EBPforCP脑瘫儿的康复

CerebralPalsySandraRogers,PhD,OTR/LSchoolofOccupationalTherapyPacificUniversityCerebralPalsyChronicchildhoodmotorimpairmentdisorder,functionalcharacteristics（慢性儿童运动障碍和功能性特征）Hallmarks(标志)Limitationsinmobility/handuse（动手能力受限）Neurologicaldysfunctionsigns（神经机能障碍的表现）Characteristics:Impairedcontrolofmovement/posture（对运动/姿势的控制力减低）Non-motorimpairments（非运动性损伤）Vision（视力）Hearing（听力）Visual-perceptual（视觉感知）Intellectualimpairment（智能障碍）OtherMedicalconditions（其他表现）TypesofCerebralPalsySpastic:（痉挛型）ThemostcommontypeofCP.Mostobviouswhenthechildtriestomove.（最常见的类型，当宝宝尝试着运动时最容易被发现）Athetoid/Dyskinetic:（徐动型/不随意运动型）

Uncontrolledmovements.Leadstoerraticmovementswhenthechildmoves.（不随意的运动，当宝宝运动时会产生奇怪的动作）Ataxic（共济失调型）:TheleastcommontypeofCP.（最少见）MixedTypeCerebralPalsy（混合型）Thistermisusedwhenmorethanonetypeofmotorpatternispresentandnoonepatternispredominate.（指同时出现两种及以上的运动障碍，但没有哪一种障碍是占主导的）CategorizedbyBodyPartQuadriplegia（四肢麻痹）:allfourlimbsareaffected.Themusclesofthefaceandmouthmayalsobeaffected.（四肢都被影响，同时面部肌肉也会受到影响）Diplegia（双侧瘫痪）:allfourlimbsareaffected,butthelegsmoresothanthearms.（四肢都严重受损，同时下肢重于上肢）Hemiplegia（偏瘫）:onesideofthebodyisaffected.（一侧肢体被影响）Paraplegia（截瘫）:bothlegs,butneitherarmisaffected.（双侧下肢运动失能，但双手正常）AssociatedDifficulties

脑瘫相关缺陷Visual（视觉）

Themostcommoneyeproblemisasquint（斜视）.Thismaybecorrectedwithglassesorinseverecasesanoperation.Moreseriouseyeproblemsaremuchlesscommon.（最常见的眼部障碍是斜视，可以通过戴眼镜纠正，或者更严重的需要手术纠正，而更加严重的就不常见了）Hearing（听觉）

Allchildrenwithcerebralpalsyshouldbeseenbyaspecialisttocheckforhearingproblems.（经过专业的听觉测试发现所有脑瘫儿童都有听力障碍）Speech（语言）Speechdependsontheabilitytocontrolmusclesinthemouth,tongue,palateandvoicebox（言语依赖于口、舌、上颚和喉头肌肉的正常功能）.AssociatedImpairments

脑瘫相关损伤Spatialperception（空间感、立体感）

Somechildrenwithcerebralpalsycannotperceivespaceandrelateittotheirownbodies(forexample,distances)orthinkspatially（一些脑瘫儿不能辨别空间，也无法将空间与自身联系起来，也没有空间想象能力）Epilepsy（癫痫）

maydevelopinapproximatelyoneinthreeofallchildrenwithcerebralpalsy.（脑瘫儿约1/3可见癫痫发生）

AssociatedDisabilities

脑瘫相关障碍Intellectualorlearningdisability智能或学习能力障碍

Thereisawiderangeofintellectualabilityinpeoplewithcerebralpalsy.（脑瘫儿的智能分布很广泛）

Oftenitisdifficulttoassesslearningabilityintheearlyyears.(而在早期评估智能是很困难的)Severephysicaldisabilitydoesnotindicateintellectualdisability.（严重的运动功能障碍和智能障碍并不对等）Incaseswhereitisknownthatthereisintellectualdisabilitythiswillrangefrommildtosevere（严重的运动障碍所对应的智能障碍从轻度到重度不等）.60%ofchildrenhavesomeformofCI,ID.（约60%的孩子有不同形式的脑损伤或是智能障碍）Assessment评估TheGrossMotorFunctionClassificationSystem(GMFCS，粗大运动功能分级)andtheManualAbilityClassificationScale(MACS，手动能力分级量表)areassessmentsdesignedtoquantifythelevelofmotorfunctioninchildrenwithCP.（这两个量表是用来量化脑瘫儿的运动情况的）AIMS（AbnormalInvoluntaryMovementScale，不自主运动量表）QualityofLifeAssessments（生活质量评估）CerebralPalsyQualityofLife(CPQOL)—ChildorTeenChildren’sAssessmentofParticipationandEnjoyment&PreferencesforActivitiesinChildren(CAPE/PAC)（参与、享受、偏好活动的儿童评估）PediatricEvaluationofDisabilityInventory（小儿残疾评估）SchoolFunctionAssessment（学校日常生活评估）MACSAssessment

