Duncan Burris, McDonough-Means Sharon, Worden Katherine, Schnyer Rosa, Andrews Jennifer, Meaney F John
Department of Pediatrics at University of Arizona Health Sciences Center in Tucson, AZ, USA.
J Am Osteopath Assoc. 2008 Oct;108(10):559-70.
Case reports and clinical trials have indicated that osteopathic manipulative treatment (OMT) may improve motor function and quality of life for children with cerebral palsy.
To assess the effectiveness of osteopathy in the cranial field, myofascial release, or both versus acupuncture in children with moderate to severe spastic cerebral palsy, as measured by several outcomes instruments in a randomized controlled trial.
Children between the ages of 20 months and 12 years with moderate to severe spastic cerebral palsy were enrolled in a single-blind, randomized wait-list control pilot study. There were three arms in the study: OMT (ie, osteopathy in the cranial field, myofascial release, or both, using direct or indirect methods), acupuncture, and control (ie, nontherapeutic attention). Children who were initially randomly assigned to the control arm were subsequently randomly reassigned to the intervention arms, increasing the sample size. Outcome measures included standard instruments used in the evaluation of children with cerebral palsy. Less traditional measures were also used, including serial evaluations by an independent blind osteopathic physician and visual analog scale assessments by an independent osteopathic physician and the parents or guardians. A total of 11 outcome variables were analyzed.
Fifty-five patients were included in the study. Individual analyses of the 11 outcome variables revealed statistically significant improvement in two mobility measures for patients who received OMT--the total score of Gross Motor Function Measurement and the mobility domain of Functional Independence Measure for Children (P<.05). No statistically significant improvements were seen among patients in the acupuncture treatment arm.
A series of treatments using osteopathy in the cranial field, myofascial release, or both improved motor function in children with moderate to severe spastic cerebral palsy. These results can be used to guide future research into the effectiveness of OMT or acupuncture in treating children with spastic cerebral palsy.
病例报告和临床试验表明，整骨手法治疗（OMT）可能改善脑瘫患儿的运动功能和生活质量。
在一项随机对照试验中，通过多种结局指标评估颅部整骨疗法、肌筋膜松解术或两者联合与针灸相比，对中重度痉挛型脑瘫患儿的疗效。
年龄在20个月至12岁之间的中重度痉挛型脑瘫患儿被纳入一项单盲、随机等待列表对照的试点研究。该研究分为三组：OMT组（即采用直接或间接方法进行颅部整骨疗法、肌筋膜松解术或两者联合）、针灸组和对照组（即非治疗性关注）。最初随机分配到对照组的患儿随后被随机重新分配到干预组，从而增加了样本量。结局指标包括用于评估脑瘫患儿的标准工具。还使用了不太传统的指标，包括由一名独立的盲法整骨医生进行的系列评估，以及由一名独立的整骨医生和患儿父母或监护人进行的视觉模拟量表评估。总共分析了11个结局变量。
55名患者被纳入该研究。对11个结局变量的个体分析显示，接受OMT治疗的患者在两项运动指标上有统计学意义的改善——粗大运动功能测量总分和儿童功能独立性测量的运动领域得分（P<0.05）。针灸治疗组的患者未观察到统计学意义的改善。
一系列采用颅部整骨疗法、肌筋膜松解术或两者联合的治疗改善了中重度痉挛型脑瘫患儿的运动功能。这些结果可用于指导未来关于OMT或针灸治疗痉挛型脑瘫患儿疗效的研究。
