改良强制性运动疗法联合任务导向性训练对痉挛型偏瘫患儿的临床疗效观察

Clinical effect of modified constraint-induced movement therapy combined with task-oriented training on children with spastic hemiplegia

目的观察改良强制性运动疗法联合任务导向性训练对痉挛型偏瘫患儿的临床效果。方法选取2016年10月至2018年12月来江苏省无锡市儿童医院接受康复治疗的100例痉挛型偏瘫患儿,按照随机数字表法分成对照组和观察组,各50例。对照组患儿采用常规康复训练治疗,而观察组患儿在对照组的基础上联合应用任务导向性训练和改良强制性运动疗法进行治疗。比较2组患儿治疗后的上肢功能,并对2组患儿治疗前后的生活质量、跨步长度和宽度、10 m步行时间、1 min步行距离、定时起身行走测试(TUG)时间和儿童残疾评定量表(PEDI)移动功能得分进行比较。结果治疗后,观察组患儿的视觉追踪、关节活动度、手眼协调性、动手操作能力和抓握发射能力得分均明显高于对照组[(11. 7±2. 6)分比(9. 4±1. 2)分、(12. 2±1. 6)分比(9. 5±1. 4)分、(12. 6±2. 4)分比(8. 8±1. 0)分、(11. 0±1. 3)分比(9. 2±1. 2)分、(10. 6±1. 4)分比(8. 4±1. 1)分],差异均有统计学意义(均P <0. 01)。治疗后2组患儿的日常生活质量量表评分、跨步长度、1 min步行距离、PEDI移动功能得分均明显增加,跨步宽度、10 m步行时间和TUG时间均明显减少,且治疗后观察组患儿的日常生活质量量表评分、跨步长度和1 min步行距离、PEDI移动功能得分均大于对照组[(65±7)分比(53±6)分、(38. 5±2. 8) cm比(36. 6±2. 5) cm、(45. 2±6. 9) m比(37. 9±6. 3) m、(88±12)分比(81±11)分],而跨步宽度和10 m步行时间、TUG时间短于对照组[(14. 3±1. 2) cm比(17. 1±1. 6) cm、(14. 1±1. 6) s比(16. 3±1. 8) s、(22±7) s比(25±9) s],差异均有统计学意义(均P <0. 05)。结论采用改良强制性运动疗法联合任务导向性训练治疗痉挛型偏瘫患儿,能够有效恢复患儿的上肢运动功能,提高患儿平衡控制功能和步行能力,还可提高生活质量。

Objective To observe the clinical effect of modified constraint-induced movement therapy combined with task-oriented training on children with spastic hemiplegia. Methods Totally 100 children with spastic hemiplegia who had rehabilitation treatment in Wuxi Children’ s Hospital,Jiangsu Province were recruited from October 2016 to December 2018. They were randomly divided into observation group and control group,with50 cases in each group;the control group was treated with routine rehabilitation training,while the observation group underwent modified constraint-induced movement therapy and task-oriented training. Upper limb function,quality of life,stride length and width,10 m walking time,1 min walking distance,time to " up and go"( TUG)and score of mobile function assessed by Pediatric Evaluation of Disability Inventory( PEDI) were analyzed.Results After treatment,scores of visual tracking,joint range of motion,hand-eye coordination,manual operation ability and grasping/launching ability in observation group were significantly higher than those in control group[( 11. 7 ± 2. 6) vs( 9. 4 ± 1. 2),( 12. 2 ± 1. 6) vs( 9. 5 ± 1. 4),( 12. 6 ± 2. 4) vs( 8. 8 ± 1. 0),( 11. 0 ±1. 3) vs( 9. 2 ± 1. 2),( 10. 6 ± 1. 4) vs( 8. 4 ± 1. 1)]( all P < 0. 01). Quality of life score,stride length,1 min walking distance and PEDI mobile function score increased in both groups after treatment;the indexes in observation group were significantly more than those in control group[( 65 ± 7) vs( 53 ± 6),( 38. 5 ± 2. 8) cm vs( 36. 6 ±2. 5) cm,( 45. 2 ± 6. 9) m vs( 37. 9 ± 6. 3) m,( 88 ± 12) vs( 81 ± 11)]( all P < 0. 05). Stride width,10 m walking time and TUG reduced after treatment,and they were significantly less in observation group than those in control group[( 14. 3 ± 1. 2) cm vs( 17. 1 ± 1. 6) cm,( 14. 1 ± 1. 6) s vs( 16. 3 ± 1. 8) s,( 22 ± 7) s vs( 25 ± 9) s]( all P <0. 05). Conclusion Combined modified constraint-induced movement therapy and task-oriented training treating children with spastic hemiplegia can effectively restore upper limb motor function,improve balance control and walking ability,and improve the quality of life.