痉挛型脑瘫上肢选择性运动控制评估及干预研究进展

doi:10.11852/zgetbjzz2024-1060

摘要/Abstract

摘要： 脑性瘫痪(脑瘫)是一种由脑发育早期损伤引起的非进行性中枢性运动和姿势发育障碍,其中最常见的是痉挛型。选择性运动控制受损是其典型表现,严重影响患儿的运动功能和日常生活活动。然而,目前对上肢选择性运动控制的评估与干预仍不足,现有方法缺乏系统化、标准化整合。本文总结了痉挛型脑瘫儿童上肢选择性运动控制评估及干预研究进展,旨在为未来研究和临床实践提供参考,以优化脑瘫儿童的康复策略。

关键词: 脑性瘫痪, 痉挛型脑瘫, 选择性运动控制, 评估, 干预

Abstract: Cerebral palsy (CP) is a non-progressive neurodevelopmental disorder of movement and posture caused by early-life brain injury, with spastic CP being the most prevalent subtype.Impaired selective motor control(SMC) is a hallmark of this condition, significantly impacting motor function and daily activities in affected children.However, current assessment and intervention approaches for upper limb SMC remain inadequate, lacking systematic and standardized integration.This review synthesizes recent advances in the evaluation and management of upper limb SMC in children with spastic CP, aiming to inform future research and clinical practice for optimizing rehabilitation strategies.

Key words: cerebral palsy, spastic cerebral palsy, selective motor control, assessment, intervention

中图分类号:

R179

钟嘉敏, 周春明, 黄美欢, 陈怡静, 王亚婷, 曹建国. 痉挛型脑瘫上肢选择性运动控制评估及干预研究进展[J]. 中国儿童保健杂志, 2025, 33(12): 1343-1347.

ZHONG Jiamin, ZHOU Chunming, HUANG Meihuan, CHEN Yijing, WANG Yating, CAO Jianguo. Advances in the assessment and intervention of selective motor control in upper limb among children with spastic cerebral palsy[J]. Chinese Journal of Child Health Care, 2025, 33(12): 1343-1347.

