患儿姿势控制及社会活动参与能力的疗效观察

1、目录中文摘要4Abstract5引言7第一章 理论研究91. 中医学对脑瘫的认识91.1 脑瘫的中医学概念91.2脑瘫的病因病机91.3辨证分型101.4脑瘫的中医治疗111.5中医治疗脑瘫的优势及不足112. 现代医学对脑瘫的认识132.1脑瘫的定义132.2脑瘫的病因132.3脑瘫的诊断及分型132.4脑瘫的治疗133. 艺术治疗153.1音乐治疗153.2美术治疗153.3戏剧治疗163.4舞蹈治疗164.本文的研究方向和意义17第二章 临床研究181临床资料181.1伦理信息181.2病例来源181.3一般资料182研究方法182.1 诊断标准182.2纳入标准192.3排除标准192

2、.4 剔除及脱落标准192.5治疗方法192.6评价指标192.7统计学方法203结果与分析203.1两组治疗前后GMFM-66评分的比较203.2两组治疗前后PDMS-2评分的比较213.3两组治疗前后X轴、Y轴平均COP比较213.4两组治疗前后婴儿初中生社会活动能力量表SM评分比较223.5两组治疗前后步行时空参数评分比较224讨论234.1中医与舞蹈234.2芭蕾舞训练与传统康复治疗结合的意义244.3量表选择244.4研究结果分析254.5不足与展望27结论28致谢29参考文献30附录33附录1：文献综述33附录2在校期间发表学术论文34中文摘要目的：1、国内首次运用芭蕾舞训练对脑瘫

3、儿童进行康复干预，观察芭蕾舞训练对脑瘫患儿的姿势控制及社会活动参与能力的疗效；2、通过本项研究，为今后脑瘫儿童的康复训练提供新的思路。（如舞蹈治疗等艺术形式的引入）。方法：选取上海脑瘫芭蕾舞团在训的脑瘫患儿9例，GMFCS分级-级、年龄4-12岁作为舞蹈组；采用1:1配对在上海市残疾人康复职业培训中心收治的脑瘫患儿中，按相同GMFCS分级、相同年龄段进行配对。若配对过程中有多个样本符合配对条件，则采用简单随机（抽签法），共配对9例为对照组，总计纳入样本18例。舞蹈组在常规综合康复训练基础上给予个性化芭蕾舞训练（由芭蕾舞老师和康复治疗师共同制定舞蹈方案）；对照组给予常规综合康复训练；每6个月为一

4、个疗程，共观察两个疗程12个月。芭蕾舞训练频率每周2次，每次1个小时。康复训练频率每周3次，每次40分钟。运用粗大运动功能评估GMFM-66、精细运动功能评定量表（PDMS-2）及Tecnobody PK254P平衡仪对舞蹈组和对照组进行首次、治疗后3个月、6个月、9个月以及末次（12个月）评估，观察脑瘫患儿粗大、精细和平衡功能疗效。运用三维步态分析系统、婴儿初中生社会活动能力量表对舞蹈组和对照组进行治疗前后评估，观察脑瘫患儿步行能力及社会活动参与能力的疗效。结果：（1）给与本实验既定的两疗程专业治疗，统计入组患者的资料完整的人数发现，舞蹈组1例患者脱落，8例最终用于实验结果分析；对照组无病例

5、脱落，最终9例。（2）GMFM-66评分显示：同一组别中，治疗后3个月、6个月、9个月以及末次（12个月）分数与患者参与治疗前的各项分数，经统计学分析可知差异有统计学意义（P0.05）；发现患者给与治疗方案实施3个月、6个月、9个月以及12个月，关于治疗效果舞蹈组明显优于对照组，经统计学分析可知差异有统计学意义（P0.05）。（3）PDMS-2结果显示，治疗前后无统计学意义。（P0.05）。（4）Tecnobody PK254P平衡仪测试结果显示：同一组别中，治疗后3个月、6个月、9个月以及末次（12个月）分数与治疗前对比，经统计学分析可知差异有统计学意义（P0.05）；治疗后3个月、6个月、

6、9个月以及末次，关于治疗效果舞蹈组明显优于对照组，经统计学分析可知差异有统计学意义（P0.05）。（5）三维步态分析结果显示：同一组别中，首次（治疗前）以及末次（12个月后）步行时空参数对比，差异具有统计学意义（P0.05）；治疗前以及末次（12个月后）步行时空参数对比，舞蹈组疗效优于对照组，差异具有统计学意义（P0.05）。（6）婴儿初中生社会活动能力量表评分显示：同一组别中，首次（治疗前）以及末次（12个月后）分数对比，差异具有统计学意义（P0.05）；不同组别之间，首次（治疗前）以及末次（12个月后）分数对比，关于治疗效果舞蹈组明显优于对照组，经统计学分析可知差异有统计学意义（P0.05

