目的:探讨基于目标导向性训练(goal directed training,GDT)对重度脑性瘫痪儿童运动功能的影响,为临床应用提供依据.方法:采用前瞻性病例对照研究,纳入重度脑性瘫痪儿童80例,按照随机数字表法分为研究组与对照组,每组40例,研究组采用目标导向性运动训练,对照组采用神经发育学疗法(neurodevelopment therapy,NDT).治疗前及治疗6个月、12个月时对两组患儿进行粗大运动功能量表88项(gross motor function measure,GMFM-88)中的仰卧位与俯卧位(A区)、坐位(B区),精细功能评估(fine motor function measure,FMFM)中视觉追踪(A区)、上肢关节活动能力(B区)、坐位分级测试(level of sitting scale,LSS)和日常生活能力(activity daily liv-ing scale,ADL)评估.结果:治疗6个月后,研究组与对照组在GMFM-88中A区与B区评分、LSS评分、FMFM中A区与B区评分及ADL评分的差异均无显著性意义(P＞0.05);治疗12个月后,研究组的各项评分均高于对照组(P＜0.05).随治疗时间延长,两组各项评分均升高.组别、时间及时间与组别的交互效应对GMFM-A、GMFM-B、LSS及FMFM-B评分有显著影响(P＜0.05),时间和时间与组别的交互效应对FMFM-A评分和ADL评分有显著影响(P＜0.05).结论:基于目标导向性训练可以提高重度脑性瘫痪儿童的粗大运动功能、坐位能力及精细运动功能,改善重度脑性瘫痪儿童的日常生活活动能力.
Effects of goal-directed training on motor function in children with severe cerebral palsy
Objective:To explore the effect of goal directed training(GDT)on motor function of children with severe ce-rebral palsy and to provide evidence for clinical application.Method:A prospective case-control study was conducted with 80 children with severe cerebral palsy,random-ly divided into the study group(n=40)and the control group(n=40).The study group received GDT,while the control group received Neurodevelopment therapy(NDT).The children of the two groups were evaluated by supine and prone position(area A)and sitting position(area B)of 88 items of the gross motor function measure(GMFM-88),visual tracking(area A)and upper limb joint activity(area B)of fine motor function measure(FMFM),level of sitting scale(LSS)and activity daily living scale(ADL)before and at 6-month,12-month after the treatment.Result:After 6 months of treatment,there was no significant difference in GMFM-88 area A and B score,LSS score,FMFM area A and B score and ADL score between the study group and the control group(P＞0.05),whereas after 12 months of treatment,the scores of the research group were significantly higher than those of the control group(P＜0.05).As treatment duration increased,the scores of both groups increased.Group classification,time and the interaction between time and group had significant effects on GMFM-A,GMFM-B,LSS and FMFM-B scores.Time and interaction between time and group had significant effects on FMFM-A and ADL scores.Conclusion:GDT can improve gross motor function,sitting ability,fine motor function,and the activities of daily living in children with severe cerebral palsy.
cerebral palsygoal directed trainingmotor function
NETL
NSTL
万方数据
