水中运动疗法联合常规康复疗法对学龄前痉挛型脑瘫儿童运动功能的影响

doi:10.11852/zgetbjzz2022-0596

中国儿童保健杂志 ›› 2023, Vol. 31 ›› Issue (5): 486-490.DOI: 10.11852/zgetbjzz2022-0596

水中运动疗法联合常规康复疗法对学龄前痉挛型脑瘫儿童运动功能的影响

仲琛¹, 胡珊珊², 张恒硕³, 张翠⁴, 姚传磊⁵, 宋祺鹏⁶

1.青岛大学附属医院康复医学科,山东青岛 266003;
2.山东体育学院研究生教育学院;
3.江苏医药职业学院;
4.山东省体育科学研究中心;
5.山东大学齐鲁儿童医院;
6.山东体育学院运动与健康学院

收稿日期:2022-05-16 修回日期:2022-12-06 发布日期:2023-05-06 出版日期:2023-05-10
通讯作者: 宋祺鹏,E-mail:songqipeng@sdpei.edu.cn
作者简介:仲琛(1994-),女,山东人,硕士学位,主要研究方向为儿童运动康复。
基金资助:
国家重点研发计划(2018YFC2000600)

Effect of aquatic motor therapy combined with routine rehabilitation therapy on motor function among children with spastic cerebral palsy

ZHONG Chen¹, HU Shanshan², ZHANG Hengshuo³, ZHANG Cui⁴, YAO Chuanlei⁵, SONG Qipeng⁶

1. Department of Rehabilitation Medicine, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, China;
2. School of Graduate Education, Shandong University of Physical Education;
3. Jiangsu Vocational College of Medicine;
4. Shandong Sports Science Research Center;
5. Qilu Children's Hospital, Shandong University;
6. School of Physical Education and Health, Shandong University of Physical Education

Received:2022-05-16 Revised:2022-12-06 Online:2023-05-10 Published:2023-05-06
Contact: SONG Qipeng, E-mail: songqipeng@sdpei.edu.cn

摘要/Abstract

摘要： 目的研究水中运动疗法(AT)联合常规康复疗法(CRT)对学龄前痉挛型脑瘫患儿运动功能的影响,为改善学龄前痉挛型脑瘫患儿运动功能提供理论依据。方法以2020年1—8月在山东大学齐鲁儿童医院就诊的25例学龄前痉挛型脑瘫患儿为研究对象,随机分为AT+CRT组(12例)和CRT组(13例),分别给予AT+CRT和CRT干预,每周干预5次,共12周。对比干预前后患儿的下肢关节活动度、小腿肌张力、足底接触面积和粗大运动功能。结果干预后AT+CRT组和CRT组患儿小腿三头肌肌张力、下肢关节活动度和足底接触面积均优于干预前,差异具有统计学意义(AT+CRT组:t=2.803、7.197、3.550、3.730、3.541;CRT组:t=2.941、6.921、4.335、3.199、4.554,P<0.05)。干预后AT+CRT与CRT两组患儿粗大运动功能评定量表(GMFM-88)D区得分,较干预前显著提高,差异均具有统计学意义(t=4.979、3.750,P<0.05),且AT+CRT组提高的幅度大于CRT组,差异具有统计学意义(t=0.757,P<0.05)。干预后AT+CRT组GMFM-88 E区得分相对干预前显著提高,差异具有统计学意义(t=5.244,P<0.05),CRT组差异无统计学意义(P>0.05),AT+CRT组提高的幅度大于CRT组,差异具有统计学意义(t=2.305,P<0.05)。结论 AT+CRT和CRT均能有效改善痉挛型脑瘫患儿的下肢关节活动度、小腿肌张力和足底接触面积。AT+CRT对粗大运动功能的改善效果优于CRT。

