全身振动训练对1～3岁痉挛型脑瘫儿童下肢运动功能的影响

发布时间：2018-10-08 14:03

【摘要】：目的:观察全身振动(Whole body vibration,WBV)训练对1~3岁痉挛型脑瘫儿童下肢痉挛状态、粗大运动功能、平衡功能的影响及不良反应。方法:1、病例选择:选取郑州大学第三附属医院儿童康复科2015年11月~2016年11月期间住院的1~3岁痉挛型脑瘫患儿共184例,随机分为常规训练组和全身振动训练组,完成24周康复治疗和随访的患儿共150例,包括常规训练组75例(n=75)和全身振动训练组75例(n=75)。2、治疗方法:常规训练组给予24周的运动疗法、石蜡疗法及神经肌肉电刺激疗法;全身振动训练组在常规训练的基础上给予24周的全身振动训练。3、疗效评定:在治疗前、治疗12周、治疗24周,采用改良Tardieu量表(Modified Tardieu Scale,MTS)、表面肌电图(surface electromyograms,sEMG)被动状态数值对患儿下肢痉挛程度进行评价,采用粗大运动功能测试量表-88(Gross Motor Function Measure,GMFM-88)、Berg平衡量表(Berg Balance Scale,BBS)对患儿粗大运动功能及平衡功能进行评价。4、不良反应的观察:全身振动训练期间及训练后,观察患儿有无哭闹、不适、眩晕、下肢红肿等不良反应,并做记录。结果:1、基线比较:治疗前两组患儿性别、月龄、GMFCS分级、MTS评分、MTS踝关节角度R1、R2、sEMG被动状态数值、GMFM-88评分、BBS评分无明显差异(P0.05);2、痉挛程度:两组患儿MTS评分、MTS踝关节角度R1、R2、sEMG被动状态数值在治疗12周、治疗24周均显著优于治疗前(P0.05)。全身振动训练组乆绳肌与踝跖屈肌的MTS评分和sEMG被动状态数值、MTS踝关节角度R1、R2在各时间点均显著优于常规训练组(P0.05)。而内收肌的MTS分级评分和sEMG被动状态数值在各时间点与常规训练组无显著差异(P0.05)。3、粗大运动功能及平衡功能两组患儿GMFM-88、BBS评分在治疗12周、治疗24周均显著优于治疗前(P0.05)。全身振动训练组BBS评分在各时间点均显著优于常规训练组(P0.05)。GMFM-88评分在治疗12周与常规训练组无显著差异(P0.05),在治疗24周显著优于常规训练组(P0.05)。4、不良反应全身振动训练期间及训练后个别患儿出现短暂哭闹,但在患儿家长安抚下迅速停止。所有患儿均未出现不适感、眩晕、下肢红肿等不良反应。结论:1、与常规康复训练相比,全身振动训练结合常规康复训练能更好的提高1~3岁痉挛型脑瘫儿童的粗大运动功能和平衡功能,缓解其乆绳肌与踝跖屈肌的痉挛程度。2、全身振动训练应用于1~3岁痉挛型脑瘫儿童安全可靠,未发现相关不良反应。
[Abstract]:Objective: to observe the effects and side effects of whole body vibration (Whole body vibration,WBV training on lower extremity spasticity, coarse motor function and balance function in children with spastic cerebral palsy aged 1 to 3 years. Methods: a total of 184 children with spastic cerebral palsy aged from November 2015 to November 2016 were randomly divided into routine training group and whole body vibration training group in the Department of Children's Rehabilitation, third affiliated Hospital of Zhengzhou University, from November 2015 to November 2016, in which 184 children with spastic cerebral palsy were randomly divided into two groups: routine training group and general vibration training group. A total of 150 children completed 24 weeks rehabilitation and follow-up, including 75 patients in routine training group and 75 patients in whole body vibration training group. The treatment methods: routine training group received 24 weeks exercise therapy, paraffin wax therapy and neuromuscular electrical stimulation therapy. The whole body vibration training group was given 24 weeks whole body vibration training on the basis of routine training. The curative effect was evaluated: before treatment, 12 weeks treatment, 24 weeks treatment, The degree of lower extremity spasm in children was evaluated by modified Tardieu scale (Modified Tardieu Scale,MTS) and surface electromyography (surface electromyograms,sEMG) passive state. Gross motor function test scale (-88 (Gross Motor Function Measure,GMFM-88) and Berg balance scale (Berg Balance Scale,BBS) were used to evaluate the gross motor function and balance function of children. The adverse reactions were observed: during and after the whole body vibration training, the children were observed whether they were crying or not. Adverse reactions, such as vertigo, redness and swelling of the lower extremities, were recorded. Results: 1. Baseline comparison: sex of the two groups before treatment, There was no significant difference in the passive state of the MTS ankle angle between the two groups (P0.05). Spasticity degree: the MTS score of the two groups and the passive state of the MTS ankle angle R1 / R2SEMG were significantly higher than those before the treatment at 12 weeks and 24 weeks (P0.05). The MTS score and sEMG passive state value of the whole body vibration training group were significantly better than that of the conventional training group at each time point (P0.05). However, there was no significant difference in MTS grading and sEMG passive state between adductor muscle and routine training group at each time point (P0.05). The GMFM-88,BBS score of coarse motor function and balance function in the two groups was significantly better than that before treatment at 12 weeks and 24 weeks (P0.05). The BBS score of the whole body vibration training group was significantly better than that of the conventional training group at each time point (P0.05). GMFM-88 score had no significant difference between the conventional training group and the conventional training group at 12 weeks (P0.05), but at the 24th week of treatment, it was significantly better than the conventional training group (P0.05). During and after training, some of the children appeared to cry for a short time. But in the child's parents under the comfort of the rapid cessation. No adverse reactions such as discomfort, dizziness, redness of lower extremities were found in all children. Conclusion compared with conventional rehabilitation training, the whole body vibration training combined with conventional rehabilitation training can improve the motor function and balance function of children with spastic cerebral palsy of 1 or 3 years old. It was safe and reliable to use the whole body vibration training in children with spastic cerebral palsy of 1 to 3 years old, and no related adverse reactions were found.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742.3

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