参考文献

[1] 中国康复医学会儿童康复专业委员会, 中国残疾人康复协会小儿脑性瘫痪康复专业委员会, 中国医师协会康复医师分会儿童康复专业委员会, 等.中国脑性瘫痪康复指南(2022)第一章:概论[J].中华实用儿科临床杂志, 2022,37(12):887-892.
Chinese Association of Rehabilitation Medicine Pediatric Rehabilitation Committee, Chinese Association of Rehabilitation of Disabled Persons Rehabilitation Committee for Cerebral Palsy, Chinese Medical Doctor Association Pediatric Rehabilitation Committee, et al.Chinese rehabilitation guidelines for cerebral palsy (2022) part 1: Overview[J].Chin J Appl Clin Pediatr,2022,37(12):887-892.(in Chinese)
[2] Ikeudenta BA, Rutkofsky IH.Unmasking the enigma of cerebral palsy: A traditional review[J].Cureus, 2020,12(10): e11004.
[3] MacWilliams BA, Prasad S, Shuckra AL, et al.Causal factors affecting gross motor function in children diagnosed with cerebral palsy[J].PLoS One,2022,17(7):e0270121.
[4] Wagner LV, Davids JR, Hardin JW.Selective Control of the Upper Extremity Scale: Validation of a clinical assessment tool for children with hemiplegic cerebral palsy[J].Dev Med Child Neurol, 2016, 58(6): 612-617.
[5] Sardogan C, Muammer R, Akalan NE, et al.Determining the relationship between the impairment of selective voluntary motor control and gait deviations in children with cerebral palsy using simple video-based analyses[J].Gait Posture,2021(90): 295-300.
[6] Lieber J, Gartmann T, Keller JW, et al.Validity and reliability of the Selective Control of the Upper Extremity Scale in children with upper motor neuron lesions[J].Disabil Rehabil,2022,44(14): 3694-3700.
[7] Yildiz A, Yildiz R, Celik HI, et al.Construct and discriminative validity and reliability of the Selective Control of the Upper Extremity Scale (SCUES) in children with unilateral cerebral palsy[J].Physiother Theory Pract,2022,38(7): 919-927.
[8] Tuncdemir M, Karakaya J, Kerem-Gunel M.Reliability and validity of the turkish version of the selective control of the upper extremity scale in children with cerebral palsy[J].Phys Occup Ther Pediatr,2022,42(1):99-112.
[9] Sukal-Moulton T, Gaebler-Spira D, Krosschell KJ.The validity and reliability of the Test of Arm Selective Control for children with cerebral palsy: A prospective cross-sectional study[J].Dev Med Child Neurol,2018,60(4):374-381.
[10] Gygax MJ, Schneider P, Newman CJ.Mirror therapy in children with hemiplegia: A pilot study[J].Dev Med Child Neurol,2011,53(5):473-476.
[11] Lennon N, Church C, Shields T, et al.Can the Shriners Hospital Upper Extremity Evaluation (SHUEE) detect change in dynamic position and spontaneous function of the upper limb in people with hemiplegic cerebral palsy?[J].J Pediatr Orthop,2023,43(6): e471-e475.
[12] Boz Sönmez D, Giray E, Atici A, et al.Validity and reliability of selective control of upper extremity scale (SCUES) in patients with chronic stroke[J].Disabil Rehabil,2024,46(20):4813-4824.
[13] Fahr A, Keller JW, Balzer J, et al.Quantifying age-related differences in selective voluntary motor control in children and adolescents with three assessments[J].Hum Mov Sci,2021(77): 102790.
[14] Keller JW, Fahr A, Balzer J, et al.Validity and reliability of an electromyography-based upper limb assessment quantifying selective voluntary motor control in children with upper motor neuron lesions[J].Sci Prog,2021,104(2):368504211008058.
[15] Keller JW, Fahr A,Balzer J, et al.Validity and reliability of an accelerometer-based assessgame to quantify upper limb selective voluntary motor control[J].J Neuroeng Rehabil, 2020, 17(1): 89.
[16] Deluca SC, Echols K, Law CR, et al.Intensive pediatric constraint-induced therapy for children with cerebral palsy:Randomized, controlled, crossover trial[J].J Child Neurol, 2006, 21(11): 931-938.
[17] DeLuca SC, Case-Smith J, Stevenson R, et al.Constraint-Induced Movement Therapy(CIMT) for young children with cerebral palsy:Effects of therapeutic dosage[J].J Pediatr Rehabil Med, 2012, 5(2):133-142.
[18] Choudhary A, Gulati S, Kabra M, et al.Efficacy of modified constraint induced movement therapy in improving upper limb function in children with hemiplegic cerebral palsy: A randomized controlled trial[J].Brain Dev,2013,35(9): 870-876.
[19] Ramey SL, DeLuca SC, Stevenson RD, et al.Constraint-induced movement therapy for cerebral palsy: A randomized trial[J].Pediatrics,2021,148(5): e2020033878.
[20] Figueiredo PRP, Mancini MC, Feitosa AM, et al.Hand-arm bimanual intensive therapy and daily functioning of children with bilateral cerebral palsy: A randomized controlled trial[J].Dev Med Child Neurol,2020,62(11):1274-1282.
