上肢力量训练对脑瘫患儿手功能和日常生活活动能力的影响

Effect of upper limb strength training on hand function and activities of daily living in children with cerebral palsy spastic hemiplegia

目的:观察上肢力量训练对痉挛型偏瘫的脑瘫患儿上肢、手功能及日常生活活动能力的影响。方法:痉挛型偏瘫脑瘫患儿60例随机分成观察组和对照组,每组30例,其中对照组采用常规的作业治疗方案,观察组在对照组的基础上介入上肢力量训练。治疗前和治疗2、4及6个月后分别采用改良的Ashworth量表、电子握力计、Carroll手功能评定、ADL量表对2组患儿的上肢屈肌肌张力、手指握力、上肢及手功能和日常生活活动能力进行评定,并对2组治疗前后及不同时间点效果进行比较。结果:2组肌张力经4及6个月治疗后较治疗前明显降低(P<0.05),组间各时间点对比无显著差异;2组各时间点握力评分均优于前一时间点(均P<0.05),2组间治疗前、治疗2及4个月的握力评分无显著差异,观察组6个月后的握力评分高于对照组(P<0.05);2组各时间点Carroll评分均优于前一时间点(均P<0.05),2组间治疗前、治疗2及4个月的Carroll评分比较无显著差异,6个月后观察组的Carroll评分明显优于对照组(P<0.05);2组各时间点ADL评分均优于前一时间点(均P<0.05),2组间治疗前、治疗2及4个月的ADL评分无显著差异,6个月后观察组的ADL评分明显优于对照组(P<0.05)。结论:在常规作业治疗的基础上,适当加强上肢力量训练能更好地改善痉挛型偏瘫患儿上肢及手的功能,有效提高患儿的日常生活活动能力。

Objective:To observe the effects of upper limb strength training on upper limb,hand function and activities of daily living in children with spastic hemiplegia with cerebral palsy.Methods:From June 2018 to June 2019,60 children with spastic hemiplegia and cerebral palsy treated in the Rehabilitation Department of Wuxi Children’s Hospital were randomly divided into treatment group and control group,with 30 cases in each group.The upper limb flexor muscle tension,finger grip strength,upper limb and hand function and activities of daily living of the two groups were analyzed by modified Ashworth scale,electronic grip meter,Carroll hand function evaluation and ADL scale before and after treatment for 2 months,4 months and 6 months respectively,and the effects of the two groups were compared before and after treatment and at different time points.Results:Muscle tension in the two groups decreased significantly after treatment of 4 and 6 months as compared with that before treatment(P<0.05).There was no significant difference between the two groups at different time points.The grip strength scores in the two groups at each time point were better than those at the previous time point(all P<0.05),and there was no significant difference between the two groups before,and 2 months and 4 months after treatment.The grip strength scores in the treatment group after 6 months of treatment were significantly higher than those in the control group(P<0.05).The Carroll scores in the two groups at each time point were higher than those at the previous time point(all P<0.05),and there was no significant difference between the two groups before treatment,2 months after treatment and 4 months after treatment.The ADL scores in the two groups at each time point were higher than those at the previous time point(all P<0.05),and there was no significant difference between the two groups before treatment,2 months after treatment and 4 months after treatment,but the ADL scores in the treatment group were significantly higher than those in the control group after 6 months of treatment(P<0.05).Con clusion:On the basis of routine occupational therapy,properly strengthening upper limb strength training can better improve the functions of upper limbs and hands of children with spastic hemiplegia,and effectively improve their activities of daily living.