患兒姿勢(shì)控制及社會(huì)活動(dòng)參與能力的療效觀察

1、目錄中文摘要4Abstract5引言7第一章 理論研究91. 中醫(yī)學(xué)對(duì)腦癱的認(rèn)識(shí)91.1 腦癱的中醫(yī)學(xué)概念91.2腦癱的病因病機(jī)91.3辨證分型101.4腦癱的中醫(yī)治療111.5中醫(yī)治療腦癱的優(yōu)勢(shì)及不足112. 現(xiàn)代醫(yī)學(xué)對(duì)腦癱的認(rèn)識(shí)132.1腦癱的定義132.2腦癱的病因132.3腦癱的診斷及分型132.4腦癱的治療133. 藝術(shù)治療153.1音樂治療153.2美術(shù)治療153.3戲劇治療163.4舞蹈治療164.本文的研究方向和意義17第二章 臨床研究181臨床資料181.1倫理信息181.2病例來(lái)源181.3一般資料182研究方法182.1 診斷標(biāo)準(zhǔn)182.2納入標(biāo)準(zhǔn)192.3排除標(biāo)準(zhǔn)192

2、.4 剔除及脫落標(biāo)準(zhǔn)192.5治療方法192.6評(píng)價(jià)指標(biāo)192.7統(tǒng)計(jì)學(xué)方法203結(jié)果與分析203.1兩組治療前后GMFM-66評(píng)分的比較203.2兩組治療前后PDMS-2評(píng)分的比較213.3兩組治療前后X軸、Y軸平均COP比較213.4兩組治療前后嬰兒初中生社會(huì)活動(dòng)能力量表SM評(píng)分比較223.5兩組治療前后步行時(shí)空參數(shù)評(píng)分比較224討論234.1中醫(yī)與舞蹈234.2芭蕾舞訓(xùn)練與傳統(tǒng)康復(fù)治療結(jié)合的意義244.3量表選擇244.4研究結(jié)果分析254.5不足與展望27結(jié)論28致謝29參考文獻(xiàn)30附錄33附錄1：文獻(xiàn)綜述33附錄2在校期間發(fā)表學(xué)術(shù)論文34中文摘要目的：1、國(guó)內(nèi)首次運(yùn)用芭蕾舞訓(xùn)練對(duì)腦癱

3、兒童進(jìn)行康復(fù)干預(yù)，觀察芭蕾舞訓(xùn)練對(duì)腦癱患兒的姿勢(shì)控制及社會(huì)活動(dòng)參與能力的療效；2、通過本項(xiàng)研究，為今后腦癱兒童的康復(fù)訓(xùn)練提供新的思路。（如舞蹈治療等藝術(shù)形式的引入）。方法：選取上海腦癱芭蕾舞團(tuán)在訓(xùn)的腦癱患兒9例，GMFCS分級(jí)-級(jí)、年齡4-12歲作為舞蹈組；采用1:1配對(duì)在上海市殘疾人康復(fù)職業(yè)培訓(xùn)中心收治的腦癱患兒中，按相同GMFCS分級(jí)、相同年齡段進(jìn)行配對(duì)。若配對(duì)過程中有多個(gè)樣本符合配對(duì)條件，則采用簡(jiǎn)單隨機(jī)（抽簽法），共配對(duì)9例為對(duì)照組，總計(jì)納入樣本18例。舞蹈組在常規(guī)綜合康復(fù)訓(xùn)練基礎(chǔ)上給予個(gè)性化芭蕾舞訓(xùn)練（由芭蕾舞老師和康復(fù)治療師共同制定舞蹈方案）；對(duì)照組給予常規(guī)綜合康復(fù)訓(xùn)練；每6個(gè)月為一

4、個(gè)療程，共觀察兩個(gè)療程12個(gè)月。芭蕾舞訓(xùn)練頻率每周2次，每次1個(gè)小時(shí)?？祻?fù)訓(xùn)練頻率每周3次，每次40分鐘。運(yùn)用粗大運(yùn)動(dòng)功能評(píng)估GMFM-66、精細(xì)運(yùn)動(dòng)功能評(píng)定量表（PDMS-2）及Tecnobody PK254P平衡儀對(duì)舞蹈組和對(duì)照組進(jìn)行首次、治療后3個(gè)月、6個(gè)月、9個(gè)月以及末次（12個(gè)月）評(píng)估，觀察腦癱患兒粗大、精細(xì)和平衡功能療效。運(yùn)用三維步態(tài)分析系統(tǒng)、嬰兒初中生社會(huì)活動(dòng)能力量表對(duì)舞蹈組和對(duì)照組進(jìn)行治療前后評(píng)估，觀察腦癱患兒步行能力及社會(huì)活動(dòng)參與能力的療效。結(jié)果：（1）給與本實(shí)驗(yàn)既定的兩療程專業(yè)治療，統(tǒng)計(jì)入組患者的資料完整的人數(shù)發(fā)現(xiàn)，舞蹈組1例患者脫落，8例最終用于實(shí)驗(yàn)結(jié)果分析；對(duì)照組無(wú)病例

