School of Physical Therapy, The University of Western Ontario, 1588 Elborn College, The University of Western Ontario, London, Ontario, Canada.
Dev Med Child Neurol. 2010 Jul;52(7):e155-60. doi: 10.1111/j.1469-8749.2010.03632.x. Epub 2010 Feb 24.
To explore associations between clinical variables and decline in motor capacity in adolescents with cerebral palsy (CP).
Participants included 76 males and 59 females, whose mean age at the beginning of the study was 14 years 6 months (SD 2.4, range 11.6-17.9); 51 at Gross Motor Function Classification System (GMFCS) level III, 47 at level IV, and 37 at level V. Ninety-six participants had tetraplegia, 32 had diplegia, and one had hemiplegia. Types of motor disorder were spastic n=98; mixed, n=11; dystonic, n=9; hypotonic, n=7; and ataxic n=3 (seven participants were not classified). Reliable raters collected data annually for 4 years on anthropometric characteristics, the Spinal Alignment and Range of Motion Measure, as well as the Gross Motor Function Measure, 66 items (GMFM-66); participants or their parents reported on health status (using the Health Utilities Questionnaire), pain, and exercise participation (using measures developed for this study). The predicted drop in GMFM-66 scores after childhood was calculated using data on the same children from an earlier study. Correlations were calculated between the drop in GMFM-66 scores and the average and change scores of the clinical variables (the alpha level for statistical significance of this exploratory study was 0.10).
The drop in GMFM-66 score was significantly correlated with limitations in range of motion (r=0.42) and spinal alignment (r=0.28), and pain (r=0.16). Increases in triceps skinfold (r=-0.19), mid-arm circumference (r=-0.23), and the ratio of mid-arm circumference to knee height (r=-0.23) were associated with less decline.
Preventing range-of-motion limitations and pain experiences and optimizing nutrition might contribute to less decline in the gross motor capacity of adolescents with CP. Further investigation is required to clarify the role other factors that contribute to maintained function over time.
探讨脑瘫（CP）青少年运动能力下降与临床变量的关系。
参与者包括 76 名男性和 59 名女性，研究开始时的平均年龄为 14 岁 6 个月（SD 2.4，范围 11.6-17.9）；51 名在粗大运动功能分类系统（GMFCS）水平 III，47 名在水平 IV，37 名在水平 V。96 名参与者患有四肢瘫，32 名患有双瘫，1 名患有偏瘫。运动障碍类型为痉挛型 n=98；混合型 n=11；张力障碍型 n=9；低张型 n=7；共济失调型 n=3（7 名参与者未分类）。可靠的评估者每年收集 4 年的人体测量特征、脊柱排列和运动范围测量以及粗大运动功能测量，66 项（GMFM-66）；参与者或其父母报告健康状况（使用健康效用问卷）、疼痛和运动参与情况（使用为此项研究开发的措施）。使用早期研究中同一儿童的数据计算 GMFM-66 评分在儿童期后的预测下降。GMFM-66 评分下降与临床变量的平均值和变化分数之间的相关性（本探索性研究的统计显著性的 alpha 水平为 0.10）进行了计算。
GMFM-66 评分下降与运动范围受限（r=0.42）和脊柱排列（r=0.28）和疼痛（r=0.16）显著相关。三头肌皮褶厚度（r=-0.19）、上臂周长（r=-0.23）和上臂周长与膝高比（r=-0.23）的增加与下降减少相关。
预防运动范围受限和疼痛体验以及优化营养可能有助于减少 CP 青少年的粗大运动能力下降。需要进一步研究以阐明随着时间的推移维持功能的其他因素的作用。
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