Study on the development of foot arch and rehabilitation treatment plan for children with spastic diplegia in cerebral palsy gross motor function classification system grade Ⅰ-Ⅱ

doi:10.11852/zgetbjzz2023-0522

Abstract

Abstract: Objective To investigate the development of the foot arch and develop a rehabilitation treatment plan for children with spastic diplegia of cerebral palsy gross motor function classification(GMFCS) system grade Ⅰ-Ⅱ. Methods Fifty children with spastic diplegia and flat exostosis with GMFCS grade Ⅰ-Ⅱ were selected into this study, and were divided into observation group (n=25) and control group (n=25) using the random number table method. The control group received conventional exercise therapy, while the observation group received arch correction exercises additionally. Both groups underwent treatment once a day for 5 days a week. Children in both groups were evaluated before and 6 months after the intervention. The arch index F, electronic plantar pressure measurement index, and the D and E scores of the Gross Motor Function Measure (GMFM-88) were used to assess the severity of clubfoot and the level of motor development. Results Bofore intervention, there were no significant differences in the arch index F, electronic plantar pressure measurement index, and GMFM-88 score between the observation group and the control group (P>0.05). After 6 months of intervention, the scores of arch index F(t=9.89, 5.35),and GMFM-88 (t＝6.59, 3.46) in both groups increased significantly(P<0.05). The scores of foot arch index F (26.08±0.73) and GMFM-88 (30.24±7.94) in the observation group and control group were significantly higher than those in the control group (25.34±0.64, 25.20±7.06) (t=3.81, 2.37, P<0.05). Plantar pressure pictures showed a gradual increase in lateral foot pressure compared to medial pressure, and a decrease in pressure in the midfoot arch area, indicating a decrease in foot valgus and progressive development of the arch. Conclusion The comprehensive rehabilitation therapy technique incorporating arch correction and gymnastics treatment can promote the arch development in children with GMFCS grade Ⅰ-Ⅱ spastic diplegia, which is important for improving their foot and ankle function and motor development level.

Key words: gross motor function grading system, cerebral palsy, foot arch, flat exostosis foot

摘要： 目的探讨GMFCSⅠ-Ⅱ级痉挛型双瘫儿童足弓发育的康复治疗方案,为临床诊疗提供参考依据。方法选取粗大运动功能分级系统(GMFCS)为Ⅰ-Ⅱ级的50例痉挛型双瘫儿童,采用随机数字表法分成观察组(25例)和对照组(25例),对照组辅以常规运动治疗,观察组则在此基础上给予足弓矫正操治疗,观察组和对照组患者均每天治疗1次,每周治疗5d,于介入前、介入6个月后评估,分别测量足弓指数F、电子足底压力测量指标和粗大运动功能测试量表(GMFM、GMFM-88)中的D、E区评分,以评定扁平外翻足严重程度及运动发育水平。结果介入前观察组和对照组儿童的足弓指数F、电子足底压力测量指标及GMFM-88评分比较,差异无统计学意义(P>0.05)。与介入前比较,介入6个月后,两组儿童的足弓指数F(t=9.89、5.35)及GMFM-88评分(t=6.59、3.46)均显著升高(P<0.05);且观察组和对照组足弓指数F和GMFM-88评分 (26.08±0.73、30.24±7.94)均显著高于对照组(25.34±0.64、25.20±7.06),差异有统计学意义(t=3.81、2.37,P<0.05)。电子足底压力测量指标足底压力图片显示足部外侧压力与内侧压力相比逐渐增加,中足足弓区域压力减少,说明足外翻程度减少和足弓的渐进发育。结论融合足弓矫正操治疗的综合康复治疗技术能促进GMFCSⅠ-Ⅱ级痉挛型双瘫儿童足弓发育,对改善其足踝功能及运动发育水平具有积极作用。

关键词: 粗大运动功能分级系统, 脑性瘫痪, 足弓, 扁平外翻足

CLC Number:

R742.3

GAO Funing, TANG Jian, CHEN Wenxiang, ZHANG Lei, ZHU Min. Study on the development of foot arch and rehabilitation treatment plan for children with spastic diplegia in cerebral palsy gross motor function classification system grade Ⅰ-Ⅱ[J]. Chinese Journal of Child Health Care, 2024, 32(5): 484-490.

高夫宁, 汤健, 陈文翔, 张磊, 朱敏. GMFCSⅠ-Ⅱ级痉挛型双瘫儿童足弓发育的研究及康复治疗方案[J]. 中国儿童保健杂志, 2024, 32(5): 484-490.

