目标-活动-运动环境疗法对全面性发育落后的疗效研究

The effect of goals-activity-motor enrichment therapy on children with global developmental delay

目的:研究目标-活动-运动环境疗法对全面性发育落后患儿的疗效,为治疗全面性发育落后提供循证医学依据。方法:采用病例对照研究,纳入2017年11月—2018年11月安徽大学第一附属医院小儿神经康复中心收治的177例全面性发育落后患儿,将全面性发育落后(global developmental delay,GDD)患儿用随机数字表法分为目标-活动-运动环境(goals-activity-motor enrichment,GAME)组与常规治疗组(以引导式教育原理为主),GAME组:85例,常规治疗组:92例。治疗前及治疗后8、12个月对两组患儿进行Gesell发育量表(Gesell development scale,GDS)、ADL量表评估(activity daily living scale,ADL),比较两组患儿治疗前,治疗后8、12个月发育商(development quotient,DQ)与ADL评分的差异性;比较两组患儿在治疗后12个月时进入正常化的发生率。结果:(1)发育商:治疗前GAME组DQ(52.13±14.11)与常规治疗组DQ(51.73±16.25)无显著性差异(t=0.177,P>0.05);治疗8个月后,GAME组DQ(69.01±13.27)高于常规治疗组DQ(62.46±17.64),差异有显著性意义(t=2.809,P<0.05);治疗12月后,GAME组DQ(79.89±12.44)高于常规治疗组DQ(71.34±18.11),差异有显著性意义(t=3.634,P<0.05)。(2)ADL评分:治疗后GAME组和常规治疗组ADL评分均高于治疗前,差异有显著性意义(P<0.05);治疗前GAME组与常规治疗组无显著性差异(P>0.05),治疗8月和12月时,GAME组ADL评分均高于常规治疗组,差异有显著性意义(P<0.05)。(3)预后:治疗12月时发展为正常儿:GAME组20例,常规组21例,两组差异无显著性意义(P>0.05)。结论:(1)GAME疗法对全面性发育落后患儿的认知提高优于常规疗法;(2)GAME疗法对改善患儿的日常生活能力优于常规疗法;(3)GAME疗法和常规疗法均能促进全面性发育落后患儿的DQ值正常的发生率。

Objective:To explore the efficacy of goals-activity-motor enrichment therapy on the children with global developmental delay,and to provide evidence-based medical basis for the intervention of generalized developmental delay.Method:A case-control study was performed for 177 hospitalized children with GDD from the Pediatric Neurological Rehabilitation Center of the First Affiliated Hospital of Anhui Medical University during November 2017 to November 2018,who were randomly divided into GAME treatment group(n=85)and conventional treatment group(n=92).The children in both groups were assessed with the Gesell Developmental Scale(DQ)and activity daily living(ADL)scale before treatment and after 8 and 12 months of treatment.The DQ,ADL scores and the incidence of normalization was compared between the two groups at 12 months after treatment.Result:(1)Developmental quotient:There was no significant difference of DQ between the GAME group(52.13±14.11)and the conventional treatment group(51.73±16.25)before treatment(t=0.177,P>0.05).After 8 and 12 months treatment,the DQ of GAME group(69.01±13.27,79.89±12.44)was higher than that of the conventional treatment group(62.46±17.64,71.34±18.11),and the difference was statistically significant(t=2.809,P<0.05,t=3.634,P<0.05).(2)ADL scores:The ADL scores of GAME group and conventional treatment group were both higher than those before treatment,and the difference was statistically significant(P<0.05).There was no significant difference between GAME group and conventional treatment group before treatment(P>0.05).After8 and 12 months treatment,the ADL scores of the GAME group were higher than those of the conventional treatment group(all P<0.05).(3)Prognosis:After 12 months treatment,20 cases in the GAME group and 21 cases in the conventional group developed into normal children.There was no significant difference between the two groups(P>0.05).Conclusion:(1)GAME therapy can improve the cognitive development of children with GDD.(2)GAME therapy is better than the conventional therapy in improving children’s daily living ability.(3)GAME therapy and the conventional therapy can equally promote the normalization of DQ with generalized development.