Effect of Bobath Therapy Combined with Suspension Technique on the Rehabilitation of Children with Cerebral Palsy
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摘要:
目的 从小腿骨骼肌发育、粗大运动功能、肢体平衡能力方面探究Bobath疗法联合悬吊技术在脑瘫患儿康复治疗中应用价值。 方法 选取2021年3月至2023年3月自贡市妇幼保健院98例脑瘫患儿，按照1∶1对照原则，采用随机数字表法分为对照组（n=49例）、研究组（n=49例）。对照组采用Bobath疗法治疗，研究组采用Bobath疗法联合悬吊技术治疗，治疗3个月。比较2组治疗效果及治疗前、治疗第1个月、3个月粗大运动功能测试量表（GMFM-88）、小腿骨骼肌发育[胫前肌、内侧腓肠肌、比目鱼肌肌肉厚度（MT）、肌束长度（FL）]、Berg平衡量表（BBS）、脑动脉血流量[大脑前动脉（ACA）、中动脉（MCA）及后动脉（PCA）平均血流速度（Vm）]、脑瘫患儿日常生活能力评价表（ADL）、改良Ashworth痉挛量表（MAS）。 结果 研究组治疗总有效率89.80%高于对照组73.47%（P < 0.05）；治疗第1个月、3个月，2组胫前肌、内侧腓肠肌、比目鱼肌MT、FL大于治疗前，且研究组大于对照组（P < 0.05）；治疗第1个月、3个月，2组GMFM-88、BBS、ADL评分高于治疗前，且研究组高于对照组（P < 0.05）；治疗第1个月、3个月，2组ACA、MCA、PCA的Vm高于治疗前，且研究组高于对照组（P < 0.05）；治疗第1个月、3个月，研究组F波波幅低于对照组，F波刺激阈值高于对照组（P < 0.05）；治疗第1个月、3个月，2组MAS评分低于治疗前，且研究组低于对照组（P < 0.05）。 结论 Bobath疗法联合悬吊技术治疗脑瘫患儿的效果确切，可促进小腿骨骼肌发育、粗大运动功能恢复，提高平衡能力，改善脑动脉血流量。 Abstract:Objective To explore the application value of Bobath therapy combined with the suspension technique in the rehabilitation treatment of children with cerebral palsy from the aspects of skeletal muscle development, gross motor function and limb balance. Methods A total of 98 children with cerebral palsy in Zigong Maternal and Child Health Hospital were selected from March 2021 to March 2023. According to the 1∶1 control principle, they were randomly divided into a control group and a study group using a computer random number table method, with 49 cases in each group. The control group was treated with Bobath therapy, and the study group was treated with Bobath therapy combined with suspension technology for 3 months. The therapeutic effects of the two groups were compared, as well as the gross motor function measurement scale （GMFM-88）, leg skeletal muscle development [thickness of the anterior tibial muscle, medial gastrocnemius muscle, and soleus muscle （MT）, muscle bundle length （FL）], Berg balance scale （BBS）, cerebral artery blood flow [Mean blood flow velocity （Vm） in the anterior cerebral artery （ACA）, middle cerebral artery （MCA） and posterior cerebral artery （PCA）], F-wave amplitude and stimulation threshold, daily living ability evaluation scale for children with cerebral palsy （ADL）, and modified Ashworth spasticity scale （MAS） before treatment, at 1 month and 3 months after treatment. Results The total effective rate of the study group was 89.80% higher than that of the control group 73.47% （P < 0.05）. At the 1st and 3rd month of treatment, MT and FL of the anterior tibial muscle, medial gastrocnemius muscle and soleus muscle in 2 groups were higher than before treatment, and the study group was higher than the control group （P < 0.05）. At the 1st and 3rd month of treatment, GMFM-88, BBS and ADL scores in 2 groups were higher than before treatment, and those in study group were higher than those in control group （P < 0.05）. At the first and third month of treatment, Vm