疫情隔离期间远程居家康复模式对脑性瘫痪儿童及家属的影响

Effect of Remote Home Rehabilitation Mode on Children with Cerebral Palsy and Their Families during Epidemic Isolation

目的:观察新型冠状病毒肺炎疫情隔离期间远程居家康复管理模式对脑性瘫痪(CP)儿童发育及家属情绪的影响。方法:选择2020年12月1日—2021年1月5日于河北省中医院儿童康复科门诊治疗的CP儿童80例,按照随机数字表法分为对照组和观察组,每组40例。对照组接受常规居家隔离防控和日常运动训练,康复治疗师应用手机或电脑视频等远程媒体平台对CP儿童及其家属进行居家隔离措施、社区防控措施、心理疏导、膳食和喂养及日常运动指导,运动训练内容主要参照《新型冠状病毒肺炎流行期间0~6岁居家儿童运动指导建议》进行,1次/d,30 min/次,5次/周,共持续1个月。观察组在居家防控隔离基础上采用远程居家康复管理模式进行干预,CP儿童家属在康复治疗师远程指导下对患儿进行居家运动、作业、言语、认知、推拿等方面的训练,1次/d,30 min/次,5次/周,共持续1个月。分别在干预前后采用Gesell量表对患儿进行发育商(DQ)评价;采用中医临床症状积分评价临床疗效;采用体质量秤测量体质量;采用彩色多普勒超声仪检测CP儿童脑动脉平均血流速度(Vm)、血管阻力指数(RI)等脑血流动力学指标;采用汉密尔顿抑郁量表(HAMD-17)评价CP儿童家属的抑郁程度。结果:干预前,2组DQ评分、中医临床症状积分、Vm、RI、体质量及HAMD-17等指标比较,差异均无统计学意义(P>0.05)。与干预前比较,2组干预后体质量、Vm、HAMD-17评分均明显升高,观察组干预后DQ评分明显升高,RI明显降低,差异具有统计学意义(P<0.05)。与对照组比较,观察组干预后DQ评分、Vm均明显更高,中医临床症状积分、RI、HAMD-17评分均明显更低,差异具有统计学意义(P<0.05)。2组干预后体质量比较,差异无统计学意义(P>0.05)。结论:远程居家康复管理模式能有效促进CP儿童生长发育,改善立迟、行迟、语迟、手足软、手足硬等症状,缓解CP儿童家属抑郁情绪,是疫情隔离期间CP儿童康复训练的有效模式之一。

Objective:To observe the effect of remote home rehabilitation mode on the development of children with cerebral palsy and their families'emotions during the quarantine for COVID-19.Methods:A total of 80 children with cerebral palsy(CP)who were treated in Children's rehabilitation department of Hebei Hospital of Traditional Chinese Medicine,the outpatient department from December 1,2020 to January 5,2021 were randomly divided into the control group and the observation group,with 40 cases in each group.The control group received routine home quarantine control and daily exercise training.Rehabilitation therapists used mobile phones or computer videos and other remote media platforms to carry out home isolation measures,community prevention and control measures,psychological counseling,dietary and feeding guidance and daily exercise guidance for CP children and their families.The exercise training content mainly refered to"exercise guidance and advice for children aged 0-6 years old during the epidemic of COVID-19",once a day,30 minutes each time,five times a week,continuous intervention for one month.The observation group received remote home rehabilitation mode on the basis of prevention and control isolation at home,CP children's families trained their Children in movement,occupation,speech,cognition,massage at home under the remote guidance of rehabilitation therapists,once a day,30 minutes a time,five times a week,continuous training for one month.Before and after intervention,Gesell scale was used to evaluate the growth and development of the children with CP;the clinical symptom score of traditional Chinese medicine(TCM)was used to evaluate clinical effect;weight scale was used to measure body mass;color doppler ultrasound was used to detecte cerebral hemodynamics indexes such as the cerebral artery mean arterial blood flow velocity(Vm)and vascular resistance index(RI);Hamilton depression scale(HAMD-17)was used to evaluate the depression of the CP children's family members.Results:Before intervention,there were no significant differences in DQ score,clinical symptom score of TCM,Vm,RI index,body mass and HAMD-17 score between two groups(P>0.05).Compare with before intervention,body weight,Vm and HAMD-17 scores of the two groups after intervention were significantly increased,DQ score of the observation group after intervention was significantly increased,the RI was significantly decreased,with statistically significant differences(P<0.05).Compared with the control group,DQ score and Vm of the observation group after intervention were significantly higher,while clinical symptom score of TCM,RI and HAMD-17 scores of the observation group after intervention were significantly lower,the difference was statistically significant(P<0.05).There was no significant difference in body mass between the two groups after intervention(P>0.05).Conclusion:Remote home rehabilitation mode can effectively promote the growth and development of CP children,improve the symptoms of tardiness in standing,walking,speaking,soft and hard hands and feet,and relieve the depression of CP children's family members,which is an effective rehabilitation training mode for CP children during the period of epidemic isolation.