基于互联网技术的脑性瘫痪儿童远程家庭康复模式构建及效果研究

doi:10.11852/zgetbjzz2023-0125

摘要/Abstract

摘要： 目的构建一种基于互联网技术的远程家庭康复模式,并观察此康复模式对脑性瘫痪(脑瘫)儿童运动功能及功能独立性的影响,以期为脑瘫儿童家庭康复训练提供临床依据。方法选取湘雅博爱康复医院2022年6—11月康复出院的65例脑瘫儿童为研究对象,按照照护人意愿分为远程组(31例)和常规组(34例)。常规组患儿按家庭训练方案予以家庭康复训练,远程组患儿则采用个性化远程家庭康复模式进行干预,远程家庭康复模式包括远程康复训练及质量控制。两组患儿训练时间不少于1.5h/d,5d/周,持续12周。于治疗前、治疗12周后采用粗大运动功能测试(GMFM)、精细运动功能测试(FMFM)、儿童功能独立性评定量表(WeeFIM)分别评估两组患儿的粗大运动功能、精细运动功能以及日常生活能力。结果治疗12周后,远程组患儿总满意率(90.32%)高于常规组患儿(70.59%),差异具有统计学意义(χ²=7.651,P＜0.05);两组患儿治疗12周后GMFM、FMFM和WeeFIM评分较治疗前明显改善(t_远程组＝16.736、36.772、18.858,t_常规组＝7.354、18.495、8.895,P＜0.05);且远程组治疗12周后上述指标评分均显著高于治疗12周后的常规组(t＝2.014、2.106、2.137,P＜0.05)。结论基于互联网技术的远程家庭康复模式能有效改善脑瘫儿童的粗大运动功能、精细运动功能及日常生活能力。

关键词: 脑性瘫痪, 互联网技术, 远程家庭康复

Abstract: Objective To construct a remote home rehabilitation model based on Internet technology, and to observe the effect of this rehabilitation model on motor function and functional independence of children with cerebral palsy (CP), in order to provide clinical evidence for home rehabilitation training of children with cerebral palsy. Methods A total of 65 children with cerebral palsy who had recovered from Xiangya Bo′ai Rehabilitation Hospital from June to November 2022 were selected into this study and were divided into remote intervention group (n=31) and conventional intervention group (n=34) according to the wishes of their caregivers.Children in conventional intervention group were given home rehabilitation training according to the home training program, while children in remote intervention group received an individualized remote home rehabilitation model, including remote rehabilitation training and quality control. Children in the two groups received intervention for 12 weeks with frequency of ≥1.5h/d, 5d/week. Gross Motor Function Measure (GMFM), Fine Motor Function Measure (FMFM), and Functional Independence Measure Children′s Edition (WeeFIM) were used to evaluate the gross motor function, fine motor function, and daily living ability of children before treatment and 12 weeks after treatment. Results After 12 weeks of treatment, the total satisfaction rate of the remote intervention group was 90.32%, significantly higher than that of the conventional intervention group (70.59%) (χ²=7.651, P<0.05). After 12 weeks of treatment, GMFM, FMFM and WeeFIM scores in the two groups were significantly improved compared with those before treatment (remote intervention group: t=16.736、36.772、18.858; conventional intervention group: t=7.354、18.495、8.895, P<0.05). The scores of the above indicators in the remote intervention group after 12 weeks of treatment were significantly higher than those in the conventional intervention group (t =2.014, 2.106, 2.137, P<0.05). Conclusion The remote home rehabilitation model based on Internet technology can effectively improve the gross motor function, fine motor function and daily living ability of children with cerebral palsy.

Key words: cerebral palsy, internet technology, remote home rehabilitation

中图分类号:

R742.3
R493

范桃林, 蒋瑛, 戴金娥, 张小丁, 杨归华, 许亚雄, 王春华. 基于互联网技术的脑性瘫痪儿童远程家庭康复模式构建及效果研究[J]. 中国儿童保健杂志, 2023, 31(11): 1202-1207.

FAN Taolin, JIANG Ying, DAI Jin′e, ZHANG Xiaoding, YANG Guihua, XU Yaxiong, WANG Chunhua. Construction and effectiveness of a remote home rehabilitation model based on internet technology for children with cerebral palsy[J]. Chinese Journal of Child Health Care, 2023, 31(11): 1202-1207.

