EBPforCP腦癱兒的康復(fù)

EBPforCP腦癱兒的康復(fù)第1頁/共16頁CerebralPalsyChronicchildhoodmotorimpairmentdisorder,functionalcharacteristics（慢性兒童運(yùn)動障礙和功能性特征）Hallmarks(標(biāo)志)Limitationsinmobility/handuse（動手能力受限）Neurologicaldysfunctionsigns（神經(jīng)機(jī)能障礙的表現(xiàn)）Characteristics:Impairedcontrolofmovement/posture（對運(yùn)動/姿勢的控制力減低）Non-motorimpairments（非運(yùn)動性損傷）Vision（視力）Hearing（聽力）Visual-perceptual（視覺感知）Intellectualimpairment（智能障礙）OtherMedicalconditions（其他表現(xiàn)）第2頁/共16頁TypesofCerebralPalsySpastic:（痙攣型）ThemostcommontypeofCP.Mostobviouswhenthechildtriestomove.（最常見的類型，當(dāng)寶寶嘗試著運(yùn)動時(shí)最容易被發(fā)現(xiàn)）Athetoid/Dyskinetic:（徐動型/不隨意運(yùn)動型）

Uncontrolledmovements.Leadstoerraticmovementswhenthechildmoves.（不隨意的運(yùn)動，當(dāng)寶寶運(yùn)動時(shí)會產(chǎn)生奇怪的動作）Ataxic（共濟(jì)失調(diào)型）:TheleastcommontypeofCP.（最少見）MixedTypeCerebralPalsy（混合型）Thistermisusedwhenmorethanonetypeofmotorpatternispresentandnoonepatternispredominate.（指同時(shí)出現(xiàn)兩種及以上的運(yùn)動障礙，但沒有哪一種障礙是占主導(dǎo)的）第3頁/共16頁CategorizedbyBodyPartQuadriplegia（四肢麻痹）:allfourlimbsareaffected.Themusclesofthefaceandmouthmayalsobeaffected.（四肢都被影響，同時(shí)面部肌肉也會受到影響）Diplegia（雙側(cè)癱瘓）:allfourlimbsareaffected,butthelegsmoresothanthearms.（四肢都嚴(yán)重受損，同時(shí)下肢重于上肢）Hemiplegia（偏癱）:onesideofthebodyisaffected.（一側(cè)肢體被影響）Paraplegia（截癱）:bothlegs,butneitherarmisaffected.（雙側(cè)下肢運(yùn)動失能，但雙手正常）第4頁/共16頁AssociatedDifficulties

腦癱相關(guān)缺陷Visual（視覺）

Themostcommoneyeproblemisasquint（斜視）.Thismaybecorrectedwithglassesorinseverecasesanoperation.Moreseriouseyeproblemsaremuchlesscommon.（最常見的眼部障礙是斜視，可以通過戴眼鏡糾正，或者更嚴(yán)重的需要手術(shù)糾正，而更加嚴(yán)重的就不常見了）Hearing（聽覺）

Allchildrenwithcerebralpalsyshouldbeseenbyaspecialisttocheckforhearingproblems.（經(jīng)過專業(yè)的聽覺測試發(fā)現(xiàn)所有腦癱兒童都有聽力障礙）Speech（語言）Speechdependsontheabilitytocontrolmusclesinthemouth,tongue,palateandvoicebox（言語依賴于口、舌、上顎和喉頭肌肉的正常功能）.第5頁/共16頁AssociatedImpairments

腦癱相關(guān)損傷Spatialperception（空間感、立體感）

Somechildrenwithcerebralpalsycannotperceivespaceandrelateittotheirownbodies(forexample,distances)orthinkspatially（一些腦癱兒不能辨別空間，也無法將空間與自身聯(lián)系起來，也沒有空間想象能力）Epilepsy（癲癇）

maydevelopinapproximatelyoneinthreeofallchildrenwithcerebralpalsy.（腦癱兒約1/3可見癲癇發(fā)生）

