目的 对脑性瘫痪(CP)儿童实施医教结合的方法,探索基于现实生活导向的CP儿童日常生活活动能力(ADL)训练有效策略。方法 2017年4月-2018年8月随机抽取在湘雅博爱康复医院就诊的41例CP儿童,采用随机单盲对照的研究方法将其分为对照组和研究组,对照组行常规ADL训练,研究组行基于现实生活导向的ADL训练,即分为个人卫生或自我照顾为导向、功能性移动为导向、手功能操作为导向、日常生活交流为导向、社会化活动为导向。治疗前后分别采用儿童生活功能评估量表(PEDI)、儿童功能独立性评定量表(WeeFIM)和中文版儿童生活质量脑瘫量表(PedsQLTM)3.0评估儿童ADL技能、功能独立程度以及生活质量(QOL)。结果 治疗4个月后,对照组和研究组在PEDI、WeeFIM和PedsQLTM3.0评分上较治疗前明显提高(对照组t值分别为14.796、6.954、31.104;研究组t值分别为5.613、31.576、20.193,P＜0.01),且研究组的各项评分明显优于对照组,差异均有统计学意义(t=2.247、2.233、2.119,P＜0.05)。结论 采用医教结合和全人发展的理念,选择个性化的ADL训练策略,基于现实生活导向的ADL训练模式更能有效地改善CP儿童的ADL技能和QOL,提高患儿在现实生活中功能独立程度。
Abstract
Objective To explore effective strategies for ability of daily living activities (ADL) training of cerebral palsy (CP) children based on real-life orientation by implementing a combination of medical and teaching methods. Methods A total of 41 children with CP who were treated in Xiangya Boai Rehabilitation Hospital from April 2017 to August 2018 were enrolled in this study and were randomly divided into control group and study group.The control group was given conventional ADL training,and study group received real-life-oriented ADL training,orientated by personal hygiene or self-care,community transfer-functional movement,hand function operation,daily life communication and social activities,respectively.Before and after treatment,Children′s Living Function Assessment Scale (PEDI),Children′s Functional Independence Rating Scale (WeeFIM),and the Chinese Version of the Children′s Quality of Life Cerebral Palsy Scale (PedsQLTM) 3.0 were used to assess children′s ADL skills,functional independence and quality of life(QOL). Result After 4 months of treatment,the PEDI,WeeFIM and PedsQLTM 3.0 scores of the two groups were significantly higher than those before treatment (control group:t=14.796,6.954,31.104;study group:t=5.613,31.576,20.193,P＜0.01),and the scores of study group were significantly better than those of the control group (t=2.247,2.233,2.119,P＜0.05). Conclusion Accepting the idea of combining medicine with education and whole-person development,and selecting individualized training strategies in ADL training,especially ADL training models based on real life orientation,can effectively improve ADL skills and QOL in CP children,thereby advancing children′s ability to live independently in real life.
关键词
脑瘫 /
现实生活导向 /
日常生活活动能力 /
医教结合 /
全人发展
Key words
cerebral palsy /
real life orientation /
ability of daily living activities /
integration of medical education and education /
whole person development
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