Résumé
Objective To compare the efficacy of goal_activity_motor environment( xAmE)therapy and neurodevelopmental therapy(NDT)in the early intervention of high_risk infants with cerebral palsy(IHRCP),and to provide scientific evidence_based medical basis for early intervention of IHRCP. Methods A total of 62 cases of IHRCP were enrolled in the Children＇s Neurological Rehabilitation Center of the First Affiliated Hospital of Anhui medi_cal University from June 2017 to December 2018. They were divided into xAmE group(32 cases)and NDT group(30 cases)according to the admission order. xross motor Function Scale(xmFm),Fine motor Function measure(FmFm) and xesell Development Scale(xDS)were used for detection and comparison. The differences among the gross motor, the fine motor score and the developmental quotient( D匝)between two groups before treatment,9 months after treat_ment and 12 months after treatment,and the normalization rate and the incidence of cerebral palsy between the two groups at 12 months of age were compared. Results ( 1 )motor function was as follows:at 9 months[ xAmE:(32. 63 ± 15. 83)scores,(30. 03 ± 15. 88)scores],[NDT:(33. 37 ± 15. 61)scores,(29. 67 ± 12. 54)scores]and at 12 months[xAmE:(40. 56 ± 15. 79)scores,(36. 31 ± 14. 98)scores],[NDT:(40. 47 ± 15. 50)scores,(36. 73 ± 14. 58)scores]after treatment,and xmFm and FmFm scores in xAmE and NDT groups were significantly higher than those before treatment[xAmE:(27. 56 ± 14. 24)scores,(21. 75 ± 11. 35)scores],[ NDT:(26. 93 ± 14. 96)scores, (21. 30 ± 10. 67)scores],and the differences were significant( all P<0. 01),but there was no significant difference between the 2 groups(all P> 0. 05).(2)D匝 had no significant difference in D匝 between xAmE group(63. 59 ± 10. 83)and NDT group(61. 59 ± 7. 96)before treatment(P>0. 05). The total D匝 at 9 months,12 months,the total D匝 of xAmE group(73. 67 ± 12. 00,81. 59 ± 13. 03)was significantly higher than that of NDT group(66. 05 ± 9. 54, 75. 17 ± 1. 92)(all P<0. 05). Among them,the improvement of xAmE in speech(79. 84 ± 16. 56,83. 19 ± 17. 05)at 9 months and 12 months,and adaptive ability(78. 63 ± 16. 37,85. 78 ± 13. 60)were significantly higher than that of NDT group(71. 63 ± 13. 36,72. 53 ± 12. 77),(68. 20 ± 14. 97,77. 43 ± 12. 10),and the differences were significant( all P<0. 05).(3)Prognosis was as follows:at 12 months after treatment,25 cases in xAmE group and 23 cases in NDT group developed into normal children,there was no significant difference in the normalization rate between the 2 groups( P>0. 05);the incidence of cerebral palsy was present in 6 cases in xAmE group and 5 cases in NDT group,and there was no significant difference between the 2 groups(P>0. 05). Conclusions xAmE therapy and NDT had significant effects on both gross and fine exercise of IHRCP,and the efficacy of the two methods is similar. Both xAmE therapy and NDT can equally promote IHRCP development into normal infants and reduce the incidence of cerebral palsy.
Résumé
Objective@#To compare the efficacy of goal-activity-motor environment (GAME) therapy and neurodevelopmental therapy (NDT) in the early intervention of high-risk infants with cerebral palsy (IHRCP), and to provide scientific evidence-based medical basis for early intervention of IHRCP.@*Methods@#A total of 62 cases of IHRCP were enrolled in the Children′s Neurological Rehabilitation Center of the First Affiliated Hospital of Anhui Medi-cal University from June 2017 to December 2018.They were divided into GAME group (32 cases) and NDT group (30 cases) according to the admission order.Gross Motor Function Scale (GMFM), Fine Motor Function Measure (FMFM) and Gesell Development Scale (GDS) were used for detection and comparison.The differences among the gross motor, the fine motor score and the developmental quotient (DQ) between two groups before treatment, 9 months after treatment and 12 months after treatment, and the normalization rate and the incidence of cerebral palsy between the two groups at 12 months of age were compared.@*Results@#(1) Motor function was as follows: at 9 months[GAME: (32.63±15.83) scores, (30.03±15.88) scores], [NDT: (33.37±15.61) scores, (29.67±12.54) scores] and at 12 months[GAME: (40.56±15.79) scores, (36.31±14.98) scores], [NDT: (40.47±15.50) scores, (36.73±14.58) scores] after treatment, and GMFM and FMFM scores in GAME and NDT groups were significantly higher than those before treatment[GAME: (27.56±14.24) scores, (21.75±11.35) scores], [NDT: (26.93±14.96) scores, (21.30±10.67) scores], and the differences were significant (all P<0.01), but there was no significant difference between the 2 groups (all P> 0.05). (2) DQ had no significant difference in DQ between GAME group(63.59±10.83) and NDT group (61.59±7.96) before treatment (P>0.05). The total DQ at 9 months, 12 months, the total DQ of GAME group (73.67±12.00, 81.59±13.03) was significantly higher than that of NDT group (66.05±9.54, 75.17±1.92) (all P<0.05). Among them, the improvement of GAME in speech (79.84±16.56, 83.19±17.05) at 9 months and 12 months, and adaptive ability(78.63±16.37, 85.78±13.60) were significantly higher than that of NDT group(71.63±13.36, 72.53±12.77), (68.20±14.97, 77.43±12.10), and the differences were significant (all P<0.05). (3) Prognosis was as follows: at 12 months after treatment, 25 cases in GAME group and 23 cases in NDT group developed into normal children, there was no significant difference in the normalization rate between the 2 groups (P>0.05); the incidence of cerebral palsy was present in 6 cases in GAME group and 5 cases in NDT group, and there was no significant difference between the 2 groups (P>0.05).@*Conclusions@#GAME therapy and NDT had significant effects on both gross and fine exercise of IHRCP, and the efficacy of the two methods is similar.Both GAME therapy and NDT can equally promote IHRCP development into normal infants and reduce the incidence of cerebral palsy.
Résumé
Cerebral palsy or high risk of cerebral palsy can be diagnosed accurately and early using the clinical signs and symptoms of cerebral palsy,involves neuroimaging,standardized neurological and standardized motor assess-ments before 6 months' corrected age. When the clinical diagnosis is suspected but cannot be made with certainty,re-commend using the interim clinical diagnosis of high risk of cerebral palsy until a diagnosis is confirmed,because infant with cerebral palsy require and benefit from different early interventions. Before 5 months' corrected age,the most pre-dictive tools for detecting risk are term - age magnetic resonance imaging(MRI),the Prechtl Qualitative Assessment of General Movements(GMs),and the Hammersmith Infant Neurological Examination(HINE). After 5 months' corrected age,the most predictive tools for detecting risk are MRI,HINE and the Developmental Assessment of Young Children. Early diagnosis and early intervention can optimize infant motor and cognitive plasticity,prevent secondary complica-tions. Cerebral palsy - specific early intervention maximizes neuroplasticity and minimizes deleterious modifications to muscle and bone growth and development. Early interventions included Goals - Activity - Motor Enrichment,neurode-velopmental treatment(Bobath,Vojta),Conductive Education and Environmental enrichment. Infants with of cerebral palsy who receive early CIMT have better hand function,and infants with any type and topography of cerebral palsy who receive GAME have better motor and cognitive skills than those who receive usual care.