GAME疗法与姿势控制对重度脑性瘫痪患儿运动功能的影响

Effect of goals-activity-motor enrichment therapy combined with postural control on motor function in children with severe cerebral palsy

目的探讨目标-活动-运动环境(goals-activity-motor enrichment,GAME)疗法与姿势控制对重度脑性瘫痪患儿运动功能发育的影响,为改善重度脑性瘫痪患儿的运动功能提供循证医学依据。方法采用前瞻性病例对照研究,纳入重度脑性瘫痪患儿92例,按照随机数字表法分为研究组(n=46)和常规治疗组(n=46)。研究组采用GAME疗法与姿势控制训练,常规治疗组采用神经发育学疗法。比较2组患儿治疗前及治疗6个月、治疗12个月时粗大运动功能量表88项评估(gross motor function measure,GMFM-88)中的仰卧位与俯卧位(A区)和坐位(B区)、精细功能评估(fine motor function measure,FMFM)中视觉追踪(A区)和上肢关节活动(B区)、坐位能力(level of sitting scale,LSS)、疼痛(face-legs-activity-cry-consolability,FLACC)和日常生活活动能力量表(activitydaily livingscale,ADL)评分。结果2组GMFM-88(A区与B区)、FMFM(A区与B区)、LSS及ADL评分均呈逐渐升高趋势,FLACC评分呈逐渐降低趋势,研究组GMFM-88(A区与B区)、FMFM(A区与B区)、LSS及ADL评分高于常规治疗组,FLACC评分低于常规治疗组,组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05)。结论GAME疗法与姿势控制可以提高重度脑性瘫痪患儿粗大运动功能、坐位能力和精细运动功能,缓解疼痛,改善日常生活活动能力。

Objective To investigate the effects of goals-activity-motor enrichment(GAME)therapy combined with postural control on motor function in children with severe cerebral palsy(CP),and to provide evidence-based medical basis for improving motor function in children with severe CP.Methods In this prospective case-control study,92 children with severe CP were included and randomly divided into research group(n=46)and conventional treatment group(n=46)according to random number table.The research group was treated with GAME therapy combined with postural control training,while the conventional treatment group was treated with neurodevelopmental therapy.Supine and prone position(area A)and sitting position(area B)in Gross Motor Function Measure-88(GMFM-88),eye tracking(area A)and upper limb joint activity(area B)in Fine Motor Function Measure(FMFM),Level of Sitting Scale(LSS),Face-Legs-Activity-Cry-Consolability(FLACC)and Activities of Daily Living(ADL)scores were compared before treatment,and at 6 months and 12 months after treatment.Results The scores of GMFM-88(area A and area B),FMFM(areaA andarea B),LSS and ADL in the two groups were gradually increased,while the scores of FLACC were gradually decreased.The scores of GMFM-88(area A and area B),FMFM(area A andarea B),LSS and ADL in the research group were higher than those in the conventional treatment group,while FLACC scores were lower than those of conventional treatment group;the difference of interaction between groups,time points and time points between groups was statistically significant(P<0.05).Conclusion GAME therapy combined with postural control can improve gross motor function,sitting ability and fine motor function,relieve pain and improve the ADL in children with severe CP.