手-臂双侧强化训练偏瘫型脑瘫患儿对上肢功能康复及日常生活能力的影响

doi:10.3877/cma.j.issn.2095-123X.2017.01.006

目的

研究手-臂双侧强化训练偏瘫型脑瘫患儿的临床效果，观察上肢功能康复和日常生活能力改善的情况。

方法

研究对象选取新疆维吾尔自治区人民医院2014年5月到2016年1月收治的偏瘫型脑瘫患儿84例，根据其入院先后顺序分为对照组和观察组，每组各42例，对照组患儿给予综合康复训练，观察组患儿采用手-臂双侧强化训练，比较两组患儿训练前后的上肢功能和日常生活能力评分，比较两组的康复效果。

结果

训练前对照组和观察组患儿的患侧上肢改良Ashworth痉挛量表(MAS)的分级评分为(2.31±0.85/2.28±0.91)分、腕关节主动背伸角度为(16.84±5.25/17.02±5.32)度、抓握和视觉-运动整合的Peabody精细运动发育量表(PDMS-FM)评分为[(34.96±6.47)分/(35.12±6.63)分、(76.93±21.05)分/(77.36±20.78)分]、上肢技巧质量量表(QUEST)评分为[(78.25±13.25)分/(78.69±12.88)分]、日常生活能力的改良巴氏指数量表(MBI)评分为[(50.24±10.63)分/(49.84±10.49)分]，以上对比均无统计学差异(P>0.05)；训练后，观察组MAS分级评分为(1.18±0.49)分明显低于对照组的(1.87±0.76)分(P<0.01)，腕关节主动背伸角度为(32.56±7.95)度、PDMS-FM评分为[(43.16±6.58)分、(85.26±19.66)分]、QUEST评分为(86.52±11.06)分、MBI评分为(76.25±11.63)分，均明显高于对照组相应的(24.73±6.82)度、[(38.22±7.64)分、(79.25±22.03)分]、(81.37±12.43)分、(63.02±12.18)分，以上对比均具统计学差异(P<0.05)。

结论

采用手-臂双侧强化训练能明显改善偏瘫型脑瘫患儿的手臂结构及功能，显著改善患儿的上肢功能，有助于其生长发育，同时还可提高患儿的日常生活能力，具有重要的临床价值，值得在临床中推广。

关键词: 手-臂双侧强化训练, 偏瘫型脑瘫患儿, 上肢功能, 日常生活能力

Objective

To study clinical effect of hand-arm bimanual intensive training the children with cerebral palsy, and to observe the effect of upper limb functional rehabilitation and improvement of daily living ability.

Methods

84 children with cerebral palsy who came to hospital from May 2014 to January 2016 were selected, and they were divided into control group and observation group by the time they came, each group had 42 patients. The patients in control group were treated by comprehensive rehabilitation training, and the patients in observation group were treated by hand-arm bimanual intensive training. The upper limb function and daily living ability score of two groups before and after treatment were compared, and the rehabilitation effect of the two groups were compared.

Results

Before the training, the grading of the Modified Ashworth Scale(MAS) for the affected upper limb of children in the control group and observation group was (2.31±0.85/2.28±0.91); the wrist dorsiflexion angle was (16.84±5.25/17.02±5.32)°; the Peabody developmental motor scale-Fine motor(PDMS-FM) of prehension and visual motor integration was[(34.96±6.47)/(35.12±6.63)、(76.93±21.05)/(77.36±20.78)]; the Quality of Upper Extremity Skills Test (QUEST) was (78.25±13.25/78.69±12.88); the Modified Barthel Index (MBI) of daily living ability was (50.24±10.63/49.84±10.49); and there were no statistical differences between above (P>0.05). After training, MAS score of the observation group was (1.18 + 0.49), which was significantly lower than that of the control group (1.87 + 0.76) (P<0.01); the active wrist dorsiflexion angle was (32.56±7.95)°; the PDMS-FM score was [(43.16±6.58)、(85.26±19.66)]; the QUEST score was (86.52±11.06); the MBI score was (76.25±11.63), which was significantly higher than that of the control group (24.73±6.82)°, [(38.22±7.64), (79.25±22.03)], (81.37±12.43), (63.02±12.18); and there were statistical differences (P<0.05).

Conclusion

Hand-arm bimanual intensive training can significantly improve the structure and function of hemiplegic arm children with cerebral palsy, also improve children's upper limb function, contribute to its growth and development, improve the children's daily living ability, and it has important clinical value, is worthy of promotion in clinical practice.

Key words: hand-arm bimanual intensive training, children with cerebral palsy, upper limb function, daily living ability

表1 两组患儿患侧上肢肌张力及腕关节主动背伸角度比较(±s，分)

组别	患侧上肢MAS分级评分		腕关节主动背伸角度(°)
组别	训练前	训练后	训练前	训练后
对照组(42例)	2.31±0.85	1.87±0.76*	16.84±5.25	24.73±6.82*
观察组(42例)	2.28±0.91	1.18±0.49*	17.02±5.32	32.56±7.95*
t	0.16	5.04	0.12	4.84
P	0.88	0.00	0.90	0.00

表1 两组患儿患侧上肢肌张力及腕关节主动背伸角度比较(±s，分)

组别	患侧上肢MAS分级评分		腕关节主动背伸角度(°)
组别	训练前	训练后	训练前	训练后
对照组(42例)	2.31±0.85	1.87±0.76*	16.84±5.25	24.73±6.82*
观察组(42例)	2.28±0.91	1.18±0.49*	17.02±5.32	32.56±7.95*
t	0.16	5.04	0.12	4.84
P	0.88	0.00	0.90	0.00

表2 两组患儿Peabody精细运动发育量表评分比较(±s，分)

组别	抓握		视觉-运动整合
组别	训练前	训练后	训练前	训练后
对照组(42例)	34.96±6.47	38.22±7.64^*	76.93±21.05	79.25±22.03^*
观察组(42例)	35.12±6.63	43.16±6.58^*	77.36±20.78	85.26±19.66^*
t	0.11	3.18	0.49	2.67
P	0.91	0.00	0.64	0.00

表2 两组患儿Peabody精细运动发育量表评分比较(±s，分)

组别	抓握		视觉-运动整合
组别	训练前	训练后	训练前	训练后
对照组(42例)	34.96±6.47	38.22±7.64^*	76.93±21.05	79.25±22.03^*
观察组(42例)	35.12±6.63	43.16±6.58^*	77.36±20.78	85.26±19.66^*
t	0.11	3.18	0.49	2.67
P	0.91	0.00	0.64	0.00

表3 两组患儿的QUEST评分和MBI评分比较(±s，分)

组别	QUEST评分		MBI评分
组别	训练前	训练后	训练前	训练后
对照组(42例)	78.25±13.25	81.37±12.43^*	50.24±10.63	63.02±12.18^*
观察组(42例)	78.69±12.88	86.52±11.06^*	49.84±10.49	76.25±11.63^*
t	0.38	2.79	0.24	5.09
P	0.73	0.00	0.81	0.00

表3 两组患儿的QUEST评分和MBI评分比较(±s，分)

组别	QUEST评分		MBI评分
组别	训练前	训练后	训练前	训练后
对照组(42例)	78.25±13.25	81.37±12.43^*	50.24±10.63	63.02±12.18^*
观察组(42例)	78.69±12.88	86.52±11.06^*	49.84±10.49	76.25±11.63^*
t	0.38	2.79	0.24	5.09
P	0.73	0.00	0.81	0.00

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