任务导向性训练对脑瘫儿童手功能的疗效研究

Effect of task-oriented training on hand function of children with cerebral palsy

目的研究任务导向性训练对痉挛型脑瘫儿童手功能及日常活动参与的疗效变化。方法选取2018年1月至2019年12月在陕西省康复医院做康复训练的4~14岁痉挛型脑瘫儿童60例,采用随机对照方法分为研究组及对照组。研究组采用任务导向性训练结合常规康复治疗,对照组采用常规康复训练,两组治疗时间均为3个月。治疗前及治疗3个月后对两组儿童分别应用Peabody运动发育量表-精细运动(PDMS-FM)、儿童能力评估量表(PEDI)进行功能及能力评定并比较。结果治疗3个月后,研究组与对照组PDMS-FM评分、PEDI评分均优于治疗前(研究组:t值分别为4.514、22.557;对照组:t值分别为3.451、16.013,均P<0.05),且研究组优于对照组(t值分别为2.016、4.011,均P<0.05)。治疗后,研究组学龄期儿童PDMS-FM、PEDI评分均高于学龄前期儿童(t值分别为3.968、4.625,均P<0.05),手功能分级(MACS)为Ⅰ~Ⅱ级的儿童PDMS-FM、PEDI评分均高于MACSⅢ~Ⅳ级儿童(t值分别为2.917、3.579,均P<0.05)。结论痉挛型脑瘫儿童通过任务导向性训练有利于改善双手抓握及实物操作能力;任务导向性训练结合常规康复训练有利于改善痉挛型脑瘫儿童的日常生活活动。年龄及功能障碍严重程度等因素可能影响任务导向性训练的康复疗效。

Objective To study the effect of task-oriented training(TOT)on hand function and daily activities participation in children with spastic cerebral palsy.Methods A total of 60 children with spastic cerebral palsy who received rehabilitation training in Shaanxi Provincial Rehabilitation Hospital from January 2018 to December 2019 and aged 4-14 years were collected and randomly divided into study group and control group by randomized control method.The study group was given task-oriented training combined with routine rehabilitation treatment,while the control group was given routine rehabilitation training only.The treatment time of both groups was 3 months.Finally,Peabody Developmental Motor Scales-Fine Motor(PDMS-FM)and Pediatric Evaluation of Disability Inventory(PEDI)were used to evaluate the function and ability of two groups of children before and 3 months after treatment.Results The PDMS-FM scores and PEDI scores of the control group and the study group after treatment were better than those before treatment(control group:t=3.451 and 16.013,respectively;study group:t=4.514 and 22.557,respectively,all P<0.05),and PDMS-FM and PEDI scores in the study group after treatment were better than those in the control group(t=2.016 and 4.011,respectively,P<0.05).After treatment,PDMS-FM and PEDI scores of school-age children in the study group were all significantly higher than those of pre-school-age children(t=3.968 and 4.625,respectively,both P<0.05),and PDMS-FM and PEDI scores of children with manual ability classification system(MACS)ofⅠ-Ⅱgrades were significantly higher than those of children with MACS ofⅢ-Ⅳgrades(t=2.917 and 3.579,respectively,both P<0.05).Conclusion Task-oriented training for children with spastic cerebral palsy is beneficial to improve hands grasping and physical operation ability.And task-oriented training combined with routine rehabilitation training can improve the daily living activities of children with spastic cerebral palsy.But age and severity of dysfunction might affect the rehabilitation effect of task-oriented training.