7、）。总结可知，关于该疾病的临床结果提示，治疗效果舞蹈组明显优于对照组，且随疗程进展而逐渐改善。 结论：（1）在传统康复治疗的基础上给予个性化芭蕾舞训练可以脑瘫患儿粗大运动能力、平衡能力、步行能力及社会活动参与能力。（2）PDMS-2结果显示，两组治疗前后、组间比较均无明显差异，说明本研究所采用的康复治疗干预以及芭蕾舞联合康复治疗干预均对精细运动功能改善不明显，且疗效并未随着疗程进展而发生明显改善；关键词：芭蕾舞训练；脑性瘫痪；姿势控制；社会活动参与能力AbstractObjective: 1. To observe the effect of ballet training on postur

8、al control and social participation ability of children with cerebral palsy; 2. Through this study, new ideas are provided for the rehabilitation training of children with cerebral palsy in the future. (the introduction of art forms such as dance therapy).Methods: 9 children from Shanghai cerebral p

9、alsy ballet training camp, GMFCS class -, ages 4 to 12 years old were divided into dance group; Children with cerebral palsy admitted to Shanghai rehabilitation vocational training center for the disabled were matched 1:1 pairs according to the same GMFCS classification and the same age group. If mo

10、re than one sample in the matching process met the matching conditions, a simple random (lottery) method was adopted. A total of 9 samples were matched as the control group, and a total of 18 samples were included. On the basis of the general comprehensive rehabilitation training, the dance team sha

11、ll provide personalized ballet training (the ballet teacher and the rehabilitation therapist shall work out the dance plan together). The control group was given routine comprehensive rehabilitation training. Every 6 months was a course of treatment, and two courses of treatment were observed for 12

12、 months. The frequency of ballet training is 1 hour twice a week. The frequency of rehabilitation training is 40 minutes 3 times a week. Gross motor function evaluation (GMFM-66), fine motor function rating scale (PDMS-2) and Tecnobody PK254P balance test were used to evaluate the dance group and co

13、ntrol group for the first time, 3 months, 6 months, 9 months and the last time (12 months) after treatment, in order to observe the effect of gross, fine and balance function in children with cerebral palsy. The three-dimensional gait analysis system and the S-M scale were used to evaluate the dance

14、 group and the control group before and after treatment to observe the effect of the walking ability and social participation ability of the children with cerebral palsy.Results:(1) two courses of professional treatment were given for this experiment, and the number of enrolled patients with complet

15、e data was counted. It was found that 1 patient in the dance group was completely excluded, and 8 patients were finally used for the analysis of experimental results.No cases were exfoliated in the control group, and 9 cases were eventually exfoliated.(2) gmfm-66 score: in the same group, the scores

16、 at 3, 6, 9 and the last time (12 months) after treatment were statistically significant compared with the scores before treatment (P 0.05).It was found that patients were given the treatment plan for 3 months, 6 months, 9 months and 12 months, and the treatment effect of the dance group was signifi

17、cantly better than that of the control group, and the difference was statistically significant (P 0.05).(4) Tecnobody PK254P balancer test results showed that: in the same group, scores at 3, 6, 9, and the last time (12 months) after treatment were compared with those before treatment, and the diffe

18、rence was statistically significant (P 0.05).3 months, 6 months, 9 months and the last time after treatment, the treatment effect of the dance group was significantly better than the control group, and the difference was statistically significant (P 0.05).(5) the results of three-dimensional gait an

19、alysis showed that: in the same group, the spatial and temporal parameters of the first (before treatment) and the last (after 12 months) walking were compared, and the difference was statistically significant (P 0.05).Before and at the end of the treatment period (12 months later), the temporal and

20、 spatial parameters of walking were compared, and the therapeutic effect of the dance group was better than that of the control group, the difference was statistically significant (P 0.05).(6) the scores of the social activity scale of infant-junior high school students showed that: in the same grou

21、p, the scores of the first (before treatment) and the last (after 12 months) were compared, and the difference was statistically significant (P 0.05).Among different groups, the scores of the first (before treatment) and the last (after 12 months) were compared. The dance group was significantly bet

22、ter than the control group in terms of treatment effect, and the difference was statistically significant (P 0.05），具有可比性。表1 基本资料组别例数性别（例）年龄（岁）GMFCS男女对照组9278.112.9881舞蹈组9277.222.82812 研究方法2.1 诊断标准2.1.1西医诊断标准参照2015年中国脑性瘫痪康复治疗指南编写委员会最新制定的，脑性瘫痪的诊断标准为4项必备条件及2项参考条件。2.1.2中医诊断标准中医儿科常见病诊疗指南（2012年）由中华中医药学会颁布，该指南制定了肝肾亏虚证 CP的辩证标准。2.2纳入标准（1）符合脑瘫诊断标准的4-12岁患儿（2）GMFCS分级为、级（3）自愿加入本试验研究的（4）无其他严重心、肝、肾等全身器质性病变及内分泌和代谢性障碍疾病（5）能配合临床观察者2.3排除标准（1）不符合上述诊断标准及纳入标准者（2）严重认知功能障碍；（3）存在其他严重心、肝、肾等