第6頁/共16頁AssociatedDisabilities

腦癱相關(guān)障礙Intellectualorlearningdisability智能或?qū)W習(xí)能力障礙

Thereisawiderangeofintellectualabilityinpeoplewithcerebralpalsy.（腦癱兒的智能分布很廣泛）

Oftenitisdifficulttoassesslearningabilityintheearlyyears.(而在早期評估智能是很困難的)Severephysicaldisabilitydoesnotindicateintellectualdisability.（嚴(yán)重的運(yùn)動功能障礙和智能障礙并不對等）Incaseswhereitisknownthatthereisintellectualdisabilitythiswillrangefrommildtosevere（嚴(yán)重的運(yùn)動障礙所對應(yīng)的智能障礙從輕度到重度不等）.60%ofchildrenhavesomeformofCI,ID.（約60%的孩子有不同形式的腦損傷或是智能障礙）第7頁/共16頁Assessment評估TheGrossMotorFunctionClassificationSystem(GMFCS，粗大運(yùn)動功能分級)andtheManualAbilityClassificationScale(MACS，手動能力分級量表)areassessmentsdesignedtoquantifythelevelofmotorfunctioninchildrenwithCP.（這兩個(gè)量表是用來量化腦癱兒的運(yùn)動情況的）AIMS（AbnormalInvoluntaryMovementScale，不自主運(yùn)動量表）QualityofLifeAssessments（生活質(zhì)量評估）CerebralPalsyQualityofLife(CPQOL)—ChildorTeenChildren’sAssessmentofParticipationandEnjoyment&PreferencesforActivitiesinChildren(CAPE/PAC)（參與、享受、偏好活動的兒童評估）PediatricEvaluationofDisabilityInventory（小兒殘疾評估）SchoolFunctionAssessment（學(xué)校日常生活評估）第8頁/共16頁MACSAssessment

手動能力分級量表LevelDescriptionofFunctionalAbilitiesLevelIHandlesobjectseasilyandsuccessfully.Atmosttimes,handlesobjectswithbothhands.Mayhavelimitationsspeedandaccuracy.DoesnotrestrictADLperformance.（雙手能輕易地操作物品，但言語和精確性可能不足，日常生活不受限）LevelIIHandlesmostobjectsbutwithsomewhatreducedqualityand/orspeedofachievement,avoidanceofcertainactivities,

achievedwithsomedifficulty.Donotusuallyrestrictindependenceindailyactivities.

能夠操作大多數(shù)物品，但完成的質(zhì)量和速度方面受到影響，會避免進(jìn)行哲學(xué)行動，但日常生活受影響不大LevelIIIHandlesobjectswithdifficulty;needshelptoprepareand/ormodifyactivities.Thechild‘sperformanceisslowandachievedwithlimitedsuccessregardingqualityandquantity.Thechildcannotperformcertainactivitiesandhisorherdegreeofindependenceisrelatedtothesupportivenessoftheenvironmentalcontext.（操作物品困難，需要幫助準(zhǔn)備或者調(diào)整活動，孩子操作的表現(xiàn)很慢完成質(zhì)量和數(shù)量也不高，他們的獨(dú)立性和環(huán)境支持相關(guān)）LevelIVHandlesalimitedselectionofeasilymanagedobjectsinadaptedsituations.Thechildperformspartsofactivitieswitheffortandwithlimitedsuccess.Requirescontinuoussupportandassistanceand/oradaptedequipment,forevenpartialachievementoftheactivity.在調(diào)整的情況下可以操作有限的簡單物品，需要連續(xù)的支持LevelVDoesnothandleobjectsandhasseverelylimitedabilitytoperformevensimpleactions.Requirestotalassistance.不能操作物品，進(jìn)行簡單活動的能力受限第9頁/共16頁ClassificationofMotorFunction

運(yùn)動功能分級GMFCS-GrossMotorFunctionClassificationSystem粗大運(yùn)動分類系統(tǒng)Level1=Walkswithoutrestrictions能不受限制的行走Level2=Walkswithoutdevice,restrictedcommunitymobility不需要輔助器械，但在社區(qū)行走受限Level3=Walkswithassistivedevice需要輔助器械協(xié)助行走Level4=Limitedself-mobility-powermobility自我移動的能力受限，孩子需要被動轉(zhuǎn)運(yùn)或者依賴電動輔助器械Level5=Selfmobilityextremelylimited自身運(yùn)動完全受限第10頁/共16頁Interventions-EBPsupport

循證干預(yù)Currentevidencesuggeststhat:近來的證據(jù)表示：Positioning,casting,andorthoticprogramshelptominimizemuscletone‘sadverseeffectsonjointalignment.擺位、塑形、骨科手術(shù)有助于減少肌肉緊張度對關(guān)節(jié)對位的負(fù)面影響Earlyintervention早期干預(yù)Functionalandgoaldirectedtraining,workonfunctionalskills功能性和目標(biāo)驅(qū)動的訓(xùn)練，在功能性的技能中顯得特別重要Motor運(yùn)動Motorcontrol運(yùn)動控制CIMT,bimanualtraining雙手訓(xùn)練Hippotherapy馬術(shù)治療Physicalexercise,fitness,homeexercises物理訓(xùn)練，適應(yīng)性和家庭訓(xùn)練Bracing,splinting,casting&positioning支撐、加班、擺位、塑形AdaptiveEquipment適應(yīng)性裝備Seating&Positioning坐姿和塑形AssistiveTechnology輔助技術(shù)第11頁/共16頁Intervention-MedicalthatcomplimentstherapyNeurocognitiveprothetics神經(jīng)認(rèn)知修復(fù)Implantedelectrodes,cochlearimplants,deepbrainstimulation(DBS)電極植入、人工電子耳蝸、大腦深部電刺激Nerveblocks,motorpointblocks,botulinumtoxin（神經(jīng)阻滯，運(yùn)動點(diǎn)阻滯、肉毒素）Localizedinjectionsfortemporaryimprovement,

3–6months局部注射以