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晚期早产儿和足月儿伸手动作时坐姿及躯干控制水平的影响

Influence of Sitting Positions and Level of Trunk Control During Reaching Movements in Late Preterm and Full-Term Infants.

作者信息

Sato Natália T da Silva, Tudella Eloisa

机构信息

Movement Analysis and Research Laboratory, Department of Physiotherapy, Federal University of São Carlos, São Paulo, Brazil.

出版信息

Front Pediatr. 2018 Jun 25;6:185. doi: 10.3389/fped.2018.00185. eCollection 2018.

Abstract

In order to acquire reaching and independent sitting, refinement of trunk control is needed by gradually and progressively incorporating the head, thoracic, lumbar, and sacral segments. Previous studies have evaluated trunk control in a segmental way, standardizing the level of manual support in the infants' trunk during reaching. The aim of this study was to identify the level of trunk control and to analyze the influence of the difference sitting positions in late preterm and full-term infants between 6 and 8 months of age during reaching. Therefore, 36 infants born full term (control group)-FTG and 20 late preterm infants at a corrected age (experimental group)-PTG were evaluated. Most of the infants started the study at 6 months and they were evaluated monthly until 8 months of age (longitudinal study) in a total of 1-3 visits. The Segmental Assessment of Trunk Control was used to identify the level of trunk control in a segmental way, as well as to verify the capacity of the infant to maintain or regain the vertical position while sitting. Kinematic analysis was used for reaching. The infants were in a ring sitting position and at 90° of flexion. To elicit reaching, an attractive object was presented at the infant's midline and at 45° to the right and left. We found that PTG infants presented lower trunk control scores, i.e., worse control. For both groups, the ring sitting position and at 90° of flexion did not influence most kinematic variables during reaching because accurate manual support was provided for the infants' trunk. The PTG group presented less trunk displacement when at 90° of flexion. Compared to the FTG, even with accurate trunk support, the PTG group presented more immature reaches. These results suggest that accurate manual trunk support favored more stability of the trunk during the reach. Thus, early intervention is suggested for PTG infants and reaching in this age group should be trained in the ring sitting position with their trunk accurately manually supported. SATCo is an effective tool for segmental trunk evaluation.

摘要

为了获得够物能力和独立坐立能力,需要通过逐步且递进地整合头部、胸部、腰部和骶部节段来优化躯干控制。以往的研究以节段方式评估躯干控制,在婴儿够物时标准化对其躯干的手动支撑水平。本研究的目的是确定躯干控制水平,并分析6至8月龄晚期早产儿和足月儿在够物时不同坐姿的影响。因此,对36名足月出生的婴儿(对照组)——FTG和20名矫正年龄的晚期早产儿(实验组)——PTG进行了评估。大多数婴儿在6个月时开始参与研究,并每月接受评估,直至8个月龄(纵向研究),总共进行1至3次访视。采用躯干控制节段评估法以节段方式确定躯干控制水平,同时验证婴儿在坐着时保持或恢复垂直姿势的能力。采用运动学分析来研究够物动作。婴儿呈环形坐姿,屈曲90°。为引出够物动作,在婴儿中线以及左右45°处呈现一个有吸引力的物体。我们发现PTG组婴儿的躯干控制得分较低,即控制能力较差。对于两组而言,环形坐姿和90°屈曲在够物过程中并未影响大多数运动学变量,因为为婴儿的躯干提供了精确的手动支撑。PTG组在屈曲90°时躯干位移较小。与FTG组相比,即使有精确的躯干支撑,PTG组的够物动作仍表现得更不成熟。这些结果表明,精确的手动躯干支撑有利于在够物过程中使躯干更稳定。因此,建议对PTG组婴儿进行早期干预,并且该年龄组的够物动作训练应在环形坐姿下进行,同时对其躯干进行精确的手动支撑。SATCo是评估躯干节段的有效工具。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cc2a/6026931/e5c2c259307d/fped-06-00185-g0001.jpg

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