引导式教育结合推拿对重度脑瘫患儿活动能力的影响

Effect of Conductive Education Combined with Massage on Activity of Children with Severe Cerebral Palsy

目的分析引导式教育与推拿治疗相结合对重度脑瘫患儿活动能力的影响。方法 2010年4月~2010年10月上海市徐汇区致康康健园接受康复治疗的11例脑瘫患儿参加本研究,其中男性7例,女性4例;痉挛型四肢瘫7例,痉挛型双瘫1例,徐动型2例,肌张力障碍型1例;年龄4.7~11.9岁,平均7.47岁。患儿随机分成两组：A组（n=5）前3个月进行引导式教育和推拿治疗,后3个月进行常规物理治疗;B组（n=6）前3个月进行常规物理治疗,后3个月进行引导式教育和推拿治疗。引导式教育结合推拿治疗期间称为干预期,常规物理治疗期间称为对照期。分别采用粗大运动功能测试量表（GMFM）和精细运动功能测试量表（FMFM）进行粗大运动功能和精细运动功能测试,采用能力低下儿童评定量表（PEDI）进行日常生活能力测试,比较引导式教育结合推拿与常规物理治疗在提高脑瘫患儿活动能力方面的疗效差异。结果干预期的GMFM分值和FMFM分值上升或呈上升趋势（P〈0.05）,而在对照期呈下降趋势。差值比较,GMFM分值变化无显著性差异;而FMFM分值变化有显著性差异,且干预期高于对照期（P〈0.05）。PEDI各项分值变化无显著性差异。结论与常规物理治疗相比引导式教育结合推拿治疗可能会提高重度脑瘫患儿的精细运动功能。

Objective To analyze the effect of conductive education combined with massage on activity of children with severe cerebral palsy.Methods 11 children（7 males and 4 females） with cerebral palsy receiving rehabilitation therapies in CereCare Wellness Centre of Xuhui,Shanghai from April to October 2010 were enrolled in this study.The type of cerebral palsy was as follows： 7 tetraplegia,1 diplegia,2 athetoid,and 1 dystonia.The average age was 7.47 years,ranging from 4.7~11.9 years.The participants were divided randomly into 2 groups.5 children in group A accepted conductive education and massage therapy in the first 3 months,and then accepted routine rehabilitation therapies in the next 3 months.6 children in group B accepted routine rehabilitation therapies in the first 3 months,and then accepted conductive education and massage therapy in the next 3 months.The phase of conductive education combined with massage was called intervention period,and the phase of routine rehabilitation therapies was called contrast period.The gross motor function was assessed with Gross Motor Function Measure Scale（GMFM）,while the fine motor function was assessed with Fine Motor Function Measure Scale（FMFM）.Pediatric Evaluation of Disability Inventory（PEDI） was used to assess activities of daily living.The different effects between conductive education combined with massage and routine rehabilitation therapies were compared.Results The scores of GMFM and FMFM both increased in intervention period,while both decreased in contrast period.The score of FMFM increased significantly（P〈0.05）.The scores of PEDI changed without statistical significance.Conclusion Conductive education combined with massage may increase the fine motor function of children with severe cerebral palsy compared with routine rehabilitation therapies.