Molnar G E, Gordon S U
Arch Phys Med Rehabil. 1976 Apr;57(4):153-8.
A prospective longitudinal study involving 233 children with cerebral palsy was carried out to select signs useful for early prognostication of ambulation. All patients were followed from the time they were 12 months old and their progress was observed until they reached the age of 3 to 11 years. The population consisted of 61 children having congenital hemiplegia, 37 having diplegia, 85 having spastic quadriparesis and 28 having the spastic-athetoid clinical type of cerebral palsy. In addition, there were 14 children with athetoid, 6 with ataxic and 2 with hypotonic cerebral palsy. Of the total population, 78.7% achieved some degree of functional walking. Findings indicated that the probability of ambulation was related to the clinical type of cerebral palsy. In some the ultimate functional outcome was rather uniform, as in those with congenital hemiplegic and ataxic types where the prognosis was consistently favorable or in those with hypotonic cerebral palsy in whom the outlook was poor. In spastic diplegic, quadriparetic, spastic-athetoid and athetoid types, on the other hand, expectations varied considerably. For this group of patients, sitting by two years was found to be a predictive sign of high reliability since all children who sat by this age eventually walked. For the group of patients not sitting by two years which included more than half of the eventual ambulators, suppression of obligatory primitive reflex activity between 18 and 24 months provided a sensitive indicator to distinguish the children who ultimately walked from those who would not be expected to do so. These data offer a possibility for predicting future ambulatory status by two years of age in those clinical types of cerebral palsy where difficulties of early accurate prognostication are most likely to be encountered. Observations also suggested that the presence of mental retardation adversely affects ambulation.
一项针对233名脑瘫患儿的前瞻性纵向研究展开，以挑选出有助于早期预测行走能力的体征。所有患者从12个月大开始接受随访，观察其进展直至3至11岁。研究对象包括61名先天性偏瘫患儿、37名双瘫患儿、85名痉挛性四肢瘫患儿以及28名痉挛 - 手足徐动型脑瘫临床类型患儿。此外，还有14名手足徐动型患儿、6名共济失调型患儿和2名低张力型脑瘫患儿。在全部研究对象中，78.7%实现了某种程度的功能性行走。研究结果表明，行走的可能性与脑瘫的临床类型有关。在某些情况下，最终的功能结局相当一致，比如先天性偏瘫型和共济失调型患儿的预后始终良好，而低张力型脑瘫患儿的前景则不佳。另一方面，在痉挛性双瘫、四肢瘫、痉挛 - 手足徐动型和手足徐动型患儿中，预期差异很大。对于这组患者，发现两岁时能坐是一个可靠性很高的预测指标，因为所有在这个年龄能坐的孩子最终都能行走。对于两岁时不能坐的患者组（其中包括超过半数最终能行走的患者），18至24个月时强制性原始反射活动的抑制为区分最终能行走的孩子和预期不能行走的孩子提供了一个敏感指标。这些数据为在最有可能遇到早期准确预后困难的脑瘫临床类型中，预测两岁时的未来行走状态提供了可能性。观察结果还表明，智力迟钝的存在对行走有不利影响。