References

[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.
Pediatric Rehabilitation Professional Committee of Chinese Association of Rehabilitation Medicine, Pediatric Cerebral Palsy Rehabilitation Professional Committee of China Association for the Rehabilitation of the Disabled, Child Rehabilitation Professional Committee of Rehabilitation Physician Branch of Chinese Medical Doctor Association, etc. Chinese rehabilitation guidelines for cerebral palsy (2022) part 1:Overview[J]. Chin J Appl Clin Pediatr,2022,37(12):887-892.(in Chinese)
[2] 李晓捷,邱洪斌,姜志梅,等. 中国十二省市小儿脑性瘫痪流行病学特征[J]. 中华实用儿科临床杂志,2018,33(5):378-383.
Li XJ, Qiu HB, Jiang ZM, et al. Epidemiological characteristics of cerebral palsy in twelve province in China[J]. Chin J Appl Clin Pediatr,2018,33(5):378-383.(in Chinese)
[3] Vitrikas K, Dalton H, Breish D. Cerebral palsy: An overview[J]. Am Fam Physician, 2020,101(4):213-220
[4] 杨丹彤,李晓捷,李庆红,等. 儿童脑性瘫痪的流行病学特征及早期防治进展[J]. 中国康复医学杂志,2022,37(10):1406-1411.
Yang DT, Li XJ, Li QH, et al. Epidemiological characteristics and early prevention and treatment of cerebral palsy in children[J]. Chin J Rehabi Med,2022,37(10):1406-1411. (in Chinese)
[5] Sellier E, Platt MJ, Andersen GL, et al. Surveillance of cerebral palsy network. decreasing prevalence in cerebral palsy: A multi-site European population-based study, 1980 to 2003[J]. Dev Med Child Neurol, 2016,58(1):85-92
[6] 陈善本,鲍琨,陈博昌. 儿童足弓发育与扁平足的研究进展[J]. 临床小儿外科杂志,2016,15(6):610-613.
Chen SB,Bao K,Chen BC. Research progress on arch development and flat feet in children[J].J Clin Pediatr Surg,2016,15(6):610-613.(in Chinese)
[7] 洪柳,梅海波.儿童脑瘫性扁平外翻足的外科治疗进展[J].临床小儿外科杂志,2016,15(6):607-609.
Hong L,Mei Hb. Advances in the surgical treatment of pediatric cerebral palsy flat valgus[J].J Clin Pediatr Surg,2016,15(6):607-609.(in Chinese)
[8] 韩艳坤,霍洪峰. 扁平足患者足型及步态特征研究[J]. 中国康复医学杂志,2020,35(4):434-439.
Han YK,Huo HF.A study on foot shape and gait characteristics of patients with fiat foot[J].Chin J Rehabi Med,2020,35(4):434-439.(in Chinese)
[9] 白啸天,霍洪峰. 足弓差异对动静态足踝功能的影响[J]. 医用生物力学,2021,36(6):951-956.
Bai XT,Huo HF. The influence of arch difference on dynamic and static foot-ankle function[J].J Med Biomech,2021,36(6):951-956.(in Chinese)
[10] 戚金飞,史惟,廖元贵,等. 脑瘫粗大运动功能分级系统的稳定性研究[J]. 中国儿童保健杂志,2014,22(11):1207-1210.
Qi JF, Shi W, Liao YG, et al. Stability study of gross motor function grading system for cerebral palsy[J].Chin J Child Health Care,2014,22(11):1207-1210.(in Chinese)
[11] 王新莹,徐伟健,史惟,等. 脑瘫儿童和青少年粗大运动功能、手功能、沟通功能分级相关性分析[J]. 中国儿童保健杂志,2020,28(3):269-272,276.
Wang XY,Xu WJ,Shi W,et al.Correlation analysis of gross motor function, hand function and communication function in children and adolescents with cerebral palsy[J].Chin J Child Health Care,2020,28(3):269-272,276.(in Chinese)
[12] 高严,战玉军,曹建国,等.《国际功能、残疾和健康的分类-儿童青少年版》框架下脑性瘫痪的分级、分类管理[J].中国康复医学杂志,2022,37(7):955-960.
Gao Y, Zhan YJ, Cao JG, et al. Classification and management of cerebral palsy under the framework of international classification of functioning, disability and health-children and adolescents[J].Chin J Rehabi Med,2022,37(7):955-960.(in Chinese)
[13] 王秋,蒋华莹,石娅娅,等. 小儿脑性瘫痪类型与粗大运动功能分级的关联性调查分析[J]. 现代预防医学,2015,42(13):2486-2489.
Wang Q, Jiang HY, Shi YY, et al. Survey on the relationship between the subtype and the gross motor function classification system in children with cerebral palsy[J]. Mod Prev Med,2015,42(13):2486-2489.(in Chinese)
