摘要
通过解读《改善脑性瘫痪儿童和青少年身体功能的干预措施国际临床实践指南》(简称指南),为改善儿童和青少年脑性瘫痪(脑瘫)患者身体功能的干预措施提供基于循证医学依据的建议。该指南通过系统搜索截至2018年11月Cochrane图书馆、CINAHL、Embase MEDLINE相关文献,使用推荐等级评估,发育和评估分级方法,与国际专家和患者进行磋商,评估证据的确定性并提出推荐。指南提出13项推荐(依据3项系统评价、30项随机试验和5项治疗前后对照研究)。指南推荐,为实现功能性目标,干预措施应包括患者选择的目标、在现实生活环境中整体任务实践、支持赋予家庭权力以及团队方法等,同时需考虑年龄、能力和儿童/家庭的偏好。指南建议,为提高步行能力,可开展地面步行并可辅以跑步机训练;多种方法可促进手部使用目标的实现:双手训练、限制性诱导运动疗法、目标导向训练和认知疗法等。指南在患者自理方面,提出整体任务实践与辅助设备相结合,可提高独立性并减轻照顾者的负担。指南提出,休闲目标可将整体任务实践与解决环境、个人和社会障碍的策略结合起来。改善儿童和青少年脑瘫患者功能的干预措施,需包括患者选择的目标和整体任务实践的目标,临床工作者在选择特定的干预措施时应考虑儿童/家庭偏好、年龄和能力。
This review aims to interpret the interventions to improve physical function for children and young people with cerebral palsy,thus providing relevant suggestions.Relevant literatures published before November 2018 were systematically searched in Cochrane library,CINAHL,and Embase MEDLINE using the Grading of Recommendations Assessment,Development and Evaluation method.Consult with international experts and patients to assess evidence and recommend it.Based on 3 systematic reviews,30 randomized clinical trials,and 5 pre-and post-treatment studies,a total of 13 recommendations were given.The guidelines recommend that,in order to achieve functional stan-dards,intervention measures should include,patient-selected goals,full-task practice in real-life settings,support for family empowerment,and a team approach.The age,ability,and child/family preferences were all needed to be considered.In order to improve walking ability,ground walking and treadmill training can be carried out.Various methods can promote the realization of hand use goals hand use,including the two-hand exercise training,constraint-induced moverment therapy,goal-oriented training and cognitive therapy.In terms of patient self-care,the guideline proposed that,the combination of full-task practice and auxiliary equipment can improve the independence of self-care and reduce the burden of care givers.Leisure goals could be achieved by the combination of the practice of the entire task with strategies to address environmental,personal,and social barriers.The intervention of children and adolescents with cerebral palsy should take into consideration of patient selection and the goal of full-task practice.The child/family preference,age and ability should be considered when clinical workers selecting specific interventions.
作者
郭津
李晓捷
曹建国
庞伟
姜志梅
曾佩
黄信萍
范艳萍
Guo Jin;Li Xiaojie;Cao Jianguo;Pang Wei;Jiang Zhimei;Zeng Pei;Huang Xinping;Fan Yanping(School of Rehabilitation Medicine,Jiamusi University,Jiamusi 154002,China;Department of Rehabilitation,Shenzhen Children′s Hospital,Shenzhen 518030,China)
出处
《中华实用儿科临床杂志》
CAS
CSCD
北大核心
2022年第7期502-509,共8页
Chinese Journal of Applied Clinical Pediatrics
基金
国家卫生计生委卫生行业科研专项(201002006)。
关键词
脑性瘫痪
身体功能
干预措施
Cerebral palsy
Physical function
Intervention