[21] Facchin P, Rosa-Rizzotto M, Visona Dalla Pozza L, et al.Multisite trial comparing the efficacy of constraint-induced movement therapy with that of bimanual intensive training in children with hemiplegic cerebral palsy: Postintervention results[J].Am J Phys Med Rehabil,2011,90(7):539-553.
[22] Hung YC, Spingarn A, Friel KM, et al.Intensive unimanual training leads to better reaching and head control than bimanual training in children with unilateral cerebral palsy[J].Phys Occup Ther Pediatr, 2020, 40(5): 491-505.
[23] Gelkop N, Burshtein DG, Lahav A, et al.Efficacy of constraint-induced movement therapy and bimanual training in children with hemiplegic cerebral palsy in an educational setting[J].Phys Occup Ther Pediatr,2015,35(1): 24-39.
[24] Araneda R, Ebner-Karestinos D, Paradis J, et al.Changes induced by early hand-arm bimanual intensive therapy including lower extremities in young children with unilateral cerebral palsy[J].JAMA Pediatrics, 2024, 178(1):19-28.
[25] Araneda R, Klöcker A, Ebner-Karestinos D, et al.Feasibility and effectiveness of HABIT-ILE in children aged 1 to 4 years with cerebral palsy: A pilot study[J].Ann Phys Rehabil Med,2021, 64(3):101381.
[26] Bleyenheuft Y, Ebner-Karestinos D, Surana B, et al.Intensive upper-and lower-extremity training for children with bilateral cerebral palsy: A quasi-randomized trial[J].Dev Med Child Neurol, 2017, 59(6): 625-633.
[27] Errante A, Di Cesare G, Pinardi C, et al.Mirror neuron system activation in children with unilateral cerebral palsy during observation of actions performed by a pathological model[J].Neurorehabil Neural Repair, 2019, 33(6): 419-431.
[28] Kirkpatrick E, Pearse J, James P, et al.Effect of parent-delivered action observation therapy on upper limb function in unilateral cerebral palsy: A randomized controlled trial[J].Dev Med Child Neurol,2016,58(10):1049-1056.
[29] Kim DH.Comparison of short-and long-time action observation training (AOT) on upper limb function in children with cerebral palsy[J].Physiother Pract Res,2020, 41(1): 53-58.
[30] Kim DH, An DH, Yoo WG.Effects of live and video form action observation training on upper limb function in children with hemiparetic cerebral palsy[J].Technol Health Care, 2018, 26(3): 437-443.
[31] Beani E, Menici V, Sicola E, et al.Effectiveness of the home-based training program Tele-UPCAT (Tele-monitored Upper Limb Children Action Observation Training) in unilateral cerebral palsy: A randomized controlled trial[J].Eur J Phys Rehabil Med, 2023, 59(5): 554-563.
[32] 中国康复医学会儿童康复专业委员会, 中国残疾人康复协会小儿脑性瘫痪康复专业委员会, 中国医师协会康复医师分会儿童康复专业委员会, 等.中国脑性瘫痪康复指南(2022)第四章:康复治疗(上)[J].中华实用儿科临床杂志, 2022, 37(16):1201-1229.
Chinese Association of Rehabilitation Medicine Pediatric Rehabilitation Committee, Chinese Association of Rehabilitation of Disabled Persons Rehabilitation Committee for Cerebral Palsy, Chinese Medical Doctor Association Pediatric Rehabilitation Committee, et al.Chinese rehabilitation guidelines for cerebral palsy (2022) part 4: Rehabilitation treatment(I)[J].Chin J Appl Clin Pediatr,2022,37(16):1201-1229.(in Chinese)
[33] Bruchez R, Jequier Gygax M, Roches S, et al.Mirror therapy in children with hemiparesis: A randomized observer-blinded trial[J].Dev Med Child Neurol, 2016, 58(9): 970-978.
[34] Mohamed RA, Yousef AM, Radwan NL, et al.Efficacy of different approaches on quality of upper extremity function, dexterity and grip strength in hemiplegic children:A randomized controlled study[J].Eur Rev Med Pharmacol Sci,2021,25(17):5412-5423.
[35] Kara OK, Yardimci BN, Sahin S, et al.Combined effects of mirror therapy and exercises on the upper extremities in children with unilateral cerebral palsy: A randomized controlled trial[J].Dev Neurorehabil, 2020, 23(4): 253-264.
[36] Taş SA, Çankaya T.Effects of structured training on spinal posture and selective motor control in children with unilateral spastic cerebral palsy[J].Gait Posture,2024(109): 22-27.
[37] Elnaggar RK.Effects of plyometric exercises on muscle-activation strategies and response-capacity to balance threats in children with hemiplegic cerebral palsy[J].Physiother Theory Pract, 2020, 38(9): 1165-1173.
[38] Abd-elmonem AM, Ali HA, Saad-eldien SS, et al.Efficacy of plyometric exercises on upper extremity function, selective motor control and hand grip strength in children with unilateral cerebral palsy: A randomized controlled study[J].Physiother Res Int, 2023, 29(1): e2061.