Objectives To analyze the effect of sling exercise therapy on the walking ability of children with spastic hemiplegia and cerebral palsy, and to provide a scientific basis for clinical treatment. Methods Children with spastic hemiplegia and cerebral palsy who were treated in the Department of Rehabilitation of Children’s Hospital of Shanghai from July 2018 to July 2019 were selected as the research subjects. The children were divided into conventional treatment group and sling exercise therapy group by random number table method. The routine treatment group was given routine rehabilitation training, and the sling exercise therapy group was given combined sling exercise therapy on the basis of routine treatment. The Gross Motor Function Measure (GMFM)-88-item E functional area score, Clinical Spasticity Index (CSI) and Berg Balance Scale (BBS) score were compared between the two groups. Results A total of 36 children were included, with 18 cases in each group. There was no significant difference in gender, age and hemiplegia side between the two groups (P>0.05). All children completed the trial without adverse reactions. Before treatment, there was no significant difference in BBS, CSI and GMFM-88 E functional area scores between the two groups (P>0.05). After 3 months of treatment, the above scores of the two groups were improved compared with those before treatment (P<0.05). The improvement of the above scores in the sling exercise therapy group after treatment was better than that in the conventional treatment group. The difference of BBS, CSI, and GMFM-88 E functional area scores in the sling exercise therapy group before and after treatment was 8.94±4.15, 2.44±0.71, and 7.28±3.23, respectively, the difference of the above scores before and after treatment in the conventional treatment group was 4.50±4.15, 1.83±0.79, and 2.89±1.64, respectively, and the differences were statistically significant (P<0.05). Conclusion Combined use of sling exercise therapy can better improve the walking ability of children with spastic hemiplegia and cerebral palsy, which is worthy of clinical promotion and application.
【摘要】 目的 观察悬吊运动系统治疗（sling exercise therapy， SET）联合神经发育疗法治疗对痉挛型脑性瘫痪儿童肌张力及日常生活活动能力（activities of daily living，ADL ）的影响。 方法 2008年8月-2009年3月收治的40例双下肢痉挛型脑性瘫痪儿童纳入研究。根据随机数字表法分为治疗组与对照组，每组各20例。对照组与治疗组均采用神经发育疗法进行康复训练，治疗组在神经发育疗法基础上配合悬吊运动系统治疗。观察两组患儿治疗1、3个月时肌张力与ADL变化。 结果 治疗1个月时，治疗组患儿肌张力缓解明显优于对照组（P＜0.05），3个月时，治疗组肌张力缓解程度明显优于对照组。两组ADL评分比较，治疗组ADL评分改善情况明显优于对照组（P＜0.05）。 结论 悬吊运动系统治疗联合神经发育疗法可明显缓解痉挛型脑性瘫痪患儿童肌张力，提高ADL。【Abstract】 Objective To observe the effects of sling exercise therapy (SET) combined with neurodevelopmental therapy on muscle tension and activities of daily living (ADL) of children with spastic cerebral palsy. Methods Forty children with spastic cerebral palsy on bilateral lower limb were selected in our study. The children were randomly divided into a treatment group and a control group, 20 children in each group. Both the two groups were accepted rehabilitation training by neurodevelopmental therapy, while the treatment group was received SET as cooperate cure based on the neurodevelopmental therapy. The changes of muscle tension and ADL on the one and three months after treatment were observed. Results On the one and three months after treatment, the remission of muscle tension and improvement of ADL score were better than those in the control group, the differences were statistically significant(Plt;0.01). Conclusion SET combined with neurodevelopmental therapy can relieve the muscle tension, and improve the ADL of children with spastic cerebral palsy.
ObjectiveTo evaluate the differences of visual evoked potentials (amplitudes and latency) between cerebral palsy (CP) children and normal children. MethodsThis study involved fourteen children aged from 4 to 7 years with CP (monoplegia) between 2009 and 2013. Another 14 normal children aged from 5 to 9 years treated in the Department of Ophthalmology in West China Hospital during the same period were regarded as the control group. Both eyes of all the participants were examined by multifocal visual evoked potential (mfVEP). The mfVEP examination results were recorded, and amplitude and latency were analyzed. First, we analyzed the differences of amplitudes and latency time between monoplegia children and children in the control group. Second, gross motor function classification system (GMFCS) was used to classify the fourteen monoplegia children among whom there were five GMFCS Ⅰ patients and nine GMFCS Ⅱ patients. The differences of mfVEP were analyzed between the two GMFCS groups. ResultsThe amplitude and latency of mfVEP in children with CP showed gradual changes similar to those in the normal children. The amplitudes were decreasing and the latencies were delaying from the first eccentricity to the sixth eccentricity. The amplitudes in children with CP were lower than those in the control group in the first to the third eccentricities for both eyes (P＜0.05), and latency of left eye was delayed in the first eccentricity in children with CP (P=0.045). No difference was found between the two GMFCS groups (P>0.05) except the amplitude of the first eccentricity (P=0.043). ConclusionsThe results of mfVEP show significant differences of amplitude and latency between CP and normal children, suggesting the existence of visual pathway impairments in cerebral palsy children. The results of mfVEP can provide an objective basis of visual impairments for cerebral palsy children.
