远程指导方式的居家康复在脑瘫SDR术后的应用分析

Analysis of the application of home based rehabilitation by telecommuting for cerebral palsy children after SDR

目的探讨痉挛型脑瘫(SCP)在单椎板选择性脊神经后根切断术(SDR)后进行远程指导居家康复模式的意义。方法回顾性分析了90例SDR术后居家康复的SCP患儿资料,使用粗大运动功能评定量表(GMFM)和儿童功能独立性评定量表(WeeFIM)量化术前、术后半年及1年的疗效,统计术后1年居家康复的相关费用和脱落率。其中,43例选择门诊康复指导方式(HR-OA),47例选择远程康复指导方式(HR-TA)。结果居家康复的HR-OA组统计结果:GMFM-66术前35.2±8.5、术后半年48.2±9.4、术后1年64.6±13.5,WeeFIM术前43.9±10.8、术后半年50.3±14.1、术后1年62.7±11.0。居家康复的HR-TA组统计结果:GMFM-66术前34.8±7.7、术后半年58.5±8.6、术后1年66.1±17.3,WeeFIM术前42.6±11.3、术后半年57.6±12.3、术后1年65.0±12.5。每组内术前和术后康复半年、术后康复半年和1年对比,GMFM-66和WeeFIM两项均P<0.05;两组间对比,GMFM-66和WeeFIM两项术前P>0.05、术后半年P<0.05、术后1年P>0.05。两组术后1年的康复相关费用分别为4.2±2.7万元、1.6±0.4万元,P<0.05;两组术后1年的康复脱落率分别为44.2%(19例)、12.8%(6例),P<0.05。两组患儿总体预后良好。结论在居家康复时,采取HR-TA方式要比HR-OA方式更具优越性。SDR结合居家康复的疗效是肯定的。

Objective To investigate the significance of home-based rehabilitation by telecommuting for spastic cerebral palsy(SCP)children after selective dorsal rhizotomy(SDR).Methods The data of 90 SCP cases undergone home-based rehabilitation after SDR,were analyzed retrospectively.The Gross Motor Function Measure Scale(GMFM)and the Functional Independence Measure for Children(WeeFIM)were used to quantify the efficacy before SDR,half year and 1 year after SDR.The related cost and the loss rate of home-based rehabilitation in 1 year after SDR were aggregated.Among all cases,43 cases chose home-based rehabilitation by outpatient assistance(HR-OA);47 cases chose home-based rehabilitation by telecommuting assistance(HR-TA).Results The statistical results of HR-OA group were,GMFM-6635.2±8.5 before SDR,48.2±9.4 half year after SDR,64.6±13.5 one year after SDR;WeeFIM 43.9±10.8 before SDR,50.3±14.1 half year after SDR,62.7±11.0 one year after SDR.The statistical results of HR-TA group were,GMFM-6634.8±7.7 before SDR,58.5±8.6 half year after SDR,66.1±17.3 one year after SDR;WeeFIM 42.6±11.3 before SDR,57.6±12.3 half year after SDR,65.0±12.5 one year after SDR.The GMFM-66 or WeeFIM data within each group were compared of in preoperative and in half year after SDR,in half year after SDR and in 1 year after SDR,and P<0.05 for all.The GMFM-66 and WeeFIM data between the two groups were compared of in preoperative and resulted P>0.05,in half year after SDR and resulted P<0.05,in 1 year after SDR and resulted P>0.05.The related rehabilitation cost(unit:10,000 yuan)in 1 year after SDR was 4.2±2.7 for HR-OA group and 1.6±0.4 for HR-TA group,and resulted P<0.05.The loss rate of rehabilitation in 1 year after SDR was 44.2%(19 cases)for HR-OA group and 12.8%(6 cases)for HR-TA group,and resulted P<0.05.The prognosis was all good in both groups.Conclusion In home-based rehabilitation,Telecommuting mode is more advantageous than Outpatient mode.The efficacy of SDR combined with home-based rehabilitation is positive.