依托扭动运动阶段全身运动质量评估对高危儿进行个性化早期综合干预的效果分析

Analysis of effect of individualized early comprehensive intervention on high-risk infants based on general movements in writhing movements stage

目的依托扭动运动阶段全身运动质量(GMs)评估结果,给予高危儿个性化早期综合干预并进行效果分析,旨在观察GMs质量评估在高危儿发育监测和早期干预中的临床应用价值,为高危儿早期干预提供研究线索。方法选取2020年1月至2022年7月在儿童保健科随访并且GMs扭动运动评估结果异常的高危儿460例,分为观察组(n=261)和对照组(n=199)。对照组接受儿童保健科常规指导,观察组在此基础上给予个性化早期综合干预。比较两组儿童不安运动(FMs)结果分布情况,并采用Gesell发育诊断量表(GDS)对两组儿童6月龄和12月龄(早产儿采用矫正月龄)的发育商(DQ)进行评估。结果干预前,两组儿童GMs扭动运动异常结果分布无差异(χ^(2)=1.568,P=0.210)。干预后,观察组正常FMs比例(末次)高于对照组(χ^(2)=6.803,P=0.009)。Gesell发育评估结果显示,观察组6月龄(近期效果)粗动作能、精细动作能、应物能、语言能和应人能DQ均高于对照组,差异有统计学意义(t值介于2.035~4.728之间,P<0.05);6个月后(12月龄),观察组儿童除外语言能DQ,对照组儿童除外粗动作能DQ,两组儿童其余能区均较6月龄时增加(均P<0.05);观察组12月龄(远期效果)各能区DQ均高于对照组,两组差距增大(t值介于6.861~9.305之间,P<0.05)。结论个性化早期综合干预可提高正常FMs的发生率,促进高危儿神经系统发育,依托扭动运动阶段全身运动质量评估对高危儿进行个性化早期综合干预具有指导意义。

Objective To analyse effect of individualized early comprehensive intervention on high-risk infants based on results of general movements assessment(GMs)in writhing movements stage,so as to explore clinical application value of GMs in development monitoring of high-risk infants.Methods 460 infants who had abnormal results of GMs assessment in writhing movements stage and were followed up in our hospital from January 2020 to July 2022 were selected.The infants were randomly divided into observation group(n=261)and control group(n=199).The infants in the control group received routine nursing,feeding and exercise guidance,while those infants in the observation group received individualized comprehensive intervention.The distributions of fidgety movements(FMs)assessment results in the infants were compared between the two groups.Gesell developmental schedule(GDS)was used to evaluate developmental quotient(DQ)of the subjects at respective 6 months of age and 12 months of age(corrected month age was used for preterm infants).Results Before intervention,there was no difference in distribution of abnormal GMs results in writhing movements stage between the two groups(χ^(2)=1.568,P=0.210).After intervention,the proportion of normal FMs results at the last time assessment in the infants in the observation group was higher than that in the control group(χ^(2)=6.803,P=0.009).GDS showed that the DQs in gross motor repertoire,fine motor repertoire,object-adaptive behavior,language skill and personal-social ability at 6 month of age(short-term effect)were higher than those in the control group,and the differences were significant(t=2.035-4.728,all P<0.05).After 6 months of intervention(at 12 months of age),except DQ in language skills in the observation group and DQ in gross motor skills in the control group,DQs in other domains of the infants in the two groups were higher than those at 6 months of age(all P<0.05).At 12 months of age(long-term effect),the DQs in all domains of the infants in the observation group were all higher than those in the control group(t=6.861-9.305,all P<0.05).Conclusion Individualized comprehensive intervention can increase incidence of normal FMs and promote neural development of those high-risk infants.Assessment of GMs in writhing movements stage has guiding significance for early individualized comprehensive intervention on high-risk infants.