摘要
目的探讨基于《国际功能、残疾和健康分类(儿童与青少年版)》(ICF-CY)框架下的口部运动联合穴位按摩干预方案在脑瘫吞咽障碍患儿中的应用效果方法选取2018年9月至2019年9月,在福建省泉州市儿童医院神经康复科诊疗的80例脑瘫伴有吞咽障碍患儿作为研究对象,采用随机数字表法分为试验组和对照组各40例。最终完成本研究者共76例。试验组在常规吞咽训练和口部运动干预的基础上以ICF-CY理论为框架,从身体功能和结构、活动和参与及环境因素进行全面评估并给予口面部穴位按摩12周。对照组给予常规吞咽训练和口部运动干预12周。采用改良洼田饮水试验评价干预12周后2组患儿吞咽障碍改善的效果;采用《口部运动功能评估分级标准》评价干预4、12周后2组患儿口部运动功能改善程度。结果干预12周后,试验组、对照组吞咽障碍改善总有效率分别为89.47%(34/38)、63.16%(24/38),2组比较差异有统计学意义(χ^2值为7.28,P<0.05)。干预4、12周后试验组口部运动功能评分分别为(67.13±2.35)、(82.08±2.33)分,均高于同时间点对照组的(56.16±2.57)、(65.63±2.54)分,差异均有统计学意义(t值为-3.320、-4.433,P<0.05)。干预4、12周后2组患儿口部运动功能评分均较本组干预前提高,与同组干预前比较,试验组t值为-5.377、-5.376;对照组t值为-10.715、-17.486;与同组干预4周比较,试验组t值为-12.732;对照组t值为-13.281,差异均有统计学意义(P<0.05);重复测量方差分析结果显示,口部运动功能评分的时间效应、分组效应、时间效应与分组效应的交互作用均有统计学意义(F=426.780、9.084、26.538,P<0.05)。结论基于ICF-CY的口部运动联合穴位按摩能有效促进脑瘫患儿口部的感知觉、运动功能恢复与重建,明显改善患儿吞咽障碍的程度,提高主动参与摄食的能力。
Objective To explore the effect of International Classification of Functioning,Disability and Health,Children and Youth Version(ICF-CY)framed oral motor therapy combined with acupoint massage intervention on children with cerebral palsy swallowing disorder.Methods From September 2018 to September 2019,80 children with cerebral palsy accompanied by dysphagia who were diagnosed and treated in the Department of Neurological Rehabilitation of our hospital were selected as the study subjects,and were divided into the experimental group(40 cases)and the control group(40 cases)by random number table method.A total of 76 patients completed the study.On the basis of routine swallowing training and oral movement intervention,the experimental group was comprehensively evaluated from the aspects of body function and structure,activity and participation,and environmental factors with ICF-CY theory as the framework,and was given oral and facial acupoint massage for 12 weeks.The control group was given conventional swallowing training and oral exercise intervention for 12 weeks.The modified water swallow test was used to evaluate the effect of improving swallowing disorder in two groups of children after 12 weeks of intervention.The improvement of oral motor function in two groups of children after 4 and 12 weeks of intervention was evaluated by using the Grading Criteria for Evaluation of Oral Motor Function.Results After 12 weeks of intervention,the total effective rate of swallowing disorder improvement in the experimental group and the control group were 89.47%(34/38)and 63.16%(24/38),respectively,and the difference between the two groups was statistically significant(χ^2 value was 7.28,P<0.05).After 4 and 12 weeks of intervention,the functional scores of oral motors in the experimental group were(67.13±2.35)and(82.08±2.33)points,respectively,which were higher than those of the control group at the same time(56.16±2.57)and(65.63±2.54)points,and the differences were statistically significant(t values were-3.320,-4.433 P<0.05).After 4 and 12 weeks of intervention,the children's functional scores of oral motors in each group were higher than those in each group before intervention.Compared with the group before intervention,t values of the experimental group were-5.377 and-5.376;t values of the control group were-10.715 and-17.486;compared to the group with 4-week intervention,t value of the experimental group was-12.732;t value of the control group was-13.281,all the differences were statistically significant(P<0.05).The results of repeated measures analysis of variance showed that the time effect,grouping effect,and the interaction between time effect and grouping effect of functional scores of oral motors were statistically significant(F values were 426.780,9.084,26.538,P<0.05).Conclusions Oral motor therapy combined with acupoint massage based on ICF-CY framework can effectively promotes the recovery and reconstruction of mouth perception and motor function in children with cerebral palsy,significantly improves the children's dysphagia and their ability to actively participate in feeding.
作者
曾丽玉
陈靖云
李红霞
黄晓云
Zeng Liyu;Chen Jingyun;Li Hongxia;Huang Xiaoyun(Department of Neurological Rehabilitation,Quanzhou Children's Hospital,Quanzhou 362000,China)
出处
《中国实用护理杂志》
2020年第27期2141-2147,共7页
Chinese Journal of Practical Nursing
基金
泉州市卫生健康科研资助项目(02-14-201903)。
关键词
脑性瘫痪
吞咽障碍
穴位按摩
口部运动
Cerebral palsy
Swallowing disorder
Acupoint massage
Oral motor therapy