[14] 孙垚,朱欢,朱敏,等. 两种评估量表对脑性瘫痪儿童粗大运动功能评定的相关性研究[J]. 东南大学学报(医学版),2018,37(3):436-440.
Sun Y,Zhu H,Zhu M,et al. Research on the relevance of two Gross Motor Measure Scales in children with cerebral palsy[J]. J Southeast Univ(Med Sci Ed),2018,37(3):436-440.(in Chinese)
[15] 史惟. 复旦中文版脑瘫粗大运动功能测试量表项目难度改良及反应度和精确度研究[J]. 中国循证儿科杂志,2018,13(2):81-87.
Shi W. The study of items difficulty order, responsiveness and precision of Fudan Chinese version gross motor function measure[J]. Chin J Evid Based Pediatrics,2018,13(2):81-87.(in Chinese)
[16] 王以文,陈功勋,朱登纳,等.基于共识选择健康测量工具对粗大运动功能评估88项和66项测量学属性的系统评价[J].中国循证儿科杂志,2022,17(5):336-342.
Wang YW,Chen GX,Zhu DN,et al.Psychometric properties of gross motor function measure-88 and 66 based on consensus-based standards for the selection of health measurement instruments:A systematic review[J].Chin J Evid Based Pediatrics,2022,17(5):336-342.(in Chinese)
[17] 陈宝亮,马小凡,肖飞云,等. 基于足底三点支撑面动态信息的足弓指数测量方法[J]. 电子测量与仪器学报,2022,36(6):48-54.
Chen BL, Ma XF, Xiao FY, et al.Arch index measurement method based on dynamic information of three-point support surface of the sole[J]. J Electr Measur Instr,2022,36(6):48-54.(in Chinese)
[18] 赵晓光.不同足弓高度对踝关节肌力和运动能力的影响[J]. 体育科学,2018,4:61-66.
Zhao XG. The impacts of different arch height on ankle strength and physical performance[J]. Chin Sport Sci,2018,4:61-66.(in Chinese)
[19] 路闯,李辉,邱俊涛,等. 一种可大批量筛查扁平足的综合测量装置的研制[J]. 医疗装备,2020,33(23):3-6.
Lu C, Li H, Qiu JT, et al.The development of a comprehensive measuring device for large-scale screening of flat foot[J].Chin J Med Device,2020,33(23):3-6.(in Chinese)
[20] 汤运启,邹灵秋,李毅,等.儿童足型分类方法的系统综述[J].中国组织工程研究,2022,26(12):1963-1968.
Tang YQ,Zou LQ,Li Y,et al.A systematic review of children′s foot type classification methods[J].Chin J Tissue Eng Res,2022,26(12):1963-1968.(in Chinese)
[21] 宋礼文,向长城,邱达,等. 基于足底压力分布的足部运动特征提取[J]. 医用生物力学,2021,3:431-436.
Song LW, Xiang CC, Qiu D, et al. Feature extraction of foot movement based on plantar pressure distributions[J].J Med Biomech,2021,3:431-436.(in Chinese)
[22] 王雪森,闫松华,郑华,等.痉挛型脑瘫儿童动态足底压力分布特征研究[J].北京生物医学工程,2019,38(1):28-35.
Wang XS,Yan SH,Zheng H,et al.Characteristics of dynamic plantar pressure during walking in children with spastic cerebral palsy[J].Beijing Biomedical Eng,2019,38(1):28-35.(in Chinese)
[23] 陈盼盼,刘夕东,韩林林,等.学龄儿童柔软性扁平足足底压力分布特征[J].中国康复,2021,36(4):226-230.
Chen PP,Liu XD,Han LL,et al.Characteristics of plantar pressure distribution of school-age children with flexible flatfoot[J].Chin J Rehabilit,2021,36(4):226-230.(in Chinese)
[24] 高夫宁,张跃,赵晓科,等.肌内效贴技术对脑瘫患儿足弓发育及运动功能的影响[J].中国急救医学,2016,36(z1):248-249.
Gao FN,Zhang Y,Zhao XK,et al. Effect of intramuscular patch technology on arch development and motor function in children with cerebral palsy[J].Chin J Crit Care Med,2016,36(z1):248-249.(in Chinese)
[25] 张燊,崔科东,张希妮,等. 足部功能训练对足趾肌力和足弓生物力学的影响[J]. 中国运动医学杂志,2021,40(4):249-258.
Zhang S, Cui KD, Zhang XN, et al.Effects of foot functional exercise on the toe flexor strength and the arch biomechanics[J]. Chin J Sports Med,2021,40(4):249-258.(in Chinese)
[26] 戴燕琼,陈丽,唐亮.矫形鞋垫联合运动贴扎技术对偏瘫型脑性瘫痪患儿姿势控制效果的临床研究[J].中国康复医学杂志,2020,35(1):65-68.