of ACA, MCA and PCA in 2 groups was higher than before treatment, and that in study group was higher than that in control group （P < 0.05）. At the first and third months of treatment, the F wave amplitude of the study group was lower than that of the control group, and the F wave stimulation threshold was higher than that of the control group （P < 0.05）. At the first and third month of treatment, MAS scores in the 2 groups were lower than before treatment, and those in the study group were lower than those in the control group （P < 0.05）. Conclusion The Bobath therapy combined with suspension technique has a definite effect on children with cerebral palsy, which can promote the development of skeletal muscle in the lower leg, restore gross motor function, improve balance ability, and improve cerebral artery blood flow. -
图 2 2组治疗前后小腿骨骼肌发育指标变化折线图
A：2组治疗前后胫前肌MT变化折线图；B：2组治疗前后胫前肌FL变化折线图；C：2组治疗前后内侧腓肠肌MT变化折线图；D：2组治疗前后内侧腓肠肌FL变化折线图；E：2组治疗前后比目鱼肌MT变化折线图；F：2组治疗前后比目鱼肌FL变化折线图。与对照组比较，△P < 0.05。
Figure 2. Line chart of changes of calf skeletal muscle development indexes before and after treatment in two groups
图 3 2组治疗前后GMFM-88、BBS评分变化折线图
A：2组治疗前后GMFM-88评分变化折线图；B：2组治疗前后BBS评分变化折线图。与对照组比较，*P < 0.05。
Figure 3. Line chart of GMFM-88 and BBS scores before and after treatment in the two groups
表 1 2组一般资料比较[n（%）/（$\bar x \pm s $）]
Table 1. Comparison of general data between the two groups [n（%）/（$\bar x \pm s $）]
组别 n 性别（男/女） 年龄（岁） 粗大运动功能分级系统（GMFCS）（级） 受累部位 病程（月） I II III 左侧 右侧 研究组 49 27/22 6.77±1.14 15（30.61） 26（53.06） 8（16.33） 31（63.27） 18（36.73） 9.48±2.24 对照组 49 24/25 7.15±1.26 13（26.53） 24（48.98） 12（24.49） 26（53.06） 23（46.94） 10.24±1.96 t/u/χ2 0.368 1.565 0.778 1.048 1.824 P 0.544 0.121 0.436 0.306 0.071 
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表 2 2组治疗效果比较[n（%）]
Table 2. Comparison of treatment effect between the two groups [n （%）]
组别 n 无效 有效 显效 总有效率 研究组 49 5（10.20） 21（42.86） 23（46.94） 44（89.80） χ2 − − − − 4.356 P − − − − 0.037* *P < 0.05。
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表 3 2组小腿骨骼肌发育比较（$\bar x \pm s $）（1）
Table 3. Comparison of calf skeletal muscle development between the two groups （$\bar x \pm s $）（1）
组别 n 胫前肌MT（mm） 胫前肌FL（cm） 治疗前 治疗第1个月 治疗第3个月 治疗前 治疗第1个月 治疗第3个月 研究组 49 10.43±1.32 12.34±1.22*b 12.61±1.18*△ 43.65±3.17 51.07±3.82*△ 52.64±4.01*△ 对照组 49 10.67±1.28 11.47±1.10* 11.75±1.04* 44.02±3.25 48.19±3.65* 49.87±3.86* F F组间=11.546，F时间=12.028，F交互=15.763 F组间=12.335，F时间=13.864，F交互=16.357 P P组间<0.001，P时间<0.001，P交互<0.001 P组间<0.001，P时间<0.001，P交互<0.001 与同组治疗前比校，*P < 0.05；与对照组比较，△P < 0.05。
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3 2组小腿骨骼肌发育比较（$\bar x \pm s $）（2）
3. Comparison of calf skeletal muscle development between the two groups （$\bar x \pm s $）（2）
组别 n 比目鱼肌MT（mm） 比目鱼肌FL（cm） 治疗前 治疗第1个月 治疗第3个月 治疗前 治疗第1个月 治疗第3个月 研究组 49 7.42±0.65 8.79±0.75*△ 9.12±0.78*△ 25.91±3.04 33.12±3.35*△ 34.08±3.56*△ 对照组 49 7.54±0.71 8.14±0.72* 8.53±0.74* 26.22±3.17 30.48±3.27* 31.72±3.39* F F组间=15.864，F时间=14.652，F交互=17.582 F组间=11.559，F时间=12.867，F交互=15.061 P P组间<0.001，P时间<0.001，P交互<0.001 P组间<0.001，P时间<0.001，P交互<0.001 与同组治疗前比校，*P < 0.05；与对照组比较，△P < 0.05。
