高危儿早期干预策略的临床研究

Clinical study on early intervention strategies for high-risk infants

目的对本康复机构就诊的高危儿系统管理,实施机构联合家庭康复方法,探索高危儿早期管理的有效策略。方法采用随机单盲对照的试验方法,选取0~24月龄发育迟缓的高危儿114例,将其分为干预组(55例)和家庭组(59例)。干预组进行机构训练,每周1次家长培训;家庭组由家长执行家庭训练,每月机构指导一次。3月后采用Gesell发育量表、Peabody运动量表2(PDMS-2)比较分析两组儿童各项功能变化。结果干预前两组儿童月龄、高危因素数比较(t值分别为-0.566、0.229)、Gesell量表各发育商比较(t值分别为-1.080、-0.504、1.929、-1.451、0.271)、PDMS-2粗大运动、精细运动发育商比较(t值分别为-0.317、-0.857)差异均无统计学意义(均P>0.05)。3月后干预组Gesell评估适应性、大运动、个人-社交能力高于家庭组(t值分别为2.417、2.266、2.082),差异有统计学意义(均P<0.05);干预组PDMS-2粗大运动、总运动发育商明显高于家庭组(t值分别为2.548、2.478),差异有统计学意义(均P<0.05)。结论早期个体化干预、机构结合家庭康复、关注家长课堂、家庭康复指导,是一种经济有效的高危儿管理模式。Gesell量表与PDMS-2联合应用,对高危儿早期干预具有评估-训练指导-再评估的作用。

Objective To explore effective strateges for early management of high-risk infants through studies of the systematic management of high-risk infants in our rehabilitation institution,and implementation of methods of institution combined family rehabilitation.Methods A randomized single-blind controlled trial was conducted.114 high-risk infants with developmental retardation aged 0-24 months were selected and divided into intervention group and family group(55 and 59 cases respectively).Based on the assessment,the rehabilitation program was developed,and the intervention group received institutional rehabilitation and parents course once a week.The family group received family training by parents directed by the therapist once a month.The functional changes of the two groups were compared after 3 months according to the Gesell developmental scale and the Peabody developmental motor scale.Results Before intervention,the comparison of age,the number of risk factors of the two groups(t=-0.566,0.229,respectively,P>0.05),Gesell developmental quotient(t=-1.080,-0.504,1.929,-1.451,0.271,P>0.05),Peabody scale(PDMS-2)gross motor and fine motor development quotient(GMQ,FMQ)(t=-0.317,-0.857,respectively,P>0.05)showed that there were no statistical differences.After 3 months,in Gesell assessment,the levels of adaptiveness,gross motor,and personal-social in the intervention group were higher than those of the family group(t=2.417,2.266,2.082,respectively,P<0.05),with a statistically significant difference.The levels of GMQ and TMQ of the intervention group was significantly higher than those of the family group(t=2.548,2.478,respectively,P<0.05),with a statistically significant difference.Conclusion Early individualized intervention and institution combined with family rehabilitation,focusing on parents’education and family rehabilitation extension,is an economical and effective management mode for high-risk infants.Gesell scale combined with PDMS-2 is useful for evaluation-training-instruction and re-evaluation for early intervention in high-risk infants.