Carenzio G, Gherardi P, Bardoni M T, Zecca M, Bonetti F, Locatelli F, Dalla Toffola E
Department of Physical Medicine and Rehabilitation, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
Eura Medicophys. 2007 Dec;43(4):445-50.
The study was aimed at evaluating clinical and functional assessment and results obtained following rehabilitative treatment in children affected by chronic graft versus host disease (cGVHD) after allogeneic transplantation of hemopoietic stem cells (HSCT). From 1999 to 2003 we evaluated 6 children with cGVHD after HSCT presenting severe complications and disabilities. Clinical and functional assessment was performed prior to rehabilitative treatment (T1), at follow-up at 6 (T6) and 12 (T12) months after treatment. Each child received a personalized rehabilitative treatment program based on the use of neuromotor re-education techniques, massotherapy, chest rehabilitation and occupational therapy. Six children presented sclerodermoid skin lesions, joint contractures, anchylosis, respiratory insufficiency, postural and walking alterations which led to reduction in motor performance and autonomy in daily living activity. After 1 year of rehabilitation treatment, 3 patients showed improvement in motor performance, 2 remained stable and 1 patient worsened. Rehabilitative treatment associated with pharmacological therapy has proven to be useful in patients affected by cGVHD. We believe that cGVHD is a pathology which must be seen by a physiatrist as early as possible at onset of first cutaneous signs of cGVHD to limit its invalidating evolution.
该研究旨在评估慢性移植物抗宿主病（cGVHD）患儿在异基因造血干细胞移植（HSCT）后接受康复治疗后的临床和功能评估及结果。1999年至2003年，我们评估了6例HSCT后发生cGVHD且出现严重并发症和残疾的患儿。在康复治疗前（T1）、治疗后6个月（T6）和12个月（T12）随访时进行临床和功能评估。每个患儿都接受了基于神经运动再教育技术、按摩疗法、胸部康复和职业疗法的个性化康复治疗方案。6例患儿出现硬皮病样皮肤病变、关节挛缩、强直、呼吸功能不全、姿势和行走改变，导致运动能力下降和日常生活活动自主性降低。经过1年的康复治疗，3例患者运动能力有所改善，2例保持稳定，1例患者病情恶化。事实证明，康复治疗联合药物治疗对cGVHD患者有用。我们认为，cGVHD是一种疾病，在cGVHD首次出现皮肤症状时，物理治疗师应尽早对其进行诊治，以限制其致残性进展。