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表 3 2组小腿骨骼肌发育比较（$\bar x \pm s $）（3）
Table 3. Comparison of calf skeletal muscle development between the two groups （$\bar x \pm s $）（3）
组别 n 内侧腓肠肌FL（cm） 内侧腓肠肌MT（mm） 治疗前 治疗第1个月 治疗第3个月 治疗前 治疗第1个月 治疗第3个月 研究组 49 27.95±4.26 33.09±3.67*△ 34.18±3.59*△ 8.31±0.86 9.45±0.92*△ 9.66±0.97*△ 对照组 49 28.21±4.12 30.86±3.88* 32.20±3.74* 8.45±0.89 8.89±0.90* 9.12±0.91* F F组间=12.240，F时间=11.859，F交互=16.323 F组间=11.567，F时间=12.939，F交互=16.581 P P组间<0.001，P时间<0.001，P交互<0.001 P组间<0.001，P时间<0.001，P交互<0.001 与同组治疗前比校，*P < 0.05；与对照组比较，△P < 0.05。
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表 4 2组粗大运动功能、肢体平衡能力比较（$\bar x \pm s $，分）
Table 4. Comparison of gross motor function and limb balance ability between the two groups （$\bar x \pm s $，scores）
组别 n GMFM-88 BBS 治疗前 治疗第1个月 治疗第3个月 治疗前 治疗第1个月 治疗第3个月 研究组 49 47.12±8.39 61.70±9.35*△ 65.84±10.27*△ 19.85±2.26 34.27±3.25*△ 37.15±3.49*△ 对照组 49 49.35±8.72 55.29±8.97* 59.51±9.62* 20.17±2.30 31.96±3.08* 35.02±3.16* F F组间=11.529，F时间=16.983，F交互=15.942 F组间=13.585，F时间=16.791，F交互=18.963 P P组间<0.001，P时间<0.001，P交互<0.001 P组间<0.001，P时间<0.001，P交互<0.001 与同组治疗前比校，*P < 0.05；与对照组比较，△P < 0.05。
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表 5 2组脑动脉血流量比较（$\bar x \pm s $，cm/s）（1）
Table 5. Comparison of cerebral arterial blood flow between the two groups （$\bar x \pm s $，cm/s）（1）
组别 n ACA MCA 治疗前 治疗第1个月 治疗第3个月 治疗前 治疗第1个月 治疗第3个月 研究组 49 35.41±4.86 45.79±5.73*△ 48.21±6.09*△ 41.52±5.68 58.36±7.21*△ 61.22±7.69*△ 对照组 49 36.20±5.07 41.82±5.56* 43.45±5.88* 42.17±5.74 53.48±6.93* 55.31±7.24* F F组间=13.257，F时间=14.025，F交互=16.854 F组间=14.961，F时间=15.747，F交互=19.624 P P组间<0.001，P时间<0.001，P交互<0.001 P组间<0.001，P时间<0.001，P交互<0.001 与同组治疗前比校，*P < 0.05；与对照组比较，△P < 0.05。
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表 5 2组脑动脉血流量比较（$\bar x \pm s $，cm/s）（2）
Table 5. Comparison of cerebral arterial blood flow between the two groups （$\bar x \pm s $，cm/s）（2）
组别 n PCA 治疗前 治疗第1个月 治疗第3个月 研究组 49 36.72±5.69 48.22±6.51*△ 52.01±6.87*△ 对照组 49 37.35±5.84 44.68±6.39* 47.13±6.52* F F组间=12.967，F时间=13.950，F交互=16.851 P P组间<0.001，P时间<0.001，P交互<0.001
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表 6 2组痉挛程度、日常生活能力比较（$\bar x \pm s $，分）
Table 6. Comparison of spasticity degree and daily living ability between the two groups （$\bar x \pm s $，scores）
组别 n MAS评分 ADL评分 治疗前 治疗第1个月 治疗第3个月 治疗前 治疗第1个月 治疗第3个月 研究组 49 1.37±0.39 0.93±0.26*△ 0.85±0.24*△ 22.37±4.28 32.29±5.31*△ 35.76±5.82*△ 对照组 49 1.41±0.42 1.15±0.33* 1.02±0.30* 22.81±4.50 29.14±5.08* 31.94±5.36* F F组间=14.658，F时间=13.252，F交互=16.381 F组间=12.934，F时间=15.066，F交互=17.219 P P组间<0.001，P时间<0.001，P交互<0.001 P组间<0.001，P时间<0.001，P交互<0.001 与同组治疗前比校，*P < 0.05；与对照组比较，△P < 0.05。
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