Dai YQ,Chen L,Tang L. Clinical study on the effect of orthopedic insole combined with sports strapping technology on posture control in children with hemiplegic cerebral palsy[J].Chin J Rehabi Med,2020,35(1):65-68.(in Chinese)
[27] 蒋莹,徐艳,谢文龙,等.肌内效贴联合康复训练对小儿脑瘫患儿运动功能的影响[J].中国妇幼保健,2020,35(24):4742-4745.
Jiang Y,Xu Y,Xie WL,et al. Effect of intramuscular plaster combined with rehabilitation training on motor func-tion of children with cerebral palsy[J].Matern Child Health Care China,2020,35(24):4742-4745.(in Chinese)
[28] 白啸天,霍洪峰. 足踝功能的生物力学测评:构建足静态和动态评价指标[J]. 中国组织工程研究,2021,17:2747-2754.
Bai XT,Huo HF. Biomechanical evaluation of foot and ankle function: Constructing static and dynamic indexes of the foot[J].Chin J Tissue Eng Res,2021,17:2747-2754.(in Chinese)
[29] Morley AJ. Knock-knee in children[J]. Br Med J, 1957,2(5051):976-979.
[30] Volpon JB. Footprint analysis during the growth period[J]. J Pediatr Orthop, 1994,14(1):83-85.
[31] 叶春娟,陈玉平. 幼儿足弓发育及异常状况文献综述[J]. 当代体育科技,2019,9(15):53-54.
Ye CJ,Chen YP. A literature review of peduncle development and abnormalities in young children[J].Contemporary Sports Technol,2019,9(15):53-54.(in Chinese)
[32] 钟雨婷,吕婧仪,陈天午,等. 上海市学龄儿童足弓指数及扁平足的流行病学研究[J]. 中国学校卫生,2020,41(9):1358-1361,1364.
Zhong YT, Lv JY, Chen TW, et al.Assessment of plantar arch index and prevalence of fiat feet in 3 226 school-age children in Shanghai[J]. Chin J Sch Health,2020,41(9):1358-1361,1364.(in Chinese)
[33] 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(下)[J]. 中华实用儿科临床杂志,2022,37(17):1281-1309.
Pediatric Rehabilitation Professional Committee of Chinese Association of Rehabilitation Medicine, Pediatric Cerebral Palsy Rehabilitation Professional Committee of China Association for the Rehabilitation of Persons with Disabilities, Pediatric Rehabilitation Professional Committee of Rehabilitation Physician Branch of Chinese Medical Doctor Association, etc. Chinese rehabilitation guidelines for cerebral palsy (2022) part 4: rehabilitation treatment(Ⅱ)[J].Chin J Appl Clin Pediatr,2022,37(17):1281-1309. (in Chinese)
[34] Horsch A, Götze M, Geisbüsch A, et al. Prevalence and classification of equinus foot in bilateral spastic cerebral palsy[J]. World J Pediatr. 2019,15(3):276-280
[35] 刘程林,郝卫亚,霍波.运动生物力学发展现状及挑战[J].力学进展,2023,53(1):198-238.
Liu CL,Hao WY,Huo B. Advances and challenges in sports biomechanics[J].Advances In Mech,2023,53(1):198-238.(in Chinese)
[36] 张燊,张希妮,崔科东,等. 足弓的运动功能进展及其在人体运动中的生物力学贡献[J]. 体育科学,2018,38(5):73-79.
Zhang S, Zhang XN, Cui KD, et al. The development of the longitude arch motor function and its biomechanical contribution to human movement[J].Chin Sport Sci,2018,38(5):73-79.(in Chinese)
[37] 袁刚,张木勋,王中琴,等. 正常人足底压力分布及其影响因素分析[J]. 中华物理医学与康复杂志,2004,26(3):156-159.
Yuan G, Zhang MX, Wang ZQ, et al.The distribution of foot pressure and its influence factors in Chinese people[J]. Chin J Phys Med and Rehabilit,2004,26(3):156-159.(in Chinese)
[38] 张雪原,马丙祥,李华伟,等.脑性瘫痪患儿足部畸形评定方法研究进展[J].康复学报,2022,32(6):562-568.
Zhang XY,Ma BX,Li HW et al. Research progress on foot deformity assessment methods of children with cerebral palsy[J].J Fujian Univ Tradit Chin Med,2022,32(6):562-568.(in Chinese)
[39] 李海,张海瑞,张瀚元,等. 扁平足检测方法研究及进展[J]. 中国卫生标准管理,2018,9(9):34-37.
Li H, Zhang HR, Zhang HY, et al. Study on detection methods and progress of flatfoot[J]. China Health Stand Manag,2018,9(9):34-37. (in Chinese)