5、脫落，最終9例。（2）GMFM-66評(píng)分顯示：同一組別中，治療后3個(gè)月、6個(gè)月、9個(gè)月以及末次（12個(gè)月）分?jǐn)?shù)與患者參與治療前的各項(xiàng)分?jǐn)?shù)，經(jīng)統(tǒng)計(jì)學(xué)分析可知差異有統(tǒng)計(jì)學(xué)意義（P0.05）；發(fā)現(xiàn)患者給與治療方案實(shí)施3個(gè)月、6個(gè)月、9個(gè)月以及12個(gè)月，關(guān)于治療效果舞蹈組明顯優(yōu)于對(duì)照組，經(jīng)統(tǒng)計(jì)學(xué)分析可知差異有統(tǒng)計(jì)學(xué)意義（P0.05）。（3）PDMS-2結(jié)果顯示，治療前后無(wú)統(tǒng)計(jì)學(xué)意義。（P0.05）。（4）Tecnobody PK254P平衡儀測(cè)試結(jié)果顯示：同一組別中，治療后3個(gè)月、6個(gè)月、9個(gè)月以及末次（12個(gè)月）分?jǐn)?shù)與治療前對(duì)比，經(jīng)統(tǒng)計(jì)學(xué)分析可知差異有統(tǒng)計(jì)學(xué)意義（P0.05）；治療后3個(gè)月、6個(gè)月、

6、9個(gè)月以及末次，關(guān)于治療效果舞蹈組明顯優(yōu)于對(duì)照組，經(jīng)統(tǒng)計(jì)學(xué)分析可知差異有統(tǒng)計(jì)學(xué)意義（P0.05）。（5）三維步態(tài)分析結(jié)果顯示：同一組別中，首次（治療前）以及末次（12個(gè)月后）步行時(shí)空參數(shù)對(duì)比，差異具有統(tǒng)計(jì)學(xué)意義（P0.05）；治療前以及末次（12個(gè)月后）步行時(shí)空參數(shù)對(duì)比，舞蹈組療效優(yōu)于對(duì)照組，差異具有統(tǒng)計(jì)學(xué)意義（P0.05）。（6）嬰兒初中生社會(huì)活動(dòng)能力量表評(píng)分顯示：同一組別中，首次（治療前）以及末次（12個(gè)月后）分?jǐn)?shù)對(duì)比，差異具有統(tǒng)計(jì)學(xué)意義（P0.05）；不同組別之間，首次（治療前）以及末次（12個(gè)月后）分?jǐn)?shù)對(duì)比，關(guān)于治療效果舞蹈組明顯優(yōu)于對(duì)照組，經(jīng)統(tǒng)計(jì)學(xué)分析可知差異有統(tǒng)計(jì)學(xué)意義（P0.05

7、）?？偨Y(jié)可知，關(guān)于該疾病的臨床結(jié)果提示，治療效果舞蹈組明顯優(yōu)于對(duì)照組，且隨療程進(jìn)展而逐漸改善。 結(jié)論：（1）在傳統(tǒng)康復(fù)治療的基礎(chǔ)上給予個(gè)性化芭蕾舞訓(xùn)練可以腦癱患兒粗大運(yùn)動(dòng)能力、平衡能力、步行能力及社會(huì)活動(dòng)參與能力。（2）PDMS-2結(jié)果顯示，兩組治療前后、組間比較均無(wú)明顯差異，說明本研究所采用的康復(fù)治療干預(yù)以及芭蕾舞聯(lián)合康復(fù)治療干預(yù)均對(duì)精細(xì)運(yùn)動(dòng)功能改善不明顯，且療效并未隨著療程進(jìn)展而發(fā)生明顯改善；關(guān)鍵詞：芭蕾舞訓(xùn)練；腦性癱瘓；姿勢(shì)控制；社會(huì)活動(dòng)參與能力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 基本資料組別例數(shù)性別（例）年齡（歲）GMFCS男女對(duì)照組9278.112.9881舞蹈組9277.222.82812 研究方法2.1 診斷標(biāo)準(zhǔn)2.1.1西醫(yī)診斷標(biāo)準(zhǔn)參照2015年中國(guó)腦性癱瘓康復(fù)治療指南編寫委員會(huì)最新制定的，腦性癱瘓的診斷標(biāo)準(zhǔn)為4項(xiàng)必備條件及2項(xiàng)參考條件。2.1.2中醫(yī)診斷標(biāo)準(zhǔn)中醫(yī)兒科常見病診療指南（2012年）由中華中醫(yī)藥學(xué)會(huì)頒布，該指南制定了肝腎虧虛證 CP的辯證標(biāo)準(zhǔn)。2.2納入標(biāo)準(zhǔn)（1）符合腦癱診斷標(biāo)準(zhǔn)的4-12歲患兒（2）GMFCS分級(jí)為、級(jí)（3）自愿加入本試驗(yàn)研究的（4）無(wú)其他嚴(yán)重心、肝、腎等全身器質(zhì)性病變及內(nèi)分泌和代謝性障礙疾?。?）能配合臨床觀察者2.3排除標(biāo)準(zhǔn)（1）不符合上述診斷標(biāo)準(zhǔn)及納入標(biāo)準(zhǔn)者（2）嚴(yán)重認(rèn)知功能障礙；（3）存在其他嚴(yán)重心、肝、腎等