摘要
目的:观察体外冲击波疗法结合作业治疗对痉挛型脑性瘫痪(SCP)儿童前臂旋前障碍的影响。方法:选择2019年1月—12月就诊于广州中医药大学附属南海妇产儿童医院儿童康复科的SCP儿童42例,按照随机数字表法分为对照组和观察组,每组21例。对照组给予针对性作业治疗,包括上肢前臂旋前肌牵伸治疗[神经生理疗法(Bobath技术)、本体感觉神经肌肉促进疗法(PNF术)],选择游戏类作业训练(前臂旋后位放置物品、旋后抓握木棍、旋后取物游戏、手心手背游戏等)。以上训练1次/d,30 min/次,每周6次,3个月为1个疗程,共治疗2个疗程。观察组在对照组基础上给予体外冲击波治疗。患儿取舒适体位,上肢前臂放置于平面上,使其不抗自身重力。使用冲击波治疗仪探头冲击旋前圆肌肌腹(压力强度:1.0~1.5 bar;频率:8~10Hz;冲击次数:1 000~2 000次)。每次3~5 min,每隔3天1次,每周2次,3个月为1个疗程,共治疗2个疗程。分别于治疗前、治疗3、6个月后采用改良Ashworth量表(MAS)评估前臂旋前肌群痉挛程度;采用关节活动度量角器测量前臂旋后主动关节活动度(AROM);采用Peabody精细运动发育量表(PDMS-FM)评估双手精细运动商(FMQ)。结果:治疗前,2组MAS评分、AROM角度和FMQ评分比较,差异均无统计学意义(P>0.05)。与治疗前比较,2组治疗后3、6个月MAS评分均明显降低,AROM角度和FMQ评分均提高,差异具有统计学意义(P<0.05)。与对照组治疗后同一时间点比较,观察组MAS评分明显更低,AROM角度和FMQ评分均明显更高,差异具有统计学意义(P<0.05)。结论:体外冲击波疗法结合作业治疗可有效改善SCP儿童上肢痉挛程度和前臂旋后关节活动度,提高手部精细运动功能。
Objective:To observe the effect of extracorporeal shock wave combined with occupational therapy therapy on forearm pronation disorder in children with spastic cerebral palsy(SCP).Methods:A total of 42 children with SCP were randomly divided into the control group and the observation group,with 21 cases in each group in the children rehabilitation department of the affiliated Nanhai maternity and children's Hospital of Guangzhou university of traditional Chinese medicine from January to December 2019.The control group was given targeted occupational therapy,including upper limb forearm pronator stretching therapy,neurophysiological therapy(Bobath technology),proprioceptive neuromuscular facilitation therapy(PNF);game type occupational training including placing objects in forearm supination position,supination grasping stick,supination fetching game,palm and back game,etc..The above training was conducted once a day,30 minutes per time,six times a week,three months as a course of treatment,continuous treatment for two courses.The observation group was given extracorporeal shock wave therapy on the basis of the control group.The child with SCP was in a comfortable position and the forearms of the upper limbs were placed on the plane so that it could free its own gravity.The abdomen of pronator teres muscle was impacted with the probe of shock wave therapeutic instrument(pressure intensity:1.0-1.5 bar;frequency:8-10 Hz;impact times:1000-2000 times).Three to five minutes each time,once every three days,twice a week,three months as a course of treatment,continuous treatment for two courses.Before treatment,after treatment for three months and six months,the modified Ashworth scale(MAS)was used to evaluate the spasticity of forearm pronator muscles;the active range of motion(AROM)of forearm supination was measured by joint range of motion protractor;and the fine motor quotient(FMQ)of hands was evaluated by Peabody development motor scale-fine motor(PDMS-FM).Results:Before treatment,there was no significant difference i
作者
刘合增
赵勇
金炳旭
张春涛
杨阳
吴妙桃
王逍丽
程吉祥
LIU Hezeng;ZHAO Yong;JIN Bingxu;ZHANG Chuntao;YANG Yang;WU Miaotao;WANG Xiaoli;CHENG Jixiang(Nanhai Maternity and Kid Hospital,Guangzhou University of TCM,Foshan,Guangdong 528200,China)
出处
《康复学报》
CSCD
2020年第6期479-483,共5页
Rehabilitation Medicine
基金
佛山市医学类科技攻关项目(2018AB001602)
广东省中医药局科研项目(20162139)。
关键词
痉挛型脑性瘫痪
前臂旋前
体外冲击波疗法
作业治疗
关节活动度
精细运动功能
儿童
spastic cerebral palsy
pronation of forearm
extracorporeal shock wave
occupational therapy
joint range of motion
fine motor function
child