关键词: 水中运动疗法, 常规康复疗法, 脑瘫, 肌肉张力, 运动康复

Abstract: Objective To study the influence of aquatic motor therapy (AT) combined with conventional rehabilitation therapy (CRT) on the motor function of preschool children with spastic cerebral palsy, in order to provide theoretical basis for improving the motor function of preschool children with spastic cerebral palsy. Methods A total of 25 preschoolers with spastic cerebral palsy who were admitted to Qilu Children's Hospital of Shandong University from January 2020 to August 2020 were enrolled in this study and were randomly divided into AT+CRT group (n=12) and CRT group(n=13).Children in CRT group were given CRT for 12 weeks, while children in AT+CRT received AT additionally, with the frequency of 5 times/week.The range of lower extremity joint motion, calf muscle tone, plantar contact area and gross motor function were compared before and after intervention. Results After intervention, triceps muscle tension, joint motion of lower extremity and plantar contact area in both AT+CRT group and CRT group were all significantly better than those before intervention (AT+CRT group: t=2.803, 7.197, 3.550, 3.730, 3.541; CRT group:t=2.941, 6.921, 4.335, 3.199, 4.554, P<0.05).After intervention, the scores in the D area of the Gross Motor Function Rating Scale (GMFM-88) in both AT+CRT and CRT groups were significantly higher than those before intervention (t=4.979, 3.750, P<0.05), and the improvement in the AT+CRT group was greater than that in the CRT group (t=0.757, P<0.05).After intervention, the score of GMFM-88E in the AT+CRT group was significantly higher than that before intervention (t=5.244, P<0.05), while there was no significant difference in the CRT group (P>0.05).The improvement amplitude in the AT+CRT group was greater than that in the CRT group, with statistical significance (t=2.305, P<0.05). Conclusion Both AT+CRT and CRT can effectively improve the range of motion, calf muscle tone and plantar contact area of lower extremity in children with spastic cerebral palsy, but AT+CRT can improve the gross motion function better than CRT.

Key words: aquatic motor therapy, conventional rehabilitation therapy, cerebral palsy, muscle tone, rehabilitation

中图分类号:

R742.3
R493

仲琛, 胡珊珊, 张恒硕, 张翠, 姚传磊, 宋祺鹏. 水中运动疗法联合常规康复疗法对学龄前痉挛型脑瘫儿童运动功能的影响[J]. 中国儿童保健杂志, 2023, 31(5): 486-490.

ZHONG Chen>, HU Shanshan>, ZHANG Hengshuo>, ZHANG Cui>, YAO Chuanlei>, SONG Qipeng>. Effect of aquatic motor therapy combined with routine rehabilitation therapy on motor function among children with spastic cerebral palsy[J]. Chinese Journal of Child Health Care, 2023, 31(5): 486-490.