ObjectiveTo summarize the advancement of precise diagnosis and treatment for spastic cerebral palsy in recent years.MethodsThe literature and own experiences were reviewed, and the surgical method, precise diagnosis, and personalized treatment of spastic cerebral palsy based on the classification of spastic cerebral palsy were summarized and analyzed.ResultsThe common classification of spastic cerebral palsy are gross motor function classification system (GMFCS) and manual ability classification system (MACS). The surgical methods of spastic cerebral palsy can be divided into soft tissue surgery, nerve surgery, and bone and joint surgery. The precise diagnosis of spastic cerebral palsy includes qualitative diagnosis, localization diagnosis, and quantitative diagnosis. Based on precise diagnosis and classification, one or more corresponding surgical methods are selected for treatment.ConclusionThe manifestations of spastic cerebral palsy are so diverse that it is necessary to select rational surgeries based on precise diagnosis to achieve individualized treatment.
The Chinese Guideline for Rehabilitation of Cerebral Palsy (hereinafter referred as Guideline) is the first evidence-based guideline for rehabilitation of cerebral palsy, which was compiled by Chinese experts from different fields in 2015. The Guideline suggests that the diagnosis of cerebral palsy needs to meet four essential conditions and two reference conditions. Although the cerebral palsy can be diagnosed according to the Guideline, there is still the question that whether there is a clear age definition and standardized prediction methods for early diagnosis and accurate prediction of cerebral palsy. The Guideline does not give a clear definition of age and standardized prediction methods. There is no international unified understanding or specific recommendations as well. Recently, Dr Iona Novak and other experts have pointed out that the historical viewpoint of the latent or silent period (before the age of 12-24 months) has already been outdated, because cerebral palsy or " high risk of cerebral palsy” can be accurately predicted before the corrected age of 6 months and it is possible to accurately predicte whether it is cerebral palsy or " high risk of cerebral palsy” before the corrected age of 6 months. They proposed a standardized assessment program for early diagnosis. This article introduces and discusses the relevant descriptions of the Guideline and the latest international understanding of early diagnosis and intervention of cerebral palsy.
ObjectiveTo observe whether multipoint target muscle injection of botulinum toxin type A (BTX-A) in the treatment of spastic cerebral palsy in children is better than non-multipoint target muscle injection. MethodsFrom February to October 2013, 42 children with spastic cerebral palsy were treated in our hospital. According to the treatment sequence, the children were numbered. Those with an odd number were designated into multipoint target muscle injection group (group A), and those with an even number were put into non-multipoint target muscle ordinary injection group (group B). Each group had 21 children, and all of them were treated with the injection of BTX-A. Modified Ashworth Scoring (MAS) was performed for all the children before treatment, and 2 weeks, one month, and three months after treatment. The change of dorsiflexion range of motion with knee flexion and extension was recorded and compared. The analysis was done by using multilevel statistical method. ResultsBoth groups of children had significantly improved their ankle range and modified Ashworth score (P<0.05). No interaction between measurement time and group was detected, and the differences between the two groups had no statistical significance (P>0.05). ConclusionLower muscle tone, greater ankle mobility and better motor function can be achieved after Botulinum toxin A treatment. For now, we cannot draw the conclusion that the effect of multipoint target muscle injection is better than that of non-multipoint target muscle injection in the treatment of spastic cerebral palsy in children.
