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.
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.
目的 研究七氟醚诱导气管插管减轻短期内行两次手术的脑性瘫痪患儿术前焦虑的效果。 方法 2009年12月－2011年7月选择需要短期内行两次全身麻醉（全麻）手术的痉挛性脑性瘫痪患儿60例，美国麻醉医师协会（ASA）Ⅰ～Ⅱ级。随机分为A组常规麻醉诱导气管插管（30例）和B组七氟醚诱导气管插管（30例）；分别在一期及二期手术术前访视时（M1、M3）、入手术室时（M2、M4）对两组患儿进行改良耶鲁围术期焦虑量表评估；并分别在一期及二期手术麻醉诱导期（N1、N2）对两组患儿进行诱导期合作度量表的标准评定。 结果 同组一期、二期手术比较，A组患儿二期手术术前焦虑更明显（P＜0.05），二期入手术室时焦虑更明显（P＜0.05），二期手术合作度更差（P＜0.05）；B组患儿两次手术术前焦虑无明显变化（P＞0.05），一期入手术室时焦虑明显（P＜0.05），一期手术合作度较差（P＜0.05）。两组之间，一期手术两组患儿焦虑情况无明显区别（P＞0.05），二期手术A组比B组的患儿焦虑更明显（P＜0.05），两次手术B组都比A组的患儿合作度更好（P＜0.05）。 结论 七氟醚麻醉诱导气管插管能够有效减轻短期内需要进行两次手术的痉挛性脑性瘫痪患儿的术前焦虑，提高患儿二期手术的合作度，提供良好的手术麻醉条件，保证患儿的围术期安全。
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。
Mirror therapy is a rehabilitation therapy in which a mirror is placed between the arms or legs so that the image of a moving non-affected limb gives the illusion of normal movement in the affected limb. As a simple, safe, and low-cost treatment, mirror therapy has been widely used. By summarizing and analyzing the literature about mirror therapy at home and abroad, this article summarizes its mechanism and clinical application in pain, stroke, cerebral palsy and so on, so as to provide reference for research and application on mirror therapy.
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.