参考文献

[1] Chen D,Bao C,Geng YX,et al.Effect of "Tonifying Kidney and Invigorating Brain" acupuncture in children with spastic cerebral palsy analyzed by multi-modality MRI combined with dynamic electroencephalogram[J].Medicine,2020,99(30):e21082.
[2] 林爱金,陈昕,施少云,等.水疗治疗痉挛型脑瘫患儿疗效的Meta分析[J].中华物理医学与康复杂志,2021,43(1):69-73.
Lin AJ,Chen X,Shi SY,et al.Meta-analysis of therapeutic effect of hydrotherapy on children with spastic cerebral palsy[J].Chin J Phys Med Rehabil, 2021,43(1):69-73.(in Chinese)
[3] 孟静,徐怡.基于Bobath理念的综合康复治疗在改善痉挛型脑性瘫痪患儿运动功能中的应用[J].中国临床研究,2020,33(3):387-390.
Meng J,Xu Y.Application of comprehensive rehabilitation therapy based on Bobath concept in improving motor function of children with spastic cerebral palsy[J].Clin J Clin Res,2020,33(3):387-390.(in Chinese)
[4] Clutterbuck G,Auld M,Johnston L.Active exercise interventions improve gross motor function of ambulant/semi-ambulant children with cerebral palsy: A systematic review[J].Disabil Rehabil,2019,41(10):1131-1151.
[5] Gorter JW,Currie SJ.Aquatic exercise programs for children and adolescents with cerebral palsy: What do we know and where do we go[J].Int J Pediatr, 2011,2011:712165.
[6] Clerici I,Maestri R,Bonetti F,et al.Land plus aquatic therapy versus land-based rehabilitation alone for the treatment of freezing of gait in parkinson disease: A randomized controlled trial[J].Phys Ther,2019,99(5):591-600.
[7] 丛芳,崔尧.脑性瘫痪儿童水中运动治疗临床实践指南[J].中国康复理论与实践,2021,27(1):1-14.
Cong F,Cui Y.Clinical practice guidelines for water exercise therapy in children with cerebral palsy[J].Chin J Rehabil Theory Pract,2021,27(1):1-14.(in Chinese)
[8] Retarekar R,Fragala-Pinkham MA,Townsend EL.Effects of aquatic aerobic exercise for a child with cerebral palsy: Single-subject design[J].Pediatr Phys Ther,2009,21(4):336-344.
[9] Getz M,Hutzler Y,Vermeer A.Effects of aquatic interventions in children with neuromotor impairments: A systematic review of the literature[J].Clin Rehabil, 2006,20(11):927-936.
[10] Li XJ,Tang JL,Ma BX,et al.Cerbral palsy of the definition,diagnostic criteria and clinical classification[J].Chinese Practical Pediatric Clinical Journal,2014,(19):1520-1520.
[11] 张莉莉,刘一苇,叶常州,等.悬吊运动训练结合家庭姿势管理对痉挛型脑瘫儿童粗大运动功能、平衡功能和日常生活活动能力的影响[J].中华物理医学与康复杂志,2021,43(10):927-929.
Zhang LL,Liu YW,Ye CZ,et al.Effects of suspension exercise training combined with family postural management on gross motor function, balance function and activities of daily living in children with spastic cerebral palsy[J].Chin J Phys Med Rehabil,2021,43(10):927-929.(in Chinese)
[12] Teixeira-Machado L,DeSantana JM.Effect of dance on lower-limb range of motion in young people with cerebral palsy: A blinded randomized controlled clinical trial[J].Adolesc Health Med Ther,2019,27(10):21-28.
[13] Kokaridas D,Lambeck J.The halliwick concept: Toward a collaborative aquatic approach[J].Inquiry Sport & Phys Edu,2015,13(2):65-76.
[14] 任雪松,蔡志军,张小安,等.全身振动训练联合肉毒毒素注射对痉挛型双瘫脑瘫儿童尖足及粗大运动功能的影响[J].中华物理医学与康复杂志,2019,41(9):688-692.
Ren XS,Cai ZJ,Zhang XA,et al.Effects of whole body vibration training combined with botulinum toxin injection on tiptoe and gross motor function in children with spastic diplegia cerebral palsy[J].Chin J Phys Med Rehabil,2019,41(9):688-692.(in Chinese)
[15] Lucena-Antón D,Rosety-Rodríguez I,Moral-Munoz JA.Effects of a hippotherapy intervention on muscle spasticity in children with cerebral palsy: A randomized controlled trial[J].Complement Ther Clin Pract,2018,31:188-192.
[16] 徐怡,赵晓科,陈梦莹,等.虚拟现实技术缓解痉挛型脑性瘫痪患儿治疗性疼痛的效果[J].中国康复理论与实践,2019,25(12):1458-1462.
Xu Y,Zhao XK,Chen MY,et al.Effect of virtual reality technology on relieving therapeutic pain in children with spastic cerebral palsy[J].Chin J Rehabil Theory Pract,2019,25(12):1458-1462.(in Chinese)
[17] Hallett M.Neurophysiology of dystonia: The role of inhibition[J].Neurobiol Dis, 2011,42(2):177-184.
