前庭训练结合常规康复对全面发育迟缓伴肌张力低下患儿整体发育水平影响的随机对照试验

doi:10.12114/j.issn.1007-9572.2021.00.310

摘要/Abstract

摘要： 背景目前，全面发育迟缓伴肌张力低下患儿的增多已引起人们的关注，但在临床上对于此类患儿的康复治疗，方法较为单一且起效较慢。目的观察前庭训练结合常规康复治疗对全面发育迟缓伴肌张力低下患儿肌张力和整体发育水平的影响，旨在优化其康复治疗方案。方法选取2018年4月至2020年1月于黑龙江中医药大学附属第二医院康复中心儿童康复部接受康复训练的全面发育迟缓伴肌张力低下患儿60例为研究对象，采用随机数字表法将其分为对照组（30例）和观察组（30例）。对照组患儿采用常规康复治疗，观察组患儿采用前庭训练结合常规康复治疗。两组均每天进行1次治疗，每周连续治疗6 d，连续治疗4周。观察并比较两组患儿治疗前、后格里菲斯儿童神经发育量表（GMDS）各领域百分比和发育商，以及肌张力评分；比较两组患儿治疗后肌张力改善的总有效率。结果干预前两组GMDS各领域百分比和发育商比较，差异无统计学意义（P>0.05）；干预后观察组GMDS各领域百分比和发育商均高于对照组，差异有统计学意义（P<0.05）。干预前两组肌张力评分比较，差异无统计学意义（P>0.05）；干预后观察组肌张力评分高于对照组（P<0.05），差异有统计学意义。在肌张力改善情况上，对照组显效9例（30.0%）、有效8例（26.7%）、无效13例（43.3%），临床总有效率为56.7%（17/30）；观察组显效17例（56.7%）、有效9例（30.0%）、无效4例（13.3%），临床总有效率为86.7%（26/30）。观察组临床总有效率高于对照组，差异有统计学意义（χ2=13.658，P<0.001）。结论前庭训练结合常规康复治疗的实施能够提高全面发育迟缓伴肌张力低下患儿的肌张力水平，并明显改善其发育迟缓状况，且其疗效优于单一常规康复治疗。

关键词: 前庭训练, 全面发育迟缓, 肌张力低下, 儿童, 康复医学, 随机对照试验

Abstract: Background

The increase in the number of children with global developmental delay and hypotonia is a growing concern. However, clinical rehabilitation for these patients is often carried out using monotherapy approaches, and the period for achieving improvement is relatively long.

Objective

To observe the effect of vestibular training with regular rehabilitation on muscle tone and global developmental level in children with global developmental delay with hypotonia, providing evidence for improving treatment options for these children.

Methods

Sixty children with global developmental delay accompanied by hypotonia who received rehabilitation training in Department of Pediatric Rehabilitation, Rehabilitation Center, the Second Affiliated Hospital of Heilongjiang University of Chinese Medicine from April 2018 to January 2020 were selected, and equally randomized into a control group (regular rehabilitation) and an observation group (vestibular training with regular rehabilitation) . Both groups were treated once daily, 6 days per week, for consecutive 4 weeks. Changes in the normative percentages of Griffiths Mental Development Scales (GMDS) subscales and development quotient, and muscle tone grading of both groups were observed before and after treatment. The overall response rates of muscle tone improvement were compared between the groups.

Results

The values of normative percentages of GMDS subscales and development quotient were similar in both groups at baseline (P>0.05) , but they were more higher in the observation group after intervention (P<0.05) . The post-intervention level of muscle tone of the observation group was higher than that in the control group (P<0.05) although intergroup difference in baseline muscle tone level was insignificant (P>0.05) . The observation group had a much higher overall response rate of muscle tone improvement 〔86.7% (26/30) : 17 (56.7%) with significant responses, 9 (30.0%) with fair responses, 4 (13.3%) with no responses〕 than the control group〔56.7% (17/30) : 9 (30.0%) with significant responses, 8 (26.7%) with fair responses, 13 (43.3%) with no responses〕 (χ²=13.658, P<0.001) .