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 Assciation of Rehabilitation of Disable 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] Maggio MG,De Luca R,Manuli A,et al.The five ′W′ of cognitive telerehabilitation in the Covid-19 era[J]. Expert Rev Med Devices,2020,17(6): 473-475.
[3] Dodakian L,McKenzie AL,Le V,et al.A home-based telerehabilitation program for patients with stroke[J].Neurorehabil Neural Repair,2017,31(10): 923-933.
[4] 刘惠林,周斌,赵政,等.脑卒中患者居家远程康复指导效果的观察[J].中国康复理论与实践,2021,27(7):807-811.
Liu HL, Zhou B, Zhao Z,et al. Home-based telerehabilitation guidance for stroke patients[J].Chin J Rehabil Theory Pract,2021,27(7):807-811.(in Chinese)
[5] Beckers LW,Schnackers ML,Janssen-Potten YJ,et al.Feasibility and effect of home-based therapy programmes for children with cerebral palsy:A protocol for a systematic review[J].BMJ Open,2017,7(2):e013687.
[6] 栾天明,吴文竹,范艳萍,等.痉挛型脑性瘫痪儿童运动功能远程家庭康复应用研究[J].中国康复医学杂志,2021,36(08):949-952,962.
Luan TM,Wu WZ,Fan YP,et al.Application study on remote home rehabilitation of motor function in children with spastic cerebral palsy[J].Chin J Rehabil Med,2021,36(8):949-952,962.(in Chinese)
[7] Kenis-Coskun O,Imamoglu S,Karamancioglu B,et al.Comparison of telerehabilitation versus home-based video exercise in patients with Duchenne muscular dystrophy:A single-blind randomized study[J].Acta Neurol Belg,2022,122(5):1269-1280.
[8] 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)第三章:ICF-CY框架下的儿童脑瘫评定[J].中华实用儿科临床杂志,2022,37(15):1121-1141.
Chinese Association of Rehabilitation Medicine Pediatric Rehabilitation Committee,Chinese Assciation of Rehabilitation of Disable Persons Rehabilitation Committee for Cerebral Palsy, Chinese Medical Doctor Association Pediatric Rehabilitation Committee, et al.Chinese rehabilitation guidelines for cerebral palsy(2022)part 3:Evaluation of children with cerebral palsy uner ICF-CY framework[J].Chin J Appl Clin Pediatr,2022,37(15):1121-1141.(in Chinese)
[9] Bican R,Christensen C,Fallieras K,et al.Rapid implementation of telerehabilitation for pediatric patients during COVID-19[J].Int J Telerehabil,2021,13(1):e6371.
[10] Alonazi A. Effectiveness and acceptability of telerehabilitation in physical therapy during COVID-19 in Children: Findings of a systematic review[J]. Children (Basel),2021,8(12):1101.
[11] Asano D, Kikuchi N, Yamakawa T,et al.Decline in motor function during the COVID-19 pandemic restrictions and its recovery in a child with cerebral palsy: A case report[J].Children (Basel),2021,8(6):551.
[12] 王丹,钟清玲.脑瘫患儿家庭远程康复的研究进展[J].中华护理杂志,2016,51(12):1474-1478.
Wang D,Zhong QL.Research progress of home telerehabilitatiao for children with cerebral palsy[J].Chin J Nurs,2016,51(12):1474-1478.(in Chinese)
[13] 徐亭亭,乔云飞,黄茂.疫情隔离期间远程居家康复模式对脑性瘫痪儿童及家属的影响[J].康复学报,2021,31(4):323-328.
Xu TT,Qiao YF,Huang M. Effect of remote home rehabilitation mode on children with cerebral palsy and their families during epidemic isolation[J].Rehabil Med,2021,31(4):323-328.(in Chinese)
[14] 林思婷,罗梦娜,汪丹,等.远程康复模式应用于脑瘫患者临床效果的Meta分析[J].中国护理管理,2019,19(6):842-849.
Lin ST,Luo MN,Wang D,et al. Meta-analysis of the effects of telerehabilitation in patients with cerebral palsy[J].Chin Nurs Man,2019,19(6):842-849.(in Chinese)
[15] Milani G,Demattè G,Ferioli M,et al.Telerehabilitation in Italy during the COVID-19 lockdown: A feasibility and acceptability study[J].Int J Telerehabil,2021,13(1):e6334.
[16] Cristinziano M,Assenza C,Antenore C,et al.Telerehabilitation during COVID-19 lockdown and gross motor function in cerebral palsy:An observational study[J].Eur J Phys Rehabil Med,2022,58(4):592-597.
[17] Maresca G,Maggio MG,De Luca R,et al.Tele-neuro-rehabilitation in Italy:State of the art and future perspectives[J].Front Neurol,2020,11:563375.
[18] Meyding-Lamadé U, Bassa B, Tibitanzl P,et al.Telerehabilitation: From the virtual world to reality-Medicine in the twenty-first century: Video-assisted treatment in times of COVID-19[J]. Nervenarzt,2021,92(2):127-136.
[19] 唐琳,邬钰玮,李源莉,等.基于现代信息技术的脑瘫儿童远程家庭康复模式的探讨[J].中国康复,2021,36(12):756-759.
Tang L,Wu YW,Li YL,et al.Remote home rehabilitation model of cerebral palsty children based on modern information technology[J].Chin J Rehabil,2021,36(12):756-759.(in Chinese)
[20] Molinaro A,Micheletti S,Pagani F,et al.Action observation treatment in a tele-rehabilitation setting:A pilot study in children with cerebral palsy[J].Disabil Rehabil,2022,44(7):1107-1112.
[21] Kanitkar A,Szturm T,Parmar S,et al.The Effectiveness of a computer game-based rehabilitation platform for children with cerebral palsy: Protocol for a randomized clinical trial[J].JMIR Res Protoc,2017,6(5):e93.
[22] Da Silva TD,Da Silva PL,Valenzuela EJ,et al.Serious game platform as a possibility for home-based telerehabilitation for individuals with cerebral palsy during COVID-19 quarantine-a cross-sectional pilot study[J].Front Psychol,2021,12:622678.
[23] Demers M, Martinie O,Winstein C,et al.Active video games and low-cost virtual reality:An ideal therapeutic modality for children with physical disabilities during a global pandemic[J].Front Neurol,2020,11:601898.