[18] Esquenazi A,Talatu M.Gait analysis: Technology and clinical applications[J].Phys Med Reh,2000,1(1):242-262.
[19] 李杜娟,周云.脑瘫患儿继发髋关节脱位的防治研究进展[J].中华物理医学与康复杂志,2020,43(1):91-94.
Li DJ, Zhou Y.Research progress of prevention and treatment of secondary hip dislocation in children with cerebral palsy[J].Chin JPhys Med Rehabil,2020,43(1):91-94.(in Chinese)
[20] Adar S,Dündar Ü,Demirdal ÜS,et al.The effect of aquatic exercise on spasticity quality of life and motor function in cerebral palsy[J].Turk J Phys Med Rehabil,2017,63(3):239-248.
[21] Becker BE.Aquatic therapy: scientific foundations and clinical rehabilitation applications[J].PMR,2009,1(9):859-872.
[22] Lai CJ,Liu WY,Yang TF,et al.Pediatric aquatic therapy on motor function and enjoyment in children diagnosed with cerebral palsy of various motor severities[J].J Child Neurol,2015,30(2):200-208.
[23] Etoom M,Khraiwesh Y,Lena F,et al.Effectiveness of physiotherapy interventions on spasticity in people with multiple sclerosis: A systematic review and Meta-analysis[J].Am J Phys Med Rehabil,2018,97(11):793-807.
[24] Akinola BI,Gbiri CA,Odebiyi DO.Effect of a 10-Week aquatic exercise training program on Gross Motor Function in children with spastic cerebral palsy[J].Glob Pediatr Health,2019,6(1):2333794X19857378.
[25] 敬竹子,张鑫,马晓东,等.水中运动疗法在膝关节周围骨折中的应用[J].四川医学,2020,41(4):351-353.
Jing ZZ,Zhang X,Ma XD,et al.Application of water exercise therapy in the treatment of periknee fracture[J].Sichuan Med,2020,41(4):351-353.(in Chinese)
[26] 赵燕挺,陈伟,苑杰华,等.水疗法治疗脑瘫患儿的康复效果[J].中华物理医学与康复杂志,2021,43(6):538-540.
Zhao YT,Chen W,Yuan JH,et al.Therapeutic effect of hydrotherapy on children with cerebral palsy[J].Chin J Phys Med Rehabil,2021,43(6):538-540.(in Chinese)
[27] 李永杰,扈盛.水中运动训练对脑卒中患者下肢肢体功能和日常生活能力影响的Meta分析[J].中国康复医学杂志,2019,34(10):1209-1215.
Li YJ,Hu S.A Meta-analysis of the effects of water exercise training on lower limb function and daily living ability of stroke patients[J].Chin J Rehabil Med,2019,34(10):1209-1215.(in Chinese)
[28] DimitrijevićL,Aleksandrović M,Madić D,et al.The effect of aquatic intervention on the gross motor function and aquatic skills in children with cerebral palsy[J].J Hum Kinet,2012,32:167-174.
[29] Bojan J,Marko A,Lidija D,et al.The effects of a program of swimming and aquatic exercise on flexibility in children with cerebral palsy[J].Astrophys J,2014,561(1):7-10.
[30] 冯重睿,郭永亮,郑炳铃,等.痉挛型脑性瘫痪马蹄足跟腱延长术后系统康复训练患儿三维步态分析表现[J].中国康复医学杂志,2020,35(10):1243-1246.
Feng ZR,Guo YL,Zheng BL,et al.Three-dimensional gait analysis of children with spastic cerebral palsy after systematic rehabilitation training of equinofoot Achilles tendon extension[J].Chin J Rehabil Med,2020,35(10):1243-1246.(in Chinese)
[31] Zhou J,Butler EE,Rose J.Neurologic Correlates of Gait Abnormalities in Cerebral palsy: Implications for Treatment[J].Front Hum Neurosci.2017,17(11):103-104.
[32] 向俊璐,周文智,田萍,等.基于肌内神经分布的针刺方法治疗痉挛型脑瘫尖足的疗效观察[J].中华物理医学与康复杂志,2019,41(8):613-615.
Xiang JL,Zhou WZ,Tian P,et al.Therapeutic effect of acupuncture based on intramuscular nerve distribution in the treatment of spastic cerebral palsy apical foot[J].Chin J Phys Med Rehabil,2019,41(8):613-615.(in Chinese)
[33] Gough M,Shortland AP.Could muscle deformity in children with spastic cerebral palsy be related to an impairment of muscle growth and altered adaptation[J].Dev Med Child Neurol,2012,54(6):495-499.
[34] Roostaei M,Baharlouei H,Azadi H,et al.Effects of Aquatic Intervention on gross motor skills in children with cerebral palsy: A systematic review[J].Phys Occup Ther Pediatr,2017,37(5):496-515.
[35] Declerck M,Daly D,Feys H.Benefits of swimming for children with cerebral palsy: A pilot study[J].Serb J Sports Sci,2013,7(2):57-69.
[36] 丛芳,崔尧.水中运动治疗的发展现状与展望[J].华西医学,2020,35(5):527-533.
Cong F,Cui Y.Current situation and prospect of water exercise therapy[J].West China Med J,2020,35(5):527-533.(in Chinese)

