目的 分析前馈控制结合躯干训练对小儿脑瘫运动发育及日常生活活动能力的影响,为临床治疗提供科学依据。方法 2015年12月-2016年12月选取40例小儿脑瘫患者随机分成训练组和对照组,每组各20例,对照组给予常规躯干控制训练,训练组在进行常规躯干训练前先进行前馈控制训练。在治疗8周和6个月、1年后两组患儿采用Berg平衡量表(BBS),粗大运动功能量表(GMFCS),Fugl-Meyer运动功能评定量表(FMA),改良Barthel指数(MBI)进行疗效分析。结果 治疗前两组患儿BBS、GMFCS、FMA及MBI评分比较组间差异均无统计学意义(P＞0.05),治疗8周后两组患儿上述各项指标与治疗前相比显著改善,且训练组的改善较明显,与对照组比较,差异均有统计学意义(t=2.124、2.393、2.283、3.048,P＜0.05)。6个月、1年后随访发现训练组的改善仍高于对照组(P＜0.05)。重复测量方差分析结果显示,两组患儿BBS,GMFCS,FMA及MBI评分的时间效应、组内效应与交互作用差异均有统计学意义(P＜0.05)。结论 前馈控制结合躯干训练可以明显改善小儿脑瘫运动功能及日常生活活动能力,长期随访发现效果仍显著。

Objective To analyze the effects of feed-forward control combined with trunk training on motor development and activities of daily living (ADL) in children with cerebral palsy(CP),so as to provide scientific basis for clinical treatment.Methods Totally 40 CP children were enrolled in this study and were randomly divided into treatment group (n=20) and control group (n=20). Both groups were treated with trunk control training while the treatment group was given feed-forward control combined additionally before trunk control training.The assessment tools including Berg Balance Scale (BBS) for balance function,the Gross Motor Function Classification System (GMFCS) for gross motor function,Fugl-Meyer Assessment (FMA) of Motor Function Rating Scale for motor function,and Modified Barthel Index (MBI) for ADL ability were adopted to assess the efficacy in both groups after 8 weeks,6 months and one year of the treatment respectively. Results There were no significant differences on BBS,GMFCS,FMA and MBI scores between treatment group and control group before treatment (P＞0.05).The above indexes of the two groups were significantly improved compared with those before treatment,and the improvement of the training group was obvious in 8 weeks after treatment.Additionally,the differences on the indexes between the two groups were significant(t=2.124,2.393,2.283,3.048,P＜0.05).And the improvement of the training group was still higher than that of the control group after six months and one year (P＜0.05).Repeated measurement anova analysis showed that the time effect,intra-group effect and interaction of BBS,GMFCS,FMA and MBI scores between the two groups were statistically significant (P＜0.05). Conclusion Feed forward control combined with trunk training might improve the motor function and ADL of children with cerebral palsy,and its effect still lasts after long-term follow-up.