手动能力分级量表LevelDescriptionofFunctionalAbilitiesLevelIHandlesobjectseasilyandsuccessfully.Atmosttimes,handlesobjectswithbothhands.Mayhavelimitationsspeedandaccuracy.DoesnotrestrictADLperformance.（双手能轻易地操作物品，但言语和精确性可能不足，日常生活不受限）LevelIIHandlesmostobjectsbutwithsomewhatreducedqualityand/orspeedofachievement,avoidanceofcertainactivities,

achievedwithsomedifficulty.Donotusuallyrestrictindependenceindailyactivities.

能够操作大多数物品，但完成的质量和速度方面受到影响，会避免进行哲学行动，但日常生活受影响不大LevelIIIHandlesobjectswithdifficulty;needshelptoprepareand/ormodifyactivities.Thechild‘sperformanceisslowandachievedwithlimitedsuccessregardingqualityandquantity.Thechildcannotperformcertainactivitiesandhisorherdegreeofindependenceisrelatedtothesupportivenessoftheenvironmentalcontext.（操作物品困难，需要帮助准备或者调整活动，孩子操作的表现很慢完成质量和数量也不高，他们的独立性和环境支持相关）LevelIVHandlesalimitedselectionofeasilymanagedobjectsinadaptedsituations.Thechildperformspartsofactivitieswitheffortandwithlimitedsuccess.Requirescontinuoussupportandassistanceand/oradaptedequipment,forevenpartialachievementoftheactivity.在调整的情况下可以操作有限的简单物品，需要连续的支持LevelVDoesnothandleobjectsandhasseverelylimitedabilitytoperformevensimpleactions.Requirestotalassistance.不能操作物品，进行简单活动的能力受限ClassificationofMotorFunction

运动功能分级GMFCS-GrossMotorFunctionClassificationSystem粗大运动分类系统Level1=Walkswithoutrestrictions能不受限制的行走Level2=Walkswithoutdevice,restrictedcommunitymobility不需要辅助器械，但在社区行走受限Level3=Walkswithassistivedevice需要辅助器械协助行走Level4=Limitedself-mobility-powermobility自我移动的能力受限，孩子需要被动转运或者依赖电动辅助器械Level5=Selfmobilityextremelylimited自身运动完全受限Interventions-EBPsupport

循证干预Currentevidencesuggeststhat:近来的证据表示：Positioning,casting,andorthoticprogramshelptominimizemuscletone‘sadverseeffectsonjointalignment.摆位、塑形、骨科手术有助于减少肌肉紧张度对关节对位的负面影响Earlyintervention早期干预Functionalandgoaldirectedtraining,workonfunctionalskills功能性和目标驱动的训练，在功能性的技能中显得特别重要Motor运动Motorcontrol运动控制CIMT,bimanualtraining双手训练Hippotherapy马术治疗Physicalexercise,fitness,homeexercises物理训练，适应性和家庭训练Bracing,splinting,casting&positioning支撑、加班、摆位、塑形AdaptiveEquipment适应性装备Seating&Positioning坐姿和塑形AssistiveTechnology辅助技术Intervention-MedicalthatcomplimentstherapyNeurocognitiveprothetics神经认知修复Implantedelectrodes,cochlearimplants,deepbrainstimulation(DBS)电极植入、人工电子耳蜗、大脑深部电刺激Nerveblocks,motorpointblocks,botulinumtoxin（神经阻滞，运动点阻滞、肉毒素）Localizedinjectionsfortemporaryimprovement,

3–6months局部注射以获得暂时运动能力暂时提高，可持续3~6个月Selectivedorsalrhizotomy选择性背部神经阻断术Interruptsdeeptendonreflex;DBS阻断深反射Orthopedicprocedures骨科手术Increaserangeofmotion增加运动范围Contractions,dislocation,scoliosis收缩、脱臼和脊柱侧凸Resourc