Suzuki J, Ito M, Tomiwa K, Okuno T
Department of Preschool Education, Shiga Women's Junior College.
No To Hattatsu. 1999 Jul;31(4):343-7.
The age at the first clinical referral or diagnosis of cerebral palsy (CP), the age at the onset of treatment, the route of referral, and the kind of school entered were investigated in 202 cases of CP in Shiga Prefecture (69 with spastic diplegia, 62 with tetraplegia, 33 with hemiplegia, 23 with the dyskinetic type and 15 with the ataxic type) born between April 1977 and March 1987. In the hemiplegia, spastic diplegia and ataxic types, the age at the first clinical referral or diagnosis, was above 1 year in 42%, 39% and 33%, respectively. In the tetraplegia and the dyskinetic types, by contrast, such a delay occurred in only 9% and 4%, respectively. Cases of the former three types were referred from medical institutions less frequently (53% in the ataxic type, 52% in spastic diplegia and 40% in hemiplegia) than those of the latter two types (76% in tetraplegia and 61% in the dyskinetic type). About 30% of the cases were referred from health centers (38% in spastic diplegia, 33% in hemiplegia, 30% in the dyskinetic type, 20% in the ataxic type and 16% in tetraplegia). A considerable number of cases visited a clinic without reference (27% in hemiplegia, 27% in the ataxic type, 10% in spastic diplegia, 9% in the dyskinetic type, and 8% in tetraplegia). Fifty-three percent of the cases entered an elementary school (ordinary classes in 30% and special classes in 23%), 41% a special school, and 5% entered a protective institution. The early diagnosis of hemiplegia, spastic diplegia and the ataxic type of CP was difficult in some cases. Cases with suspected signs of CP should be referred to clinic early in the absence of definite diagnosis.
对1977年4月至1987年3月出生在滋贺县的202例脑瘫（CP）患儿进行了调查，内容包括首次临床转诊或诊断脑瘫的年龄、开始治疗的年龄、转诊途径以及进入的学校类型。其中痉挛性双瘫69例、四肢瘫62例、偏瘫33例、运动障碍型23例、共济失调型15例。在偏瘫、痉挛性双瘫和共济失调型中，首次临床转诊或诊断的年龄分别有42%、39%和33%在1岁以上。相比之下，在四肢瘫和运动障碍型中，这种延迟分别仅发生在9%和4%的病例中。前三型病例从医疗机构转诊的频率（共济失调型为53%，痉挛性双瘫为52%，偏瘫为40%）低于后两型（四肢瘫为76%，运动障碍型为61%）。约30%的病例是从保健中心转诊的（痉挛性双瘫为38%，偏瘫为33%，运动障碍型为30%，共济失调型为20%，四肢瘫为16%）。相当多的病例未经转诊就去了诊所（偏瘫为27%，共济失调型为27%，痉挛性双瘫为 10%，运动障碍型为9%，四肢瘫为8%）。53%的病例进入了小学（普通班占30%，特殊班占23%），41%进入了特殊学校，5%进入了养护机构。偏瘫、痉挛性双瘫和共济失调型脑瘫的早期诊断在某些情况下存在困难。对于有脑瘫疑似症状的病例，在没有明确诊断的情况下应尽早转诊至诊所。