Conclusion

Vestibular training with regular rehabilitation could improve the muscle tone and developmental delay in children with global developmental delay and hypotonia, which was superior to regular rehabilitation.

Key words: Vestibular training, Global developmental delay, Hypotonia, Children, Rehabilitation medicine, Randomized controlled trails

中图分类号:

R749.93
R493

王艳,乌云塔娜,项栋良,等. 前庭训练结合常规康复对全面发育迟缓伴肌张力低下患儿整体发育水平影响的随机对照试验[J]. 中国全科医学, 2022, 25(07): 867-873. DOI: 10.12114/j.issn.1007-9572.2021.00.310.

WANG Yan, WUYUN Tana, XIANG Dongliang, ZHAO Mingyue, YUAN Yiming.

Effect of Vestibular Training with Regular Rehabilitation on the Overall Development of Children with Global Developmental Delay and Hypotonia: a Randomized Controlled Trial [J]. Chinese General Practice, 2022, 25(07): 867-873.

图/表 4

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组别	例数	性别（男/女）	月龄〔n（%）〕
组别	例数	性别（男/女）	12~18个月	19~24个月
对照组	30	14/16	18（60.0）	12（40.0）
观察组	30	17/13	14（46.7）	16（53.3）
χ²值		0.601	1.071
P值		0.438	0.301

组别	例数	性别（男/女）	月龄〔n（%）〕
组别	例数	性别（男/女）	12~18个月	19~24个月
对照组	30	14/16	18（60.0）	12（40.0）
观察组	30	17/13	14（46.7）	16（53.3）
χ²值		0.601	1.071
P值		0.438	0.301

组别	例数	A运动		B个人与社会		C语言		D手眼协调		E视觉表现
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
对照组	30	24.42±8.30	33.08±9.25^a	27.00±7.58	35.83±8.21^a	25.25±6.77	37.33±10.15^a	24.33±7.22	38.67±9.28^a	24.67±7.65	38.00±8.57^a
观察组	30	25.58±5.46	53.83±7.03^a	24.00±6.52	54.00±7.00^a	23.33±4.22	53.17±6.50^a	24.25±5.54	54.33±8.28^a	22.75±7.41	53.33±6.61^a
t值		-0.608	-9.778	1.643	-9.225	1.316	-7.197	0.050	-6.901	0.986	-7.760
P值		0.546	<0.001	0.106	<0.001	0.193	<0.001	0.960	<0.001	0.328	<0.001

组别	例数	A运动		B个人与社会		C语言		D手眼协调		E视觉表现
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
对照组	30	24.42±8.30	33.08±9.25^a	27.00±7.58	35.83±8.21^a	25.25±6.77	37.33±10.15^a	24.33±7.22	38.67±9.28^a	24.67±7.65	38.00±8.57^a
观察组	30	25.58±5.46	53.83±7.03^a	24.00±6.52	54.00±7.00^a	23.33±4.22	53.17±6.50^a	24.25±5.54	54.33±8.28^a	22.75±7.41	53.33±6.61^a
t值		-0.608	-9.778	1.643	-9.225	1.316	-7.197	0.050	-6.901	0.986	-7.760
P值		0.546	<0.001	0.106	<0.001	0.193	<0.001	0.960	<0.001	0.328	<0.001

组别	例数	AQ		BQ		CQ		DQ		EQ		GQ
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
对照组	30	81.34±6.19	87.95±5.55^a	79.37±6.20	86.08±6.39^a	82.55±4.86	90.19±5.84^a	81.89±6.37	90.09±5.08^a	82.59±5.12	90.52±5.18^a	82.71±3.13	89.84±3.31^a
观察组	30	80.99±5.24	99.71±4.29^a	81.66±4.63	99.74±4.94^a	81.11±4.54	99.00±4.12^a	82.62±4.85	99.35±4.75^a	80.33±5.09	99.05±3.44^a	81.49±1.96	99.37±1.76^a
t值		0.241	-9.182	-1.616	-9.268	1.182	-6.756	-0.498	-7.286	1.712	-7.527	1.801	-13.951
P值		0.811	<0.001	0.111	<0.001	0.242	<0.001	0.620	<0.001	0.092	<0.001	0.077	<0.001