数码听觉统合训练治疗痉挛型脑性瘫痪的疗效

Clinical effects of auditory integrative training on children with spastic cerebral palsy

目的 探讨数码听觉统合训练治疗痉挛型脑性瘫痪患儿智力、语言、运动方面的效果.方法 选取2011年1月至2013年12月在广西壮族自治区人民医院康复科门诊随访已停止常规康复治疗的痉挛型脑性瘫痪患儿60例,年龄2-4岁,按随机数字表法分为2组,接受数码听觉统合训练治疗的30例为治疗组,另30例无任何治疗的患儿为对照组.采用盖塞尔（Gesell）发育量表及粗大运动功能评估量表（GMFM-66）评定2组患儿训练前、训练后3个月在智力、语言及运动方面的变化情况,并用单光子发射断层成像（SPECT）技术观察患儿治疗前后脑血流灌注情况.结果 治疗组治疗后社会适应能力、个人社交能力、语言能力发育商（DQ）总体均数（52.44±13.43、52.07±11.57、57.19 ±6.18）高于对照组（45.09±11.02、45.86±9.66、53.44±5.49）,2组间差异有统计学意义（t=-2.32、-2.26、-2.49,P均＜0.05）;治疗组治疗前后粗大运动DQ、精细运动DQ及GMFM-66总分差异无统计学意义[40.40±8.57、49.50±14.20、（55.81 ±8.72）分比44.03±11.90、46.34±9.78、（58.81±7.86）分,t=-1.42、1.08、-0.52,P均＞0.05].治疗前后头颅SPECT检查比较,2组患儿脑血流灌注均有不同程度恢复,治疗前2组脑血流异常灌注100.00％,治疗后下降至36.67％,优于对照组,差异有统计学意义（x2=35.49,P＜0.05）.结论 短期数码听觉统合训练能促进痉挛型脑性瘫痪患儿智力、语言的发育,改善患儿大脑血液灌注,可作为治疗脑性瘫痪合并智力、语言发育障碍的一项重要的辅助方法.但对运动方面影响较少.

Objective To investigate the short-term treatment effectiveness of the auditory integrative training（AIT） on intelligence, language and gross motor function in children with spastic cerebral palsy （CP）.Methods Sixty patients with spastic CP, aged 2 to 4 years old,who had been given all the routine conventional rehabilitation at the Rehabilitation Department of the People＇s Hospital of Guangxi Zhuang Autonomous Region from January 2011 to December 2013 were randomly divided into AIT treatment group （30 cases） and control group without AIT （30 cases）, all patients were investigated by using Gesell Developmental Scales and the Gross Motor Function Measure （GMFM）-66 before and after 3-month therapy, and the changes in the regional cerebral blood flow of children （rCBF） were detected by single photon emission computed tomography （SPECT） before and after treatment.Results The scores of development quotient （DQ） of the treatment group after the AIT in areas of adaptive behavior, personal-social behavior,language（52.44 ± 13.43,52.07 ± 11.57,57.19 ± 6.18） were higher than those of the control group （45.09 ± 11.02,45.86 ± 9.66,53.44 ± 5.49）, and the differences between the 2 groups were greatly significant statistically（t =-2.32,-2.26,-2.49, all P 〈 0.05）.There were no significant difference in DQ of gross motor, fine motor and scores on the GMFM-66 in the treatment group before and after treatment [40.40 ± 8.57,49.50 ± 14.20, （55.81 ±8.72） scores vs 44.03 ±11.90,46.34±9.78,（58.81 ±7.86） scores,t=-1.42,1.08,-0.52,all P〉 0.05].SPECT detected abnormalities in all patients （100.00%） both in the 2 groups, compared with the control group,the rCBF was improved significantly after treatment in the treatment group （86.67%） （x2 =35.49 ,P 〈 0.05）.Conclusions The treatment of AIT can greatly improve the intelligence, language development and the brain function in children with spastic CP.It is an effective adjutant of rehabilitation method for children with spastic CP to improve intelligence and language development, and has less influence on motor function.