Objective To assess the medium- and long-term effectiveness of selective posterior rhizotomy (SPR) for spastic cerebral palsy. Methods A retrospective analysis was made on 27 patients with spastic cerebral palsy undergoing SPR between January 1997 and January 2008, whose data were complete with more than 5 years follow-up. There were 14 males and 13 females with an average age of 10.1 years (range, 4-19 years). All patients had simple spastic cerebral palsy, including 17 cases of bilateral spastic palsy and 10 cases of unilateral spastic palsy. The muscle strength, muscle tone, ambulatory function, the sharp foot and crossing-feet, knee jerk, ankle clonus, and Babinski’s sign were evaluated before and after operation. Results All the patients were followed up 5-16 years (mean, 9.6 years). No obvious limitation of lumbar flexion, extension and lateral flexion, spondylolisthesis, kyphosis, and other deformities occurred. At last follow-up, the muscle strength of hip extensors, hip flexors, and knee extensors were significantly increased when compared with preoperative ones (P lt; 0.05); but no significant difference was found in the muscle strength of hip abductors, hip adductors, knee flexors, plantar extensors, and plantar flexors (P gt; 0.05). Abnormal increased muscle tone of hip flexors, hip adductors, knee flexors, and plantar flexors was declined in different degrees in all patients, showing significant differences when compared with preoperative ones (P lt; 0.05); but no significant difference was found in hip extensors, hip abductors, knee extensors, and plantar extensors (P gt; 0.05). At last follow-up, the status of toe steps and crossing-feet disappeared without recurrence for a long time. Sthenic knee jerk was eliminated, but there were several patients also keeping the active knee jerk, showing significant difference when compared with preoperative ones (Z= — 7.404, P=0.000). The results of Babinski’s sign were negative in 31 sides and positive in 13 sides, showing significant difference when compared with preoperative ones (Z= — 6.897, P=0.000). No sharp foot or crossing-feet was observed. And ambulation ability was significantly improved after operation (Z= — 4.111, P=0.000). Conclusion SPR is very effective in decreasing the muscle tone and improving the motor function without recurrence in long-term.
Present study used diffusion tensor image and tractography to construct brain white matter networks of 15 cerebral palsy infants and 30 healthy infants that matched for age and gender. After white matter network analysis, we found that both cerebral palsy and healthy infants had a small-world topology in white matter network, but cerebral palsy infants exhibited abnormal topological organization: increased shortest path length but decreased normalize clustering coefficient, global efficiency and local efficiency. Furthermore, we also found that white matter network hub regions were located in the left cuneus, precuneus, and left posterior cingulate gyrus. However, some abnormal nodes existed in the frontal, temporal, occipital and parietal lobes of cerebral palsy infants. These results indicated that the white matter networks for cerebral palsy infants were disrupted, which was consistent with previous studies about the abnormal brain white matter areas. This work could help us further study the pathogenesis of cerebral palsy infants.
目的 研究需要行颈动脉外膜剥脱术脑瘫患儿全身麻醉（全麻）诱导时给予盐酸戊乙奎醚预防术后口腔分泌物过多的效果。 方法 2009年12月－2011年12月选择60例美国麻醉医师协会分级Ⅰ～Ⅱ级的需要在全麻下行颈动脉外膜剥脱术的脑瘫患儿，随机分为两组，每组30例。A组于麻醉诱导时静脉注射阿托品10 μg/kg，B组于麻醉诱导时静脉注射戊乙奎醚10 μg/kg。分别记录两组的麻醉持续时间、入室心率、气管插管后10 min的心率差、停药后的拔管时间及拔管时口腔分泌物评分[采用视觉模拟评分法（VAS）]。 结果 两组相比，患儿麻醉持续时间、入室心率和停药后拔管时间差异均无统计学意义（P＞0.05），而拔管时口腔分泌物的VAS评分差异有统计学意义（P＜0.05），其中口腔分泌物过多（VAS＞2分），A组为46.67%，B组为16.67%，B组比A组口腔分泌物更少，气管插管后10 min心率A组为（28.30 ± 9.73）次/min，B组为（9.93 ± 10.25）次/min，两组差异有统计学意义（P＜0.05）。 结论 盐酸戊乙奎醚能够有效减少需要行颈动脉外膜剥脱术的脑瘫患儿术后口腔分泌物过多的情况，且比常规应用阿托品的效果更好。
目的 探讨康复护理日常生活活动（RNADL）评定在小儿脑性瘫痪（脑瘫）手术后护理的价值。 方法 选择2012年6月－10月200例脑瘫术后患儿为研究对象，随机分为观察组和对照组，每组100例，采用 RNADL对两组患儿进行功能障碍分型判断及障碍等级评定，并分别实施相应治疗方案及护理措施，并就2个月后的康复效果进行评价。 结果 与入组时比较，观察组患儿在2个月时的RNADL评分显著增高（P＜0.01），其2个月时重度障碍的患儿较对照组明显减少（P＜0.05）。 结论 RNADL评定是脑瘫患儿康复治疗的前提和基础，通过正规RNADL评定后采取合理有效的康复治疗方案能明显改善患儿的日常生活能力。