水中运动疗法联合常规康复疗法对学龄前痉挛型脑瘫儿童运动功能的影响

Effect of aquatic motor therapy combined with routine rehabilitation therapy on motor function among children with spastic cerebral palsy

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

[1]	杨婷婷, 李鑫, 俞鑫璐, 张博, 庞伟. 体感游戏对脑瘫儿童上肢功能影响的系统评价[J]. 中国儿童保健杂志, 2023, 31(5): 535-540.
[2]	刘金, 张芳, 王建忠. 脑瘫患儿血清25-羟维生素D水平与小腿骨骼肌发育及粗大运动功能量表评分的关系[J]. 中国儿童保健杂志, 2023, 31(5): 541-545.
[3]	吴茜茜, 郝朝丽, 曾佩, 郭津. 脑性瘫痪儿童伴随交流障碍的影响因素及治疗研究进展[J]. 中国儿童保健杂志, 2023, 31(1): 52-57.
[4]	梁伟健, 丁忠冰, 李梦雅. 44例5~7岁痉挛型脑瘫儿童言语流利性障碍的临床特征[J]. 中国儿童保健杂志, 2022, 30(7): 702-705.
[5]	熊华春, 周志恒, 周洋萍, 王军, 朱登纳, 陈精慧. 下肢康复机器人训练联合家庭姿势管理对脑瘫患儿运动功能的疗效研究[J]. 中国儿童保健杂志, 2022, 30(7): 711-714.
[6]	赵明月, 项栋良, 张春艳, 乌云塔娜, 杨海凤, 李爽, 王琰, 王艳. 高危儿早期干预的研究进展[J]. 中国儿童保健杂志, 2022, 30(5): 531-534.
[7]	陈婧, 童光磊. 脑瘫儿童进食功能分级系统及营养不良分析[J]. 中国儿童保健杂志, 2022, 30(5): 544-547.
[8]	胡昊, 亓毅飞. 脑性瘫痪致病机制中的遗传因素初探[J]. 中国儿童保健杂志, 2022, 30(3): 237-239.
[9]	王静, 岳玲, 陈智红, 孙素真, 马贵林, 白冰, 陈翠英. 悬吊训练联合MOTOmed智能训练应用于痉挛型脑瘫儿童的康复疗效研究[J]. 中国儿童保健杂志, 2022, 30(3): 240-243.
[10]	钟得香, 翟淳, 陈建平. 目标达成量表在脑瘫康复中的应用进展[J]. 中国儿童保健杂志, 2022, 30(2): 172-175.
[11]	陈婧, 童光磊, 施磊, 叶福玲, 冯超, 徐学翠, 李红. 脑瘫儿童主观全面营养评估方法的临床研究[J]. 中国儿童保健杂志, 2022, 30(2): 212-215.
[12]	邓经辉, 龙正印, 吕志刚, 卢永雪, 牟尅蓉, 唐雪怡. 核心稳定训练改善痉挛型脑瘫患儿运动能力的Meta分析[J]. 中国儿童保健杂志, 2022, 30(11): 1226-1230.
[13]	郝朝丽, 吴茜茜, 韩清梅, 曾佩, 郭津. 目标-活动-运动强化疗法对脑瘫高危儿早期干预的应用进展[J]. 中国儿童保健杂志, 2022, 30(10): 1104-1107.
[14]	许业涛, 史惟. 节律性听觉刺激改善痉挛型脑瘫患儿步态的研究进展[J]. 中国儿童保健杂志, 2021, 29(8): 873-876.
[15]	谢伟想, 陈蜀, 谭育华, 李葶. 蜡疗治疗儿童痉挛型脑瘫临床疗效的Meta分析[J]. 中国儿童保健杂志, 2021, 29(8): 881-885.