Stieber Nicole A, Gilmour Stephanie, Morra Angela, Rainbow Jacqueline, Robitaille Stacy, Van Arsdell Glen, McCrindle Brian W, Gibson Barbara E, Longmuir Patricia E
Department of Physical Therapy, University of Toronto, 160-500 University Ave, Toronto, ON M5G 1V7, Canada.
Pediatr Cardiol. 2012 Apr;33(4):521-32. doi: 10.1007/s00246-011-0144-0. Epub 2011 Nov 25.
This study investigated the feasibility of administering motor assessments, delivering rehabilitation via parent-led activities, and enhancing motor function in children with complex congenital heart defects. Gross and fine motor development were evaluated in 20 toddlers ages 12 to 26 months after either a superior cavopulmonary connection (SCPC) procedure or an arterial switch operation (ASO) using the Peabody developmental scale, version 2 (PDMS-2). Feasibility of assessment and program delivery were examined using open-ended interviews with parents. The ASO group scored consistently higher than the SCPC group in every subscore of the PDMS-2 (ASO gross motor quotient, 96.78 ± 7.396 vs SCPC gross motor quotient, 77.56 ± 7.715 [P < 0.001]; ASO fine motor quotient, 101.20 ± 6.512 versus SCPC fine motor quotient, 87.70 ± 9.945 [P = 0.002]; ASO total motor quotient, 98.78 ± 6.515 versus SCPC total motor quotient, 79.56 ± 8.095 [P < 0.001]). A lower total motor quotient was associated with the use of anticoagulant medication (-20.3 ± 4.6; P < 0.001), longer and more frequent hospital stays (respectively, -3.6 ± 1 .4; P = 0.01 and -0.8 ± 0.4; P = 0.02), and shorter times between the most recent surgery and the assessment date (2.1 ± 0.5; P < 0.001). Age-standardized scores were constant between baseline and follow-up evaluation (baseline gross motor quotient, 87 ± 12 vs. post-intervention gross motor quotient, 88 ± 15 [P = 0.89]; baseline fine motor quotient, 94 ± 11 vs. post-intervention fine motor quotient, 94 ± 12 [P = 0.55]; baseline total motor quotient, 89 ± 12 vs. post-intervention total motor quotient, 90 ± 14 [P = 0.89]), indicating achievement of the expected rate of development. The most common barrier to home activity completion was illness in the SCPC group and lack of interest in the ASO group. Providing enjoyable activities and incorporating the activities into the participants' schedules were keys to compliance. All the children were able to complete the assessments, and the parents reported a positive impact of the intervention on family life. Children who have had the SCPC procedure experience significant motor delays early in life. However, toddlers after ASO have age-appropriate motor skills. Completion of the rehabilitation program enables post-SCPC children to increase their rate of development to age-appropriate norms.
本研究探讨了对患有复杂先天性心脏病的儿童进行运动评估、通过家长主导的活动进行康复治疗以及增强其运动功能的可行性。使用第二版皮博迪发育量表（PDMS - 2）对20名年龄在12至26个月的幼儿进行了粗大和精细运动发育评估，这些幼儿在接受上腔静脉肺动脉连接术（SCPC）或动脉调转术（ASO）后进行了评估。通过与家长进行开放式访谈，考察了评估和项目实施的可行性。在PDMS - 2的每个子评分中，ASO组的得分始终高于SCPC组（ASO粗大运动商数为96.78±7.396，SCPC粗大运动商数为77.56±7.715 [P < 0.001]；ASO精细运动商数为101.20±6.512，SCPC精细运动商数为87.70±9.945 [P = 0.002]；ASO总运动商数为98.78±6.515，SCPC总运动商数为79.56±8.095 [P < 0.001]）。较低的总运动商数与使用抗凝药物有关（-20.3±4.6；P < 0.001），住院时间更长且更频繁（分别为-3.6±1.4；P = 0.01和-0.8±0.4；P = 0.02），以及最近一次手术与评估日期之间的时间更短（2.1±0.5；P < 0.001）。年龄标准化得分在基线和随访评估之间保持不变（基线粗大运动商数为87±12，干预后粗大运动商数为88±15 [P = 0.89]；基线精细运动商数为94±11，干预后精细运动商数为94±12 [P = 0.55]；基线总运动商数为89±12，干预后总运动商数为9
