looked for according to the inclusion criteria of whether was controlled clinical trial or related to rehabilitation training. DATA EXTRACTION： A total of 68 literatures and monographs related to rehabilitation training of CP were collected regardless of whether they were randomized designs, 15 literatures were in accordance with the inclusion criteria, 53 were excluded, 35 out of which were repetitive studies, 6 were reviews and 12 were Meta analysis researches. DATA SYNTHESIS： ①The causes of CP were complex ,many diseases in pre-born period, perinatal period and post-bern period can result in CP, but causes in 15 to 20 percent of patients with CP were not clear.②Treatment of CP should be comprehensive and extensive rehabilitation treatment. Patients should be treated and trained with physical therapy, occupational therapy （OT）, language therapy and operative treatment. Chinese traditional medicine ,etc. One of the most important methods was rehabilitative training,which based on the neurophysiologic therapy of pediatric growth neurology, motor neurology and physiology. Basic theory of rehabilitative treatment can promote the functional reconstruction of brain cells was a plastic theory of central nerve. ③Main therapeutic methods included Vojta, Bobath, Rood, Shangtian method, guidance education, sensory integrated training and OT,etc.④Vojta and Bobath etc. had remarkable therapeutic effects on young children with severe CP. As to older children with CP who had some motor function and good abilities in intelligence and language, training of strength, concordance and controllability should be conducted on them. Muscular controllability training had better subjective motility, which had satisfactory rehabilitative effects in strengthening the controllability of knee and pelvis as well as reinforcing the muscular power, concordance＇and controllability of motor. Through repetitive training and studying, correct motor procedure can form in children＇s brains. CONCLUSION： Rehabilitation of CP is to persistently rectify abnormal posture, and exercise limbs in earlier period. The therapeutic effect of each rehabilitative technique is affirmative. However,ideal effects can only he achieved by alternatively and comprehensively applying and consolidating these techniques.