沙盘游戏疗法在脑瘫儿童心理康复中的临床应用

Clinical application of sandplay therapy in psychosocial rehabilitation of children with cerebral palsy

目的探讨沙盘游戏在脑瘫儿童心理康复中的作用。方法选取2012年1月至2014年1月来沂水县人民医院进行诊治的150例脑瘫患儿作为研究对象,按照Conners父母症状问卷(PSQ)量表测评,对脑瘫儿童进行肢体行为和心理行为测量,并按照电脑产生的随机数列将150例患者平均分为观察组和对照组,每组75例。观察组在传统康复治疗的基础上加用沙盘游戏疗法治疗脑瘫儿童,对照组采用传统物理康复疗法。每周治疗次数为3次,每次持续40min,进行12周连续治疗,比较两组脑瘫患儿治疗前后PSQ各因子(品行问题、学习问题、心身问题、冲动-多动、焦虑、多动指数)得分变化情况和治疗前后患儿焦虑自评量表(SAS)及抑郁自评量表(SDS)评分情况。结果观察组和对照组治疗后PSQ各因子(品行问题、学习问题、心身问题、冲动-多动、焦虑、多动指数)得分相对于治疗前均有所降低,差异均具有统计学意义(t值分别为3.42、4.28、3.59、3.57、4.38、5.41,均P<0.05);两组患儿治疗干预前SAS及SDS评分情况均无明显差异,试验组患儿干预后SAS及SDS评分情况均明显优于对照组患儿,差异均具有统计学意义(t值分别为5.13、5.28,均P<0.05)。结论常规物理康复治疗、沙盘游戏治疗联合应用临床效果较佳,既可以改善脑瘫患儿行为异常,又可以对患者进行心理康复治疗,唤醒他们的意识,最终发挥自我治愈的能力,值得临床推广应用。

Objective To explore the role of sandplay in psychological rehabilitation of children with cerebral palsy （CP）. Methods From January 2012 to January 2014, 150 cases of CP diagnosed and treated in Shandong Province Yishui County People＇ s Hospital were selected as study objects, and their physical and psychological behavior were measured with Conners Parent Symptom Questionnaire （PSQ） scale. In accordance with computer-generated random number column, the patients were divided into control group and observation group with 75 cases in each. In the observation group sandplay therapy was used based on traditional rehabilitation, while in the control group only traditional physical rehabilitation therapy was provided. Treatment was given 3 times a week lasting 40 minutes, and 12 weeks of treatment were continuously given. Two groups of children were compared before and ＇after treatment in terms of PSQ factors （ conduct problems, learning problems, psychosomatic problems, impulsivity - hyperactivity, anxiety, hyperactivity index） and clinical efficacy. Results After treatment both groups had lower scores in PSQ factors （conduct problems, learning problems, psychosomatic problems, impulsivity- hyperactivity, anxiety, hyperactivity index） and the differences were significant （t value was 3.42, 4.28, 3.59, 3.57, 4.38 and 5.41, respectively, all P 〈 0.05 ）. The total effective rate of the observation group was significantly higher than that of the control group （X2 = 5. 39, P 〈 0.05 ）. Conclusion Combining traditional physical rehabilitation therapy with clinical application of sandplay therapy obtains better clinical effect on improving both abnormal behavior of children with CP and psychological rehabilitation. It can awaken patients＇ consciousness and ultimately self-healin~ ability.